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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.
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.)
A new study by Brazilian researchers suggests an association between adherence to the Mediterranean diet, and bone density and muscle mass in post-menopausal women. This diet involves a high intake of fruit, vegetables, grains, potatoes, olive oil and seeds, moderately high fish intake, plus low saturated fat, dairy and red meat consumption, and regular but moderate intake of red wine. The Mediterranean diet has previously been linked to a lower risk of heart disease, diabetes and cancer.
A total of 103 healthy women from southern Brazil, average age 55 and who had gone through menopause a mean 5.5 years earlier, underwent measurements of their bone mineral density, total body fat and lean mass. The subjects also completed a food questionnaire about what they had eaten in the past month.
A higher Mediterranean diet score, meaning better adherence to the Mediterranean diet, was significantly associated with higher bone mineral density measured at the lumbar spine, and with greater muscle mass. This association was independent of whether the women had previously used hormone replacement therapy, their smoking behaviour or their current level of physical activity.
(Mediterranean diet is linked to higher muscle mass, bone density after menopause. The Endocrine Society, on-line press release 20 March 2018.)
The largest and most rigorous study of its kind has found that acupuncture significantly reduces the joint pain experienced by women having treatment for early stage breast cancer and taking aromatase inhibitors (eg Arimidex, Aromasin,Femara). These drugs are normally prescribed for post-menopausal women whose breast cancers are hormone receptor-positive, but up to 50% of patients who take them experience significant joint pain and stiffness.
In the multi-centre clinical trial led by researchers at NewYork-Presbyterian Hospital and Columbia University Irving Medical Center, 226 women were randomised to receive either true acupuncture, sham control or no treatment. Sessions were given twice a week for six weeks, then weekly for a further six weeks. After six weeks, the improvement seen in the true acupuncture group compared to the other two groups, was significantly greater, and larger than that exhibited by antidepressants when they are used for cancer pain. Around 30% of control group participants reported a clinically meaningful change, whereas the same figure for the true acupuncture group was 58%. Additionally, unlike the results of drug therapy, the pain relief from acupuncture was still apparent 24 weeks after treatment had ended.
Dr. Katherine Crew, director of the Clinical Breast Cancer Prevention Program at NewYork-Presbyterian/Columbia University Irving Medical Center says “There are so few side effects [to acupuncture] and it’s non-addictive. This has real implications for patients in how patients can address their pain. Our goal now is to make sure patients have access to it and that insurance will cover it, just like they would for a pain medication.”
(NewYork-Presbyterian News, on-line 7 December 2017.)
Researchers in China have found that acupuncture can contribute to clinically relevant improvements in perimenopausal insomnia, both objectively and subjectively. A total of 76 such patients were randomised to receive either ten sessions of acupuncture or sham needling at the same points, over a period of three weeks. After treatment, sleep quality improved by 8.0 points in the acupuncture group versus 1.3 points in the sham group. Insomnia severity scores reduced by 11.3 points in the acupuncture group, and 2.9 points in the sham group.
Further, overnight polysomnography at baseline and completion of treatment, showed that acupuncture significantly improved sleep efficiency and total sleep time, and was associated with both more rapid sleep onset and less waking after falling asleep. No significant differences between baseline and post-treatment were found in the placebo group.
(Acupuncture Improves Peri-menopausal Insomnia: A Randomized Controlled Trial. Sleep, 22 September 2017.)