Acupuncture & Chinese Medicine | Painful periods

Acupuncture for Painful periods

Painful Periods or Dysmenorrhoea the facts

 

Painful periods or dysmenorrhoea is known as primary dysmenorrhoea when no underlying cause is know. However if secondary cause such as certain reproductive disorders, such as endometriosis or fibroids, is known as secondary dysmenorrhoea (1). In primary dysmenorrhoea, it is thought that the muscles of the uterus squeeze and contract harder than normal to shed the thickened lining (endometrium). These contractions may also reduce blood flow to the uterus, making the pain worse, sometimes cramps ease after passing large pieces of the endometrium.

 

 

Symptoms of primary dysmenorrhoea

 

  • Pain low in the abdomen that can spread to the lower back and legs
  • Pain that is gripping or experienced as a constant ache

 

Also commonly seen

  • Onset of pain in the 24 hours and ending after first few days of bleeding
  • Passing of clots in menstrual blood
  • Headaches
  • Nausea and if severe vomiting
  • Changes in bowels such as constipation leading up to the period then loose bowels with the onset of bleeding (1)

 

 

Causes of primary dysmenorrhoea

 

In primary dysmenorrhoea, it is commonly believed that the uterus works harder than normal to shed its lining, and the resulting contractions and associated reduced blood flow cause the pain. The hormone-like compounds that prompt these contractions are prostaglandins. Women with primary dysmenorrhoea tend to have raised levels of prostaglandins, which cause more intense contractions of the uterus than normal. The reason for the increased prostaglandins is not known (1).

 

 

Traditional treatment for primary dysmenorrhea

 

Treatment options often listed are;

 

  • Bed rest during the first day or so of the period
  • Applying heat, such as a hot water bottle, to the abdomen
  • Pain-relieving medication, such as paracetamol
  • Medication that inhibits prostaglandins, such as ibuprofen or other anti-inflammatory medication
  • The oral combined contraceptive pill, which usually reduces period pain (1)

It is important to note that many of the above treatment options offer temporary relief, so many women are faced with painful periods each and every month of the prospect of using the oral contraceptive pill to avoid having periods.

 

 

Acupuncture treatment of dysmenorrhoea Ferntree Gully

 

From a Traditional Chinese medicine perspective Painful periods, Adenomyosis and Endometriosis results from a slowdown and stagnation of blood flow to the pelvis, typically caused in Chinese medicine terms by cold. The stagnation can gradually becomes visible on laparoscopy as endometrial lesions. We can see the slowdown and stagnation of blood flow in the menstrual period; Blood that can be in appearance dark clotty, un-fresh.

 

From a more modern and integrative approach we understand that perspective painful periods, which are termed membranous dysmenorrhea is caused by the dysfunction of the corpus luteum, causing a deficiency in the hormone progesterone and a relative excess in the hormone oestrogen as well as high prostaglandin levels.

 

When progesterone is insufficient the endometrium is poor, and cannot breakdown and dissolve as it normally would during a period. The lack of breakdown makes it difficult to peel of the uterine wall, thus increasing the contractions of the uterine muscles. As we age or after childbirth the uterine walls often become less toned so the pain decreases but the heaviness and clotting is still present.

 Acupuncture treatment of Dysmenorrhea the Research

 

The current basis of research of Acupuncture in the treatment of dysmenorrhea is considered poor and insufficient (2), from a research point of view it is currently unclear if Acupuncture can aid in the treatment of dysmenorrhea.  Acupuncture literature in the treatment of reproductive dysfunction is not well investigated, plagued by poor design, and lack of valid outcomes, making the results difficult for both Acupuncturist and research scientists to interpret. Some authors review papers including animal studies and all study designs in order to provide a contemporary and broader view of evidence base (3).

 

Here is a review of the most recent research included in The Acupuncture Evidence Project (2);

 

  • Chen et al, 2013 (MA of 3 acupuncture and 4 acupressure RCT’s): Acupuncture is effective and acupressure may be effective for pain relief; acupuncture trials had low to moderate risk of bias; acupressure trials had a high risk of bias (4)
  • Xu 2014 (MA of 20 RCT’s of acupoint stimulation): Acupoint stimulation superior to controls for pain relief; low to moderate quality evidence (5)
  • Abaraogu 2015 (SR of 8 RCT’s and MA of 4 RCT’s): Acupuncture and acupressure vs placebo, waitlist or medication reduced pain intensity, while acupuncture also improved physical and mental aspects of QoL; moderate quality evidence (5)
  • Smith 2016 (Cochrane update): Insufficient evidence; low to very low quality evidence (7)
  • Kim 2012: Acupuncture is cost effective for dysmenorrhea, allergic rhinitis, osteoarthritis and headache (8)

 

Other research not included;

 

  • Kim 2011: The researchers concluded that manual acupuncture at bilateral acupoints of LI4 and SP6 may play a role in dysmenorrhea treatment with autonomic nervous system involvement (9)
  • Li 2011: Researchers compared one acupuncture point verses a multi point prescription, both groups showed a significant decreases in the severity and frequency of pain. This study supports the idea that there may be more than one successful prescription (10).
  • Yu 2010 / Kashefi 2010: Another pair of studies suggests that needling at Sanyinjiao SP6 can immediately improve the uterine arterial blood flow of patients with primary dysmenorrhea, thereby relieving the pain (11, 12)
  • Smith 2011: Conducted the following year found that acupuncture may reduce period pain; however, there is a need for further well-designed randomized controlled trials

References

 

  1. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menstruation-pain-dysmenorrhoea
  2. McDonald, John & Janz, Stephen. (2016). The Acupuncture Evidence Project : A Comparative Literature Review (Revised). Australian Acupuncture & Chinese Medicine Association Ltd, Coorparoo
  3. Suzanne Cochrane, Caroline A Smith, Alphia Possamai-Inesedy, and Alan Bensoussan. (2014) Acupuncture and women’s health: an overview of the role of acupuncture and its clinical management in women’s reproductive health. . 2014; 6: 313–325. Published online 2014 Mar 17. doi:  10.2147/IJWH.S38969
  4. Chen HM, Chen HC (2004). Effects of acupressure at the sanyinjiao point on primary dysmenorrhea, J Adv Nurs. Nov; 48 (4): 380-7
  5. Xu T, Hui L, Juan YL, Min SG, Hua WT. (2014). Effects of moxibustion or acupoint therapy for the treatment of primary dysmenorrhea: a meta-anylsis. Altern There Health Med. July-Aug; 20 (4): 33-42
  6. Abaraogu UO, Tabansi-Ochugu CS. (2015) As acupressure decreases pain, Acupuncture may improve some quality of life for women with primary dysmenorrhea: a systematic review with meta-anylsis. J Acupunct Meridian Stud. Oct; 8 (5): 220-8
  7. Smith CA, Armour M, Zhu X, Li X, Lu ZY, Song J. (2016) Acupuncture for dysmenorrhea. Cochrane database cyst rev. 4:Cd007854
  8. Kim SY, Lee H, Chai Y, Park HJ. (2012) A systematic review of cost-effectiveness analysis alongside random controlled trials of acupuncture. Acupunct Med. Dec; 30 (4): 273-85
  9. Kim E, Cho JH, Jung WS, Lee S, Pak SC. (2011). Effect of acupuncture on heart rate variability in primary dysmenorrheic women. Am J Chin Med.39(2):243–249.
  10. Li YM, Bu YQ, Hou WJ, Chen SZ, Gao SZ. Observation on immediate analgesic effect of acupuncture at Shiqizhui (EX-B 8) only or multi-acupoints in patients with dysmenorrhea: a randomized controlled trial. Zhongguo Zhen Jiu. 2011;31(3):199–202. Chinese
  11. Yu YP, Ma LX, Ma YX, et al. Immediate effect of acupuncture at Sanyinjiao (SP6) and Xuanzhong (GB39) on uterine arterial blood flow in primary dysmenorrhea. J Altern Complement Med. 2010;16(10):1073–1078. 
  12.  Kashefi F, Ziyadlou S, Khajehei M, Ashraf AR, Fadaee AR, Jafari P. Effect of acupressure at the Sanyinjiao point on primary dysmenorrhea: a randomized controlled trial. Complement Ther Clin Pract. 2010;16(4):198–202
  13. Smith CA, Zhu X, He L, Song J. Acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev. 2011;(1):CD007854