Dysmenorrhoea (2019)

Overview

Key points

• Pain related to menstruation, or dysmenorrhea, is very prevalent in young women and significantly affects many areas of their lives
• Acupuncture was significantly more effective at reducing menstrual pain compared with no acupuncture or NSAIDs (Woo 2018; Mavrelos 2017; Xu 2017)
• Acupuncture may reduce pain levels immediately after treatment (Mohammadi 2019; Woo 2018; Wang 2016)
• In one small study, the reductions of dysmenorrhea with acupuncture lasted up to 1 year after treatment (Armour 2017)
• Studies suggest that acupressure and moxibustion may also reduce pain levels and improve the symptoms of dysmenorrhea (Abaraogu 2016; Smith 2016; Yang 2017; Gao 2015)
• Acupuncture has an excellent safety profile in the management of dysmenorrhea (Mavrelos 2017)

Background

Primary dysmenorrhea involves pain before, during, or after menstruation in women of reproductive age (Mohammadi 2019). The cramping pain is usually felt in the lower abdomen and back and can radiate into the thighs (Mohammadi 2019; Shetty 2018). It can be accompanied by nausea, vomiting, diarrhoea, headache and fatigue (Shetty 2018). Dysmenorrhea is extremely common and estimates of its prevalence range from 50–90% in young women (Woo 2018; Blödt 2018). It has a significant impact on school and work attendance, participation in sports and quality of life in general (Blödt 2018; Woo 2018; Armour 2017; Bazarganipur 2017). First-line treatments are non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives (Woo 2018). About a quarter of women do not achieve effective pain relief with NSAIDs, or may experience side effects such as nausea, indigestion or headaches (Woo 2018; Wang 2019; Blödt 2018; Smith 2016). Oral contraceptives may not be effective and aren’t suitable if the woman is trying to conceive. Side effects may include nausea, vomiting, and weight gain (Woo 2018; Penn 2018).

Several studies have investigated the effect of acupuncture on dysmenorrhea however systematic reviews of these studies show that large, well-designed trials are required to draw firm conclusions (Mavrelos 2017; Wang 2019).

Systematic Reviews

• A systematic review of 60 randomised controlled trials (RCTs) and a meta-analysis of 49 RCTs compared acupuncture with no acupuncture or NSAIDs (n=3,171). Acupuncture was significantly more effective at reducing menstrual pain than no acupuncture or NSAIDs, and may reduce pain levels from the first treatment (Woo 2018).
• A systematic review and meta-analysis of 19 studies of acupuncture point stimulation (including acupuncture, moxibustion, ear acupressure, electroacupuncture, acupoint application) for dysmenorrhea compared with NSAIDs concluded that pain reduction was similar between groups but the side effects were fewer with acupuncture point stimulation (n=1,679). A meta-analysis revealed that acupuncture point stimulation was better than NSAIDs in reducing the concentration of PGF2α in peripheral blood [a hormone-like prostaglandin that causes uterine muscle contraction] (Xu 2017).
• A meta-analysis found that true acupuncture was associated with greater improvements in pain compared with NSAIDs in the treatment of primary dysmenorrhoea, but there were no significant differences between true acupuncture and sham acupuncture (Mavrelos 2017).
• A Cochrane review concluded that acupuncture may reduce pain compared with NSAIDs in dysmenorrhoea. The data from the 42 studies included in the complete review [10 relating to acupuncture versus NSAIDS] was considered to be inconsistent with a risk of study bias (Smith 2016).

Individual Clinical Trials:

• In women with moderate-to-severe pain (n=62), acupuncture[G1]  over three menstrual cycles significantly reduced pain intensity and symptom severity compared with ibuprofen (Wang 2019).
• In a RCT with 501 women with primary dysmenorrhea, pain reductions were immediate with acupuncture (Wang 2016).
• In another small study (n=26), acupuncture reduced the severity of pain related to dysmenorrhea immediately after treatment (Mohammadi 2019).
• In one RCT, women with dysmenorrhea were randomised to receive acupuncture for a period of 15 days every month over 90 days or to a no acupuncture control group [G2]  (n=60). A significant reduction in pain scores, menstrual cramps, nausea, fatigue and headache were seen with acupuncture compared with the control group (Shetty 2018).
• Another small study (n=74), acupuncture significantly menstrual pain scores and these reductions were sustained for 12 months. The use of analgesics also decreased with acupuncture for up to 12 months (Armour 2017).