Abstract: Objective This study aimed to investigate the clinical efficacy of cervical three-needle therapy combined with Anpa Ningshen decoction in the treatment of perimenopausal insomnia based on repeated measures analysis of variance (ANOVA). Methods A total of 68 patients with perimenopausal insomnia admitted to our hospital from January 2022 to March 2024 were selected as the study subjects. According to the treatment methods, all patients were divided into a control group (n= 36) and a treatment group (n= 32). The control group received cervical three-needle therapy, while the treatment group received cervical three-needle therapy combined with Anpa Ningshen decoction. The sleep quality scores, serum sex hormones levels, and neurotransmitter levels were compared between the two groups before and after treatment. Repeated measures ANOVA was used to examine whether there was an interaction effect between time and treatment factors. Multiple linear regression analysis was performed to explore the relationship between serum sex hormones and neurotransmitter levels at different time points. Binary Log-binomial regression analysis was conducted to compare the incidence of adverse reactions between the two groups. Results Compared with the levels before treatment, after 8 weeks of treatment, the Pittsburgh Sleep Quality Index (PSQI) total score, number of awakenings, sleep latency, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels significantly decreased in both groups (P＜0.05), while total sleep time, sleep efficiency, estradiol (E₂), dopamine (DA), and norepinephrine (NE) levels significantly increased (P＜0.05). Repeated measures ANOVA results showed that the effect of time on serum sex hormones and neurotransmitters levels varied depending on the different methods of treatment. Multiple linear regression analyses indicated that E₂ was positively correlated with DA and NE at different time points, while LH and FSH were negatively correlated with DA and NE (P＜0.05). The total effective rate in the treatment group was significantly higher than that in the control group (P＜0.05), while the total incidence of adverse reactions was lower than that of the control group (P＜0.05). There was no significant difference in recurrence rate between the two groups (P＞0.05). Conclusion Compared with the use of cervical three-needle therapy alone, cervical three-needle therapy combined with Anpa Ningshen decoction achieved better clinical efficacy in the treatment of perimenopausal insomnia, with more significant improvement in serum sex hormone and neurotransmitter indexes.