Abstract
BACKGROUND: Perimenopausal women frequently experience insomnia and negative emotions due to hormonal fluctuations. Acupuncture, a traditional Chinese therapy, has attracted significant interest for its potential to regulate endocrine function and alleviate insomnia. Despite this, no systematic review has hitherto evaluated the efficacy of acupuncture on insomnia and negative emotions in perimenopausal women. This network meta-analysis was conducted to assess the therapeutic effects of acupuncture on these conditions, thereby generating robust clinical evidence to inform evidence-based practice and guide future research directions. METHODS: A systematic literature search was performed in multiple databases, such as PubMed, Web of Science, Medline, Scopus, Wanfang, CNKI, VIP Database, and CBM, covering all records from inception through November 2025. The primary outcome was measured using the Pittsburgh Sleep Quality Index (PSQI), while secondary outcomes were evaluated through various depression and anxiety scales, including the Kupperman Menopausal Index, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Self-Rating Anxiety Scale, Self-Rating Depression Scale, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Beck Depression Inventory, and Beck Anxiety Inventory. RESULTS: According to the network meta-analysis, the top three interventions identified for the improvement of PSQI scores were, in order: routine acupuncture combined with auricular acupuncture; auricular acupuncture combined with Western medicine; and routine acupuncture combined with Pentatonic therapy. Seven interventions demonstrated significant effects compared to SH (P < 0.05). Regarding negative moods, balance acupuncture combined with Xiaoyao powder, routine acupuncture combined with pentatonic therapy, and abdominal acupuncture combined with sedative prescription and western medicine ranked highest (P < 0.05). CONCLUSION: This network meta-analysis suggests that routine acupuncture combined with auricular acupuncture may be an effective intervention treatment for treating insomnia in perimenopausal women. Furthermore, balanced acupuncture combined with Xiaoyao powder may have a positive effect in alleviating negative emotions.