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Sommaire

dysmenorrhoea:

Dysménorrhées : évaluation de l'acupuncture

Articles connexes : - conduites thérapeutiques -

1. Systematic Reviews and Meta-Analysis

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
☆ Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

1.1. Generic Acupuncture

1.1.1. Liu 2022 ★★

Liu W, Wang CC, Lee KH, Ma X, Kang TL. Efficacy and Safety of Acupuncture and or Moxibustion for Managing Primary Dysmenorrhea: A Systematic Review and Meta-Analysis. Clin Nurs Res. 2022 Sep;31(7):1362-1375. https://doi.org/10.1177/10547738221086984. Epub 2022 May 2.

Background Acupuncture and moxibustion have been accepted as add-on options for primary dysmenorrhea (PD); however, the clinical evidence is still inadequate.
Methods We searched AMED, CENTRAL, EMBASE, PubMed, Web of Science, CBM, CNKI, VIP, Wangfang database, ANZCTR, ClinicalTrials.gov, and the WHO ICTRP, from their inception to February 2021.
Results The pooled analysis of 13 RCTs with 675 participants for VAS showed that acupuncture and moxibustion were more effective in managing PD than the control group with the MD of -1.93 (95% CI [-2.80, -1.06] and -2.67 (95% CI [-4.96, -0.38]). With the CMSS, seven studies with 487 participants showed that these modalities were more effective than the control group with the MD of -7.58 (95% CI [-10.97, -4.19]) and -3.78 (95% CI [-6.90, -0.66]).
Conclusions The findings indicated that acupuncture and moxibustion could relieve pain effectively and has fewer adverse events (AEs) in managing PD.

1.1.2. Yang 2020 (Versus Western Medication) ☆

Yang Jun, Xiong Jun, Yuan Ting, et al. [Efficacy of Acupuncture-moxibustion Versus Western Medication for Primary Dysmenorrhea: A Meta-analysis]. Shanghai Journal of Acupuncture and Moxibustion. 2020;39(10):1339. [214569].

Objective To systematically evaluate the clinical efficacy of acupuncture-moxibustion and Western medication in treating primary dysmenorrhea.
Method A comprehensive retrieval was conducted through the Chinese Biomedical database (CBM), China National Knowledge Infrastructure (CNKI), VIP database (VIP), Wanfang database (WF), Pubmed, Embase and Cochrane Library by computer, assisted by manual retrieval through the relevant journals and references, to collect randomized controlled trials (RCTS) comparing acupuncture-moxibustion with Western medication in treating primary dysmenorrhea. The Jadad scale and Cochrane bias risk assessment tool were used for quality evaluation. The statistician performed meta-analysis with RevMan 5.3 software.
ResultForty-two studies were included, including a total of 3179 participants. There were 7 studies (1 6.67%) scored) 4 points by the Jadad scale. The studies were evaluated as high risk in the performance of blinding, with other potential bias, and the randomized allocation and concealment were assessed as unclear. The meta-analysis showed that there was statistical significant comparing the total effective rate between the acupuncture-moxibustion group and the Western medication group [RR=1.22, 95%CI (1.16,1.29), Z=7.86]. The funnel plot showed possible publication bias. There was statistical significance comparing the real-time efficacy between the acupuncture-moxibustion group and the Western medication group [RR=1.25, 95%CI (1.08,1.45), Z=2.95]. There was no statistical significance comparing the long-term efficacy between the acupuncture-moxibustion group and the Western medication group [RR= 1 .34, 95%CI (0.93, 1 .94), Z=1 .57]. The relapse rate in the acupuncture-moxibustion group was significantly different from that in the Westem medication group [RR=0.28, 95%CI (0. 1 5,0.5 1), Z=4. 1 3]. There was statistical significance comparing the VAS score between the acupuncture-moxibustion group and the Westem medication group [WMD= - 2.58, 95%CI (- 3.88, - 1.29), Z=3.91]. The general score of dysmenorrhea symptoms in the acupuncture-moxibustion group was significantly different from that in the Western medication group [WMD= - 2.58, 95%CI ( - 3.88, - 1.29), Z=3.91].
Conclusion Compared with Western medication, acupuncture-moxibustion shows significant advantage in treating primary dysmenorrhea, but RCTs with large sample size, multiple centers and high quality are required for in-depth study and observation considering the included low-quality studies currently.

1.1.3. Luo 2019 (versus NSAIDs) ☆

Luo F, Huang X, Liu X, Wang L, Xu N. Comparative efficacy and safety of NSAIDs-controlled acupuncture in the treatment of patients with primary dysmenorrhoea: a Bayesian network meta-analysis. J Int Med Res. 2019;47(1):19-30. [198557].

BackgroundAcupuncture and non-steroidal anti-inflammatory drugs (NSAIDs) are used frequently to treat primary dysmenorrhoea. However, it is unclear whether this treatment greatly reduces the risk of primary dysmenorrhoea.
MethodsEight databases were searched up to January 2018. Pair-wise and network meta-analyses were conducted to synthesize data from eligible studies.
ResultsSeventeen randomized controlled trials were included. The following acupuncture types showed more efficacy than NSAIDs in reducing primary dysmenorrhoea risk: traditional acupuncture (odds ratio [OR] = 6.70, 95% confidence interval [CI] 2.60-20.0), eye acupuncture (OR = 3.50, 95% CI 1.40-8.90), wrist-ankle acupuncture (OR = 6.00, 95% CI 1.30-32.0), superficial acupuncture (OR= 5.10, 95% CI 1.20-26.0), moxibustion (OR = 7.70, 95% CI 2.90-25.0), electroacupuncture (OR = 23.0, 95% CI 4.80-130), ear acupuncture (OR = 13.0, 95% CI 2.80-100) and abdominal acupuncture (OR = 5.30, 95% CI 2.10-16.0). Surface under the cumulative ranking curve values were traditional acupuncture (53.0%), eye acupuncture (22.0%), wrist-ankle acupuncture (81.5%), superficial acupuncture (50.0%), moxibustion (57.8%), electroacupuncture (99.9%), ear acupuncture (41.6%) and abdominal acupuncture (44.1%).
ConclusionAcupuncture is more efficacious than NSAIDs in reducing primary dysmenorrhoea risk. Acupuncture, particularly electroacupuncture, can decrease the risk of primary dysmenorrhoea.

1.1.4. Armour 2018 ☆☆

Armour M, Ee CC, Hao J, Wilson TM, Yao SS, Smith CA. Acupuncture and acupressure for premenstrual syndrome. Cochrane Database Syst Rev. 2018;:. [189990].

BackgroundAcupuncture has a history of traditional use in China for women's health conditions including premenstrual syndrome (PMS), but its effectiveness for this condition remains unclear. This review examined the available evidence supporting the use of acupuncture or acupressure to treat PMS.
ObjectivesTo evaluate the effectiveness and safety of acupuncture or acupressure for women with PMS or premenstrual dysphoric disorder (PMDD). SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility Specialised Register, Cochrane Central Register of Studies Online (CENTRAL CRSO), MEDLINE, Embase, AMED, PsycINFO, CINAHL (from inception to 21 September 2017), two clinical trial databases (from their inception to 21 September 2017), and four electronic databases in China (from their inception to 15 October 2017): Chinese Biomedical Literature database (CBM), China National Knowledge Infrastructure (CNKI), VIP information/ Chinese Scientific Journals database and WANFANG. Reference lists from included articles were handsearched. SELECTION CRITERIA: We included studies if they randomised women with PMS and associated disorders (PMDD and late luteal phase dysphoric disorder/LPDD) to receive acupuncture or acupressure versus sham, usual care/waiting-list control or pharmaceutical interventions mentioned by the International Society for Premenstrual Disorders (ISPMD). If acupuncture or acupressure were combined with another therapy, these studies were also included where the additional therapy was the same in both groups. Cross-over studies were eligible for inclusion, but only data from the first phase could be used. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the studies, assessed eligible studies for risk of bias, and extracted data from each study. Study authors were contacted for missing information. The quality of the evidence was assessed using GRADE. Our primary outcomes were overall premenstrual symptoms and adverse events. Secondary outcomes included specific PMS symptoms, response rate and quality of life.
Main results Five trials (277 women) were included in this review. No trials compared acupuncture or acupressure versus other active treatments. The number of treatment sessions ranged from seven to 28. The quality of the evidence ranged from low to very low quality, the main limitations being imprecision due to small sample sizes and risk of bias related to detection bias and selective reporting. Acupuncture versus sham acupuncture. Acupuncture may provide a greater reduction in mood-related PMS symptoms (mean difference (MD) -9.03, 95% confidence interval (CI) -10.71 to -7.35, one randomised controlled trial (RCT), n = 67, low-quality evidence) and in physical PMS symptoms (MD -9.11, 95% CI -10.82 to -7.40, one RCT, n = 67, low-quality evidence) than sham acupuncture, as measured by the Daily Record of Severity of Problems scale (DRSP). The evidence suggests that if women have a mood score of 51.91 points with sham acupuncture, their score with acupuncture would be between 10.71 and 7.35 points lower and if women have a physical score of 46.11 points, their score with acupuncture would be between 10.82 and 7.4 points lower. There was insufficient evidence to determine whether there was any difference between the groups in the rate of adverse events (risk ratio (RR) 1.74, 95% CI 0.39 to 7.76, three RCTs, n = 167, I2 = 0%, very low-quality evidence).Specific PMS symptoms were not reported. There may be little or no difference between the groups in response rates. Use of a fixed-effect model suggested a higher response rate in the acupuncture group than in the sham group (RR 2.59, 95% CI 1.71 to 3.92; participants = 100; studies = 2; I2 = 82%), but owing to the high heterogeneity we tested the effect of using a random-effects model, which provided no clear evidence of benefit for acupuncture (RR 4.22, 95% CI 0.45 to 39.88, two RCTs, n = 100, I2 = 82%, very low-quality evidence).Acupuncture may improve quality of life (measured by the WHOQOL-BREF) compared to sham (MD 2.85, 95% CI 1.47 to 4.23, one RCT, n = 67, low-quality evidence).Acupuncture versus no treatment. Due to the very low quality of the evidence, we are uncertain whether acupuncture reduces PMS symptoms compared to a no treatment control (MD -13.60, 95% CI -15.70 to -11.50, one RCT, n = 14).No adverse events were reported in either group. No data were available on specific PMS symptoms, response rate or quality of life outcomes. Acupressure versus sham acupressure. We found low-quality evidence that acupressure may reduce the number of women with moderate to severe PMS symptoms at the end of the trial compared to sham acupressure (RR 0.64 95% CI 0.52 to 0.79, one RCT, n = 90, low-quality evidence). The evidence suggests that if 97 women out of 100 in the sham acupressure group had moderate to severe PMS symptoms, the number of women in the acupressure group with moderate to severe symptoms would be 50 to 76 women. Acupressure may improve both physical (MD 24.3, 95% CI 17.18 to 31.42, one RCT, n = 90, low-quality evidence) and mental (MD 17.17, 95% CI 13.08 to 21.26, one RCT, n = 90, low-quality evidence) quality of life. No data were available on adverse events, specific symptoms or response rates.
Authors' conclusionsThe limited evidence available suggests that acupuncture and acupressure may improve both physical and psychological symptoms of PMS when compared to a sham control. There was insufficient evidence to determine whether there was a difference between the groups in rates of adverse events. There is no evidence comparing acupuncture or acupressure versus current ISPMD recommended treatments for PMS such as selective serotonin reuptake inhibitors (SSRIs). Further research is required, using validated outcome measures for PMS, adequate blinding and suitable comparator groups reflecting current best practice.

1.1.5. Woo 2018 ☆☆

Woo HL, Ji HR, Pak YK, Lee H, Heo SJ, Lee JM, Park KS. The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis. Medicine (Baltimore). 2018;97(23). [165819].

BACKGROUND This systematic review aimed to evaluate the current evidence regarding the efficacy and safety of acupuncture on primary dysmenorrhea.
METHODS Ten electronic databases were searched for relevant articles published before December 2017. This study included randomized controlled trials (RCTs) of women with primary dysmenorrhea; these RCTs compared acupuncture to no treatment, placebo, or medications, and measured menstrual pain intensity and its associated symptoms. Three independent reviewers participated in data extraction and assessment. The risk of bias in each article was assessed, and a meta-analysis was conducted according to the types of acupuncture. The results were expressed as mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (Cis).
RESULTSThis review included 60 RCTs; the meta-analysis included 49 RCTs. Most studies showed a low or unclear risk of bias. We found that compared to no treatment, manual acupuncture (MA) (SMD = -1.59, 95% CI [-2.12, -1.06]) and electro-acupuncture (EA) was more effective at reducing menstrual pain, and compared to nonsteroidal anti-inflammatory drugs (NSAIDs), MA (SMD = -0.63, 95% CI [-0.88, -0.37]) and warm acupuncture (WA) (SMD = -1.12, 95% CI [-1.81, -0.43]) were more effective at reducing menstrual pain. Some studies showed that the efficacy of acupuncture was maintained after a short-term follow-up.
CONCLUSIONThe results of this study suggest that acupuncture might reduce menstrual pain and associated symptoms more effectively compared to no treatment or NSAIDs, and the efficacy could be maintained during a short-term follow-up period. Despite limitations due to the low quality and methodological restrictions of the included studies, acupuncture might be used as an effective and safe treatment for females with primary dysmenorrhea.

1.1.6. Li 2017 ☆☆

Li Ge, Si Jinhua, Zhao Chen, Ge Long, Tian Jinhui, Shang Hongcai, Wang Zixin, Xu Xiangling, Wang Shuhe. [Network meta-analysis on clinical effects of acupuncture in treatment of primary dysmenorrhea]. Chinese Journal of Evidence-Based Medicine. 2017;17(10):1212. [175772].

Objective To assess the effectiveness of acupunctures in treatment of primary dysmenorrhea by using network meta-analysis.
Methods Databases including the PubMed, EMbase, The Cochrane Library (Issue 6, 2016), CBM, CNKI and WanFang Data were searched for relevant clinical randomized controlled trials (RCTs) comparing acupunctures with ibuprofen or other kinds of acupuncture from inception to July 6th 2016. Two reviewers independently screened literature extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using Stata 13.0 and WinBugs 1.43 software.
ResultsA total of 56 RCTs involving 4 600 PD patients were included. The results of network meta-analysis showed that: for the clinical effects: simple acupuncture, acupuncture plus moxa moxibustion, acupuncture plus indirect-moxibustion, electroacupuncture, warm-acupuncture and electroacupuncture plus warm-acupuncture were superior to ibuprofen, acupuncture plus moxa-moxibustion, acupuncture plus indirect moxibustion and warm-acupuncture were superior to simple acupuncture. For VAS score, there was no significant difference among all treatments. Simple acupuncture and ibuprofen were superior to acupuncture plus indirect moxibustion in dysmenorrhea symptom scores.
Conclusion The included 6 kinds of acupunctures are superior to ibuprofen and different acupunctures have different advantages in the treatment of PD. When selecting treatment regimen, it is better to consider the clinical situation and TCM syndrome differentiation

1.1.7. Xu 2017 (versus NSAIDs) ☆☆

Xu Y, Zhao W, Li T, Bu H , Zhao Z, Zhao Y, Song S. Effects of acupoint-stimulation for the treatment of primary dysmenorrhoea compared with NSAIDs: a systematic review and meta-analysis of 19 RCTs. BMC Complement Altern Med. 2017;17(1):436. [171496].

BackgroundPrimary dysmenorrhoea (PD), defined as painful menses in women with normal pelvic anatomy, is one of the most common gynaecological syndromes. Acupoint-stimulation could potentially be an effective intervention for PD. Our aim was to determine the effectiveness of acupoint-stimulation compared with Non-Steroidal Anti-Inflammatory Drugs (NASIDs) in the treatment of PD.
Methods Six databases were searched to December 2014. Sixteen studies involving 1679 PD patients were included. We included randomized controlled trials that compared acupoint-stimulation with NASIDs for the treatment of PD. The main outcomes assessed were clinical effectiveness rate, symptom score, visual analogue score, variation in peripheral blood prostaglandin F2α (PGF2α) and side effects. All analyses were performed using Comprehensive Meta-Analysis statistical software.
Results (1) The total efficacy was better than control group: odds ratio = 5.57; 95% confidence interval (95% CI) = 3.96, 7.83; P < 0.00001; (2) The effect of intervention was positive in relieving the severity of PD symptoms: mean difference (MD) = 2.99; 95%CI = 2.49, 3.49; P < 0.00001; (3) No statistical difference existed between two groups in terms of a reduction in the VAS: MD = 1.24; 95%CI = -3.37, 5.85; P = 0.60; (4) The effect of intervention on the variation in peripheral blood PGF2α between two groups was positive: MD = 7.55; 95%CI = 4.29,10.82; P < 0.00001; (5) The side effects of control groups was more than the acupoint-stimulation group: OR = 0.03; 95%CI =0.00,0.22; P = 0.0005.
ConclusionsAccording to this article, acupoint-stimulation can relieve pain effectively in the treatment of PD and offers advantages in increasing the overall effectiveness.

1.1.8. Smith 2016 Ø

Smith CA, Armour M, Zhu X, Li X, Lu ZY, Song J. Acupuncture for dysmenorrhoea. Cochrane Database Syst Rev. 2016. [186528].

BackgroundPrimary dysmenorrhoea is the most common form of period pain and affects up to three-quarters of women at some stage of their reproductive life. Primary dysmenorrhoea is pain in the absence of any organic cause and is characterised by cramping pain in the lower abdomen, starting within the first eight to 72 hours of menstruation. This review examines the currently available evidence supporting the use of acupuncture (stimulation of points on the body using needles) and acupressure (stimulation of points on the body using pressure) to treat primary dysmenorrhoea.
OBJECTIVES To determine the effectiveness and safety of acupuncture and acupressure in the treatment of primary dysmenorrhoea when compared with a placebo, no treatment, or conventional medical treatment.
MethodsSEARCH METHODS: We searched the following databases: the Cochrane Menstrual Disorders and Subfertility Group Trials Register (to September 2015), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, EMBASE, PsycINFO, CINAHL and Chinese databases including Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP database and registers of ongoing trials. SELECTION CRITERIA: We included all published and unpublished randomised controlled trials (RCTs) comparing acupuncture with sham acupuncture or placebo control, usual care, pharmacological treatment or no treatment. We included the following modes of treatment: acupuncture, electro-acupuncture, and acupressure. Participants were women of reproductive age with primary dysmenorrhoea during the majority of the menstrual cycles or for three consecutive menstrual cycles, and moderate to severe symptoms. DATA COLLECTION AND ANALYSIS: We calculated odds ratios (Ors) for dichotomous outcomes and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, with 95% confidence intervals (Cis). We pooled the data where appropriate. Our primary outcomes was pain. Secondary outcomes included menstrual symptoms, quality of life, and adverse effects.
Main ResultsWe included 42 RCTs (4640 women). Acupuncture or acupressure was compared with a sham/placebo group, medication, no treatment or other treatment. Many of the continuous data were not suitable for calculation of means, mainly due to evidence of skew.1. Acupuncture studies Acupuncture versus sham or placebo control (6 RCTs) Findings were inconsistent and inconclusive. However, the only study in the review that was at low risk of bias in all domains found no evidence of a difference between the groups at three, six or 12 months. The overall quality of the evidence was low. No studies reported adverse events. Acupuncture versus NSAIDs Seven studies reported visual analogue scale (VAS) pain scores, but were unsuitable for pooling due to extreme heterogeneity (I² = 94%). In all studies the scores were lower in the acupuncture group, with the mean difference varying across studies from 0.64 to 4 points on a VAS 0 - 10 scale (low-quality evidence). Four RCTs reported rates of pain relief, and found a benefit for the acupuncture group (OR 4.99, 95% CI 2.82 to 8.82, 352 women, I² = 0%, low-quality evidence). Adverse events were less common in the acupuncture group (OR 0.10, 95% CI 0.02 to 0.44, 4 RCTs, 239 women, 4 trials, I² = 15%, low-quality evidence). Acupuncture versus no treatment Data were unsuitable for analysis, but pain scores were lower in the acupuncture group in all six studies reporting this outcome. The quality of the evidence was low. No studies reported adverse events.2. Acupressure studies No studies of acupressure reported adverse events. Acupressure versus sham or placebo control Data were unsuitable for pooling, but two studies reported a mean benefit of one to three points on a 0 - 10 VAS pain scale. Another four studies reported data unsuitable for analysis: all found that pain scores were lower in the acupuncture group. No studies reported adverse events. The quality of the evidence was low. Acupressure versus NSAIDsOne study reported this outcome, using a 0 - 3 pain scale. The score was higher (indicating more pain) in the acupressure group (MD 0.39 points, 95% CI 0.21 to 0.57, 136 women, very low-quality evidence). Acupressure versus no treatmentThere was no clear evidence of a difference between the groups on a VAS 0 - 10 pain scale (MD -0.96 points, 95% CI -2.54 to 0.62, 2 trials, 140 women, I² = 83%, very low-quality evidence).
Authors' conclusions There is insufficient evidence to demonstrate whether or not acupuncture or acupressure are effective in treating primary dysmenorrhoea, and for most comparisons no data were available on adverse events. The quality of the evidence was low or very low for all comparisons. The main limitations were risk of bias, poor reporting, inconsistency and risk of publication bias.

1.1.9. Lin 2015 ☆

Lin Han-Mei, Zeng Qian-Ru, Liu Dan-Qing, Lei Yuan. [Meta-Analysis of Primary Dysmenorrhea Treated by Acupuncture]. Henan Traditional Chinese Medicine 2015;4:862-865. [186981]

Objective To systematically evaluate the effectiveness of acupuncture treatment for primary dysmenorrhea.
Methods The PubMed, CNKI, VIP, Chongqing Vipdatabase and Wan Fangdatabase were retrieved by computer, literature retrieval and manual searching were also added to collect the randomized controlled trials (RCTs) that related with primary dysmenorrhea treated by acupuncture ( (published from January 1, 2003 to August 1, 2013). The research quality were included after literature screening according to inclusive criteria and emission standard. Then Meta-analysis was made via Rev Man 5. 2 software.
Results The effective rate of acupuncture for primary dysmenorrhea is higher than that of western medicine and Chinese patent medicine. The total scores of treatment group were better than these of control group; the difference was statistically significant.
Conclusion The current study shows that acupuncture is effective in treating primary dysmenorrhea and has advantages over routine medicine. However, due to the limitation of included research quality, it needs high-quality RCTs to further test the clinical effect and safety of acupuncture for treating primary dysmenorrhea.

1.1.10. Abaraogu 2015 ☆

Abaraogu UO, Tabansi-Ochuogu CS. As acupressure decreases pain, acupuncture may improve some aspects of quality of life for women with primary dysmenorrhea: a systematic review with meta-analysis. J Acupunct Meridian Stud 2015. 8(5):220-8. [184386].

Background Primary dysmenorrhea is the most common gynecological symptom reported by women and constitutes a high health, social, and economic burden. Chemotherapies, along with their side effects, have not yielded satisfactory outcomes. Alternative nonpharmacological interventions, including acupuncture and acupressure, have been advocated, but evidence regarding their beneficial effect is inconclusive.
Methods This study sought to obtain evidence on the effectiveness of acupuncture and acupressure interventions. Twelve electronic databases were searched by using menstrual pain intensity and quality of life as primary and secondary outcomes, respectively, with the PEDro guideline for quality appraisal. Data unsuitable for a meta-analysis were reported as descriptive data.
Results The search yielded 38 citations, from which eight studies were systematically reviewed, four of the eight being eligible for meta-analysis. The systematic review showed moderate methodological quality with a mean of 6.1 out of 10 on the PEDro quality scale. Acupressure showed evidence of pain relief while acupuncture improved both the mental and the physical components of quality of life.
Conclusion In conclusion, physiotherapists should consider using acupuncture and acupressure to treat primary dysmenorrhea, but a need exists for higher quality, randomized, blinded, sham-controlled trials with adequate sample sizes to establish clearly the effects of these modalities.

1.1.11. Jung 2015 (Korean Literatures)

Jung Wan Kim, Bong Ki Park, Jong Ik Jeon, Yun Kyoung Yim. [Acupuncture and Moxibustion for Primary Dysmenorrhea in Korean Literatures: A Systematic Review of Randomized Controlled Trials]. The Acupuncture. 2015;32(2):123-130. [153052].

Objectives Primary dysmenorrhea is one of the most common female gynecological diseases. Acupuncture and moxibustion therapy have been used to treat dysmenorrhea in Korea. The aim of this review was to examine the effectiveness of acupuncture and moxibustion therapy for primary dysmenorrhea as described in studies in Korea.
Methods A total of 8 databases were searched, with the search concluding February 15, 2015. These were the Oriental Medicine Advanced Searching Integrated System, Dbpia, Korean Studies Information Service System, National Digital Science Library, Korean Traditional Knowledge Portal, Research Information Sharing Service, and Pubmed. Randomized controlled Trails(RCTs) comparing acupuncture or moxibustion therapy with non acupoints stimulation or medication were selected. Data abstraction and assessment of methodology was conducted by authors and disagreements were resolved by discussion.
Results 7 trials were included in this review, with a total of 308 participants. 4 trials reported on acupuncture, 1 trial reported on acupress by magnet, 1 trial reported on pharmacopuncture, and the other trial reported on moxibustion. Quality of methodology was low. 2 trials showed that experimental therapy was effective for pain relief compared to the controlled group. However, 5 trials did not show a significant difference in pain relief.
Conclusions Acupuncture and moxibustion therapy may reduce period pain, however, it is needed for well designed RCTs in Korea.

1.1.12. Xu 2014 ☆☆

Xu T, Hui L, Juan YL, Min SG, Hua WT. Effects of moxibustion or acupoint therapy for the treatment of primary dysmenorrhea: a meta-analysis. Altern Ther Health Med. 2014;20(4):33-42. [177247].

Purpose The study intended to compare the effectiveness of moxibustion and acupoint therapy- such as sandwiched moxibustion, moxibustion, acupuncture, eye of floating needle, and acupoint application-with other therapeutic methods for the treatment of primary dysmenorrhea .
Methods Six electronic databases-PubMed, Web of Science, the Chinese Biomedical Literature Database (CBM), the Chinese Journal Full-text Database (CNKI), the Chinese Science and Technology Journal Full-text Database (VIP), and Chinese Wanfang Data-were searched electronically, from inception to December, 2012, to find randomized, controlled trials (RCTs). Relevant references in articles used in the current study were searched manually. Literature was screened, data were extracted, and the methodological quality of the included studies was assessed. Then, meta-analyses were performed.
Results A total of 20 RCTs, involving 2134 participants, were included in the current study. Results of the metaanalysis showed that (1) the total efficacy for the 2 studied interventions was better, with a statistically significant difference from that of the control methods: degrees of freedom (df) = 14, relative risk (RR) = 1.19, 95% confidence interval (95% CI) = (1.14 - 1.24), P < .000 for the UTG, and df = 4, RR = 1.15, 95% CI (1.02 - 1.29), P = .03 for the CDSTG; (2) the studied interventions were better than the control methods, with statistically significant differences, in relieving the severity of symptoms of PD: df = 3, mean difference (MD) = 3.20, 95% CI (2.36 - 4.04), P < .000 for the UTG and df = 1, MD = 2.09, 95% CI (0.16 - 4.02), P = .03 for the CDSTG; and (3) no statistical difference existed between the intervention and control methods groups in the reduction of the level of peripheral blood PGF2α: df = 2, standardized mean difference (SMD) = 0.13, 95% CI (-0.13 - 0.39), P = .32.
Conclusion Moxibustion and acupoint therapy can relieve pain effectively for individuals with PD, and these treatments have advantages in overall efficiency.

1.1.13. Kannan 2014 ☆

Kannan P, Claydon LS. Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhea: a systematic review. J Physiother. 2014. 60(1):13-21. [171188].

QuestionIn women with primary dysmenorrhoea, what is the effect of physiotherapeutic interventions compared to control (either no treatment or placebo/sham) on pain and quality of life?
DesignSystematic review of randomised trials with meta-analysis. Participants: Women with primary dysmenorrhea. Intervention: Any form of physiotherapy treatment. Outcome measures: The primary outcome was menstrual pain intensity and the secondary outcome was quality of life.
ResultsThe search yielded 222 citations. Of these, 11 were eligible randomised trials and were included in the review. Meta-analysis revealed statistically significant reductions in pain severity on a 0-10 scale from acupuncture (weighted mean difference 2.3, 95% CI 1.6 to 2.9) and acupressure (weighted mean difference 1.4, 95% CI 0.8 to 1.9), when compared to a control group receiving no treatment. However, these are likely to be placebo effects because when the control groups in acupuncture/acupressure trials received a sham instead of no treatment, pain severity did not significantly differ between the groups. Significant reductions in pain intensity on a 0-10 scale were noted in individual trials of heat (by 1.8, 95% CI 0.9 to 2.7), transcutaneous electrical nerve stimulation (2.3, 95% CI 0.03 to 4.2), and yoga (3.2, 95% CI 2.2 to 4.2). Meta-analysis of two trials of spinal manipulation showed no significant reduction in pain. None of the included studies measured quality of life.
Conclusion Physiotherapists could consider using heat, transcutaneous electrical nerve stimulation, and yoga in the management of primary dysmenorrhea. While benefits were also identified for acupuncture and acupressure in no-treatment controlled trials, the absence of significant effects in sham-controlled trials suggests these effects are mainly attributable to placebo effects.

1.1.14. Qin 2014 ☆☆

Qin Ai-Ling, Ma Rui-Ping, Xiao Wan, Yi Li-Juan, Tian Xu. [Effects of Associated Simple Acupuncture Therapy in the Treatment of Primary Dysmenorrhea: a Systematic Review]. Journal of International Obstetrics and Gynecology. 2014;4:453-458. [187003]

Objective To systematically review the effectiveness of associated simple acupuncture therapy in the treatment of primary dysmenorrhea (PD).
Methods Databases such as PubMed, Web of Science (SCI), CBM, CNKI, VIP and WANFANG DATA were electronically searched to collect the randomized controlled trials (RCTs) (up to December 2012), and the relevant references of the included articles were also manually searched. According to the inclusion and exclusion criteria, literature was screened, data were extracted and methodological quality of the included studies was assessed. Then Meta analyses were performed by using RevMan 5. 2 software.
Results A total of 20 RCTs involving 2 134 participants were included. Results of Meta analyses showed that: ①total efficiency of associated simple acupuncture therapy was better than that of control method , with statistically significant differences [RR=1. 19, 95%CI (1. 14, 1. 24), P<0. 000] and [RR=1. 15, 95%CI (1. 10, 1. 21), P=0. 03]. ②Associated simple acupuncture therapy was better than control method in releasing degree of serious symptoms of PD , with statistically significant differences [MD=3. 20, 95%CI (2. 36, 3. 04), P<0. 000] and [MD=2. 09, 95%CI (0. 16, 4. 02), P=0. 03]. ③There was no statistical difference in reducing level of the peripheral blood prostaglandin F 2α between the two groups [MD=0. 13, 95%CI (-0. 13, 0. 39), P=0. 32].
Conclusions Associated simple acupuncture therapy can significantly relieve pain in patients with PD and overall efficiency. Due to limitations on the quantity and quality of included studies, this conclusion has yet to be carried out in large, multicenter study to verify.

1.1.15. Chen 2013 ☆

Chen Wen, Yu Haihong, Liu Shihong, Huang Wanling, Tian Weizhen. [Systematic Review of Acupuncture Treatment of Primary Dysmenorrhea]. Chinese Archives of Traditional Chinese Medicine. 2013;2:321-325. [186932]

Objective To evaluate the clinical efficacy of acupuncture treatment of primary dysmenorrhea (PD) and analyze the current research status.
Methods 28 randomized controlled trials were used for application of standard quality evaluation. Meta-analysis, funnel plot analysis and other methods of statistical data were used for a comprehensive conclusion.
Results There were 24 papers below 3 with general quality;Meta-analysis combined with OR=6. 82, 95% confidence interval 5. 20-8. 94, diamond in vertical right (Z=13. 89, P<0. 00001), it showed that the control effect of acupuncture and moxibustion on PD in treatment group had significant meaning;funnel plot showed a skewed distribution, suggesting the possible presence of publication bias.
Conclusion Results from the statistical analysis, acupuncture treatment of this disease is basically affirmed, but the research of low quality is the main factor that influences the system evaluation conclusion. Therefore, application of these conclusions should be cautious. To confirm its efficacy and safety, it need randomized controlled trials of strict design and implementation with multicenter large sample and enough follow-up time.

1.1.16. Chung 2012 ☆☆

Chung YC, Chen HH, Yeh ML. Acupoint stimulation intervention for people with primary dysmenorrhea: Systematic review and meta-analysis of randomized trials. Complement Ther Med. 2012 Oct;20(5):353-63.[157955].

Purpose The aim of this study was to determine the effectiveness of acupoint stimulation for primary dysmenorrhea.
Methods All searches in the Cochrane Library, MEDLINE, PubMed, CINAHL Plus with Full Text, and CEPS databases (inception to March 2011 ). Study selection: Randomized controlled trials (RCTs) included were comparing acupoint stimulation with non-acupoint-related stimulation or medication. Thirty RCTs met the selection criteria, and 25 reported sufficient data for pooling. The main outcomes assessed were cure rate, total effective rate, pain intensity, menstrual pain, plasma PGF2/PGE2 ratio, and adverse events. According to the type of outcome, the strength of a relationship between two dichotomous variables was described by odds ratios and 95% confidence intervals, and continuous variables were expressed as mean± standard deviation.
Results Twenty-five randomised controlled trials with a total of over 3000 participants were included for the meta-analysis. effective.
Conclusion Acupoint stimulation when compared with non-acupoint-related stimulation or medication had significant effects. Moderator analysis further confirmed that invasive and noninvasive acupoint stimulation was effective separately, with the latter being more effective. The most common adverse events were hemorrhage and hematoma. Limitations: Papers written in language other than English or Chinese were not included.

1.1.17. Smith 2011 ☆☆☆

Smith CA, Zhu X, He L, Song J. Acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev. 2011;(1):CD007854.[156154]

Purpose To determine the efficacy and safety of acupuncture in the treatment of primary dysmenorrhoea when compared with a placebo, no treatment, or conventional medical treatment (for example oral contraceptives and non-steroidal anti-inflammatory medication nSAIDs)).
Methods The following databases were searched (from inception until March 2010): the Cochrane Menstrual Disorders and Subfertillity Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), PubMed, CINAHL, PsycINFO, Chinese Biomedical Literature Database (CBM), ChineseMedical Current Content (CMCC), China National Knowledge Infrastructure (CNKI), VIP database, Dissertation Abstracts International, BIOSIS, AMED(The Allied and ComplementaryMedicine Database), Acubriefs, and Acubase. Inclusion criteria included all published and unpublished randomised controlled trials comparing acupuncture with placebo control,usual care, and pharmacological treatment. The following modes of treatment were included: acupuncture, electro-acupuncture, and acupressure. Participants were women of reproductive age with primary dysmenorrhoea during the majority of the menstrual cycles or for three consecutive menstrual cycles, and moderate to severe symptoms. Meta-analyses were performed using odds ratios (OR) for dichotomous outcomes and mean differences or standard mean différences (SMD) for continuous outcomes, with 95% confidence intervals (CI). Primary outcomes were pain relief and improved menstrual symptoms, measured by self-rating scales. Other outcomes included use of analgesics, quality of life, and absence from school or work.
Results Ten trials were included in the review with data reporting on 944 participants. Six trials reported on acupuncture (n = 673) and four trials (n = 271) reported on acupressure. There was an improvement in pain relief from acupuncture compared with a placebo control (OR 9.5, 95% CI 21.17 to 51.8), NSAIDs (SMD -0.70, 95% CI -1.08 to -0.32) and Chinese herbs (SMD -1.34, 95% CI -1.74 to -0.95). One trial found a reduction in pain intensity compared with usual care (MD -2.09, 95% CI -2.99, -1.19). In two trials acupuncture reduced menstrual symptoms (for example nausea, back pain) compared with medication (OR 3.25, 95% CI 1.53 to 6.86); in one trial acupuncture reduced menstrual symptoms compared with Chinese herbs (OR 7.0, 95% CI 2.22, 22.06); and in one trial acupuncture improved quality of life compared with usual care. There was an improvement in pain relief from acupressure compared with a placebo control (SMD -0.99, 95% CI -1.48 to -0.49), and in one trial acupressure reduced menstrual symptoms compared with a placebo control (SMD -0.58, 95% CI -1.06 to -0.10). The risk of bias was low in 50% of trials.
Conclusion Acupuncture may reduce period pain, however there is a need for further well-designed randomised controlled trials.

1.1.18. Latthe 2011

Latthe PM, Champaneria R, Khan KS. Dysmenorrhoea. BMJ Clin Evid. 2011. [146374].

IntroductionDysmenorrhoea may begin soon after the menarche, after which it often improves with age, or it may originate later in life after the onset of an underlying causative condition. Dysmenorrhoea is common, and in up to 20% of women it may be severe enough to interfere with daily activities.
Methods and outcomesWe conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for primary dysmenorrhoea? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
ResultsWe found 35 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
ConclusionsIn this systematic review we present information relating to the effectiveness and safety of the following interventions: acupressure, acupuncture, aspirin, behavioural interventions, contraceptives (combined oral), fish oil, herbal remedies, magnets, non-steroidal anti-inflammatory drugs, paracetamol, progestogens (intrauterine), spinal manipulation, surgical interruption of pelvic nerve pathways, thiamine, toki-shakuyaku-san, topical heat, transcutaneous electrical nerve stimulation (TENS), vitamin B12, and vitamin E.

1.1.19. Cho 2010 ☆

Cho SH, Hwang EW. Acupuncture for Primary Dysmenorrhoea: A Systematic Review. BJOG 2010;117(5):509-21. [73928].

Objectifs The effectiveness of acupuncture in primary dysmenorrhoea is not fully understood. Objectives: To assess the effectiveness of acupuncture for the symptomatic treatment of primary dysmenorrhoea from randomised controlled trials (RCTs).
Méthodes Search Strategy: Nineteen electronic databases, including English, Korean, Japanese and Chinese databases, were systematically searched for RCTs investigating acupuncture for primary dysmenorrhoea up to July 2008 with no language restrictions. Selection Criteria: All RCTs that evaluated the effects of acupuncture compared with controls were included. Studies that assessed the effect of moxibustion or body acupressure were excluded. Data Collection and Analysis: The study abstraction and quality assessment of all studies were undertaken following the detailed descriptions of these categories as described in the Cochrane Handbook for Systematic Reviews of Interventions.
Résultats Twenty-seven RCTs were systematically reviewed. Only nine of the 27 trials clearly described their methods of randomisation and none of the trials stated the methods of allocation concealment. Compared with pharmacological treatment or herbal medicine, acupuncture was associated with a significant reduction in pain. Three studies reported reduced pain within groups from baseline; however, two RCTs did not find a significant difference between acupuncture and sham acupuncture.
Conclusion The review found promising evidence in the form of RCTs for the use of acupuncture in the treatment of primary dysmenorrhoea compared with pharmacological treatment or herbal medicine. However, the results were limited by methodological flaws. The evidence for the effectiveness of acupuncture for the treatment of primary dysmenorrhoea is not convincing compared with sham acupuncture. Further rigorous nonpenetrating placebo-controlled RCTs are warranted.

1.1.20. Yang 2008 ☆

Yang H, Liu CZ, Chen X, Ma LX, Xie JP, Guo NN, Ma ZB, Zheng YY, Zhu J, Liu JP. Systematic Review of Clinical Trials of Acupuncture-related Therapies for Primary Dysmenorrhea. Acta Obstet Gynecol Scand. 2008;87(11):1114-22. [153109]

Objectives Acupuncture-related therapies might be an effective intervention for primary dysmenorrhea. To evaluate the effects of acupuncture-related therapies for treating primary dysmenorrhea.
Méthods SEARCH STRATEGY: A specified literature search was performed of the Cochrane Library, MEDLINE, EMBASE, CNKI, and CBM databases. SELECTION CRITERIA: All clinical controlled trials pertaining to acupuncture-related therapies for primary dysmenorrhea were included, and the quality of the trials was assessed. DATA COLLECTION AND ANALYSIS: Two independent reviewers were responsible for data extraction and assessment. The original data of each trial were analyzed with software (Revman 4.2), but a meta-analysis could not be carried out because of the heterogeneity of the trials.
Results Thirty randomized controlled trails (RCTs) and two controlled clinical trials (CCTs) were identified. Most of the trials were of low methodologic quality (six trials were Grade B and 26 trials were Grade C). Data analysis indicated that there were conflicting results regarding whether acupuncture-related therapies were more effective than control treatments. However, there was a small, methodologic sound trial of acupuncture which suggested that acupuncture was more effective than control groups (placebo acupuncture: WMD=-0.57 and 95% CI=-0.76-0.38; standard control: WMD=-.19 and 95% CI=-0.37-0.01; visitation control: WMD=-1.04 and 95% CI=-1.28-0.80).
Conclusions Because of low methodologic quality and small sample size, there is no convincing evidence for acupuncture in the treatment of primary dysmenorrhea. There is an urgent need for randomized, blinded, placebo-controlled trials to assess the effects of acupuncture.

1.1.21. Proctor 2007

Proctor ML, Farquhar CM. Dysmenorrhoea. BMJ Clin Evid. 2007. [158956].

IntroductionDysmenorrhoea may begin soon after the menarche, after which it often improves with age, or it may originate later in life after the onset of an underlying causative condition. Dysmenorrhoea is common, and in up to 20% of women it may be severe enough to interfere with daily activities.
Methods and outcomesWe conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for dysmenorrhoea? We searched: Medline, Embase, The Cochrane Library and other important databases up to July 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
ResultsWe found 34 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
ConclusionsIn this systematic review we present information relating to the effectiveness and safety of the following interventions: acupressure, acupuncture, aspirin, behavioural interventions, combined oral contraceptives, compound analgesics, fish oil, herbal remedies, magnesium, magnets, non-steroidal anti-inflammatory drugs, paracetamol, spinal manipulation, surgical interruption of pelvic nerve pathways, thiamine, toki-shakuyaku-san, topical heat, transcutaneous electrical nerve stimulation (TENS), vitamin B12, and vitamin E.

1.1.22. Chou 2005

Chou Chin-Shan, Liu Bao-Yan, Zhang Lu, Jin Zhi-Gao. Acupuncture for primary dysmenorrhea -a meta-analysis. World Journal of Acupuncture and Moxibustion. 2005;15(1):53. [140372].

Recent literature search showed that up to now there are a total of 9 theses about clinical treatment of primary dysmenorrhea with acupuncture therapy, among them 5 clinical trials are from Chinese journals and the rest 4 from foreign journals. Majority of the trials have some methodological and/or reporting shortcomings. The frequency and intensity of dysmenorrhea are divided into intermittent and continuous types. Results of quantitative meta-analysis with Revman 4. 1 software showed that the existing evidence supports the value of acupuncture for the treatment of dysmenorrhea. However, the quality of evidence is not fully convincing. There is an urgent need for well-planned, large-scale and multiple-center studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions.

1.2. Special Acupuncture Techniques

1.2.1. Moxibustion

1.2.1.1. Wu 2021 ☆

Wu ZX, Cai MJ, Huang PD, Chen JY, Lv ZH, Huang XY. Comparative efficacy and dysmenorrhea score of 6 object-separated moxibustions for the treatment of Chinese patients with dysmenorrhea: A systematic review and network meta-analysis. Medicine (Baltimore). 2021;100(26). [219692]. doi

BackgroundPrimary dysmenorrhea (PD), one of the most common diseases in women, is known to be effective with object-separated moxibustion. However, because there is no large sample size for comparison, it is difficult to choose the best method for the clinical treatment of these different treatments. Therefore, our aim was to compare and rank different moxibustion methods to determine the most effective treatment method for PD.
Materials and methodsA systematic search was carried out in PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, and Chinese Biomedical Literature, to identify the randomized controlled trials (RCTs) investigated the object-separated moxibustion is associated with dysmenorrhea, as well as we also manually checked the bibliographies of eligible studies and topic-related reviews, RCTs from their inception to May 1, 2020. Three investigators read the citations and excluded quasi-randomized trials and trials that were incomplete. We extracted data following a predefined hierarchy. We assessed the studies' risk of bias in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The primary outcomes were efficacy (response rate) and dysmenorrhea scores. We estimated the summary odds ratio (OR) and mean difference (MD) using pairwise and network meta-analyses with random effects. STATA software version 16.0, ADDIS software version 1.16.5, and R software version 3.6.1 were used to statistically analyze all data.
ResultsFifty-six RCTs with 5550 patients were included, comparing 6 object-separated moxibustion therapies with acupuncture or oral medicine. All moxibustions were more effective than ibuprofen, with OR ranging between 6.75 (95%CI: 3.58 to 13.22) for moxibustion at the navel. For relieving pain which uses dysmenorrhea score to evaluate, mild moxibustion (MD = -1.42, -4.24 to 0.85) was more effective than others. A total of 24 (42.8%) of 56 trials were rated as having a high risk of bias, 31(55.4%) as moderate, and 1(1.8%) as low, and the certainty of the evidence was moderate.
Conclusions Mild moxibustion cannot only effectively treat PD but also relieve pain in comparison with ibuprofen. Although GRADE evidence indicate low to moderate for most comparisons, mild moxibustion seems to be an advisable option for PD treatment to relieve symptoms.
1.2.1.2. Li 2018

Li Xiao-Dong , Liu Yong-Ming , Pang Li-Jian , Liu Chuang , Liu Yan-Tong , Wang Si-Han , Shi Yan. [Clinical Effect of Primary Dysmenorrhea on Treatment by Indirect Moxibustion: A Meta-Analysis]. JournaI of Basic Chinese Medicine. 2018;24(7):983. [181055].

Objective To evaluate the efficacy and security of indirect moxibustion on primary dysmenorrheal.
MethodWe searched PubMed, CBM,CNKI,VIP Database and WANFANG Database for randomized controlled trials of indirect moxibustion on primary dysmenorrheal by computer. Time had beer, limited to July 2016 since the database was established. Evaluate the quality of the included studies and extracted the data , and then use the RevMan 5. 3 software for meta-analysis.
Results Thirteen researches were incorporated in the end , including 1524 cases. Meta-analysis showed: Indirect moxibustion was more effective in clinical efficacy rate compared with the control group ( RR=1. 14, 95% CI: 1. 10 ～ 1. 18); Indirect moxibustion could effectively decrease in patients with dysmenorrhea symptom scores, the comparisons have significant difference( WMD )= - 1. 16, 95% CI：-1. 46 ～ - 0. 87).At the same time, indirect moxibustion could also reduce the incidence of adverse reactions (OR=0. 01, 95% CI:0. 00 ～ 0. 11). The PGF2./PGE2、E T-1/NO content in serum showed no difference compared with the control group.
ConclusionIndirect moxibustion can relieve the pain of patients with primary dysmenorrheal to some extent and alleviate the symptoms of primary dysmenorrheal, reduce the incidence of adverse reactions , but in terms of safety, it needs to be demonstrated. It is not enough comprehensive to evaluate the effectiveness and security of indirect moxibustion due to the quality and quantity of the included Literatures. The results still need high quality literatures to be validated.
1.2.1.3. Zhou 2018

Zhou Mei, Huang Xianbao, Chen Rixin. [System Evaluation and Meta-Analysis of Thermal Moxibustion Treatment for Primary Dysmenorrhea]. Liaoning Journal of Traditional Chinese Medicine. 2018;(4):812-22. [115724].

ObjectiveTo evaluate the Meta-analysis on the validity and security of the thermal moxibustion treatment for primary dysmenorrhea.
MethodsComprehensive electronic retrieval database in Chinese included CBM,CNKI,VIP and WF. English database included Pubmed,EMBASE and Medline. We collected clinical randomized controlled trials about thermal moxibustion treatment for primary dysmenorrhea and supplemented by manual retrieval of Jiangxi University of Traditional Chinese Medicine Library item database. After assessed by the two researchers’ reading,we screened the independence to extract the effective information and used the Cochrane Review Handbook 5. 1. 0 for quality evaluation and Rev Man 5. 1 software for statistical analysis.
Results There were 7 qualified references,with a total of 542 cases. The result of Meta-analysis showed thermal moxibustion treatment of primary dysmenorrhea was superior to the other control groups. Combined effect amount OR value was 5. 89( > 1);95% CI was( 2. 75,12. 61) and Z = 4. 56,P = 0. 00001( < 0. 01). The difference was statistically significant. Thermal moxibustion cure rate was superior to that of the other control groups for the treatment of primary dysmenorrhea. Combined effect amount OR value was 3. 04( > 1) and 95% CI was( 1. 88,4. 89),Z = 4. 56,P = 0. 00001( < 0. 01). The difference was statistically significant. Thermal moxibustion treatment of primary dysmenorrhea in improving CMSS score was better than that of the other control groups,WMD =-0. 78,95% CI(-0. 96,-0. 60),Z = 8. 64,P = 0. 00001( < 0. 01). The difference was statistically significant.
Conclusion With traditional moxibustion therapy,acupuncture and massage,Western medicine and moxibustion according to sydnrome differentiation,the curative effect of heat-sensitive moxibustion treatment of primary dysmenorrhea has certain advantages. But it still need to be confirmed by more high quality research.
1.2.1.4. Gou 2016 ☆ (Interventional Times)

Gou CQ, Gao J, Wu CX, Bai DX, Mou HY, Hou XL, Zhao X. Moxibustion for Primary Dysmenorrhea at Different Interventional Times: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2016. [191063].

Objectives Primary dysmenorrhea (PD) is one of the most common diseases in gynecology at present. Some clinical trials have reported the effects of moxibustion and confirmed temporal factors are the important elements influencing the efficacy of moxibustion. However, no systematic review has yet been conducted.
Methods In this study, we assessed the effects of moxibustion in patients with PD enrolled in randomized controlled trials (RCTs) and the difference among different intervention times to start moxibustion. We extracted data for studies searched from 10 electronic databases and evaluated the methodological quality of the included studies. We discussed three outcomes: effective rate, pain remission, and the level of PGF2α in serum.
Results Current clinical researches showed that, compared with nonmoxibustion treatments for PD, moxibustion leads to higher effective rate and lower level of PGF2α in serum. However, there was no difference in using moxibustion to treat PD at different intervention times.
Conclusions Based on the theory of Chinese medicine and the results of this study, choosing 5 ± 2 days before menstruation to start moxibustion can achieve good efficacy for PD patients. However, more high-quality RCTs are needed to confirm the conclusions.

1.2.2. Puncture or acupression at sanyinjiao acupoint

1.2.2.1. Chen 2013 ☆

Chen MN, Chien LW, Liu CF. Acupuncture or Acupressure at the Sanyinjiao (SP6) Acupoint for the Treatment of Primary Dysmenorrhea: A Meta-Analysis. Evid Based Complement Alternat Med 2013:493038. doi: 10.1155/2013/493038.[166862]

Purpose This meta-analysis aimed to evaluate the effectiveness of acupuncture or acupressure at the Sanyinjiao (SP6) acupoint in relieving pain associated with primary dysmenorrhea.
Methods We searched the scientific literature databases to identify randomized controlled trials. The primary outcome was visual analogue scale (VAS) pain score. Three acupuncture and four acupressure trials were included in the meta-analyses.
Results Three acupuncture and four acupressure trials were included in the meta-analyses. For the acupuncture analysis, there was no difference in themeanVAS score reduction between the SP6 acupoint and control (GB39 acupoint) groups (−4.935; lower limit = −15.757, upper limit = 5.887; 𝑃 = 0.371). For the acupressure analysis, there was a significant difference in the mean VAS score after intervention between the SP6 acupoint and control (rest/light touch at SP6/nonacupoint acupressure) groups, favoring the SP6 acupoint group (−1.011; lower limit = −1.622, upper limit = −0.400; 𝑃 =0.001). Sensitivity analyses demonstrated good reliability of the meta-analyses findings.
Conclusion These findings suggest that acupuncture at SP6 is not more effective than acupuncture at an unrelated acupoint in the relief from primary dysmenorrhea. Acupressure at SP6 may be effective in the relief from primary dysmenorrhea.
1.2.2.2. Abaraogu 2016 ☆ (acupression)

L Abaraogu UO, Igwe SE, Tabansi-Ochiogu CS. Effectiveness of SP6 (Sanyinjiao) acupressure for relief of primary dysmenorrhea symptoms: A systematic review with meta- and sensitivity analyses. Complement Ther Clin Pract. 2016;:92-105. [195747].

ObjectiveWe reviewed the available evidence for SP6 (Sanyinjiao) acupressure for the relief of primary dysmenorrhea (PD) symptoms, as well as patients' experiences of this intervention.
MethodsWe searched six relevant databases and gray literature for publications dated up to March 2016.
ResultsThe search yielded 72 potential studies. Six of these studies, contributing a total of 461 participants, were included in this review. The primary outcome was pain intensity. Studies with significant homogeneity were pooled for meta-analysis. Qualitative data and quantitative data not suitable for meta-analysis were presented as a narrative synthesis. The Cochrane criteria demonstrated that the included studies were generally of low quality with a high risk of bias. SP6 acupressure delivered by trained personnel significantly decreased pain intensity immediately after the intervention (effect size = -0.718; CI = -0.951 to -0.585; p = 0.000), and pain relief remained up to 3 h after the intervention (effect size = -0.979; CI = -1.296 to 0.662; p = 0.000). However, patient-administered intervention required multiple monthly cycles to effect pain reduction.
ConclusionSP6 acupressure appears to be effective when delivered by trained personnel for some PD symptoms. Findings suggest that self-administered acupressure shows promise for the alleviation of PD symptoms. High-quality research is needed before conclusive recommendations are proposed.

1.2.3. Acupression

1.2.3.1. Armour 2019 ☆

Armour M , Smith CA , Steel KA , Macmillan F. The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: a systematic review and meta-analysis. BMC Complement Altern Med. 2019;19(1):22. [193063].

BackgroundMenstrual pain is very common amongst young women. Despite the significant impact that menstrual pain has on academic attendance and performance, social activities and quality of life, most young women do not seek medical treatment but prefer to use self-care; commonly OTC analgesic medications and rest. Many women do not get significant pain relief from these methods, therefore other low cost, easy to learn self-care methods may be a valuable approach to management. This review and meta-analysis examines the evidence for participant lead self-care techniques.
MethodsA search of Medline, PsychINFO, Google Scholar and CINAHL was carried out in September 2017.
Results Twenty-three trials including 2302 women were eligible and included in the meta-analysis. Studies examined self-delivered acupressure, exercise and heat as interventions. Risk of bias was unclear for many domains. All interventions showed a reduction in menstrual pain symptoms; exercise (g = 2.16, 95% CI 0.97 to 3.35) showed the largest effect size, with heat (g = 0.73, 95% CI 0.06 to 1.40) and acupressure (g = 0.56, 95% CI 0.10 to 1.03) showing more moderate effect sizes. Exercise (g = 0.48, 95% CI 0.12 to 0.83) and heat (g = 0.48, 95% CI 0.10 to 0.87), were more effective than analgesics in reducing pain intensity, whereas acupressure was significantly less effective (g = - 0.76, 95% CI -1.37 to - 0.15).
ConclusionExercise showed large effects, while acupressure and heat showed moderate effects in reducing menstrual pain compared to no treatment. Both exercise and heat are potential alternatives to analgesic medication. However, difficulties in controlling for non-specific effects, along with potential for bias, may influence study findings.
1.2.3.2. Jiang 2013

Jiang HR, Ni S, Li JL, Liu MM, Li J, Cui XJ, Zhang BM.. Systematic review of randomized clinical trials of acupressure therapy for primary dysmenorrhea. Evid Based Complement Alternat Med. 2013 . [169121].

ObjectiveThe evidence of acupressure is limited in the management of dysmenorrhea.
MethodsTo evaluate the efficacy of acupressure in the treatment of primary dysmenorrhea based on randomized controlled trials (RCTs), we searched MEDLINE, the Chinese Biomedical Database (CBM), and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception until March 2012. Two reviewers independently selected articles and extracted data. Statistical analysis was performed with RevMan 5.1 software.
Results & conclusionsEight RCTs were identified from the retrieved 224 relevant records. Acupressure improved pain measured with VAS (-1.41 cm 95% CI [-1.61, -1.21]), SF-MPQ at the 3-month followup (WMD -2.33, 95% CI [-4.11, -0.54]) and 6-month followup (WMD -4.67, 95% CI [-7.30, -2.04]), and MDQ at the 3-month followup (WMD -2.31, 95% CI [-3.74, -0.87]) and 6-month followup (WMD -4.67, 95% CI [-7.30, -2.04]). All trials did not report adverse events. These results were limited by the methodological flaws of trials.
1.2.3.3. Cho 2010 ☆

Cho SH, Hwang EW. Acupressure for Dysmenorrhoea: A Systematic Review. Complementary Therapies in Medicine. 2010;18(1):49-56. [154012].

Objectifs To assess the effectiveness of acupressure for the symptomatic treatment of primary dysmenorrhoea from randomised controlled trials (RCTs).
Méthodes Electronic databases including English, Korean, Japanese and Chinese databases were systematically searched for RCTs investigating acupressure for primary dysmenorrhoea up to July 2008 with no language restrictions. The methodological qualities of eligible studies were assessed using the criteria described in the Assessing risk of bias of the Cochrane Handbook edited by Higgins and Altman.
Résultats Four RCTs comprising a total of 458 participants were systematically reviewed. Only one of the included trials described adequate methods of randomisation. All trials did not have clear descriptions of their method of allocation concealment. Two studies reported significant improvements in the severity of pain for acupressure compared with sham acupressure on non-acupoints. Acupressure reduced the pain and anxiety typical of dysmenorrhoea in a Taiwan study. The U.S. study using an acupressure device reported that the reduction of menstrual pain was significantly better in worst menstrual pain, menstrual pain symptom intensity and the consumption of pain medication, compared with conventional treatment. One study investigated adverse events and reported that there was no adverse event in acupressure treatment.
Conclusion The available data from RCTs suggest that acupressure alleviates menstrual pain. These results were limited by the small number of trials. Well-designed RCTs with rigorous methods of randomisation, and adequately concealed allocation, are needed.

1.2.4. Catgut Embedding

1.2.4.1. Wu 2016

Wu Yuan-rong, Zhao Ruo-hua, Yu Ting-ting, Li Ya-ling, Lin Xiao-qiong. [Efficacy on Primary Dysmenorrhea Treated by Acupoint Catgut Embedding: a Meta Analysis Meta]. Journal of Clinical Acupuncture and Moxibustion. 2016;32(1):50-55,56. [169250].

ObjectiveTo evaluate the efficacy and security of acupoint catgut embedding on primary dysmenorrheal.
MethodsWe searched the Cochrane library, PubMed, OVID, CNKI, CMCC, Wanfang Database and VIP Database for randomized or semi -random controlled trials of acupoint catgut embedding on primary dysmenorrhea by computers. Time had been limited to March 2015 since the database was established. Evaluate the quality of the included studies and extracted the data, and then use the RevMan5.2 software for meta-analysis.
ResultsNine researches were incorporated in the end, including 704 cases. Meta-analysis showed: Acupoint catgut embedding could effectively relieve patients' pain compared with the control group ( WMD=-1 .79 , 95%CI:-2 .37~-1 .21 );the dysmenorrhea symptom integral showed no difference compared with the control group after 3 months of intervention ( WMD=-0 .35 ,95%CI:-1 .24~0 .31 ) and stopping intervention after three months (WMD=-0.97,95%CI:-2.25,0.31).At the same time it could also reduce the recurrence rate ( RR=0 .08 , CI 95%:0 .02 ,0 .14 ) but we couldn't give a conclusion for the adverse reactions .
ConclusionAcupoint catgut embedding can relieve the pain of patients with primary dysmenorrheal to some extent and relieve the symptoms of dysmenorrheal, reduce the recurrence, but in terms of safety, it needs to be demonstrated. It is not enough comprehensive to evaluate the effectiveness and security of acupoint catgut embedding due to the quality and quantity of the included literatures. To validate the results still need high quality literatures.

1.2.5. Electroacupuncture

1.2.5.1. Yu 2017

Yu S-Y, Lv Z-T, Zhang Q, et al. Electroacupuncture is Beneficial for Primary Dysmenorrhea: The Evidence from Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Alternat Med. 2017:1-14. [203370]. DOI

Objectives Electroacupuncture (EA) is considered to be a promising alternative therapy to relieve the menstrual pain for primary dysmenorrhea (PD), but the conclusion is controversial. Here, we conducted a systematic review and meta-analysis specifically to evaluate the clinical efficacy from randomized controlled trials (RCTs) on the use of EA in patients with PD.
Methods PubMed, Embase, ISI Web of Science, CENTRAL, CNKI, and Wanfang were searched to identify RCTs that evaluated the effectiveness of EA for PD. The outcome measurements included visual analogue scale (VAS), verbal rating scale (VRS), COX retrospective symptom scale (RSS), and the curative rate.
Results Nine RCTs with high risk of bias were included for meta-analysis. The combined VAS 30 minutes after the completion of intervention favoured EA at SP6 when compared with EA at GB39, nonacupoints, and waiting-list groups. EA was superior to pharmacological treatment when the treatment duration lasted for three menstrual cycles, evidenced by significantly higher curative rate. No statistically significant differences between EA at SP6 and control groups were found regarding the VRS, RSS-COX1, and RSS-COX2.
Conclusions The findings of our study suggested that EA can provide considerable immediate analgesia effect for PD. Additional studies with rigorous design and larger sample sizes are needed.

1.2.6. TENS

1.2.6.1. Proctor 2002 ☆

Proctor ML, Smith CA, Farquhar CM, Stones RW. Transcutaneous Electrical Nerve Stimulation and Acupuncture for Primary Dysmenorrhoea. The Cochrane Database of Systematic Reviews. 2002;1. [141320]

Background Dysmenorrhoea is the occurrence of painful menstrual cramps of the uterus. Medical therapy for dysmenorrhoea commonly consists of nonsteroidal anti-inflammatory drugs or the oral contraceptive pill both of which work by reducing myometrial (uterine muscle) activity. However, these treatments are accompanied by a number of side effects, making an effective non-pharmacological method of treating dysmenorrhoea of potential value. Transcutaneous electrical nerve stimulation (TENS) is a treatment that has been shown to be effective for pain relief in a variety of conditions. Electrodes are placed on the skin and electric current applied at different pulse rates (frequencies) and intensities is used to stimulate these areas so as to provide pain relief. In dysmenorrhoea. TENS is thought to work by alteration of the body's ability to receive or perceive pain signals rather than by having a direct effect on the uterine contractions. Acupuncture may also be indicated as a useful, non-pharmacological method for treating dysmenorrhoea. Acupuncture is thought to excite receptors or nerve bres which, through a complicated interaction with mediators such as serotonin and endorphins, blocks pain impulses. Acupuncture typically involves penetration of the skin by ne, solid metallic needles, which are manipulated manually or by electrical stimulation.
Objectives To determine the effectiveness of high and low frequency transcutaneous electrical nerve stimulation and acupuncture when compared to each other, placebo, no treatment, or medical treatment for primary dysmenorrhoea.
Méthods Search strategy: Electronic searches of the CochraneMenstrual Disorders and Subfertility Group Register of controlled trials, CCTR (Cochrane Library Issue 3, 2001), MEDLINE, EMBASE, CINAHL, Bio extracts, PsycLIT and SPORTDiscus were performed in August 2001 to identify relevant randomised controlled trials (RCTs). The Cochrane ComplementaryMedicine Field's Register of controlled trials (CISCOM) was also searched. Attempts were also made to identify trials from the UKNational Research Register, the Clinical Trial Register and the citation lists of review articles and included trials. In most cases, the rst or corresponding author of each included trial was contacted for additional information. Selection criteria: The inclusion criteria were randomised controlled trials of transcutaneous electrical nerve stimulation and acupuncture that compared these treatments to each other, placebo, no treatment, or medical treatment for primary dysmenorrhoea. Exclusion criteria were: mild, infrequent or secondary dysmenorrhoea and dysmenorrhoea associated with an IUD. Data collection and analysis: Nine RCTs were identi ed that ful lled the inclusion criteria for this review, seven involving TENS, one acupuncture, and one both treatments. Quality assessment and data extraction were performed independently by two reviewers. Meta analysis was performed using odds ratios for dichotomous outcomes and weighted mean differences for continuous outcomes. Data unsuitable for meta-analysis was reported as descriptive data and was also included for discussion. The outcome measures were pain relief (dichotomous, visual analogue scales, descriptive), adverse effects, use of analgesics additional to treatment and absence from work or school.
Results Overall high frequency TENS was shown to be more effective for pain relief than placebo TENS. Low frequency TENS was found to be no more effective in reducing pain than placebo TENS. There were conflicting results regarding whether high frequency TENS is more effective than low frequency TENS. One small trial showed acupuncture to be signi cantly more effective for pain relief than both placebo acupuncture and two no treatment control groups.
Conclusions High frequency TENS was found to be effective for the treatment of dysmenorrhoea by a number of small trials. The minor adverse effects reported in one trial requires further investigation. There is insuff icient evidence to determine the effectiveness of low frequency TENS in reducing dysmenorrhoea. There is also insuff icient evidence to determine the effectiveness of acupuncture in reducing dysmenorrhoea, however a single small but methodologically sound trial of acupuncture suggests bene fit for this modality.

1.3. Specific outcome

1.3.1. Lin 2020 (Acupuncture vs TCM)

Lin J, Liao W, Mo Q, Yang P, Chen X, Wang X, Huang X, Lu D, Ma M, He F, Wu P, Li K, Liang W, Tang H. A systematic review of the efficacy comparison of acupuncture and traditional Chinese medicine in the treatment of primary dysmenorrhea. Ann Palliat Med. 2020;9(5):3288-3292. [212820]. doi

Background Dysmenorrhea is one of the most common symptoms in gynecology. It refers to people who experience lower abdominal pain, swelling, backache, or another discomfort before and after menstruation or during menstruation, which seriously affects the quality of life and work. Clinically, there are many methods to treat primary dysmenorrhea, among which acupuncture and traditional Chinese medicine (TCM) are beneficial. This work aimed to test the efficacy of acupuncture and TCM in the treatment of primary dysmenorrhea and hope to supply more reliable evidence for clinical treatment.
MethodsWe searched articles from the Wanfang database and China National Knowledge Infrastructure and collected the clinical, randomized, or quasi-randomized controlled trials of acupuncture compared with TCM for primary dysmenorrhea. We tested the quality and data of the included studies according to the Cochrane criteria and compiled detailed systematic reviews and meta-analysis.
ResultsSeven articles (including 492 patients) on acupuncture and TCM for primary dysmenorrhea were included in the systematic review. Seven studies were included in the final analysis, and there was no heterogeneity among the studies (P=0.98, I2=0%). The results showed that the clinical effectiveness of acupuncture was better than TCM (OR: 4.86, 95% CI: 2.84-8.33, Z =5.75, P<0.00001).
Conclusions The efficacy of acupuncture is superior to TCM in the treatment of primary dysmenorrhea.

1.4. Methodological quality of studies

1.4.1. Su 2007

Su Li, Deng Bai-Ying, Liang Liu, Zhang Jian-Fei, Wang Chao-Dong. [Quality evaluation to all literature of acupuncture and moxibustion treating painful menstruation]; Journal of Liaoning University of Traditional Chinese Medicine 2007; 9(3):76-8. [159859]

Objectives Understand domestic acupuncture and moxibustion treats clinical trials state of menstruation and carries on the method to study the quality evaluation to all literature.
Methods Examine through machine and hand examine, win acupuncture and moxibustion clinic to treat menstruation contrast and treat and test (RCT) the literature and analyze too literature according to following the medical pieces of literature actually, accord with random contrasting of literature to test (RCT) (account for 8.98), diagnose with curative effect 16 of standard clearly among here 29 literatures (account for 55.17).
Conclusions Acupuncture and moxibustion treat clinical random controlled studies (RCT) of menstruation quality take, wait for, raise, should follow the clinical research characteristics that acupuncture and moxibustion treat menstruation, explore that sets up the best healing solution, in order to improve clinical curative effect.

2. Overviews of Systematic Reviews

2.1. Yang 2020

Yang J, Xiong J, Yuan T, Wang X, Jiang Y, Zhou X, Liao K, Xu L. Effectiveness and Safety of Acupuncture and Moxibustion for Primary Dysmenorrhea: An Overview of Systematic Reviews and Meta-Analyses. Evid Based Complement Alternat Med. 2020. [209251]. doi

Background Acupuncture and moxibustion have been accepted as treatment options for primary dysmenorrhea (PD). So far, several systematic reviews (SRs) and meta-analyses (MAs) have reported on the efficacy and safety of acupuncture and moxibustion in treating PD.
Objectives The aim of this study was to critically summarize the evidence from relevant SRs and MAs reporting on the efficacy and safety of acupuncture and moxibustion in treatment of PD.
Materials and Methods Seven electronic databases, including Cochrane Database of Systematic Reviews, EMBASE, PubMed, SinoMed, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang database, were systematically searched. SRs or MAs about acupuncture for PD published up to May 2019 were included in the analysis. More than two authors independently assessed the quality of the evidence by AMSTAR2, PRISMA, PRISMA-A, and GRADE approach.
Results A total of 28 SRs and MAs, 281 original studies, reporting on 26,459 female patients were analyzed. The majority of the SRs were of moderate reporting quality and poor methodological quality. Moderate-quality evidence suggested that acupuncture and moxibustion were more effective compared to indomethacin or Fenbid in treating PD. Low-quality evidence suggested that, compared to NSAIDs, acupuncture and moxibustion could relieve pain with less adverse effects.
Conclusion Acupuncture and moxibustion seem to be effective and safe approaches in treatment of PD; yet, the methodological quality of most of the studies and the quality of evidence were low. Thus, additional studies are required to further confirm these results.

3. Clinical Practice Guidelines

⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation (or lack of evidence)

3.1. Australian and New Zealand College of Anaesthetists (ANZA) 2020 ⊕

Acute Pain Management: Scientific Evidence Australian and New Zealand College of Anaesthetists (ANZA). 2020:1317P. [205268] . URL.

Acupuncture or acupressure may be effective in the treatment of primary dysmenorrhoea (S) (Level I [Cochrane Review]).

3.2. American College of Obstetricians and Gynecologists 2018 ⊕

Dysmenorrhea and endometriosis in the adolescent. ACOG Committee Opinion No. 760. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;132:e249-58. [197580].

Transcutaneous electrical nerve stimulation, acupuncture, herbal preparations, and yoga have demonstrated improvement in dysmenorrhea in some studies, but current evidence does not support them as first-line complementary and alternative therapies.
Adolescents with endometriosis often benefit from ongoing education and support and integration of other multidisciplinary services such as biofeedback, pain management teams, acupuncture, and herbal therapy.

3.3. National Institute for Health and Clinical Excellence (NICE, UK) 2018 Ø

National Clinical Guideline Centre. Dysmenorrhoea London (UK): National Institute for Health and Clinical Excellence (NICE). 2018;:14p. [193206].

There is a lack of good-quality evidence to support the use of herbal remedies, dietary supplements, acupuncture, acupressure, spinal manipulation, behavioural therapy, and exercise to treat dysmenorrhoea.

3.4. Emblemhealth (insurance provider, USA) 2017 ⊕

Acupuncture — Medicare Dual-Eligible Members Emblemhealth. 2017. [111547].

Members with the Medicare Dual-Eligible benefit are eligible for acupuncture when performed by an individual licensed by New York State to perform acupuncture and when performed for the following diagnoses: 1. Adult postoperative nausea and vomiting 2. Chemotherapy related nausea and vomiting 3. Pregnancy related nausea and vomiting 4. Carpal tunnel syndrome 5. Epicondylitis (tennis elbow) 6. Headache 7. Low back pain 8. Menstrual pain 9. Myofascial pain 10. Osteoarthritis

3.5. Australian and New Zealand College of Anaesthetists (ANZCA, Autralia- New Zealand) 2015 ⊕

Acute Pain Management: Scientific Evidence. Australian and New Zealand College of Anaesthetists. 2015:714P. [196721].

3. Acupuncture or acupressure may be effective in the treatment of primary dysmenorrhoea (S) (Level I [Cochrane Review]).

Acupuncture. U.S. Navy Bureau of Medicine and Surgery. 2013.17p. [180539].

Category B (limited evidence): Authorized but not recommended for routine use (consider as adjunct). Menstrual cramps

3.7. Royal College of Obstetricians and Gynaecologists 2012 Ø

Acupuncture and Chinese Herbal Medicine for Women with Chronic Pelvic Pain Scientific Impact Paper No. 30. Royal College of Obstetricians and Gynaecologists. 2012. [197593].

Acupuncture and CHM may have roles to play in the treatment of CPP associated with dysmenorrhoea, endometriosis, IBS and PID, either as an adjunct or as an alternative to conventional treatments. Unfortunately the current evidence lacks rigour and the available trials are frequently small, poorly designed, and inadequately reported. As a consequence we can only consider this preliminary evidence. This area clearly requires further more rigorous investigation

3.8. Society of Obstetricians and Gynecologists of Canada (SOGC, Canada) 2005 ⊕

Lefebvre G, Pinsonneault O. Primary Dysmenorrhea Consensus Guideline. J Obstet Gynaecol Can. 2005;27(12):1117-30. [165636].

Women who inquire about alternatives to relieve dysmenorrhea may be instructed that, at the present time, there is limited evidence that acupuncture may be of benefit (II-B),