Effects of acupuncture-related therapies on endocrine and metabolic outcomes in obese women with polycystic ovary syndrome: a systematic review and network meta-analysis

Background Evidence on the effectiveness of acupuncture and combination therapies for metabolic and hormonal disturbances in obese women with PCOS remains limited. This NMA compared the relative efficacy of acupuncture-related interventions. Methods RCTs evaluating acupuncture-based therapies for metabolic outcomes (BMI, HOMA-IR, TG) and endocrine parameters (T, LH/FSH ratio) in obese women with PCOS were included. A Bayesian NMA assessed the comparative effects of ten modalities. Continuous outcomes were reported as MD with 95% CrIs. SUCRA was used to rank the relative efficacy of each intervention, and certainty of evidence was evaluated using CINeMA. The study was registered in PROSPERO (CRD420251118032). Results Forty-one RCTs involving 3, 500 obese women with PCOS were included. Methodological quality was generally moderate, and certainty of evidence was low. Acupuncture and related therapies produced greater metabolic and hormonal improvements than Western medication. MoxACE showed the strongest metabolic benefits across BMI, HOMA-IR, and TG, while ACWM provided the most favorable hormonal regulation, improving both T and LH/FSH ratio. AC ranked within the top three for HOMA-IR, LH/FSH ratio, and TG, and AbdA ranked second to ACWM in reducing T. Conclusion Acupuncture and related therapies may offer meaningful improvements in metabolic and endocrine profiles in obese women with PCOS. Low-certainty evidence suggests that acupuncture-related therapies may improve metabolic and endocrine profiles in obese women with PCOS. However, the clinical relevance of these findings remains uncertain pending high-quality trials. Systematic review registration PROSPERO (CRD420251118032): https: //www. crd. york. ac. uk/PROSPERO/view/CRD420