In short
- Hormone therapy remains the most effective treatment for hot flushes and night sweats for those who can take it.
- Acupuncture has moderate evidence for reducing the frequency and severity of hot flushes, and a notable placebo response in trials.
- It is a reasonable option for people who cannot or prefer not to take hormone therapy.
- Track symptoms for two weeks before starting, or you will not be able to tell what changed.
What is actually happening
Around menopause, falling and fluctuating oestrogen affects the part of the brain that regulates body temperature, narrowing the range it tolerates. Small changes then trigger the body's cooling response: flushing, sweating, a racing heart. Night sweats break sleep, and broken sleep makes everything else harder to cope with.
Symptoms vary enormously. Some people have a few mild flushes; others have dozens a day for years. Treatment decisions follow from how much they are actually affecting your life.
What the evidence shows
Trials of acupuncture for hot flushes generally find that people treated report fewer and less severe flushes. The complication is that sham acupuncture also performs well in these trials, which suggests a substantial part of the benefit is non-specific.
How you read that depends on what you want from treatment. If the question is whether needling at specific points has a unique physiological effect, the answer is uncertain. If the question is whether people who have a course of acupuncture tend to report fewer flushes afterwards, the answer is more often yes. Both statements are true at once.
Sleep is a related gain: when night sweats wake you less, sleep improves, and the daytime burden drops with it.
Acupuncture sits alongside medical care, not in place of it. Keep any treatment your physician has prescribed, and tell your acupuncturist about it.
How it compares with other options
Hormone therapy is the most effective treatment available for vasomotor symptoms and is appropriate for many people, with risks that depend on age, time since menopause and personal history: a conversation for your physician. Certain non-hormonal prescription medications also help. CBT has evidence for reducing how much flushes bother you, even when frequency is unchanged.
Acupuncture is a reasonable choice if hormone therapy is not suitable or not wanted, or as an addition. It is not a reason to rule out a conversation about the options with stronger evidence.
Measuring whether it works
Keep a simple tally for two weeks before you start: how many flushes a day, how severe on a one-to-ten scale, how many times you wake at night. Repeat during treatment. Menopausal symptoms fluctuate on their own, and without a baseline you are comparing against memory.
Things that warrant a doctor
- Any vaginal bleeding after menopause. This always needs assessment.
- Flushes with weight loss, fever or night sweats that soak bedding, where menopause is not clearly the cause.
- Heart palpitations that are new, prolonged, or come with chest pain or faintness.
- Low mood that persists, which is common around menopause and treatable.