Acupuncture and polycystic ovarian syndrome
24 women with polycystic ovarian syndrome who had amenorrhoea or oligomenorrhoea, 19 of whom were resistant to clomiphene, were given 10-14 mostly electro-acupuncture treatments at points Shenshu BL-23, Pangguangshu BL-28, Sanyinjiao SP-6, Yinlingquan SP-9, Neiguan P-6, Waiguan SJ-5 and Baihui DU-20. 9 women, 7 of whom were clomiphene resistant, showed a significant rise in rate of ovulation.
(Acta Obstet Gynecol Scand 2000;79:180-8).
Acupuncture for polycystic ovaries
A review article has evaluated the use of acupuncture to prevent and reduce symptoms related with polycystic ovary syndrome (PCOS). Reporting on experimental observations in rat models of polycystic ovaries and clinical data from studies in women with PCOS, the Swedish authors suggest that acupuncture can affect PCOS via modulation of the neuroendocrine system (in particular the sympathetic nervous system) and can exert long-lasting beneficial effects on the metabolic and endocrine systems and on ovulation.
(Acupuncture in Polycystic Ovary Syndrome: Current Experimental and Clinical Evidence.J Neuroendocrinol. 2007 Nov 28]).
Japanese-style acupuncture for adolescent endometriosis pain
A US randomised, sham-controlled pilot study has assessed the use of Japanese-style acupuncture for reducing chronic pelvic pain and improving health-related quality of life (HRQOL) in adolescents with endometriosis. Eighteen young women (13-22 years) with laparoscopically-diagnosed endometriosis-related chronic pelvic pain were treated with either Japanese style acupuncture or sham acupuncture. Participants in the active acupuncture group experienced an average 4.8 point reduction in pain measured on a 11 point scale (62%) after four weeks, which differed significantly from the control average reduction of 1.4 points. Reduction in pain in the active group persisted at six-month follow up; however, after four weeks, differences between the active and control group decreased and were not statistically significant. All HRQOL measures indicated greater improvements in the active acupuncture group compared with controls; however, the majority of these trends were not significant.
(Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial. J Pediatr Adolesc Gynecol. 2008 Oct;21(5):247-57).
Acupuncture for painkiller-resistant period pain
Italian scientists have evaluated the effect of acupuncture on dysmenorrhoea that is resistant to treatment by non-steroidal anti-inflammatory drugs (NSAIDs). Fifteen patients received eight weekly acupuncture treatments (at Taixi KID-3, Taichong LIV-3, Gongsun SP-4, Zusanli ST-36, Tianshu ST-25, Guilai ST-29, Qichong ST-30, Guanyuan REN-4, Qihai REN-6, Shenmai BL-62, Shenmen HT-7, Hegu LI-4, Neiguan PC-6 and Zigong (M-CA-18). Patients were allowed to continue using painkillers as necessary. Pain was measured on a visual analogue scale at baseline (T1) and four time points: mid-treatment (T2), end of treatment (T3) and three (T4) and six months (T5) after the end of treatment. A substantial reduction in pain and NSAID use was observed in 87% of patients. Pain intensity was significantly reduced with respect to baseline by 64, 72, 60 and 53% at T2, T3, T4 and T5. Average pain duration at baseline (2.6 days) was significantly reduced by 62, 69, 54 and 54% at T2, T3, T4 and T5. Average NSAID use was significantly reduced by 63, 74, 58 and 58% at T2, T3, T4 and T5, respectively, and ceased totally in seven patients, who were still asymptomatic six months after treatment.
(Acupuncture Treatment of Dysmenorrhea Resistant to Conventional Medical Treatment. Evid Based Complement Alternat Med. 2008 Jun;5(2):227-230.)
Acupuncture cost-effective for dysmenorrhoea
In another German study, the clinical effectiveness and cost-effectiveness of acupuncture in patients with dysmenorrhoea was studied. In a randomised controlled trial plus non-randomised cohort, patients with dysmenorrhoea were randomised to 15 sessions of acupuncture over three months or to a control group (no acupuncture). All subjects were allowed to receive usual medical care. Of 649 women, 201 were randomised. Those who declined randomisation received acupuncture treatment. After three months, the average pain intensity was lower with acupuncture than without (3.1 vs. 5.4). The authors concluded that additional acupuncture in patients with dysmenorrhoea was associated with improvements in pain and quality of life as compared to usual care alone and was cost-effective within usual thresholds (overall ICER 3,011 euros per QALY).
(Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008 Feb;198(2):166.e1-8).
Acupuncture cost-effective for period pain
A pragmatic randomised study has evaluated the clinical and economic effectiveness of acupuncture in the treatment of women with dysmenorrhoea. 201 patients were allocated to receive either up to 15 acupuncture sessions over three months or no acupuncture. Both groups additionally received usual medical care. Outcome measures of pain intensity and quality of life were recorded at baseline and after three months. After three months, patients in the acupuncture group were found to have less pain than controls. A cost-effectiveness calculation was performed, based on calculating quality-adjusted life years (QALYs). This analysis showed that although acupuncture treatment incurred additional costs when compared with usual care, the improvement to patient’s quality of life means it can be regarded as cost-effective when compared with international benchmarks.
(Pragmatic randomised study evaluating clinical and economic effectiveness of acupuncture treatment in patients with dysmenorrhoea. Focus Altern Complement Ther. 2006;11(S):53).
Acupuncture and endometrial pain
A study of 101 women (aged 20 to 40), of whom 83 completed the trial, with laparoscopic-proofed endometriosis, randomised them to one of two groups. The first received specific acupuncture for the condition while the other were treated at non-specific points (points with no relation to the diagnosis). Treatment was given twice weekly for ten weeks. After a two month interval, the two groups changed. There was a highly significant decrease in ain levels in the specific group compared to the non-specific group where the pain remained nearly unchanged.
(Is acupuncture in addition to conventional medicine effective as pain treatment for endometriosis? A randomised controlled crossover trial. Focus Altern Complement Ther 2006; 11: 42).
Acupressure and dysmenorrhoea
In a study which compared acupressure at Sanyinjiao SP-6 with simple resting for female technical college students in Taiwan suffering from dysmenorrhoea, the acupressure – whether in the form of treatment or self-treatment – was found to significantly reduce pain.
(J Adv Nurs. 2004 Nov; 48(4):380-7).
Chinese herbs comparable to hormones for endometriosis
UK authors have carried out a systematic review of the use of Chinese herbal medicine (CHM) for endometriosis-related pain and infertility. Database searches revealed 100 relevant studies, but only two Chinese RCTs were deemed of high enough quality for analysis. Meta-analysis of the pooled results involving a total of 158 women concluded that administration of CHM after laparoscopic surgery for endometriosis has effects comparable to those achieved with the drug gestrinone (a synthetic progesterone that suppresses the secretion of oestrogen by the ovaries), but with fewer side effects. In addition they concluded that oral CHM may have a better overall treatment effect than danazol (synthetic testosterone) and that it may be more effective in relieving dysmenorrhea and shrinking endometrial masses when used in conjunction with a CHM enema.
(Chinese herbal medicine for endometriosis. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD006568).
Herbal medicines for dysmenorrhoea
In a Japanese study, two herbal medicine prescriptions administered alternately within the menstrual cycle were found to have powerful antidysmenorrhoeic effects. The two prescriptions were Shakuyaku-kanzo-to (Shao Yao Gan Cao Tang/Peony & Licorice Decoction) and Toki-shakuyaku-san (Dang Gui Shao Yao San/Tangkuei and Peony powder). All 17 dysmenorrhea patients in the study, including recurrent endometriotic and adenomyotic patients obtained complete relief within three months. Nine of 12 patients treated with the herbal therapy ovulated and all three secondary ammenorrhoea patients with moderate levels of serum estradiol, but none of the three secondary amenorrhoea patients with little serum estradiol, also ovulated. One of the treated patients, who had a history of 10 repetitive spontaneous abortions. carried the 11th pregnancy to term.
(Clin Exp Obstet Gynecol. 2003;30(2-3):95-8).
Chinese herbal medicine better than drugs for dysmenorrhoea
The evidence supporting the use of Chinese herbal medicine (CHM) for primary dysmenorrhoea is promising, but better quality research on the subject is still required. These are the conclusions of a systematic review by Australian researchers, which included 39 RCTs involving a total of 3475 women. CHM was found to result in significant improvements in pain relief, overall symptoms and use of additional medication when compared with use of pharmaceutical drugs. CHM also resulted in better pain relief than either acupuncture or heat compression in the studies analysed. There were no indications that CHM caused any adverse events.
(Chinese herbal medicine for primary dysmenorrhoea. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005288).
Electro-acupuncture for PCOS
Acupuncture can lower high sympathetic nerve activity, which may be a contributory factor in the aetiology of polycystic ovary syndrome (PCOS). A Swedish team, which has previously found that women with PCOS have significantly higher sympathetic nerve activity than controls, investigated the effect of low-frequency electroacupuncture (EA) and physical exercise on the sympathetic activity of a muscle fascicle of the peroneal nerve. In a randomised controlled trial, twenty women with PCOS were randomly allocated to low-frequency EA, physical exercise, or no treatment for a 16 week period. Both EA and exercise were found to decrease muscle sympathetic nerve activity although no differences were found between the groups in haemodynamic, endocrine, and metabolic variables. (Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol. 2009 Aug;297(2):R387-95). Researchers at the same institute have also carried out animal studies that have shown that EA and exercise downregulate the expression of gene markers of sympathetic activity and improve ovarian morphology. The ovaries of rats treated with EA or exercise display a higher proportion of healthy antral follicles and a thinner theca interna cell layer than those of untreated PCOS rats.
(Acupuncture and exercise restore adipose tissue expression of sympathetic markers and improve ovarian morphology in rats with dihydrotestosterone-induced PCOS. Am J Physiol Regul Integr Comp Physiol. 2009 Apr;296(4):R1124-31).
