Acupuncture for polycystic ovary syndrome

Area of Science:

• Reproductive Medicine
• Integrative Medicine
• Gynecology

Background:

• Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, characterized by ovulatory dysfunction, hyperandrogenism, and polycystic ovarian morphology.
• Current treatments for PCOS include pharmacotherapy, lifestyle interventions, and surgical options, with varying success rates.
• Acupuncture is explored as a complementary therapy, hypothesized to improve ovulatory function by modulating beta-endorphin and gonadotropin-releasing hormone (GnRH) secretion.

Purpose of the Study:

• To evaluate the efficacy and safety of acupuncture for improving fertility and managing symptoms in women diagnosed with oligo/anovulatory polycystic ovary syndrome.
• To synthesize evidence from randomized controlled trials (RCTs) comparing acupuncture with sham acupuncture, other interventions, or standard treatments.

Main Methods:

• A comprehensive search of multiple databases including Cochrane, MEDLINE, Embase, and Chinese databases was conducted up to December 2024.
• Included were nine randomized controlled trials (RCTs) involving 1606 women with PCOS, comparing acupuncture against sham acupuncture, exercise, relaxation, clomiphene, or Diane-35.
• Critical outcomes included live birth, multiple pregnancy, and ovulation rates, with important outcomes being clinical pregnancy, menstrual regularity, miscarriage, and adverse events. Risk of bias and GRADE certainty were assessed.

Main Results:

• Evidence remains uncertain regarding acupuncture's effectiveness for PCOS fertility and symptom control compared to sham acupuncture, with no significant differences observed in live birth, clinical pregnancy, or ovulation rates.
• Acupuncture may lead to a reduction in menstrual cycle length but is probably associated with a higher incidence of adverse events, such as vaginal bleeding and nausea.
• Data for comparisons with exercise, relaxation, clomiphene, and Diane-35 are very limited and uncertain, precluding firm conclusions.

Conclusions:

• Current evidence does not clearly support the use of acupuncture for improving fertility or key symptoms in women with PCOS.
• The likely increased risk of adverse events warrants caution, and the overall effectiveness remains uncertain due to limited high-quality research.
• Larger, well-designed randomized controlled trials are necessary to definitively establish the benefits and harms of acupuncture for managing polycystic ovary syndrome.