Effects and mechanisms of acupuncture on women related health
Huichao Qin1,2, Jiaxing Feng2, Xiaoke Wu2()
1. Department of Reproductive Medicine, Heilongjiang Provincial Hospital, Harbin Institute of Technology, Harbin 150036, China 2. Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China
Globally, public health interventions have resulted in a 30-year increase in women’s life expectancy. However, women’s health has not increased when socioeconomic status is ignored. Women’s health has become a major public health concern, for those women from developing countries are still struggling with infectious and labor-related diseases, and their counterparts in developed countries are suffering from physical and psychological disorders. In recent years, complementary and alternative medicine has attracted wide attentions with regards to maintaining women’s health. Acupuncture, a crucial component of traditional Chinese medicine, has been used to treat many obstetric and gynecological diseases for thousands of years due to its analgesic and anti-inflammatory effects and its effects on stimulating the sympathetic/parasympathetic nervous system. To fully understand the mechanism through which acupuncture exerts its effects in these diseases would significantly extend the list of available interventions and would allow for more reasonable advice to be given to general practitioners. Therefore, by searching PubMed and CNKI regarding the use of acupuncture in treating obstetric and gynecological diseases, we aimed to summarize the proven evidence of using acupuncture in maintaining women’s health by considering both its effectiveness and the underlying mechanisms behind its effects.
. [J]. Frontiers of Medicine, 2024, 18(1): 46-67.
Huichao Qin, Jiaxing Feng, Xiaoke Wu. Effects and mechanisms of acupuncture on women related health. Front. Med., 2024, 18(1): 46-67.
12 treatments over the course of three menstrual cycles
Group A: LF-MA Group B: HF-MA Group C: LF-EA Group D: HF-EA
Acupuncture can reduce the intensity and duration of pain, with no difference between the four groups, and the effect can be sustained for one year after entering the trial
Small sample size; the acupoint protocol was not provided
26
PD
RCT
600
Three menstrual cycles
Group A: before menstruation at Shiqizhui (EX-B8) Group B: when pain occurred, treated at EX-B8 Group C: before menstruation at Sanyinjiao (SP6), Diji (SP8), Ciliao (BL32), and EX-B8 Group D: when pain occurred, treated at SP6, SP8, BL32, and EX-B8 Group E: no treatment
Treating before menstruation is better than immediately treating when pain occurs; a single point is better than multiple points when treating as soon as pain occurs; and EX-B8 is a convenient point
Adverse events were not mentioned
27
PD
RCT
80
One session
Group A: saline injection at SP6 and the right buttock Group B: vitamin K deep muscle injection in the right buttock and saline injection at a non-acupoint near but not including SP6 Group C: vitamin K injection at SP6 and saline injection in the right buttock
Acupoint injection of vitamin K3 quickly relieves menstrual pain
Small sample size; no mention of adverse events
28
Endome-triosis
RCT
106
A 30-min session once per day, 3 times a week, for 12 weeks giving a total of 39 sessions
Acupuncture: Guanyuan (CV4), bilateral SP6, Taichong (LR3), Zhaohai (KI6), and Qichong (ST30) Sham acupuncture: performed at non-acupoints
Acupuncture can relieve dysmenorrhea, shorten the pain time, and improve well-being and quality of life in women with endometriosis, although its efficacy recedes after the termination of therapy
No mention of adverse events; acupuncturists not blinded to treatment
29
Endome-triosis
RCT
31
Twice a week with intervals of at least 48 h for 16 sessions over 8 weeks
Acupuncture + usual care group: SP6, SP8, Xuehai (SP10), Guilai (ST29), Zusanli (ST36), Zhongji (CV3), CV4, and LR3 Usual care group
Acupuncture is an acceptable and well tolerated therapy that may relieve pelvic discomfort and enhance quality of life
Small sample size
30
Cesarean delivery
RCT
174
Four sessions at 6, 12, 24, and 48 h after surgery
PCIA + sham EA group: PCIA combined with sham acupoints (20 mm away from ST36 and SP6) PCIA + 2 Hz EA group: PCIA combined with acupuncture at ST36 and SP6 at a frequency of 2-Hz continuous wave PCIA + 20/100 Hz EA group: PCIA combined with acupuncture at ST36 and SP6 at the frequency of 20/100 Hz continuous wave
EA can be a safe and effective routine complementary therapy for patient-controlled intravenous analgesia for pain management after cesarean delivery
Limited patient demographic variability; the presence of confounding factors such as mood and sleep
31
Cesarean delivery
RCT
180
One session within 20 min of the cesarean delivery
Acupuncture group: auricular acupoints — namely MA-SC (kidney), MA-TF1, MA-IC1 (lung), MA-AT1 (subcortex) — and body acupoints, including LI4, ST36, SP6, BL25, BL26, and BL27 Placebo acupuncture group: the skin areas around acupoints were treated with a SVESA neural pen Standard care group: received the standard postoperative analgesia
Acupuncture is effective and safe in relieving pain and accelerating the mobilization of patients after cesarean delivery and can be a supplemental or routine therapy for pain control in patients after cesarean delivery
The inability to blind the practitioners; non-randomized groups; a single-center design
32
Vaginal delivery
RCT
360
One session
CSEA + AI group: acupoint injection at ST36 and SP6 combined with CSEA CSEA-only group AI group: acupoint injection at ST36 and SP6 Control group: no intervention
The CSEA + AI group had significantly lower VAS scores, adverse events, and dose of ropivacaine/sufentanil and had shorter labor duration
Not completely double blinded
Tab.1
Ref. ID
Design
Sample size
Number of treatments
Interventions
Conclusion
Limitation
53
RCT
84
Twice weekly for 2 weeks, once weekly for 6 weeks, and once every other week for 8 weeks, for a total of 14 sessions over 16 weeks
LF-EA: CV3, CV6, ST29, SP6, SP9 stimulated electrically with LF-EA of 2 Hz and LI4, Neiguan (PC6) stimulated manually Physical exercises: brisk walking, cycling, or any other aerobic exercise at least 30 min for no less than 3 days per week No active intervention: received oral information about the benefits of regular physical exercise
LF-EA and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in PCOS patients. LF-EA was superior to physical exercise in treating hyperandrogenism and oligo/amenorrhea
The variability of sham methods, the location and depth of needling, and the number and duration of treatments
54
RCT
54
Twice a week, with each session separated by an interval of 2–4 days for a total of 32 sessions over 16 weeks
Acupuncture group: Set 1: CV3, CV6, SP6, ST29, Yinlingquan (SP9), LI4, and Baihui (GV20). Set 2: Tianshu (ST25), ST29, CV3, SP9, LI4, GV20, LR3, and PC6 Control group: shallow acupoints through EA without electricity at 4 non-meridian points in the shoulders and upper arms
The treatment of PCOS by acupuncture may be beneficial in improving glucose and lipid metabolism. Sham acupuncture may also improve several aspects of glucose and lipid metabolism through the placebo effect
Some heterogeneities in the results such as body weight; small sample size
55
RCT
1000
Twice a week, with a maximum of 32 acupuncture treatments
Active acupuncture protocol includes Set 1 and Set 2 which was alternated every other treatment. Set 1: GV20, CV6, CV3, ST29, SP9, SP6; Set 2: GV20, ST27, ST29, CV6, CV3, PC6, SP6, LR3 with low- frequency (2 Hz) Sham acupuncture protocol is using the thin needles inserted superficially, < 5 mm, in non- acupuncture points at acromion and lateral on humerus. Needles were not stimulated by manual rotation when inserted. Electrical stimulator was attached to the needles but no stimulation was delivered Clomiphene or placebo: patients started with an initial oral dose of 1 pill of clomiphene (50 mg) from days 3 to 7 of the menstrual cycle. The dosage of oral medication was increased by 1 pill in the absence of ovulation or maintained in the presence of ovulation. The maximum dosage of clomiphene didn’t exceed 150 mg per day or 750 mg per cycle. The treatment could be repeated for up to 4 cycles Group A: active acupuncture plus clomiphene Group B: control acupuncture plus clomiphene Group C: active acupuncture plus placebo Group D: control acupuncture plus placebo
Among Chinese women with PCOS, the use of acupuncture with or without clomiphene, compared with control acupuncture and placebo, did not increase live births
–
57
RCT
32
Twice a week for 10–13 weeks, with two sets of 11 and 13 acupoints alternating every other treatment
Acupuncture group: Set 1: CV3, CV6, ST29, SP6, SP9, LI4, GV20. Set 2: CV3, CV6, ST25, ST29, SP6, LR3, PC6, GV20 Control group: visited the same physical therapists, twice weekly for 10–13 weeks
The treatment with acupuncture can reduce the levels of ovarian and adrenal sex steroid, thereby improving the ovulation rate of lean/overweight PCOS patients
Small sample size; no reporting of adverse events; no use of placebo or sham needles
58
RCT
54
30 min per session for a total of 16 weeks
The treatment protocol was consistent with that of Ref. 54
EA can improve anxiety/depression and quality of life and may influence levels of NE and 5-HT in PCOS patients
Small sample size; no reporting of adverse events
59
RCT
72
Twice weekly for 2 weeks, once weekly for 6 weeks, and once every other week for 8 weeks (14 treatments over 16 weeks)
Acupuncture:CV3, CV6, ST29, SP6, SP9 stimulated electrically with LF-EA of 2 Hz, and LI4, PC6 stimulated manually Exercises: brisk walking, cycling, or any other aerobic exercise at least 30 min, no less than 3 days per week No active intervention: received oral information about the benefits of regular physical exercise No intervention: –
There was a modest improvement in depression and anxiety scores in women treated with acupuncture, and improved HRQoL scores were noted in both intervention groups
The variability of sham methods, location and depth of needling, and the number and duration of treatments
Tab.2
Ref. ID
Design
Sample size
Number of treatments
Interventions
Conclusion
Limitation
79
RCT
150
One session at least 30 min before oocyte aspiration
EA group: LI4, Waiguan (TE5), ST29, GV20, and ST36 Control group: 0.25–0.5 mg alfentanil and 0.25 mg atropine
EA has similar anesthetic properties as alfentanil during oocyte aspiration and thus can be an alternative option during oocyte aspiration
Non-blinded; no reporting of adverse events; small sample size
82
RCT
848
Three times, with the first session given after 6–8 days of follicle stimulation, and two sessions given prior to and after ET
Acupuncture group: first treatment: ST29, CV4, Qihai (CV6), SP6 and SP10; 1 h prior to ET: ST29, SP8, SP10, LR3, CV4, one point from Shenmen (HT7), PC6, or GV29, and auricular point Zhigong; following ET: GV20, KI3, ST36, SP6, PC6, and auricular point Shenmen (MA-TF1) Sham acupuncture group: non-insertive acupuncture
Acupuncture at the time of ovarian stimulation and ET resulted in no significant difference in live birth rates
Did not achieve the planned sample size; single blinding; non-identical eligibility criteria
83
RCT
739
Two sessions, with 2 Hz applied for 30 min at 24 h before ET and 30 min after ET
TEAS: 24 h before ET: SP8, ST29, EX-CA1, and SP10 30 min after ET: ST36, Zhongwan (CV12), BL23, CV4, and KI3 Control: IVF treatment
TEAS can increase the pregnancy rate in women undergoing IVF-ET, especially in older women; TEAS can improve endometrial receptivity
Not blinded; no reporting of adverse events
86
RCT
150
Two sessions, 25 min before and after ET
Acupuncture group: body acupoints before ET: PC6, SP8, LR3, GV20, and ST29; after ET: ST36, SP6, SP10, and LI4; and auricular acupuncture: MA-TF1, Zhigong, Neifenmi, and Naodian Control group: lying quietly
Acupuncture during IVF does not increase pregnancy rates, but can make patients more relaxed and optimistic
Single-blinded; small sample size; no reporting of adverse events
87
RCT
848
The same as Ref. 82
The treatment protocol was consistent with that of Ref. 82
Acupuncture can reduce anxiety during ET. Women have reduced emotional well-being 3 months following the IVF cycle, highlighting ongoing unmet psychosocial needs
The same as Ref. 82.
88
RCT
228
Three sessions, including injection on day 9 and immediately before and after ET
Acupuncture group: the acupuncture protocol was consistent with that of Ref. 86 Sham acupuncture group: using sham acupoints that were located close to but not on real acupoints
Acupuncture has a small effect on pregnancy and live birth rates that is not statistically significant, and it is safe for women undergoing ET
Single-blindness; no reporting of adverse events
Tab.3
Ref. ID
Design
Sample size
Number of treatments
Interventions
Conclusion
Limitation
109
RCT
33
3 times a day, 30 min each time, for 7 consecutive days
Group A: deep acupuncture at PC6 on days 1, 2, 5, and 6 and acupuncture at PC6 on days 3 and 4 Group B: superficial acupuncture at PC6 on days 1, 2, 5, and 6 and deep acupuncture at PC6 on days 3 and 4
In comparison with placebo, acupuncture at PC6 may help HG patients recover better and faster
Small sample size; single-blindness; no reporting of adverse events
110
RCT
593
The first week was treated twice, then once a week for a total of 4 weeks
Traditional acupuncture: the liver qi stagnation pattern for CV12, PC6, Yanglingquan (GB34), Shangwan (CV13), Youmen (KI21), Liangqiu (ST34), ST36; the stomach or spleen qi deficiency pattern for ST36, PC6, CV12; the stomach heat pattern for Neiting (ST44), Jianli (CV11), ST34, Liangmen (ST21), PC6 and Quze (PC3); the phlegm pattern for ST40,SP9, Burong (ST19), Pishu (BL20), KI21; the heart qi deficiency pattern for Tongli (HE5), PC6, ST36, Juque (CV14); the heart fire pattern for PC6, CV14, Xinshu (BL15) P6 acupuncture: PC6 Sham acupuncture: acupuncture needles inserted into an area close to, but not on, acupuncture points Control group: no acupuncture
Acupuncture is an effective treatment for women who experience nausea and dry retching in early pregnancy. A time-related placebo effect was found for some women
Single-blindness; no reporting of adverse events
111
RCT
90
4 times a day, 10 min each time for 5 consecutive days
The acupressure group: PC6 pressure The sham acupressure group: pressure at TE5 The medication group: vitamin B6 (tab 40 mg, oral) 1/2 tab every 8 h and metoclopramide (tab 5 mg, oral) 5 mg every 8 h
It seems that PC6 acupoint pressure can reduce the severity of nausea, vomiting, and retching in pregnant women
Small sample size; single-blindness; no reporting of adverse events
112
RCT
66
7 days
The acupressure group: SeaBands on PC6 point and identical looking tablets were used as placebo in the same regimen as vitamin B6 The vitamin B6 group: SeaBands on the dummy point and 50 mg tablets of vitamin B6 were prescribed every 12 h for 5 days
Acupressure therapy is not more effective than vitamin B6 in reducing nausea and vomiting in symptomatic women in the first trimester of pregnancy
Single-blindness; not reported adverse events
113
RCT
128
Three times a day, for 30 s for 4 days
Auriculotherapy group: point zero, stomach, sympathetic autonomic, Shen Men cardia The sham control group: the points where these magnetic seeds were placed (e.g., the vision, knee, shoulder, and eyes) had no effects on the nausea and vomiting
Pregnant women who experience nausea may achieve relief with the proper application of effective points on the ears to manage nausea and vomiting as a supplementary and alternative therapy
Not reported adverse events
116
RCT
352
Acupuncture treatment for 30 min per day, up to 14 sessions over 2 weeks
Placebo plus acupuncture group: the core points were PC6 and ST36, and adjuvant points included the liver heat pattern for LR3, the stomach deficiency pattern for CV12, and the phlegm-dampness pattern for Fenglong (ST40) Doxylamine–pyridoxine plus sham acupuncture group: sham acupuncture was a pragmatic placebo needle on sham acupoints with the same acupuncture protocol Acupuncture plus doxylamine–pyridoxine group Placebo plus sham acupuncture group
Both acupuncture and doxylamine–pyridoxine alone was efficacious for moderate to severe NVP. Their combination may yield a potentially greater benefit than each alone
–
Tab.4
Ref. ID
Design
Sample size
Number of treatments
Interventions
Conclusion
Limitation
126
RCT
55
Not mentioned
Acupuncture group: 5–7 acupoints for each session, namely Pangguangshu (BL28), BL32, Lieque (LU7), KI6, GV20, HT7, and SP6 The control group: catheterization
Acupuncture is an excellent alternative to catheterization in treatment of women with postpartum urinary retention
Small sample size; no report of treatment sessions; lack of sham acupoints
127
RCT
1200
3 sessions of a 4-h acupoint hot compress at 30 min, 24 h, and 48 h after delivery
Intervention group: received routine postpartum care plus 3 sessions of acupoint hot compress administered at Shenque (RN8), Baliao including Shangliao (BL31), BL32, Zhongliao (BL33), BL34, and Yongquan (KI1) for time point 1 and at RN8 for time points 2 and 3 Control group: received routine postpartum care
Acupoint hot compresses after vaginal delivery decreased postpartum urinary retention, and thus may be considered as an adjunctive intervention in postnatal care that meets patient self-care needs
Failure to adopt personalized intervention protocols based on different syndromes in the subjects; not double-blinded; not applied to those with multiparas or complications
Tab.5
Ref. ID
Design
Sample size
Number of treatments
Interventions
Conclusion
Limitation
138
RCT
209
20 sessions decided by the acupuncturist and patient within the first 6 months (acupuncture group) or within the second 6 months (waitlist control group)
Acupuncture needling based on anatomical location
Acupuncture treatments was associated with significant reduction in VMS and several quality-of-life measures compared with no acupuncture, and the clinical benefit persisted for at least 6 months after treatment
No reporting of specific acupoints; potential unreliability and risk of bias associated with self-reporting of VMS
139
RCT
40
Acupuncture for 12 weekly treatments and three capsules of Chinese medicine orally with water twice per day
TCM acupoints: CV4, GV20, PC6, ST36, SP6, LI4, KI3, and Fengchi (GB20) and 7–10 supplementary acupoints based on individual’s TCM syndrome type as determined by TCM practitioners, i.e., kidney yang with spleen yang deficiency: Pishu (BL20), BL23, SP9, CV6; kidney yin with liver yin deficiency: Ganshu (BL18), BL23, Yinxi (HT6), KI6, LR3 Sham acupoint: needles were inserted superficially into seven bilateral sites that did not correspond to established TCM acupoints
TCM acupoints were superior to sham acupoint and verum CHM in reducing menopausal symptoms, whereas verum CHM showed no significant improvements when compared with placebo CHM
Small sample size; did not take into account TCM treatment principles
140
RCT
70
One treatment per week for five consecutive weeks
The intervention group: CV3, CV4, Ququan (LR8), SP6, and SP9 for the first 5 weeks The control group: the same protocol as the intervention group after 6 weeks
The standardized and brief acupuncture treatment produced a fast and clinically relevant reduction in moderate-to-severe menopausal symptoms during the six-week intervention
Small sample size; lack of placebo; no correct acupuncture technique training; not double-blinded
141
RCT
76
3 times per week for 10 times sessions
Acupuncture group: BL23 and BL18 with unilateral Qimen (LR14) and Jingmen (GB25) Placebo-acupuncture group: Streitberger needles at the same acupoints
Acupuncture can contribute to improvement in the short term treatment of PMI, both subjectively and objectively
Small sample size
143
RCT
360
24 sessions, 30 min each session, over 8 weeks (3 times per week)
EA group: CV4 and ST25, EX-CA1, SP6 Sham EA group: nonacupoints laterally and horizontally 1–2 cun (approximately 1–2 inches) away from the corresponding acupoints
Although it seemed to improve the quality of life, 8 weeks of EA might not relieve menopausal symptoms among women during menopause transition
Small sample size
144
RCT
68
One tablet once daily and 3 sessions per week of LA for 12 weeks
Drug group: oral calcium and vitamin D3 supplement containing fluoride Drug/LA group: oral calcium and vitamin D3 supplement containing fluoride plus LA including CV4, Mingmen (GV4) and bilaterally Dazhu (BL11), BL18, BL20, BL23, ST36, SP6, GB25, Yanglingquan (GB34), and Xuanzhong (GB39)
LA in combination with calcium and vitamin D supplementation containing fluoride is an effective modality for improving forearm BMD and reducing pain in osteoporotic post-menopausal women
Small sample size; lack of follow-up to assess the lasting effect of LA on BMD and pain; non-blinded
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