Gynaecology and acupuncture: The evidence for effectiveness
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This paper evaluates the evidence for the effectiveness of acupuncture in the treatment of primary dysmenorrhoea, dysfunctional uterine bleeding and chronic pelvic inflammatory disease. The results of the studies indicate that acupuncture can be highly effective for the treatment of primary dysmenorrhoea. It may be a valuable treatment for the other two conditions as well, but as yet little evidence has been collected.
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The Evidence Series of Briefing Papers aims to provide a review of the key papers
in the literature, which provide evidence of the effectiveness of acupuncture in the
treatment of specific conditions. The sources of evidence will be clearly identified
ranging from clinical trials, outcome studies and case studies. In particular this series
of briefing papers will seek to present, discuss and critically evaluate the evidence.
Introduction
Menstrual problems are a common cause for presentation to both the general practitioner
and the gynaecology out patients’ clinic.
In a British survey (Scrambler and Scambler 1985), 79 women between the ages of 16 and
44 compiled health diaries and 82% reported at least one distressing symptom associated
with menstruation. Ten years later in Canada it was found that gynaecological conditions
were one of the most frequently mentioned primary health problems and accounted for at
least 8% of patients consulting acupuncturists (Kelner & Welman 1997). Acupuncture has
been used in China for gynaecological problems for 2000 years.
Literature Search
A search was made on the specialist acupuncture database, ARRCBASE. ARRCBASE is
a composite database, which has been built up by the Acupuncture Research Resources
Centre, and incorporates relevant articles from the British Library’s AMED and the US
Medline databases. Using the terms ‘dysmenorrhoea’, ‘amenorrhoea’, ‘premenstrual
syndrome’, ‘PMS’, ‘menorrhagia’, ‘metrorrhagia’ and ‘menstruation’ 102 references were
found. This number was reduced to 11 when foreign language articles, letters, herbal
medicine articles and articles concerned solely on treatment were excluded. These 11
articles included 2 randomised controlled trials evaluating acupuncture and
dysmenorrhoea and 9 outcome studies of which 5 related to dysmenorrhoea, 3 to uterine
bleeding and 1 to pelvic inflammatory disease.
Introduction to the Trials
Whilst the results from outcome studies are useful indicators of effectiveness, randomised
controlled trials (RCT) are generally considered more rigorous. An evaluation of efficacy
takes place where an RCT is designed to assess the specific effect of acupuncture
treatment while excluding the other non-specific effects of treatment generally.
The 2 controlled trials reviewed both related to dysmenorrhoea (Helms1987 and Thomas
et al 1995). Outcomes were assessed through the analysis of monthly symptom evaluation
forms maintained by the patients.
The 9 outcome studies all followed a group of patients treated with acupuncture. Patient
response to treatment was assessed by the practitioner and ascribed to one of the following
outcome categories: ‘clinical cure’ with the amelioration of all presenting symptoms,
‘marked improvement’, ‘some improvement’, and ‘no improvement’. The ‘total effective
rate’ included all those who had obtained benefits from treatment. In a number of the
studies, points prescriptions and/or numbers of treatments were standardised. In one trial
(Liu et al 1988), biomedical tests were carried out to further validate findings.
