Comparative effectiveness of different acupuncture therapies for perimenopausal syndrome: a systematic review and network meta-analysis

Background: Perimenopausal women commonly suffer from symptoms like hot flashes, insomnia, and mood swings, impacting quality of life. While acupuncture is a widely used and effective non-pharmacological treatment, the relative efficacy of different acupuncture modalities remains unclear. This study aimed to compare the effects of various acupuncture approaches on perimenopausal symptoms through a network meta-analysis. Methods: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, CBM, and VIP databases for randomized controlled trials (RCTs) comparing acupuncture interventions for perimenopausal syndrome, with the search updated to June 27, 2025. Risk of bias was assessed using the Cochrane tool. Network meta-analysis was performed using Stata 15 and R version 4.3. Results: A total of 49 RCTs with 4,579 participants were included. Acupuncture combined with Western medicine (AWM) was most effective for hormone regulation. Acupuncture plus Chinese medicine (ACM) best improved traditional Chinese medicine (TCM) symptoms, while electroacupuncture combined with Western medicine (EAWM) was optimal for menopausal symptoms and depression. Electroacupuncture (EA) alone was most effective for anxiety, auricular plus body acupuncture (AAA) improved sleep the most, and moxibustion (M) showed the highest overall effectiveness. Conclusion: Various acupuncture modalities show beneficial effects on perimenopausal syndrome, particularly AWM, EAWM, EA, AAA, and M. These findings provide evidence-based guidance for individualized treatment selection, although further high-quality RCTs are warranted for validation. Systematic Review Registration: https://osf.io/search, identifier 10.17605/OSF.IO/3F2GJ.