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Can acupuncture help with premenstrual syndrome (PMS)?

Can acupuncture help with premenstrual syndrome (PMS)?

Researcher Lianne Aquilina, who is also a British Acupuncture Council member, considers the evidence supporting claims that acupuncture can help women manage severe premenstrual syndrome (PMS).

Q: Can you describe the symptoms of severe PMS?

A: Generally, PMS refers to physical, emotional and behavioural symptoms that occur in the two weeks prior to the onset of menstruation. This condition affects a woman’s quality of life and the term applies when the symptoms occur for two or more consecutive menstrual cycles. A woman is asked to subjectively record her symptoms in a diary before a diagnosis is made. Diagnosis is made based on the timing of and also severity of her symptoms.

Severe PMS is possibly currently underdiagnosed, with different estimates of prevalence. A differential diagnosis may need to be made. Women with severe PMS can benefit from management by a multidisciplinary specialist team of health professionals, which could include a professional acupuncturist.

Q: What does the current research show us?

A: A Cochrane systematic review found that acupuncture may help to improve the overall mood and physical symptoms of PMS compared to sham acupuncture. Acupressure was found to possibly produce a reduction in the number of women experiencing severe or moderate PMS and improve the physical and mental aspects associated with her quality of life.

This research is based on a small number of women and clinical trials. A more recent review with a much larger sample size of women and clinical trials found acupuncture reduced the symptoms of moderate to severe PMS.

The limitations in the existing results are that some acupuncture trials were found to be potentially at high risk of bias due to lack of blind-testing of women and incomplete data. Reporting of randomisation methods and allocation concealment should be improved to be clearer in regard to selection bias.

It is also necessary to note that, while selective serotonin reuptake inhibitors (SRRIs) are a routine treatment recommended for severe PMS, a Cochrane systematic review reveals limitations that should also be considered. Researchers assessing the risk of bias were not able to determine whether there was a high risk or low risk of bias across many domains including methods of randomisation (sequence generation and allocation concealment), blind-testing and selective reporting bias. Certain findings in this review are based on low-quality evidence.

The researchers of the Cochrane review on acupuncture and PMS did not identify any trials where acupuncture was compared to current recommended pharmaceutical management for PMS (SSRIs).  Future research could answer this very important question: “how does acupuncture compare to usual care?”

For now, in the UK, acupuncture should be based on a case by case management basis. This is similar to how other medical professionals manage their patients (according to NICE guidelines).

Q: In your opinion, how does acupuncture help with the emotional symptoms of PMS such as irritability and mood swings?

A: Many women who suffer with severe PMS describe great upset, irritability, frustration, anger, sensitivity, depression and anxiety, as well as lethargy or restlessness. There are many other possible physical symptoms. The onset of a period modifies a woman’s perspective and emotional symptoms abate, albeit only until the next point of the menstrual cycle.

Acupuncture reduces severe PMS through mechanisms associated with relaxation, and by ‘regulation of the menstrual cycle.’ This model of regulating the menstrual cycle diverges from conventional approaches. Ancient transcripts focused on helping women with menstrual cycle irregularities; PMS falls under this category. Central to this, a professional acupuncturist would take a detailed history of her patient’s menstrual cycle. Using this model of health, PMS is better understood.

It is important to point out that the current conventional standpoint is that PMS is not fully understood. PMS is thought to be due to hormonal change, and some research with limitations indicates that serotonin reuptake inhibitors (SSRIs) have been found to be effective for symptom relief. Research into the scientific mechanisms of acupuncture have identified biochemical markers that influence health, including serotonin. Acupuncture modulates stress, regulates hormones and relaxation. For information about the scientific mechanisms of acupuncture visit Evidence Based Acupuncture.

Q: Do you think acupuncture can provide immediate relief from certain symptoms? How many treatment sessions before most patients start to notice the effects?

A: Yes. Clinically, immediate relief is often in the form of an overall improved sense of wellbeing. Women are likely to notice these changes after a few treatments.

I recommend weekly acupuncture treatment up to three menstrual cycles before assessment of the full impact of treatment effect. This is similar to the time needed to assess the impact of pharmaceutical management.

However, there is now a pressing requirement for an expert consensus committee to determine the adequate acupuncture dose response and to pilot a standardised intervention, as acupuncture was found to be significantly effective even though the frequency, number and timing of experimental acupuncture varied considerably.

Q: What other treatments are available to women?

A: Cognitive behavioural therapy may be useful to equip them with management skills. 

In general, self-care includes regular exercise, reducing alcohol, stopping smoking (if applicable). A balanced diet is helpful; in particular, it is recommended that small, balanced meals rich in complex carbohydrates are best every few hours. Stress management and ensuring 7-8 hours of sleep nightly may have positive effects as well.

As mentioned, serotonin reuptake inhibitors (SSRIs) are an available option, as previously discussed. Side effects, such as nausea, body aches and fatigue, are relative to the dose of medication. Acupuncture may help manage the side effects of medication, as well as physical symptoms such as pain.

Women who are suffering with severe PMS or PMDD (premenstrual dysphoric disorder) without support really should feel able to visit their GP to discuss available treatment and self-care options and referral to other health professionals.

Q: What do you recommend to patients based on the evidence?

A: Management of severe PMS should be based on severity and symptomology of the person and should include their treatment preferences.

My recommendations to patients suffering from severe PMS, based on the evidence, are similar to the updated recommendations by the National Institute Clinical Excellence (NICE):  that there is possibly some benefit to complementary treatment such as acupuncture.

Like NICE, I indicate that although the evidence base has certain limitations, some women with severe PMS may benefit from a holistic approach such as acupuncture. More research is recommended that considers and resolves current limitations.

Most importantly she should be able to discuss the options available and make an informed healthcare choice.

Links to Support and Further Information

Mind UK: http://mind.org.uk
PMS UK: http://www.pms.org.uk

 

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