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acupuncture:evaluation:gyneco-obstetrique:03. syndrome des ovaires polykystiques [14 Sep 2023 10:58] Nguyen Johan [1.5. Overview of systematic reviews] |
acupuncture:evaluation:gyneco-obstetrique:03. syndrome des ovaires polykystiques [29 Oct 2025 14:13] (Version actuelle) Nguyen Johan |
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| ===== Systematic Reviews and Meta-Analysis===== | ===== Systematic Reviews and Meta-Analysis===== | ||
| - | | ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture | | + | ==== Generic Acupuncture ==== |
| - | | ☆☆ | Evidence for effectiveness of acupuncture | | + | === Jin 2025 (network meta-analysis) === |
| - | | ☆ | Limited evidence for effectiveness of acupuncture | | + | |
| - | | Ø | No evidence or insufficient evidence | | + | |
| + | Jin Q, Xu G, Ying Y, Liu L, Zheng H, Xu S, Yin P, Chen Y. Effects of non-pharmacological interventions on biochemical hyperandrogenism in women with polycystic ovary syndrome: a systematic review and network meta-analysis. J Ovarian Res. 2025 Jan 20;18(1):8. https://doi.org/10.1186/s13048-025-01595-5 | ||
| + | ^Objective| To systematically evaluate the effectiveness of non-pharmacological interventions (NPIs), including electroacupuncture, exercise, diet, and lifestyle changes, in reducing androgen levels in women with polycystic ovary syndrome (PCOS) through a systematic review and network meta-analysis.| | ||
| + | ^Methods| Comprehensive searches were conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang up to June 2024. Randomized controlled trials (RCTs) comparing NPIs with other NPIs or placebo treatments in adult women with PCOS were included. Study selection was independently performed by three authors. Quality assessment followed PRISMA guidelines using the Cochrane RoB2 tool. The confidence of evidence was examined using Confidence in Network Meta-Analysis (CINeMA). Traditional meta-analysis of continuous variables was conducted using Stata 17.0 software with a random-effects model, reporting effect sizes as standardized mean differences (SMD) and weighted mean differences (WMD). Network meta-analysis (NMA) was used to synthesize data, with network diagrams illustrating comparisons between NPIs. We assessed the consistency of the results, performed sensitivity analyses, and examined publication bias to evaluate the influence of individual studies. Furthermore, subgroup analysis and network meta-regression analysis were conducted to explore potential sources of heterogeneity.| | ||
| + | ^Results| The review included **21 studies with 1,196 participants**, with meta-analysis focusing on 17 studies involving 1,013 participants. NPIs significantly reduced serum testosterone (SMD = -0.57; 95% CI: -0.86 to -0.29, p < 0.01), A4 (SMD = -1.37; 95% CI: -2.63 to -0.12, p = 0.03), and mFG score (WMD = -0.81; 95% CI: -1.26 to -0.37, p < 0.01). Notably, the reduction in testosterone levels achieved with NPIs met the Minimum Clinically Important Difference (MCID) of 12.47 ng/dL (WMD = -12.57; 95% CI: -18.92 to -6.23; p < 0.01), affirming the clinical relevance of these reductions. No significant effects were observed on Free Androgen Index (FAI), Sex Hormone-Binding Globulin (SHBG), Dehydroepiandrosterone (DHEA), DHEA Sulfate (DHEAS), Free Testosterone (FT), or Dihydrotestosterone (DHT) levels (all p > 0.05). The NMA (18 studies, 1,067 participants) identified electroacupuncture combined with diet and exercise as the most effective intervention for reducing serum testosterone (WMD = -21.75; 95% CI: -49.58 to 6.07; SUCRA 72.3%). Evidence certainty for many interventions was low, highlighting the need for higher-quality studies. Sensitivity analysis confirmed the robustness of the findings, and no publication bias was detected.| | ||
| + | ^Conclusions| NPIs, particularly electroacupuncture combined with exercise and dietary management, effectively reduce androgen levels in PCOS patients. These findings provide valuable guidance for clinicians and women with PCOS, with multi-component approaches recommended for more substantial clinical benefit.| | ||
| + | === Zhang 2025 === | ||
| + | Zhang GS, Lim ECN, Cheng NCL, Lim CED. Acupuncture for polycystic ovary syndrome. Cochrane Database Syst Rev. 2025 Oct 28;10:CD007689. https://doi.org/10.1002/14651858.CD007689.pub5 | ||
| - | + | ^Background| Polycystic ovary syndrome (PCOS) is characterised by oligo-amenorrhoea, infertility, and hirsutism. Treatments include pharmacological agents, lifestyle modifications, and surgery. During ovulation in healthy women, the concentration of beta-endorphin, a neuropeptide involved in pain and hormonal regulation, is higher in follicular fluid than in plasma. Acupuncture may improve ovulatory function by stimulating beta-endorphin production, which is hypothesised to enhance gonadotropin-releasing hormone (GnRH) secretion. This is an update of a review first published in 2011 and last updated in 2019.| | |
| - | ==== Generic Acupuncture ==== | + | ^Objective| To assess the benefits and harms of acupuncture in managing fertility and symptoms in oligo/anovulatory women with polycystic ovary syndrome.| |
| + | ^Methods| Search methods: We searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, and three Chinese databases (CNKI, CBM, and VIP). We also reviewed trial registries and reference lists for related papers. The searches in CENTRAL, MEDLINE, Embase, PsycINFO, and CNKI are current to December 2024, the VIP search to November 2024, and the CBM search to November 2015. We also performed reference checking, citation searching, and contacted study authors to identify additional studies. Eligibility criteria: We included randomised controlled trials (RCTs) on the efficacy of acupuncture for oligo/anovulatory women with PCOS. Outcomes: Critical outcomes were live birth rate, multiple pregnancy rate, and ovulation rate. Important outcomes were clinical pregnancy rate, restored regular menstrual period, miscarriage rate, and adverse events. Risk of bias: We used the original Cochrane risk of bias tool (RoB 1). Synthesis methods: Two authors independently selected studies, extracted data, and assessed risk of bias. We calculated risk ratios (RRs), mean differences (MDs), and standardised mean differences (SMDs) with 95% confidence intervals (CIs). Certainty of evidence was evaluated using GRADE. Skewed data and small-study effects were considered, and unreliable results interpreted cautiously.| | ||
| + | ^Results| **Nine RCTs (one added in this update) with 1606 women** were included: acupuncture versus sham acupuncture (3 RCTs), low-frequency electroacupuncture versus exercise/no intervention (1 RCT), acupuncture versus relaxation (1 RCT), acupuncture versus clomiphene (1 RCT), and acupuncture versus Diane-35 (3 RCTs). Evidence remains uncertain regarding fertility and symptom control. Compared with sham acupuncture, acupuncture may result in little to no difference in live birth (RR 0.97, 95% CI 0.76-1.23), multiple pregnancy (RR 0.89, 95% CI 0.33-2.45), ovulation (SMD 0.02, 95% CI -0.15-0.19), clinical pregnancy (RR 1.07, 95% CI 0.85-1.35), and miscarriage (RR 1.10, 95% CI 0.77-1.56). Acupuncture may reduce mean days between menstrual periods at 12 weeks (MD -312.09 days, 95% CI -344.59--279.59; very low-certainty) and is probably associated with more adverse events (RR 1.16, 95% CI 1.02-1.31). Other comparisons (electroacupuncture, relaxation, clomiphene, Diane-35) yielded very low-certainty evidence with inconsistent outcomes.| | ||
| + | ^Conclusion| No clear evidence of a difference between acupuncture and sham acupuncture in live birth, multiple pregnancy, ovulation, clinical pregnancy, miscarriage, or restored menstrual periods. Acupuncture is probably associated with more adverse events. The limited number and quality of RCTs mean that the effectiveness of acupuncture for PCOS remains uncertain.| | ||
| === Li 2022 ☆☆=== | === Li 2022 ☆☆=== | ||
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| | see [[acupuncture:evaluation:gyneco-obstetrique:09. infertilite#Infertilité du syndrome des ovaires polykystiques|corresponding item]] | | | see [[acupuncture:evaluation:gyneco-obstetrique:09. infertilite#Infertilité du syndrome des ovaires polykystiques|corresponding item]] | | ||
| - | ==== Methodological quality of systematic reviews ==== | ||
| - | === Luo 2018 === | ||
| - | Luo YN, Zheng QH, Liu ZB, Zhang FR, Chen Y, Li Y. Methodological and reporting quality evaluation of systematic reviews on acupuncture in women with polycystic ovarian syndrome: A systematic review. Complement Ther Clin Pract. 2018;:197-203. [181359]. | ||
| - | ^Purpose| To evaluate the methodological and reporting quality of systematic reviews (SRs) on acupuncture treatment for women with polycystic ovarian syndrome (PCOS). | | ||
| - | ^Methods|A comprehensive search on multiple databases was performed. Methodological and reporting quality of reviews were assessed by revised assessment of multiple systematic reviews (AMSTAR 2) and preferred reporting items for SRs and meta-analyses (PRISMA), respectively. | | ||
| - | ^Results| Ten SRs were included. Among the SRs using AMSTAR 2, two achieved a good overall rating (percentage of items with "yes" > 50%) and severe limitation existed in eleven items (percentage of items with "yes" < 50%). Among the SRs using PRISMA, six reviews achieved a good overall rating (percentage of items with "yes" > 50%), while twelve items were poorly reported (percentage of items with "yes" < 50%). | | ||
| - | ^Conclusion|There were many deficiencies in the methodological and reporting quality of SRs assessing acupuncture in women with PCOS. | | ||
| ===== Overview of systematic reviews ===== | ===== Overview of systematic reviews ===== | ||
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| + | |||
| + | ==== Bai 2024 ==== | ||
| + | |||
| + | Bai T, Deng X, Bi J, Ni L, Li Z, Zhuo X. The effects of acupuncture on patients with premature ovarian insufficiency and polycystic ovary syndrome: an umbrella review of systematic reviews and meta-analyses. Front Med (Lausanne). 2024 Nov 25;11:1471243. https://doi.org/10.3389/fmed.2024.1471243 | ||
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| + | ^Backgound| Previous studies have suggested that acupuncture could improve the clinical outcomes of women with premature ovarian insufficiency (POI) and polycystic ovary syndrome (PCOS). However recent meta-analyses have provided inconclusive findings. This umbrella meta-analysis aimed to explore the effect of acupuncture therapies on PCOS and POI outcomes.| | ||
| + | ^Methods| A systematic literature search was carried out in in PubMed, Scopus, Web of Science, and Chinese databases, including Wan Fang Data Knowledge Service Platform, CBM, CNKI, and VIP up until April 2024 to gather relevant studies. Inclusion criteria were meta-analyses on the effect of acupuncture or combined therapies with standard medications or traditional Chinese medicine (TCM) on PCOS and POI. The outcomes were pregnancy rates, ovulation rates, hormone levels, glycemic indices, resumption of menstruation, endometrial thickness, live birth rates, abortion rates, and body mass index (BMI). Studies with irrelevant interventions, animal studies, reviews without quantitative analysis, and studies with insufficient data were excluded. Standardized mean difference (SMD) with a 95% confidence interval (CI) and relative risk (RR) with a 95% CI were used as effect sizes to pool the data using a random effects model.| | ||
| + | ^Results| A total of 38 meta-analyses, 20 studies (sample size: 27,106 patients) for PCOS and **18 studies (sample size: 19,098 patients)** for POI, were included. Overall, in women with PCOS, acupuncture therapies were significantly associated with a higher pregnancy rate, ovulation rate, and reduced serum levels of luteinizing hormone (LH), testosterone, LH/follicle-stimulating hormone (FSH), insulin resistance, and BMI. Moreover, FSH, fasting glucose, and fasting insulin levels were improved in subgroup analyses. For POI, acupuncture significantly improved serum levels of LH, FSH, LH/FSH ratio, and estradiol.| | ||
| + | ^Conclusion| Acupuncture-related therapies improve pregnancy rate, and metabolic and hormonal imbalances in patients with POI and PCOS.| | ||
| === Yang 2023 === | === Yang 2023 === | ||
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| ^Conclusion|The efficacy and safety of acupuncture for PCOS remains uncertain due to the limitations and inconsistencies of current evidence. More high-quality studies are needed to support the use of acupuncture in PCOS.| | ^Conclusion|The efficacy and safety of acupuncture for PCOS remains uncertain due to the limitations and inconsistencies of current evidence. More high-quality studies are needed to support the use of acupuncture in PCOS.| | ||
| + | === Luo 2018 === | ||
| + | |||
| + | Luo YN, Zheng QH, Liu ZB, Zhang FR, Chen Y, Li Y. Methodological and reporting quality evaluation of systematic reviews on acupuncture in women with polycystic ovarian syndrome: A systematic review. Complement Ther Clin Pract. 2018;:197-203. [181359]. | ||
| + | ^Purpose| To evaluate the methodological and reporting quality of systematic reviews (SRs) on acupuncture treatment for women with polycystic ovarian syndrome (PCOS). | | ||
| + | ^Methods|A comprehensive search on multiple databases was performed. Methodological and reporting quality of reviews were assessed by revised assessment of multiple systematic reviews (AMSTAR 2) and preferred reporting items for SRs and meta-analyses (PRISMA), respectively. | | ||
| + | ^Results| Ten SRs were included. Among the SRs using AMSTAR 2, two achieved a good overall rating (percentage of items with "yes" > 50%) and severe limitation existed in eleven items (percentage of items with "yes" < 50%). Among the SRs using PRISMA, six reviews achieved a good overall rating (percentage of items with "yes" > 50%), while twelve items were poorly reported (percentage of items with "yes" < 50%). | | ||
| + | ^Conclusion|There were many deficiencies in the methodological and reporting quality of SRs assessing acupuncture in women with PCOS. | | ||
| ===== Clinical Practice Guidelines ===== | ===== Clinical Practice Guidelines ===== | ||
