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Category Archives: Gynaecology
Gynaecology has a very long history in Chinese medicine: the earliest writings date from the Shang dynasty (1500-1000BC), infertility was being discussed two thousand years ago, the earliest obstetrics text was written during the Tang dynasty (618-907AD), and probably the earliest medical school department devoted entirely to gynaecology and obstetrics, was that of the Imperial Medical College during the Song dynasty (960-1279AD). The subject occupies a very special place in traditional Chinese medicine, and acupuncture in the twenty-first century can assist with many problems for which women often feel there is a lack of really satisfactory solutions.
Some of the conditions I most commonly see include PMS, painful periods, heavy periods and other menstrual irregularities, infertility, habitual miscarriage, endometriosis, polycystic ovary syndrome and menopausal symptoms. With most of these problems, the precise characteristics of your monthly cycle can offer a lot of clues about what lies behind your symptoms. I am likely to ask about your cycle length, its regularity, any variability, and other such matters, so it helps if you can consider these in advance. The history of your problem and any investigations and results are important too.
With regard to menopausal symptoms, these may include joint pains, fatigue, anxiety, loss of confidence, disturbed sleep, flushes, night sweats, and feeling perpetually premenstrual, although the period and hence relief, never comes.
As usual in traditional Chinese acupuncture, your health and well-being are looked at in the widest sense: any other health issues, as well as the amount of energy you have to devote to both work and family, are all relevant to me.
For complaints related to your monthly cycle, I tell my patients as a rule of thumb, to be prepared to come for treatment more or less weekly, for three cycles ie. around three months. This gives acupuncture a proper opportunity to start to help, and is an appropriate length of time after which to review progress. We will usually track your cycle down to the day, because on each visit, treatment should be tailored not only to your main complaint, but also so as to harmonise with what your body is naturally trying to do at that point in your cycle; this way, acupuncture goes with the flow, and does not try to run counter to any perfectly natural aspect of your monthly rhythm.
I hope this has given you a little bit of background to Chinese medical gynaecology, but because this area spans so many different conditions, you are always welcome to just pick up the telephone and ask me more about anything specific. Meanwhile, we began this article with medicine 3000 years ago, and by contrast, you will find below the results of some modern research into acupuncture in the gynaecological sphere.
A systematic review by Korean authors looking at acupuncture for menstrual pain shows it is an effective intervention. The review examined 60 randomised controlled trials covering over 3000 patients; 49 trials were subject to meta-analysis. The studies compared acupuncture to no treatment, placebo or medication.
Compared with both no treatment and nonsteroidal anti-inflammatory drugs, acupuncture was more effective at reducing menstrual pain. The benefits of acupuncture were also maintained during short-term follow-up.
(The efficacy & safety of acupuncture in women with primary dysmenorrhea. A systematic review & meta-analysis. Medicine (Baltimore), June 2018.)
A Cochrane Database systematic review by Australian authors, has concluded that acupuncture and acupressure may improve both physical and psychological symptoms of PMS. Five trial results, covering 277 women, were analysed. The results suggest acupuncture can improve overall mood and physical symptoms, compared with sham acupuncture. Quality of evidence was limited by small sample sizes.
(Acupuncture & acupressure for premenstrual syndrome. Cochrane Database of Systematic Reviews, 14 August 2018.)
A large American trial has shown that acupuncture can help postmenopausal women with breast cancer, who experience joint pain (arthralgia) as a side-effect of taking aromatase inhibitor drugs eg anastrozole/arimidex. Researchers randomised 226 such women, mean age 61, across 11 academic centres and clinics, to either true acupuncture, sham acupuncture or a waiting list control. Real or sham acupuncture was given twice a week for 6 weeks, then once a week for a further 6 weeks. All patients were followed up for a further 12 weeks.
Compared with the sham acupuncture and waiting list groups, the true acupuncture group at 6 weeks experienced a statistically significant reduction in their worst joint pain: 58% had at least a two-point pain reduction, compared with 33% in the sham group and 31% in the waiting list group. There were also improvements in average pain and joint stiffness in the true acupuncture group. Even at six month follow-up, average worst pain in the true acupuncture group was lower than in the other two groups.
(Effect of Acupuncture vs Sham Acupuncture or Waitlist Control on Joint Pain Related to Aromatase Inhibitors Among Women With Early-Stage Breast Cancer: A Randomized Clinical Trial. Journal of the American Medical Association, 10 July 2018.)
An American umbrella systematic review assessing the benefits of acupuncture for menopause symptoms, has concluded that evidence from randomised controlled trials supports its use. Data was taken from three systematic reviews covering over 1100 women, and from four randomised controlled trials covering 700 women. There were statistically significant differences associated with acupuncture treatment, either adjunctive or stand-alone, compared with no acupuncture, for reducing vasomotor symptoms eg hot flushes and night sweats, and improving health-related quality of life. Follow-up times varied but some studies demonstrated reductions in hot flush frequency lasting 12 months or more. Differences were smaller or not statistically significant when acupuncture was compared with sham acupuncture.
The authors conclude that the evidence supports the use of acupuncture to treat menopausal vasomotor symptoms, although the clinical benefits may be partly due to non-specific effects.
(Management of Menopause Symptoms with Acupuncture: An Umbrella Systematic Review & Meta-Analysis. Journal of Alternative & Complementary Medicine, April 2018.)