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 neuroscience, 12, 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 Endocrinology, 37(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 medicine, 2019.
Helen