GYNAECOLOGY RESEARCH © JCM Ltd

ACUPUNCTURE FOR MENOPAUSAL HOT FLUSHES
A multicentre randomised clinical study of menopausal women has concluded that acupuncture carried out in addition to usual care is associated with marked clinical improvement in hot flushes and other menopause-related symptoms. One hundred and seventy five Korean women were randomised to receive 12 sessions of acupuncture over four weeks in addition to usual care, or to usual care alone. The mean change in the average 24 hour hot flush score was -16.57 in the treatment group compared with -6.93 in the control group, a significant difference. Scores for psychological, somatic and urogenital symptoms of menopause also showed significant improvement in the acupuncture group compared with the control group. (Effects of acupuncture on hot flashes in perimenopausal and postmenopausal women - a multicenter randomised clinical trial. Menopause. 2009 Nov 10. [Epub ahead of print]).

MOXIBUSTION EFFECTIVE FOR BREECH PRESENTATION
UK researchers exploring the effects of moxibustion on breech presentation have concluded that it creates a better chance of achieving vaginal delivery. In a prospective multicentre study, 76 pregnant women were taught how to apply moxibustion and instructed to continue it at home, twice a day, for seven days. If breech presentation persisted after treatment, external cephalic version (ECV) was carried out. After moxibustion 40.8% of breech presentations spontaneously turned and a further 43.4% of breech presentations were turned by ECV. Women who involved other people in the administration of moxibustion were found to be twice as likely to successfully achieve breech version. Multiparous women were also 16% more likely than primiparous women to achieve spontaneous version with moxibustion. Of the women who were successful in turning their babies using moxibustion, 88% went on to have a normal birth and 12% had a caesarean section. The authors conclude that moxibustion treatment should be offered to all women with a breech presentation. (Factors affecting the success of moxibustion in the management of a breech presentation as a preliminary treatment to external cephalic version. Midwifery. 2009 Dec;25(6):774-80).
       Spanish authors have carried out a systematic review of the evidence for moxibustion to correct nonvertex presentation of the foetus. Six studies with 1087 subjects and a high degree of heterogeneity compared moxibustion with observation or postural methods. Meta-analysis showed a rate of cephalic version for moxibustion of 72.5% versus 53.2% in the control group; the number of women who would have to be treated with moxibustion to achieve one breech version was calculated to be five. No significant safety differences were found between moxibustion and other techniques. The authors conclude that moxibustion at Zhiyin BL-67, whether used alone or in combination with acupuncture or postural measures, produces a positive effect on the correction of nonvertex presentation compared with observation or postural methods alone. (Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis. Am J Obstet Gynecol. 2009 Sep;201(3):241-59).

ACUPUNCTURE FOR FEMALE GENITAL PAIN
A Canadian pilot study has found that acupuncture has positive effects on provoked vestibulodynia (PVD), a distressing genital pain condition affecting women. Eight women with PVD (mean age 30) underwent ten one-hour acupuncture sessions with needle placement according to an individual TCM diagnosis. Analysis of the results showed significant decreases in helplessness (a measure on the Pain Catastrophising Scale) and pain with manual genital stimulation. It also revealed strong (though nonsignificant) effects for improved ability to have intercourse and sexual desire. Qualitative analysis of patient interviews showed overall positive effects of acupuncture and revealed an improvement in perceived sexual health, reduced pain and improved mental well-being in the majority of participants. (J Sex Med. 2009 Nov 12. [Epub ahead of print]).

ACUPRESSURE DECREASES PAIN AND DURATION OF LABOUR
Iranian clinicians have found that acupressure at Sanyinjiao SP-6 can decrease the duration and severity of pain in the active phase of labour, lower the requirement for oxytocin and reduce the need for caesarean section. One hundred and twenty nulliparous women at the beginning of the active phase of labour were randomised to receive either acupressure at Sanyinjiao SP-6 for 30 minutes during contractions, or light touch at this point. In the absence of forceful contractions two hours later, oxytocin infusion was initiated. The mean duration of the active phase was significantly shorter in the treatment group (252.37 minutes versus 441.38 minutes). 10% of patients in the acupressure group and 41.7% of the control group delivered via cesarean section. Pain severity in the acupressure group was less than the control group (5.87 versus 6.79). 41.7% of the acupressure group and 63.3% in the control group required oxytocin. The amount of oxytocin used in the acupressure group was also less than the control group (73.33 ml vs. 126.6 ml). (J Matern Fetal Neonatal Med. 2009 Sep 15:1-4. [Epub ahead of print]).

ACUPUNCTURE DECREASES POST-CAESARIAN PAIN
A Chinese study has shown that acupuncture at Sanyinjiao SP-6 can decrease the amount of analgesia required in the first 24 hours after caesarian section. Sixty women who had spinal anesthesia during caesarian section were randomly assigned to receive either acupuncture or electro-acupuncture at bilateral Sanyinjiao SP-6, or to a control group. Women in the acupuncture and electro-acupuncture groups delayed the time of requesting morphine up to 11 minutes later than the control group. The total dose of patient-controlled analgesia (PCA) used within the first 24 hours was 30%-35% less in the acupuncture groups compared with the control group, which was statistically significant. There was no significant difference between acupuncture and electro-acupuncture. Both acupuncture groups’ pain scores were significantly lower than the control group's within the first two hours. Two hours later, however, there were no significant differences in pain scores between groups. The incidence of opioid-related side effects, such as dizziness, was also less in the acupuncture groups. (Effects of acupuncture on post-cesarean section pain. Chin Med J (Engl). 2009 Aug 5;122(15):1743-8).

CHINESE HERBS COMPARABLE TO HORMONES FOR ENDOMETRIOSIS
UK authors have carried out a systematic review of the use of Chinese herbal medicine (CHM) for endometriosis-related pain and infertility. Database searches revealed 100 relevant studies, but only two Chinese RCTs were deemed of high enough quality for analysis. Meta-analysis of the pooled results involving a total of 158 women concluded that administration of CHM after laparoscopic surgery for endometriosis has effects comparable to those achieved with the drug gestrinone (a synthetic progesterone that suppresses the secretion of oestrogen by the ovaries), but with fewer side effects. In addition they concluded that oral CHM may have a better overall treatment effect than danazol (synthetic testosterone) and that it may be more effective in relieving dysmenorrhea and shrinking endometrial masses when used in conjunction with a CHM enema. (Chinese herbal medicine for endometriosis. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD006568).

ELECTRO-ACUPUNCTURE FOR PCOS
Acupuncture can lower high sympathetic nerve activity, which may be a contributory factor in the aetiology of polycystic ovary syndrome (PCOS). A Swedish team, which has previously found that women with PCOS have significantly higher sympathetic nerve activity than controls, investigated the effect of low-frequency electroacupuncture (EA) and physical exercise on the sympathetic activity of a muscle fascicle of the peroneal nerve. In a randomised controlled trial, twenty women with PCOS were randomly allocated to low-frequency EA, physical exercise, or no treatment for a 16 week period. Both EA and exercise were found to decrease muscle sympathetic nerve activity although no differences were found between the groups in haemodynamic, endocrine, and metabolic variables. (Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol. 2009 Aug;297(2):R387-95). Researchers at the same institute have also carried out animal studies that have shown that EA and exercise downregulate the expression of gene markers of sympathetic activity and improve ovarian morphology. The ovaries of rats treated with EA or exercise display a higher proportion of healthy antral follicles and a thinner theca interna cell layer than those of untreated PCOS rats. (Acupuncture and exercise restore adipose tissue expression of sympathetic markers and improve ovarian morphology in rats with dihydrotestosterone-induced PCOS. Am J Physiol Regul Integr Comp Physiol. 2009 Apr;296(4):R1124-31).

ACUPUNCTURE FOR MENOPAUSAL HOT FLUSHES
A systematic review by a Korean team has assessed the effectiveness of acupuncture as a treatment for menopausal hot flushes. They searched 17 databases, without language restrictions, for randomised clinical trials (RCTs) of acupuncture versus sham acupuncture. Six RCTs met the inclusion criteria. The authors concluded that the results of sham-controlled RCTs fail to show specific effects of acupuncture for control of menopausal hot flushes. (Acupuncture for treating menopausal hot flushes: a systematic review. Climacteric. 2009 Feb;12(1):16-25). Meanwhile, an RCT carried out in China has explored the effects of acupuncture and auricular acupressure in relieving menopausal hot flushes in women who had undergone bilateral ovariectomy. Forty-six women were randomised into an acupuncture/auricular acupressure group and a hormone replacement therapy (HRT) group. After treatment both severity and frequency of hot flushes in the two groups were relieved significantly, compared with pre-treatment, with no significant difference in severity of hot flushes between the two groups. At four week follow-up, the severity of hot flushes in the HRT group was alleviated more. After treatment, levels of FSH decreased significantly and levels of PGE2 increased significantly in both groups. The increase in the HRT group was greater. The authors conclude that acupuncture and auricular acupressure can be used as alternative treatments to relieve menopausal hot flashes for bilaterally ovariectomised women who are unable or unwilling to receive HRT. (Acupuncture and Auricular Acupressure in Relieving Menopausal Hot Flashes of Bilaterally Ovariectomized Chinese Women: A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2009 Feb 2. [Epub ahead of print]). Meanwhile a Korean study has investigated the use of moxibustion in treating menopausal hot flushes. Fifty-one participants were randomly assigned into three groups, moxibustion protocol 1, moxibustion protocol 2 and wait list control. The moxibustion groups received 14 sessions of moxibustion over four weeks. The protocols were supported by evidence from clinical experts (group 1) or published literature (group 2), and participants were followed for an additional two weeks after the end of the study. By week four, the difference in severity and frequency of hot flushes was statistically significant between the treatment and the control groups. In addition, there was a statistically significant difference in Menopausal-Specific Quality of Life Scale scores between treatment group 2 and the other groups. (Moxibustion for treating menopausal hot flashes: a randomized clinical trial. Menopause. 2009 Mar 13).

JAPANESE-STYLE ACUPUNCTURE FOR ADOLESCENT ENDOMETRIOSIS PAIN
A US randomised, sham-controlled pilot study has assessed the use of Japanese-style acupuncture for reducing chronic pelvic pain and improving health-related quality of life (HRQOL) in adolescents with endometriosis. Eighteen young women (13-22 years) with laparoscopically-diagnosed endometriosis-related chronic pelvic pain were treated with either Japanese style acupuncture or sham acupuncture. Participants in the active acupuncture group experienced an average 4.8 point reduction in pain measured on a 11 point scale (62%) after four weeks, which differed significantly from the control average reduction of 1.4 points. Reduction in pain in the active group persisted at six-month follow up; however, after four weeks, differences between the active and control group decreased and were not statistically significant. All HRQOL measures indicated greater improvements in the active acupuncture group compared with controls; however, the majority of these trends were not significant. (Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial. J Pediatr Adolesc Gynecol. 2008 Oct;21(5):247-57).
   
ACUPUNCTURE FOR PAINKILLER-RESISTANT PERIOD PAIN
Italian scientists have evaluated the effect of acupuncture on dysmenorrhoea that is resistant to treatment by non-steroidal anti-inflammatory drugs (NSAIDs). Fifteen patients received eight weekly acupuncture treatments (at Taixi KID-3, Taichong LIV-3, Gongsun SP-4, Zusanli ST-36, Tianshu ST-25, Guilai ST-29, Qichong ST-30, Guanyuan REN-4, Qihai REN-6, Shenmai BL-62, Shenmen HT-7, Hegu LI-4, Neiguan PC-6 and Zigong (M-CA-18). Patients were allowed to continue using painkillers as necessary. Pain was measured on a visual analogue scale at baseline (T1) and four time points: mid-treatment (T2), end of treatment (T3) and three (T4) and six months (T5) after the end of treatment. A substantial reduction in pain and NSAID use was observed in 87% of patients. Pain intensity was significantly reduced with respect to baseline by 64, 72, 60 and 53% at T2, T3, T4 and T5. Average pain duration at baseline (2.6 days) was significantly reduced by 62, 69, 54 and 54% at T2, T3, T4 and T5. Average NSAID use was significantly reduced by 63, 74, 58 and 58% at T2, T3, T4 and T5, respectively, and ceased totally in seven patients, who were still asymptomatic six months after treatment. (Acupuncture Treatment of Dysmenorrhea Resistant to Conventional Medical Treatment. Evid Based Complement Alternat Med. 2008 Jun;5(2):227-230.)

ACUPUNCTURE COST-EFFECTIVE FOR DYSMENORRHOEA
In another German study, the clinical effectiveness and cost-effectiveness of acupuncture in patients with dysmenorrhoea was studied. In a randomised controlled trial plus non-randomised cohort, patients with dysmenorrhoea were randomised to 15 sessions of acupuncture over three months or to a control group (no acupuncture). All subjects were allowed to receive usual medical care. Of 649 women, 201 were randomised. Those who declined randomisation received acupuncture treatment. After three months, the average pain intensity was lower with acupuncture than without (3.1 vs. 5.4). The authors concluded that additional acupuncture in patients with dysmenorrhoea was associated with improvements in pain and quality of life as compared to usual care alone and was cost-effective within usual thresholds (overall ICER 3,011 euros per QALY). (Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008 Feb;198(2):166.e1-8).

ACUPUNCTURE FOR POLYCYSTIC OVARIES
A review article has evaluated the use of acupuncture to prevent and reduce symptoms related with polycystic ovary syndrome (PCOS). Reporting on experimental observations in rat models of polycystic ovaries and clinical data from studies in women with PCOS, the Swedish authors suggest that acupuncture can affect PCOS via modulation of the neuroendocrine system (in particular the sympathetic nervous system) and can exert long-lasting beneficial effects on the metabolic and endocrine systems and on ovulation. (Acupuncture in Polycystic Ovary Syndrome: Current Experimental and Clinical Evidence. J Neuroendocrinol. 2007 Nov 28 [Epub ahead of print]).

CHINESE HERBAL MEDICINE BETTER THAN DRUGS FOR DYSMENORRHOEA
The evidence supporting the use of Chinese herbal medicine (CHM) for primary dysmenorrhoea is promising, but better quality research on the subject is still required. These are the conclusions of a systematic review by Australian researchers, which included 39 RCTs involving a total of 3475 women. CHM was found to result in significant improvements in pain relief, overall symptoms and use of additional medication when compared with use of pharmaceutical drugs. CHM also resulted in better pain relief than either acupuncture or heat compression in the studies analysed. There were no indications that CHM caused any adverse events. (Chinese herbal medicine for primary dysmenorrhoea. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005288).

ACUPUNCTURE ‘AS GOOD AS HRT’ AFTER OOPHORECTOMY
Acupuncture results in a significant improvement in perimenopausal symptoms in women who have had their ovaries surgically removed (oophorectomy). Sixty-seven women who had undergone oophorectomy were non-randomly divided into two groups. One group was given acupuncture and the comparison group was given usual medical care (HRT drug Livial - a combination of synthetic oestrogen, progesterone and androgen). Kupperman index score (a scale for measuring the severity of menopausal complaints) and levels of serum beta-endorphin were found to differ significantly between the acupuncture and the Livial group. Based on these findings, the authors concluded that acupuncture performs as well as or better than Livial, but cautioned that bias and small sample size may have influenced the results. (Acupuncture for perimenopausal symptoms in women who underwent oophorectomy a comparative study. Forsch Komplementarmed. 2007 Feb;14(1):25-32).

ACUPUNCTURE REDUCES HOT FLUSH SEVERITY
Acupuncture is associated with a significant decrease in the severity, but not the frequency, of postmenopausal hot flushes. In a randomised, placebo-controlled pilot study, 29 postmenopausal women averaging at least seven moderate to severe hot flushes per 24 hours, were randomised to receive seven weeks (nine treatment sessions) of either active acupuncture (standardised, individually-tailored point prescriptions) or placebo acupuncture (non-penetrating placebo needles at sham acupuncture points). Those receiving active treatment had a significantly greater reduction in hot flush severity than those receiving placebo. There was no significant difference in the reduction of hot flush frequency between the active and placebo groups, however both groups experienced significantly fewer episodes of flushing. (Acupuncture for postmenopausal hot flashes. Maturitas. 2007 Apr 20;56(4):383-95).

ACUPUNCTURE COST-EFFECTIVE FOR PERIOD PAIN
A pragmatic randomised study has evaluated the clinical and economic effectiveness of acupuncture in the treatment of women with dysmenorrhoea. 201 patients were allocated to receive either up to 15 acupuncture sessions over three months or no acupuncture. Both groups additionally received usual medical care. Outcome measures of pain intensity and quality of life were recorded at baseline and after three months. After three months, patients in the acupuncture group were found to have less pain than controls. A cost-effectiveness calculation was performed, based on calculating quality-adjusted life years (QALYs). This analysis showed that although acupuncture treatment incurred additional costs when compared with usual care, the improvement to patient’s quality of life means it can be regarded as cost-effective when compared with international benchmarks. (Pragmatic randomised study evaluating clinical and economic effectiveness of acupuncture treatment in patients with dysmenorrhoea. Focus Altern Complement Ther. 2006;11(S):53).

ACUPUNCTURE & HOT FLUSHES
In a study of 29 postmenopausal women who experienced at least seven moderate to severe hot flushes a day, active acupuncture was found to significantly decrease the severity of nocturnal flushes (by 28%) compared to 6% in women given sham acupuncture. The frequency of flushes was reduced by more in the active treatment group compared to the sham but not significantly so. (A randomized controlled pilot study of acupuncture for postmenopausal hot flashes: effect on nocturnal hot flashes and sleep quality. Fertility and Sterility, September 2006; Vol. 86: pp. 700-710).

ACUPUNCTURE & ENDOMETRIAL PAIN
A study of 101 women (aged 20 to 40), of whom 83 completed the trial, with laparoscopic-proofed endometriosis, randomised them to one of two groups. The first received specific acupuncture for the condition while the other were treated at non-specific points (points with no relation to the diagnosis). Treatment was given twice weekly for ten weeks. After a two month interval, the two groups changed. There was a highly significant decrease in ain levels in the specific group compared to the non-specific group where the pain remained nearly unchanged. (Is acupuncture in addition to conventional medicine effective as pain treatment for endometriosis? A randomised controlled crossover trial. Focus Altern Complement Ther 2006; 11: 42).

ACUPRESSURE & DYSMENORRHOEA
In a study which compared acupressure at Sanyinjiao SP-6 with simple resting for female technical college students in Taiwan suffering from dysmenorrhoea, the acupressure – whether in the form of treatment or self-treatment – was found to significantly reduce pain. (J Adv Nurs. 2004 Nov; 48(4):380-7).

ACUPUNCTURE FORT MENOPAUSAL SYMPTOMS
In a randomised study, women suffering menopausal symptoms were treated either with acupuncture points specifically chosen to treat their disorder, or more general qi tonifying acupuncture. The acupuncture specific group showed a decrease in mean monthly hot flush severity whilst the comparison acupuncture treatment group showed no significant changes. Sleep disturbances in the point specific acupuncture treatment group also declined over the study, whilst mood changes in both groups showed a significant difference between the baseline and the third month of the study. (Holist Nurs Pract. 2003 Nov-Dec;17(6):295-9).

ORIENTAL HERBAL MEDICINE FOR MENOPAUSE
A Japanese study compared the use of traditional Kampo herbal formulas and HRT, in two groups of women suffering menopausal symptoms. In the 18 patients in the Kampo group, treatment was able to alleviate the whole range of symptoms, whilst in the 16 women in the HRT group, symptoms such as cold limbs, sleeping disorders, shoulder stiffness/lumbago, and fatigue, were unaffected. In addition, the serum level of oestradiol in postmenopausal women was raised by the combined use of two Kampo formulas. (Gynecol Obstet Invest 2004;57:144-148).

HERBAL MEDICINES FOR DYSMENORRHOEA
In a Japanese study, two herbal medicine prescriptions administered alternately within the menstrual cycle were found to have powerful antidysmenorrhoeic effects. The two prescriptions were Shakuyaku-kanzo-to (Shao Yao Gan Cao Tang/Peony & Licorice Decoction) and Toki-shakuyaku-san (Dang Gui Shao Yao San/Tangkuei and Peony powder). All 17 dysmenorrhea patients in the study, including recurrent endometriotic and adenomyotic patients obtained complete relief within three months. Nine of 12 patients treated with the herbal therapy ovulated and all three secondary ammenorrhoea patients with moderate levels of serum estradiol, but none of the three secondary amenorrhoea patients with little serum estradiol, also ovulated. One of the treated patients, who had a history of 10 repetitive spontaneous abortions. carried the 11th pregnancy to term. (Clin Exp Obstet Gynecol. 2003;30(2-3):95-8).

ACUPUNCTURE & POLYCYSTIC OVARIAN SYNDROME
24 women with polycystic ovarian syndrome who had amenorrhoea or oligomenorrhoea, 19 or whom were resistant to clomiphene, were given 10-14 mostly electro-acupuncture treatments at points Shenshu BL-23, Pangguangshu BL-28, Sanyinjiao SP-6, Yinlingquan SP-9, Neiguan P-6, Waiguan SJ-5 and Baihui DU-20. 9 women, , 7 of whom were clomiphene resistant, showed a significant rise in rate of ovulation. (Acta Obstet Gynecol Scand 2000;79:180-8).