Efficacy of acupuncture therapies for polycystic ovary syndrome: a network meta-analysis.

BACKGROUND

Polycystic ovary syndrome (PCOS) is a prevalent gynecological disorder that significantly impairs quality of life and reduces patient confidence in treatment. The efficacy of current Western pharmacological therapies is limited. Acupuncture has shown promise in the management of PCOS, but comparative research on different acupuncture modalities remains scarce.

METHODS

PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and the Chinese Biomedical Literature Database were comprehensively searched from database inception to 18 August 2024. Two reviewers independently screened studies, extracted data, and assessed the risk of bias in the eligible studies. Network meta-analysis was conducted using STATA 15.1 and R 4.4.1.

RESULTS

Ninety-two randomized controlled trials (RCTs) involving 15 acupuncture-based interventions or combinations were included. According to the surface under the cumulative ranking curve (SUCRA) analysis, for total efficacy (TE), electroacupuncture (99.03%), filiform needle + thunder fire moxibustion (74.77%), and filiform needle with electroacupuncture (64.02%) ranked the highest. For follicle-stimulating hormone (FSH) regulation, fire needle (90.99%) ranked first, followed by filiform needle + electroacupuncture (75.29%) and filiform needle + warming needle moxibustion + electroacupuncture (66.76%). For luteinizing hormone (LH) regulation, warming needle moxibustion (86.75%) ranked first, followed by warming needle moxibustion + electroacupuncture (72.76%) and filiform needle alone (69.55%). For testosterone reduction, filiform needle + moxibustion (96.53%) ranked first, followed by catgut embedment in acupoint + moxibustion (85.64%) and electroacupuncture (82.33%). For LH/FSH ratio improvement, catgut embedment in acupoint (77.73%), warming needle moxibustion + electroacupuncture (72.87%), and filiform needle + warming needle moxibustion + electroacupuncture (66.39%) ranked the highest. For adverse events, fire needle (91.69%) ranked highest, followed by Western medicine (83.17%) and catgut embedment in acupoint (64.08%).

CONCLUSION

No statistically significant differences were observed between single and combined acupuncture therapies. However, modalities incorporating electrical, thermal, or sustained stimulation appear to be more effective. Given the methodological limitations of the included studies, high-quality, rigorously designed RCTs are warranted to validate these findings.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42024609903.