OBJECTIVE: To assess the efficacy, comparative effectiveness and safety of electroacupuncture (EA) in the treatment of perimenopausal syndrome (PMS). METHODS: Nine databases were searched until June 2019. Only relevant randomized controlled trials (RCTs) of EA for PMS were included. RESULTS: Twelve trials involving 746 women were included. EA and hormone therapy (HT) did not significantly differ in terms of effective rate (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.93 to 1.04), Kupperman index (KI) (mean difference (MD) -0.25, 95% CI -0.76 to 0.26) and serum levels of follicle-stimulating hormone (FSH) (MD -3.80, 95% CI -11.59 to 3.98) or luteinizing hormone (LH) (MD -2.51, 95% CI -10.72 to 5.70). Serum estradiol (E2) levels were significantly lower in EA versus HT groups (MD -60.58, 95% CI -71.93 to -49.23). Compared with sham EA, EA had a significantly greater effect on reductions in KI (MD -4.71, 95% CI -6.57 to -2.86) and hot flushes score/24 h (MD -2.43, 95% CI -2.93 to -1.93). There were no significant differences between EA and manual acupuncture (MA) in terms of effective rate (RR = 1.14, 95% CI 0.98 to 1.33) or serum FSH (MD -2.87, 95% CI -29.65 to 23.91), LH (MD 2.73, 95% CI -9.65 to 15.11) or E2 (MD 26.80, 95% CI -12.06 to 65.65). However, it seemed that EA had a better effect than MA on KI (MD -2.44, 95% CI -4.80 to -0.08). Subgroup analyses indicated that EA may have more of a benefit in the pre-menopausal state (hot flushes score/24 h: MD -1.66, 95% CI -3.49 to 0.17) compared to post-menopause (p > 0.05). CONCLUSION: The effect of EA appeared broadly similar to HT and MA in the treatment of PMS, although EA-associated reductions in KI were superior to MA and sham EA, suggesting effects beyond placebo. The evidence base is limited by a small number of eligible studies, risk of bias and clinical/statistical heterogeneity, limiting our ability to draw firm conclusions. As such, additional larger scale, high-quality RCTs are needed.

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