Acupuncture for PMS: does it work?

Acupuncture may ease PMS symptoms more than doing nothing, and more than a sham needle, in several small trials. But the quality of that evidence is weak, and reviewers don't fully agree on what it means. (If you're not sure what counts as PMS, see what is PMS.)

A 2011 meta-analysis pooled ten trials and found acupuncture outperformed all controls combined, and outperformed sham acupuncture specifically [4]. A 2019 review of 1,103 cases across 15 trials also found acupuncture raised the share of women who improved, compared with medication and sham treatment [2].

Comparison	Finding	Trials	Evidence strength
Acupuncture vs sham acupuncture	Large improvement (risk ratio 5.99) [4]	2 trials [4]	Weak, very few trials
Acupuncture vs all controls (pooled)	Improvement (risk ratio 1.55) [4]	8 trials [4]	Weak, high bias risk
Acupuncture vs medication	Similar or slightly better (risk ratio 1.49) [4]	4 trials [4]	Weak, high bias risk
Cochrane review, overall verdict	Evidence insufficient to conclude [1]	Multiple	Insufficient

The 2018 Cochrane review looked at much of this same evidence and reached a more cautious verdict. It found the proof insufficient to draw firm conclusions, since most trials were small, had unclear randomization, and weren't properly blinded [1]. An earlier 2010 systematic review reached a similar conclusion. Some trials favored acupuncture over medication, but the overall evidence had real gaps in design [5].

Acupuncture probably helps some women, but no one yet knows how much, or whether the benefit is more than a strong placebo effect. For more on how researchers grade evidence like this, see PMS and PMDD research, summarised.

There's no single approved protocol, but trials give some clues.

Treatment is usually delivered by a licensed acupuncturist, using needles placed at points on the lower leg, abdomen or ear. The three most commonly used acupoints in PMS trials are [2]:

• SP6
• LR3
• RN4

Some studies used variations instead of standard needling [3]:

• Moxibustion (heat instead of needles)
• Auricular acupuncture
• Herbal medicine studied as a separate approach in the same review, including Vitex agnus-castus

One useful finding is that it doesn't seem to matter when in your cycle you start. A 2019 meta-analysis of 15 trials found no significant difference in effectiveness between starting acupuncture before symptoms appear versus after they've already begun [2]. That means you don't need to time your first session around a particular cycle day, you can start whenever you're ready and continue across one or more cycles.

If you decide to try it, ask the practitioner about their experience treating PMS specifically, since protocols vary a lot between studies.

The research doesn't give one clear answer, since trial lengths varied a lot between studies.

Most trials that found a benefit measured it over one or more full menstrual cycles, not after a single session. That fits with how acupuncture is usually described for most conditions, as cumulative sessions over several weeks rather than a one-time fix.

A practical approach is to give it at least two to three menstrual cycles before deciding whether it's working for you. Track your symptoms daily rather than relying on memory, so you can see whether a pattern shifts from one cycle to the next. A DRSP chart makes that comparison easier, since you rate the same symptoms on the same scale every day.

If nothing has changed after three cycles, it's reasonable to try something else instead of continuing indefinitely.

Acupuncture is generally low-risk when done by a trained practitioner.

The 2011 meta-analysis of ten PMS trials found no evidence of harm from acupuncture at all [4]. A separate systematic review noted that only two of nine trials even reported on adverse events, and between them, the only side effect recorded was a single small hematoma, a spot of bruising under the skin at a needle site [5].

Acupuncture in general can also cause brief soreness, tiredness, or lightheadedness after a session, though these weren't specifically tracked in the PMS trials. Choosing a licensed acupuncturist who uses single-use sterile needles lowers the risk further. Serious complications are rare when needles are sterile and the practitioner is properly trained.

A few situations call for caution before you try it.

• You have a bleeding disorder or take blood thinners, since needles can cause more bruising or bleeding than usual.
• You're pregnant, since some acupuncture points are traditionally avoided during pregnancy and a practitioner needs to know to adjust.
• You have a strong needle phobia, since the distress of the session could outweigh any benefit.
• You have an infection or skin condition at the usual treatment sites.

None of this means acupuncture is risky for PMS specifically. It means the usual precautions for any acupuncture treatment apply, so tell your acupuncturist your full health history first. Acupuncture hasn't been well studied for the mood side of PMS, so if irritability or low mood are your main symptoms, other approaches might matter more for you.

Acupuncture doesn't have to be the only thing you try.

Guidelines for PMS point to other options with more consistent evidence behind them: regular exercise, cognitive behavioral therapy, certain hormonal contraceptives, and SSRIs taken either daily or only in the days before your period, depending on what a doctor recommends. Read more on other PMS treatment options.

Whatever you try, alongside acupuncture or instead of it, tracking matters. Two months of daily notes make it easier for you, or a doctor, to tell whether something is working or your symptoms were simply lighter that month anyway.

Niyora is a PMS and PMDD support app. It gives you an estimated PMS window, so the pattern you're tracking on paper has a second place to check it against.

If your symptoms look more like PMDD, mood symptoms most days in the week before your period, it's worth reading about acupuncture for PMDD specifically, since the evidence there is graded separately.