Gynecology

ELECTRO-ACUPUNCTURE FOR PCOS
Acupuncture can lower high sympathetic nerve activity, which may be a contributory factor in the aetiology of polycystic ovary syndrome (PCOS). A Swedish team, which has previously found that women with PCOS have significantly higher sympathetic nerve activity than controls, investigated the effect of low-frequency electroacupuncture (EA) and physical exercise on the sympathetic activity of a muscle fascicle of the peroneal nerve. In a randomised controlled trial, twenty women with PCOS were randomly allocated to low-frequency EA, physical exercise, or no treatment for a 16 week period. Both EA and exercise were found to decrease muscle sympathetic nerve activity although no differences were found between the groups in haemodynamic, endocrine, and metabolic variables. (Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol. 2009 Aug;297(2):R387-95). Researchers at the same institute have also carried out animal studies that have shown that EA and exercise downregulate the expression of gene markers of sympathetic activity and improve ovarian morphology. The ovaries of rats treated with EA or exercise display a higher proportion of healthy antral follicles and a thinner theca interna cell layer than those of untreated PCOS rats. (Acupuncture and exercise restore adipose tissue expression of sympathetic markers and improve ovarian morphology in rats with dihydrotestosterone-induced PCOS. Am J Physiol Regul Integr Comp Physiol. 2009 Apr;296(4):R1124-31).

ACUPUNCTURE FOR MENOPAUSAL HOT FLUSHES
A systematic review by a Korean team has assessed the effectiveness of acupuncture as a treatment for menopausal hot flushes. They searched 17 databases, without language restrictions, for randomised clinical trials (RCTs) of acupuncture versus sham acupuncture. Six RCTs met the inclusion criteria. The authors concluded that the results of sham-controlled RCTs fail to show specific effects of acupuncture for control of menopausal hot flushes. (Acupuncture for treating menopausal hot flushes: a systematic review. Climacteric. 2009 Feb;12(1):16-25). Meanwhile, an RCT carried out in China has explored the effects of acupuncture and auricular acupressure in relieving menopausal hot flushes in women who had undergone bilateral ovariectomy. Forty-six women were randomised into an acupuncture/auricular acupressure group and a hormone replacement therapy (HRT) group. After treatment both severity and frequency of hot flushes in the two groups were relieved significantly, compared with pre-treatment, with no significant difference in severity of hot flushes between the two groups. At four week follow-up, the severity of hot flushes in the HRT group was alleviated more. After treatment, levels of FSH decreased significantly and levels of PGE2 increased significantly in both groups. The increase in the HRT group was greater. The authors conclude that acupuncture and auricular acupressure can be used as alternative treatments to relieve menopausal hot flashes for bilaterally ovariectomised women who are unable or unwilling to receive HRT. (Acupuncture and Auricular Acupressure in Relieving Menopausal Hot Flashes of Bilaterally Ovariectomized Chinese Women: A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2009 Feb 2. [Epub ahead of print]). Meanwhile a Korean study has investigated the use of moxibustion in treating menopausal hot flushes. Fifty-one participants were randomly assigned into three groups, moxibustion protocol 1, moxibustion protocol 2 and wait list control. The moxibustion groups received 14 sessions of moxibustion over four weeks. The protocols were supported by evidence from clinical experts (group 1) or published literature (group 2), and participants were followed for an additional two weeks after the end of the study. By week four, the difference in severity and frequency of hot flushes was statistically significant between the treatment and the control groups. In addition, there was a statistically significant difference in Menopausal-Specific Quality of Life Scale scores between treatment group 2 and the other groups. (Moxibustion for treating menopausal hot flashes: a randomized clinical trial. Menopause. 2009 Mar 13).

JAPANESE-STYLE ACUPUNCTURE FOR ADOLESCENT ENDOMETRIOSIS PAIN
A US randomised, sham-controlled pilot study has assessed the use of Japanese-style acupuncture for reducing chronic pelvic pain and improving health-related quality of life (HRQOL) in adolescents with endometriosis. Eighteen young women (13-22 years) with laparoscopically-diagnosed endometriosis-related chronic pelvic pain were treated with either Japanese style acupuncture or sham acupuncture. Participants in the active acupuncture group experienced an average 4.8 point reduction in pain measured on a 11 point scale (62%) after four weeks, which differed significantly from the control average reduction of 1.4 points. Reduction in pain in the active group persisted at six-month follow up; however, after four weeks, differences between the active and control group decreased and were not statistically significant. All HRQOL measures indicated greater improvements in the active acupuncture group compared with controls; however, the majority of these trends were not significant. (Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial. J Pediatr Adolesc Gynecol. 2008 Oct;21(5):247-57).

ACUPUNCTURE FOR PAINKILLER-RESISTANT PERIOD PAIN
Italian scientists have evaluated the effect of acupuncture on dysmenorrhoea that is resistant to treatment by non-steroidal anti-inflammatory drugs (NSAIDs). Fifteen patients received eight weekly acupuncture treatments (at Taixi KID-3, Taichong LIV-3, Gongsun SP-4, Zusanli ST-36, Tianshu ST-25, Guilai ST-29, Qichong ST-30, Guanyuan REN-4, Qihai REN-6, Shenmai BL-62, Shenmen HT-7, Hegu LI-4, Neiguan PC-6 and Zigong (M-CA-18). Patients were allowed to continue using painkillers as necessary. Pain was measured on a visual analogue scale at baseline (T1) and four time points: mid-treatment (T2), end of treatment (T3) and three (T4) and six months (T5) after the end of treatment. A substantial reduction in pain and NSAID use was observed in 87% of patients. Pain intensity was significantly reduced with respect to baseline by 64, 72, 60 and 53% at T2, T3, T4 and T5. Average pain duration at baseline (2.6 days) was significantly reduced by 62, 69, 54 and 54% at T2, T3, T4 and T5. Average NSAID use was significantly reduced by 63, 74, 58 and 58% at T2, T3, T4 and T5, respectively, and ceased totally in seven patients, who were still asymptomatic six months after treatment. (Acupuncture Treatment of Dysmenorrhea Resistant to Conventional Medical Treatment. Evid Based Complement Alternat Med. 2008 Jun;5(2):227-230.)

ACUPUNCTURE COST-EFFECTIVE FOR DYSMENORRHOEA
In another German study, the clinical effectiveness and cost-effectiveness of acupuncture in patients with dysmenorrhoea was studied. In a randomised controlled trial plus non-randomised cohort, patients with dysmenorrhoea were randomised to 15 sessions of acupuncture over three months or to a control group (no acupuncture). All subjects were allowed to receive usual medical care. Of 649 women, 201 were randomised. Those who declined randomisation received acupuncture treatment. After three months, the average pain intensity was lower with acupuncture than without (3.1 vs. 5.4). The authors concluded that additional acupuncture in patients with dysmenorrhoea was associated with improvements in pain and quality of life as compared to usual care alone and was cost-effective within usual thresholds (overall ICER 3,011 euros per QALY). (Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008 Feb;198(2):166.e1-8).

ACUPUNCTURE FOR POLYCYSTIC OVARIES
A review article has evaluated the use of acupuncture to prevent and reduce symptoms related with polycystic ovary syndrome (PCOS). Reporting on experimental observations in rat models of polycystic ovaries and clinical data from studies in women with PCOS, the Swedish authors suggest that acupuncture can affect PCOS via modulation of the neuroendocrine system (in particular the sympathetic nervous system) and can exert long-lasting beneficial effects on the metabolic and endocrine systems and on ovulation. (Acupuncture in Polycystic Ovary Syndrome: Current Experimental and Clinical Evidence. J Neuroendocrinol. 2007 Nov 28.

ACUPUNCTURE ‘AS GOOD AS HRT’ AFTER OOPHORECTOMY
Acupuncture results in a significant improvement in perimenopausal symptoms in women who have had their ovaries surgically removed (oophorectomy). Sixty-seven women who had undergone oophorectomy were non-randomly divided into two groups. One group was given acupuncture and the comparison group was given usual medical care (HRT drug Livial – a combination of synthetic oestrogen, progesterone and androgen). Kupperman index score (a scale for measuring the severity of menopausal complaints) and levels of serum beta-endorphin were found to differ significantly between the acupuncture and the Livial group. Based on these findings, the authors concluded that acupuncture performs as well as or better than Livial, but cautioned that bias and small sample size may have influenced the results. (Acupuncture for perimenopausal symptoms in women who underwent oophorectomy a comparative study. Forsch Komplementarmed. 2007 Feb;14(1):25-32).

ACUPUNCTURE & HOT FLUSHES
In a study of 29 postmenopausal women who experienced at least seven moderate to severe hot flushes a day, active acupuncture was found to significantly decrease the severity of nocturnal flushes (by 28%) compared to 6% in women given sham acupuncture. The frequency of flushes was reduced by more in the active treatment group compared to the sham but not significantly so. (A randomized controlled pilot study of acupuncture for postmenopausal hot flashes: effect on nocturnal hot flashes and sleep quality. Fertility and Sterility, September 2006; Vol. 86: pp. 700-710).