Gynecological & Reproductive Disorders

 

Gynecological & Reproductive DisordersThe use of acupuncture for treatment of female reproductive disorders can produce excellent results, and is recommended by the World Health Organization (WHO). Various gynecological and reproductive conditions and disorders, such as symptoms associated with menopause, premenstrual syndrome (PMS), infertility, assisted reproductive technology (ART) support, morning sickness, and other pregnancy related problems, are routinely treated by acupuncture.

 

 

Menopause

 

Menopause is the cessation of a woman's reproductive ability, and typically occurs in women in midlife, during their late 40s or early 50s. Although menopause is a natural biological process, the physical symptoms, such as hot flashes and emotional symptoms, may disrupt sleep, lower energy level, and for some women, trigger anxiety or feelings of sadness and loss. Menopause requires no medical treatment. Instead, management focuses on relieving signs and symptoms and preventing chronic conditions that may occur with aging. These include both conventional (e.g., hormone replacement therapy) and alternative (e.g., acupuncture) therapies.(1)


Hormone replacement therapy (HRT) continues to have a clinical role in the management of menopausal symptoms, but there has been a marked global decline in its use due to concerns about its risks and benefits.(2) Consequently many women with menopause symptoms are now seeking alternative therapies. Acupuncture has a long tradition of use for the treatment of different menopause symptoms. A recent systematic reviews on acupuncture in menopausal symptoms suggest that acupuncture is an effective and valuable option for women suffering from menopause. Women who underwent acupuncture experienced a reduction in the severity and frequency of hot flashes for up to 3 months.(3) Acupuncture also improves the emotion and quality of life in women experiencing menopause.(4)


It is hypothesized that acupuncture may trigger a reduction in the concentration of beta-endorphin (a neuropeptide found in the cells of the central and peripheral nervous system) in the hypothalamus of the brain. Lower levels of beta-endorphin may activate the release of calcitonin gene-related peptide (CGRP), which regulates body temperature. Although further studies are needed to examine the mechanisms of acupuncture for treating menopausal symptoms, the current evidence suggests that acupuncture be an effective alternative for managing menopause symptoms, especially for those seeking non-pharmacologic therapies.(5,6)

 

Sources & References

 

1. Mayo CLinic: Diseases and Conditions - Menopause.

2. Chin J Integr Med. 2011 Dec;17(12):893-7.

3. Menopause. 2015 Feb;22(2):234-44.

4. Menopause. 2010 Mar;17(2):269-80.

5. Menopause. 2010 Mar;17(2):262-8.

6. Menopause. 2009 May-Jun;16(3):484-93.

 

Premenstrual Syndrome (PMS)

 

Premenstrual syndrome (PMS) is related to a woman's menstrual cycle, and has a wide variety of symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression.(1) It's estimated that as many as 3 of every 4 menstruating women experience some form of PMS. Symptoms tend to recur in a predictable pattern. But the physical and emotional changes experienced with PMS may vary from slightly noticeable to intense. While mild PMS cases require no special attention, severe cases may need drug (e.g., antidepressants and hormonal contraceptives) or non-drug (e.g., herbal remedies and acupuncture) intervention.


Acupuncture is widely used for gynaecological conditions. Premenstrual syndrome is one of the major indications for acupuncture in the field of gynaecological disorders. The beneficial effect of acupuncture on this condition has been repeatedly reported in randomized controlled trials.(2,3) Acupuncture relieves pain and also regulates the motility of the uterus to facilitate menstrual discharge and further alleviate the pain. In addition, acupuncture improves the emotion and quality of life in women with PMS. Systematic reviews of controlled trials also show promising results of acupuncture in management of PMS.(4,5)


With respect to the mechanisms, there is good evidence that acupuncture may lead to a release of neurotransmitters, especially beta-endorphin and serotonin in several parts of the brain.(6) These transmitters are involved in descending inhibitory pain control. Another possible mechanism for pain control, but one that awaits confirmation, suggests that needling inactivates ‘trigger points’ in muscles.(7) Trigger points are areas of chronic hyperactivity, initially resulting from physical injury or microtrauma, that may continue to cause pain for a long period of time. Acupuncture may also produce effects through local changes in the tissues, e.g. stimulating blood flow, which facilitates pain relief.(8)

 

Sources & References

 

1. Mayo CLinic: Diseases and Conditions - Premenstrual Syndrome (PMS).

2. Obstet Gynecol. 1987 Jan;69(1):51-6.

3. Acupunct Med. 2013 Dec;31(4):358-63.

4. Arch Gynecol Obstet. 2009 Dec;280(6):877-81.

5. J Fam Plann Reprod Health Care. 2003 Oct;29(4):233-6.

6. Annu Rev Pharmacol Toxicol. 1982;22:193-220.

7. Arch Phys Med Rehabil. 2001 Jul;82(7):986-92.

8. J Tradit Chin Med. 2013 Dec;33(6):757-60.

 

Infertility

 

Infertility is the inability of a couple to get pregnant after one-year unprotected intercourse.(1) Identifiable causes of infertility include: ovulatory disorders (25%), tubal damage (15%), low sperm count or low sperm quality (20%). In about 30% of couples the cause of infertility remains unexplained. Female fertility declines with age, but the effect of age on male fertility is less clear. The difficulties couples encounter when facing fertility problems can lead to stress, which may further decrease chances of conception.(2) Infertility may be managed by conventional or alternative therapies. Acupuncture is a popular treatment choice for infertility.(3)


Acupuncture is reported to be effective in treatment of both female and male infertility.(4,5) In a prospective controlled study,(6) 160 women undergoing assisted reproductive technology (ART) treatment were randomly assigned to a acupuncture and a control group. The subsequent pregnancy rate was significantly higher in the acupuncture group (42.5%) than in the control group (26.3%). In a male infertility study,(7) 16 infertile men receiving acupuncture had significant increases in total unctional sperm fraction, percentage of viability, total motile sperm per ejaculation, and overall integrity of the axonema, compared to the 16 men in the control group.


The possible mechanisms of acupuncture for treatment of infertility include: (i) regulating fertility hormone level by promoting the release of beta-endorphin in the brain, which affects the release of gonadotrophin releasing hormone by the hypothalamus, follicle stimulating hormone from the pituitary gland, and oestrogen and progesterone levels from the ovary;(8) (ii) increasing blood flow to the reproductive organs to enhance the environment in which ovarian follicles develop,(9) and to improve the thickness of the endometrial lining to increase the chances of embryo implantation;(10) (iii) improving sperm maturation in the epididymis, increasing testosterone levels, and reducing liquid peroxidation of sperm.(11)

 

Sources & References

 

1. Am J Clin Pathol. 2002 Jun;117 Suppl:S95-103.

2. Soc Sci Med. 1999 Mar;48(5):575-89.

3. Fertil Steril. 2010 May 1;93(7):2169-74.

4. Zhen Ci Yan Jiu. 1986;11(2):86-90.

5. Urologe A. 1984 Nov;23(6):329-33.

6. Fertil Steril. 2002 Apr;77(4):721-4.

7. Arch Androl. 1997 Sep-Oct;39(2):155-61.

8. Acupunct Electrother Res. 1997;22(2):97-108.

9. Acupunct Med. 2006 Dec;24(4):157-63.

10. Hum Reprod. 1996 Jun;11(6):1314-7.

11. J Androl. 2001 Mar-Apr;22(2):173-82.

 

Assisted Reproductive Technology (ART) Support

 

Assisted reproductive technology (ART) is the technology used to achieve pregnancy in procedures such as fertility medication, intrauterine insemination (IUI), in vitro fertilization (IVF) and surrogacy.(1) It is reproductive technology used primarily for infertility treatments. The aims of infertility treatment in conventional medicine are to achieve the delivery of one healthy baby, and to reduce the distress associated with infertility, with minimal adverse effects. Acupuncture is possibly the most popular alternative therapy for infertility, and more and more infertility clinics provide or recommend acupuncture in supporting ART technologies.(2)


Acupuncture has recently been studied for its role in supporting ART therapies (IVF and IUI). Although there are exceptions,(3) most clinical trials suggest that acupuncture is useful in the embryo transfer stage of IVF, and results in an increased pregnancy rate and a greater number of live births.(4,5) In a recent study, women who received IUI only (control group) conceived in 39.4% of cases. But those receiving IUI together with acupuncture and Chinese herbal medicine (study group) conceived in 65.5% of cases. Moreover, the average age of the women in the study group was 39.4, compared to 37.1 in the control group (normally, the older the women, the lower the pregnancy rates).(6) The findings support the role of acupuncture in ART therapies.


Acupuncture may help in supporting ART therapies by: (i) regulating fertility hormones - the hypothalamic pituitary-ovarian axis (HPOA);(7) (ii) increasing blood flow to the reproductive organs,(8) which can improve the thickness of the endometrial lining, so increasing the chances of embryo implantation; (iii) improving oocyte quality, which could increase the chance of fertilization;(9) (iv) normalising cortisol and prolactin levels on IVF medication days;(10) (v) reducing stress(11) and promoting embryo implantation.(12)

 

Sources & References

 

1. Assisted Reproductive Technologies - A Guide for Patients. 2011

2. Fertil Steril. 2010 May 1;93(7):2169-74.

3. Fertil Steril. 2009 Mar;91(3):723-6.

4. Trials. 2012 May 18;13:60. doi: 10.1186/1745-6215-13-60.

5. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD006920.

6. Eur J Integr Med. 2011 Jun 3(2):77-81.

7. Acupunct Electrother Res. 1997;22(2):97-108.

8. Acupunct Med. 2006 Dec;24(4):157-63.

9. Zhongguo Zhen Jiu. 2009 Oct;29(10):775-9.

10. Fertil Steril. 2009 Dec;92(6):1870-9.

11. Altern Ther Health Med. 2007 May-Jun;13(3):38-48.

12. Zhongguo Zhen Jiu. 2008 Apr;28(4):254-6.

 

Morning Sickness

 

Morning sickness refers to nausea and vomiting during early pregnancy. It occurs in about 50% of pregnancies, usually between the 6th and 16th weeks. Morning sickness is believed to be due to the drastic change in hormone levels although other factors such as fatigue, stress or emotional may also contribute. Women experiencing nausea and vomiting during pregnancy can suffer considerable physical and psychological stress.(1) The symptoms can affect daily activities and relationships, and result in lost productivity and increased healthcare costs.(2) Abundant evidence exists that acupuncture is useful in preventing and treating morning sickness.


Acupuncture and acupressure at nèiguān (P6) has been repeatedly reported in placebo-controlled studies to be effective in preventing and reducing morning sickness.(3,4) The National Institutes of Health (NIH) Consensus Statement on Acupuncture concluded that promising results have emerged showing the efficacy of acupuncture in treating nausea and vomiting, and the treatment is safe.(5) A 2006 Cochrane systematic review examining acupuncture for nausea and vomiting also concluded that P6 stimulation may be beneficial for various conditions involving nausea and vomiting.(6)


A growing number of studies suggest different mechanisms of acupuncture for treating morning sickness. One study suggest that the anti-emetic effects of acupuncture arise from the resultant increase in hypophyseal secretion of beta-endorphins and adrenocorticotropic hormone (ACTH), with subsequent inhibition of the chemoreceptor trigger zone (CTZ) and vomiting center.(7) Acupuncture also affects the upper gastrointestinal tract, decreasing acid secretion and repressing gastric arrhythmias.(8) Acupuncture at the P6 point may affect the modulation of vagal nerve pathways involved in emesis.(9)

 

Sources & References

 

1. Am J Obstet Gynecol. 2002 May;186(5 Suppl Understanding):S220-7.

2. Curr Med Res Opin. 2007 Apr;23(4):833-40.

3. J Reprod Med. 2001 Sep;46(9):835-9.

4. J Adv Nurs. 2007 Sep;59(5):510-9. Epub 2007 Jul 20.

5. NIH Consensus Statement Program - Acupuncture

6. J Altern Complement Med. 2006 Jun;12(5):489-95.

7. Harefuah. 2003 Apr;142(4):297-300, 316.

8. J Altern Complement Med. 1999 Feb;5(1):27-45.

9. Am J Chin Med. 2005;33(1):157-64.

 

Other Pregnancy Related Problems

 

An overview of systematic reviews of randomized or non-randomized controlled trials across the full spectrum of pregnancy suggests that acupuncture and other TCM approaches may help to: (i) relieve pain (e.g. back and labour pain),(1,2) (ii) improve mood and reduce anxiety,(3) (iii) alleviate dyspepsia,(4) (iv) correct breech presentation (in combination with moxibustion),(5) and, (v) induce labour (acupuncture alone or in combination with acupressure).(6)


The above actions may be achieved by: (i) changing pain processing by releasing endorphins and other neurohumoral factors through stimulating nerves located in muscles and other tissues;(7) (ii) increasing relaxation through reducing serotonin levels, increasing endorphins and neuropeptide Y levels in the brain and spinal cord;(8) (iii) reducing inflammation through promoting release of vascular and immunomodulatory factors;(9) and, (iv) increasing cortico-adrenal secretion, placental estrogens, and changes in prostaglandin levels, which lead to raised basal tone of the uterus and enhanced movement of the fetus.(10)

 

Sources & References

 

1. Am J Obstet Gynecol. 2004 Nov;191(5):1573-9.

2. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD009232.

3. Acupunct Med. 2007 Sep;25(3):65-71.

4. Acupunct Med. 2009 Jun;27(2):50-3.

5. Am J Obstet Gynecol. 2009 Sep;201(3):241-59.

6. J Altern Complement Med. 2009 Nov;15(11):1209-14.

7. Prog Neurobiol. 2008 Aug;85(4):355-75.

8. Behav Med. 2008 Summer;34(2):55-64.

9. Integr Cancer Ther. 2007 Sep;6(3):251-7.

10. Complement Ther Med. 2008 Apr;16(2):92-100.

 

 

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