Women’s Health – Condition Resources

Acupuncture is a popular choice for women for a number of issues relating to the menstrual cycle, fertility, pregnancy, post-partum and the menopause.

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Acupuncture is safe in pregnancy, but do ensure you tell your midwife (and consultant if you are under one) that you’re using it, and also tell your acupuncturist, as there are certain points which must be avoided in pregnancy.

Below (under Resources) is a list of specific conditions for which the British Acupuncture Council (BAcC) has produced evidence-based factsheets regarding women’s health.

The BAcC has also produced a paper on gynaecology and acupuncture, which in addition looks at the use and evidence of effectiveness of acupuncture in dysmenorrhoea, dysfunctional uterine bleeding and chronic pelvic inflammatory disease, where the BAcC concluded that there is a growing body of evidence to support the value of acupuncture in addressing these gynaecological conditions.

About the research:

It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

Mechanisms of action:

Acupuncture has also been shown to affect certain areas of the brain, which influence particular hormones involved in the menstrual cycle. It is thought that acupuncture balances the hormonal system by controlling the hypothalamic-pituitary-adrenal (HPA) axis. The hormones and neurotransmitters that have been shown to be thus influenced in scientific studies include:

  • Gonadotrophin releasing hormone (GnRH)
  • Lutenising hormone (LH)
  • Cortisone
  • Follicle Stimulaitng Hormone (FSH)
  • Prolactin (PRL)
  • Oestrogen uptake
  • Testosterone levels
  • Beta-endorphin levels

See our Fertility and Pregnancy page for full details on the studies and mechanisms of the above.

Resources:

The British Acupuncture Council has several relevant evidence based factsheets about Women’s Health, including specific research, trials and mechanisms of action for acupuncture in these conditions.

BAcC Childbirth and acupuncture factsheet

BAcC Dysmenorrhoea (painful periods) and acupuncture factsheet

BAcC Endometriosis and acupuncture factsheet

BAcC Female Fertility and acupuncture factsheet

BAcC Fertility and IVF briefing paper

BAcC Menopausal Symptoms and acupuncture factsheet

BAcC Obstetrics (pregnancy and childbirth) and acupuncture factsheet

BAcC PCOS (Polycystic Ovarian Syndrome) and acupuncture factsheet

BAcC Premenstrual Syndrome and acupuncture factsheet

BAcC Puerperium (postnatal / postpartum) acupuncture factsheet

The British Acupuncture Council also has a review paper on Gynaecology and acupuncture: The evidence for effectiveness

Our own page on Fertility, Pregnancy and Acupuncture

Our own blog on Acupuncture and Menopause

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Trigeminal Neuralgia – Condition Resources

Page under construction

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Our page on TMJ disorder and pain may be of assistance whilst we construct this page.

References:

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Research Resources

About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. The n= figure tells you how many people were participants in the study.

Resources:

British Acupuncture Council Factsheet Directory of Evidence A-Z

British Acupuncture Council Research Digest

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PMS – Pre-Menstrual Syndrome – Condition Resources

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

The British Acupuncture Council have produced an evidence-based factsheet on PMS and acupuncture research, including details of the research studies done, and you can also find and read the original research from this resource.

PMS is a common gynaecological condition affecting 30-40% of women, usually in the luteal phase of their menstrual cycle and causing mood and physical symptoms which can affect their daily lives at that for those days of their cycle (Pang et al, 2018).

Research and Resources on PMS and Acupuncture, overview:

A scholarly search of the available research papers on the terms “acupuncture” + “PMS” yields over 4,250 papers, and narrowing this to “RCT” OR “randomised controlled trial”, gives over 630 results; of which just under a quarter (24%) have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, leading to a body of research being carried out, the pace of which has increased in recent years, indicating increased recognition that it is worthy of scientific appraisal regarding its potential role.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

Mechanisms of Action Research

Brain scans are a good way of seeing what happens when we insert acupuncture needles, demonstrating to us which areas of the brain “light up” to certain stimuli. Functional MRI (fMRI) brain scans were used on women with PMS undergoing acupuncture at a classically indicated acupoint (SP6) in a study by Pang et al (2018; n=23). Becuase previous fMRI studies of PMS patients had shown abnormal neural activity in a specific brain area (the Default Mode Network – DMN), the researchers focussed on this area in the scan, and any effect elicited in this area (and others) from the use of electroacupuncture at SP6 point (as compared to a nearby “sham” point control). Regional Homogeneity (ReHo) is the measure used in functional MRI to examine level of activity in a brain area. This study’s brain scans showed ReHo values in the area of interest (DMN) were lowered by acupuncture at SP6. The researchers concluded therefore that the abnormal brain activity associated with PMS was being modulated by the use of electroacupuncture at SP6.

The same research team have carried out further research more recently with fMRI to further examine these effects (Pang et al, 2021; n=23), using the SP6 point and electroacupuncture again in a PMS group.

Systematic Reviews on PMS and Acupuncture

A 2018 Cochrane Systematic Review acupuncture and acupressure for PMS (Armour et al, 2018), included 5 trials (n=277), and noting the fact that the trials were small and in some cases of low quality, drew the conclusion that “limited evidence available suggests that acupuncture and acupressure may improve both physical and psychological symptoms of PMS when compared to a sham control”. They stated that more studies of a higher methodological quality were warranted going forward.

Zhang et al, 2019 (systematic review of 15 studies; N=11-3), looked at the timing of acupuncture intervention in PMS as well as the most frequently used points (Spleen 6; Liver 3 and Ren 4). They concluded positive trend in the use of acupuncture in this area, and that timing of the treatment within the menstrual cycle did not make a statistically significant difference. Their finding was tentative due to the small sizes of many of the studies as well as some of the methodology in some studies being of low quality, overall they stated that “large-scale, case-control studies with rigorous designs are required to provide more accurate evidence.”

As mentioned above, 24% of the RCT’s ever carried out into acupuncture and PMS, have been done in the years since 2017. A further systematic review seems due for this area in the light of ongoing research in the interim.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

British Acupuncture Council evidence based factsheet about PMS including specific research, trials and mechanisms of action for acupuncture in this condition.

Our own page on gynaecological issues

References:

Armour, M., Ee, C.C., Hao, J., Wilson, T.M., Yao, S.S. and Smith, C.A., 2018. Acupuncture and acupressure for premenstrual syndrome. Cochrane Database of Systematic Reviews, (8).

Pang, Y., Liu, H., Duan, G., Liao, H., Liu, Y., Feng, Z., Tao, J., Zou, Z., Du, G., Wan, R. and Liu, P., 2018. Altered brain regional homogeneity following electro-acupuncture stimulation at sanyinjiao (SP6) in women with premenstrual syndrome. Frontiers in human neuroscience12, p.104.

Pang, Y., Liao, H., Duan, G., Feng, Z., Liu, H., Zou, Z., Tao, J., Li, J., He, H., Gao, C. and Liu, P., 2021. Regulated aberrant amygdala functional connectivity in premenstrual syndrome via electro-acupuncture stimulation at sanyinjiao acupoint( SP6). Gynecological Endocrinology37(4), pp.315-319.

Zhang, J., Cao, L., Wang, Y., Jin, Y., Xiao, X. and Zhang, Q., 2019. Acupuncture for Premenstrual Syndrome at Different Intervention Time: A Systemic Review and Meta-Analysis. Evidence-based complementary and alternative medicine2019.

Helen
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Paediatric and Acupuncture in Children – Research Resources

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Acupuncture is safe for children when given by a trained acupuncturist, and with their parent present. If they are unable to tolerate needles, acupressure or moxibustion can be used on the relevant points.

Research and Resources on Acupuncture for Children:

A scholarly search of the available research papers on the terms “acupuncture” + “paediatric OE “pediatric” yields over 35,700 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 3,970 results; of which 40% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, leading to a body of research being carried out, the pace of which has increased in recent years, indicating increased recognition that it is worthy of scientific appraisal regarding its potential role.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

Research has looked at acupuncture in a number of areas including paediatric pain, nausea, and post-operative symptoms. Research and information on post-operative pain in an adult population is here.

In the hospital setting, acupuncture reduces postoperative nausea and vomiting (PONV) in children, particularly during the first 4 hours after surgery and was most effective when performed before anaesthesia (Veiga-Gil at al, 2017, systematic review of 16 RCT, n=1773). More information on acupuncture, nausea and the research is here.

Azarfar et al’s (2017) systematic review of 7 trials showed promise in the area of nocturnal enuresis (bedwetting) in children, many of the studies used low level laser acupuncture in lieu of needling. The positive trend limited by the small number of trials available to the researchers at the time, warranting further large RCT trials of quality. Research and mechanisms of action on the urinary system are here.

Stadler et al’s systematic review concluded acupuncture may have a role in neonatal pain, (2019) although they also pointed out that the number and quality of trials available was low, meaning more research is warranted. More on the pain research in the adult population, and the research is here.

A systematic review has also found that acupuncture appears “safe and effective for the treatment of migraine in children” (Doll et al, 2019). More information on acupuncture research for headache and migraine is here

In the area of allergic rhinitis (hayfever), there is already some research evidence for adult populations with acupuncture (see our specific page), and a forthcoming systematic review will examine this in children (protocol: Li et al, 2021).

A systematic review has drawn tentatively positive conclusions in trends in the fields of autism spectrum disorder (Lee at al, 2018, 27 articles, n=1736); however it is of note the quality of the available studies examined was low and therefore further high quality trials are needed.

A systematic review protocol was put forward in 2021 for an examination of the efficacy and safety of acupuncture for the treatment of children with attention deficit hyperactivity disorder (Lin et al, 2021), so it will be of interest to see the forthcoming publication of this.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

References:

Azarfar, A., Ravanshad, Y., Aval, S.B., Khamnian, S. and Mehrad-Majd, H., 2017. A systematic review and a meta-analysis of using acupuncture for the treatment of nocturnal enuresis. Journal of Nephrology & Therapeutics7(2), pp.292-297.

Doll, E., Threlkeld, B., Graff, D., Clemons, R., Mittel, O., Sowell, M.K. and McDonald, M., 2019. Acupuncture in adult and pediatric headache: a narrative review. Neuropediatrics50(06), pp.346-352.

Lee, B., Lee, J., Cheon, J.H., Sung, H.K., Cho, S.H. and Chang, G.T., 2018. The efficacy and safety of acupuncture for the treatment of children with autism spectrum disorder: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine2018.

Li, J., Liu, L., Jiao, L., Liao, K., Xu, L., Zhou, X. and Xiong, J., 2021. Clinical acupuncture therapy for children with allergic rhinitis: A protocol for systematic review and meta analysis. Medicine100(3).

Lin, Y., Jin, H., Huang, B., Zhao, N., Li, Z., Mao, J., Chen, C., Xu, J., Zhang, J. and Shuai, B., 2021. Efficacy and safety of acupuncture on childhood attention deficit hyperactivity disorder: A protocol for systematic review and meta-analysis. Medicine100(5).

Stadler, J., Raith, W., Mileder, L.P., Schmölzer, G.M. and Urlesberger, B., 2019. Invasive and non-invasive acupuncture techniques for pain management in neonates: A systematic review. Acupuncture in Medicine37(4), pp.201-210.

Veiga-Gil, L., Pueyo, J. and López-Olaondo, L., 2017. Postoperative nausea and vomiting: physiopathology, risk factors, prophylaxis and treatment. Revista Española de Anestesiología y Reanimación (English Edition)64(4), pp.223-232.

Helen
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Neuralgia – Condition Resources

Page under construction

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

For Trigeminal Neuralgia, see our page on TMJ disorder and pain may be of assistance

Resources:

British Acupuncture Council evidence based factsheet about Neuralgia including specific research, trials and mechanisms of action for acupuncture in this condition.

Helen
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