Acupuncture for premenstrual syndrome: a systematic review and meta-analysis of randomised controlled trials

Background Although acupuncture is widely applied in obstetrics and gynaecology, evidence for its efficacy in treating premenstrual syndrome (PMS) is equivocal. Objective To summarise and evaluate the current evidence for acupuncture as a treatment for PMS. Search strategy Ten databases were searched electronically, and relevant reviews were searched by hand through June 2009. Selection criteria Our review included randomised controlled trials (RCTs) of women with PMS; these RCTs compared acupuncture with sham acupuncture, medication, or no treatment. Data collection and analysis Study outcomes were presented as mean differences (for continuous data) or risk ratios (RRs) (for dichotomous data) with a 95% confidence interval (95% Cl). The risk of bias was assessed using the assessment tool from the Cochrane Handbook. Main results Ten RCTs were included in our review. The pooled results demonstrated that acupuncture is superior to all controls (eight trials, pooled RR 1.55, 95% Cl 1.33-1.80, P < 0.00001). A meta-analysis comparing the effects of acupuncture with different doses of progestin and/or anxiolytics supported the use of acupuncture (four trials, RR 1.49, 95% Cl 1.27-1.74, P < 0.00001). In addition, acupuncture significantly improved symptoms when compared with sham acupuncture (two trials, RR 5.99, 95% CI 2.84-12.66, P < 0.00001). No evidence of harm resulting from acupuncture emerged. Most of the included studies demonstrated a high risk of bias in terms of random sequence generation, allocation concealment, and blinding. Author's conclusions Although acupuncture seems promising for symptom improvement in women with PMS, important methodological flaws in the included studies weaken the evidence. Considering the potential of acupuncture, further rigorous studies are needed.