Effect of different acupuncture modalities on sex hormone levels in perimenopausal women: a network meta-analysis.

BACKGROUND: Acupuncture, a common intervention in traditional Chinese medicine (TCM), has been widely applied for regulating hormonal fluctuations in perimenopausal women. However, the efficacy of various acupuncture modalities is not comprehensively compared. This network meta-analysis (NMA) evaluated the effects of different acupuncture approaches on sex hormone levels, specifically estradiol (E2), follicle-stimulating hormone (FSH), and luteinizing hormone (LH), in perimenopausal women. METHODS: PubMed, Embase, the Cochrane Library, Web of Science, CNKI, Wanfang, and the VIP Database were searched until March 17, 2026. Randomized controlled trials (RCTs) on acupuncture interventions for perimenopausal women were included. The risk of bias was assessed for included studies, and data were synthesized based on a Bayesian NMA framework. RESULTS: 36 studies on 1, 480 participants were included. Compared with control interventions, acupoint application (AA) and acupuncture therapy (AT) significantly reduced Kupperman scores. In terms of FSH reduction, AA, abdominal moxibustion (AM), and AT were superior to control. For LH, AA, AT, and AM demonstrated notable reductions compared with control. As for E2 elevation, AA, AT, and compression acupuncture (PN) achieved statistically significant improvements. CONCLUSIONS: AM, AT, and AA significantly improved Kupperman scores, with AM being the most effective. Catgut implantation acupoint (CA) and PN showed significant effects in reducing FSH levels, followed by AT and AM, whereas plum blossom needling exhibited the greatest efficacy in increasing E2 levels. Overall, acupuncture presents a promising non-pharmacological strategy for modulating hormonal balance and alleviating menopausal symptoms in perimenopausal women. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251066613.