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Acupuncture & Women's Health: A Summary of Research and Support

Posted on January 23rd, 2013 by | 5 views

Introduction

Acupuncture originated in China more than 2,000 years ago, making it one of the oldest and most commonly used medical procedures in the world. Overall, acupuncture is a time-tested, safe, natural, and drug-free alternative that can provide immediate relief and long-lasting benefits, and can work well along with Western medicine, or on its own. Relatively few complications from the use of acupuncture have been reported to the FDA in light of the millions of people treated each year.

Acupuncture combined with the use of Chinese herbs forms the basis of Traditional Chinese Medicine, which can be especially effective in treating gynecological symptoms. Additionally, the World Health Organization recognizes the ability of acupuncture and Traditional Chinese Medicine to treat over 43 common disorders (see below). Acupuncture has also been effective in treating other conditions in which there is no clear explanation or origin for its cause. Many seek acupuncture to maximize their wellbeing and to maintain balance as part of a preventative medicine protocol.

Conditions Recommended for Acupuncture by the World Health Organization

Respiratory Diseases
Acute sinusitis
Acute rhinitis
Bronchial asthma
Acute bronchitis
Common Cold
Acute tonsillitis
Bronchopulmonary Diseases
Gastrointestinal Disorders
Heartburn
Hiccups
Gastroptosis
Acute and chronic gastritis
Gastric hyperacidity
Chronic duodenal ulcer
Acute and chronic colitis
Acute bacterial dysentery
Constipation
Diarrhea
Paralytic ileus
Neurologic Disorders
Headache
Migraine
Trigeminal neuralgia
Facial paralysis
Nocturnal enuresis
Intercostal neuralgia
Eye Disorders
Disorders of the Mouth Cavity
Orthopedic Disorders
Tennis elbow
Arthritis
Sciatica
Low back pain
Rheumatoid arthritis

Gynecological Disorders
Fertility
Menopause
Menstrual irregularities
Morning Sickness
PMS
Emotional and Psychological Disorders
Anxiety
Stress
Depression
Uro-genital Disorders
Incontinence
Urinary tract infections
Circulatory Disorders
Addictions
Sleep Problems

Acupuncture works through the insertion of very fine, sterile needles at specific points to stimulate the body's production of its own natural pain killers (endorphins), anti-inflammatory agents, and hormones. The goal of treatment is to achieve biochemical balance, improve energy, and promote both physical and emotional well being.

Acupuncture and Fertility

Traditional Chinese Medicine (TCM) has a long history of treating women's health problems, with texts from 200 BC describing medicinal plants to treat infertility. Today, Traditional Chinese medicine specialists have adapted and incorporated these traditional applications into modern fertility treatment; these two forms of medicine are especially complementary. This has resulted in clinical feed back and research suggesting that acupuncture is capable of significantly enhancing fertility.


Acupuncture offers women and their partners the opportunity to prepare for conception through optimizing their health. This can be directed at specific health problems such as PCOS, endometriosis, and irregular menstrual cycles, as well as general health problems such as stress. TCM aims through the use of acupuncture, herbs, and lifestyle advice to achieve the following:

Regulate the woman's hormonal cycle

  • A regular 28 to 30 day cycle with good quality fertile mucus, pain free ovulation mid-cycle, no premenstrual symptoms, and a pain free period with efficient bleeding indicates a balanced hormonal cycle.

Improve the quality of a woman's fertile mucus

  • Fertile mucus appears several days prior to ovulation and is required to help nourish the sperm and guide it to the egg.

Regulate ovulation

  • An ovulation occurring on day 13 to 15 of a cycle indicates that the egg is being released at its optimal developmental time.

Promote an efficient menstrual bleed

  • In TCM, the menstrual bleeding reflects the quality of the uterine lining. This lining appears important for implantation as women with poor endometrial development have an association with IVF failure or recurrent miscarriage.

  • Chinese medicine aims to increase the thickness and quality of this lining; it does this through promoting corpus luteal function (which in turn produces progesterone) and through its documented action of increasing blood flow to the uterus ( Human Reproduction 11:1314-1317)

  • Ideally it is expected that a woman will experience menstrual bleeding for at least 3 to 5 days and that this blood flow will be red in color without any clotting or flooding.

Enhance the internal environment of the fallopian tubes.

  • TCM aims to improve the elasticity and the secretions of the fallopian tubes, facilitating the passage of the fertilized egg into the uterus.

Enhance egg development.

  • While the genetic material for a woman‚Äôs eggs are created when the woman is herself an embryo, the process of the egg maturing comes under the influence of her hormones.
  • Clinically it also appears possible to influence the integrity of the eggs released following acupuncture treatment; this may be due to increasing the blood supply to the developing follicles or by increasing the nutritional supply to the egg via the fluids that surround and nourish it.

Improve sperm quality

Normal sperm count values are currently given as;

  • greater than 20 million sperm per ml
  • greater than 50% of sperm moving vigorously (motility)
  • greater than 14 % with no deformities (morphology).

A population study looking at men's fertility found that those men that succeeded in fathering a child had

  • greater than 48 million sperm per ml
  • a motility of more than 63%
  • a normal morphology of 12% (New England Journal of Medicine 345(19):1388-1393).

This study indicates the importance of men achieving the highest sperm count and motility possible.

Promote embryo implantation

  • In a study acupuncture used during IVF at the time of egg retrieval and embryo resulted in a significantly higher viable pregnancy rate. (Fertility and Sterility 74(4):721-72). In this study 160 women undergoing IVF were monitored. The success rate in the acupuncture group was 42.5% compared to a 26.3% success rate in the group of women that did not receive acupuncture.

  • In a study of 114 women at the Reproductive Medicine and Fertility Center in Colorado Springs (American Society for Reproductive Medicine (ASRM) October 2004) half of the women received acupuncture prior to and following embryo replacement.

  • The women who received acupuncture had a 51% pregnancy rate compared to 36% in control group and a 08% miscarriage rate compared to 20% in control group.

  • Acupuncture also was found to reduce the risk of tubal pregnancy and increase the live birth rate. The live birth rate for each IVF cycle was 23 % higher than the cycles for the control group.

*Research Compiled by Debra Betts author of The Essential Guide to Acupuncture in Pregnancy and Childbirth © 2006

Acupuncture and Pregnancy

Acupuncture can be a very useful tool in pregnancy by promoting preventative care, strengthening the mom and baby, and in dealing with problems as they occur. It can be a safe, comfortable, and cost effective treatment for many problems that commonly develop during pregnancy, including:

  • Morning sickness
  • Heartburn
  • Constipation
  • Threatened miscarriage
  • Musculoskeletal conditions
  • Pregnancy-induced hypertension
  • Edema
  • Small for date babies
  • Breech and posterior presenting babies
  • Fatigue and exhaustion
  • Stress and depression
  • Induction
  • Pain relief during labor
  • Postpartum recovery

The research articles outlined below can be used to promote the use of acupuncture in pregnancy. Some, like the articles on pelvic pain, nausea and vomiting and breech presentations, have been selected for their publication in medical and midwifery journals readily accessible to medical professionals. Others such as the pre-birth and cervical ripening articles are included as they represent the research available to date.

Pelvic Pain in Pregnancy

Elden et al. 2005[1] published a randomized single blind controlled trial involving 386 pregnant women in the British Medical Journal (BMJ).

Summary
The objective was to compare the efficacy of standard treatment for pelvic pain (a pelvic belt, patient education, and home exercises for the abdominal and gluteal muscles) with standard treatment plus acupuncture or standard treatment plus physiotherapy stabilizing exercises (for the deep lumbo-pelvic muscles). The study time frame consisted of one week which was used to establish a baseline, followed by six weeks of treatment. The acupuncture treatment was given twice a week and the stabilizing exercise sessions one hour per week (with patients then doing these exercises several times a day on a daily basis). Follow up was carried out one week after treatment finished. Three physiotherapists gave standard treatment, two medical acupuncturists delivered the acupuncture treatment, and two physiotherapists gave the stabilizing exercises. Pain was measured by a visual analogue scale and by an independent examiner before and after treatment.

Conclusion
Acupuncture was superior to stabilizing exercises in the management of pelvic girdle pain in pregnancy, with acupuncture the treatment of choice for patients with one sided sacroiliac pain, one sided sacroiliac pain combined with symphysis pubis pain, and bilateral sacroiliac pain.

Morning sickness

Smith et al. in 2002 published two articles from their research on nausea and vomiting in pregnancy. The first looked at the effectiveness of acupuncture[2] and the second at the safety of acupuncture treatment in early pregnancy.[3]

Summary
The objective was to compare i. traditional acupuncture treatment, ii. acupuncture at Neiguan P-6 only, iii. sham acupuncture and iv. no acupuncture treatment for nausea and vomiting.

593 women who were less than 14 weeks pregnant and were suffering nausea and vomiting of pregnancy were randomized into 4 groups and received treatment weekly. The acupuncture group, in which points were chosen according to a traditional acupuncture diagnosis, received two 20 minute acupuncture treatments in the first week followed by one weekly treatment for the next four weeks.

The sham acupuncture group was needled at points close to but not on acupuncture points and both the sham and Neiguan P-6 acupuncture groups were treated with the same frequency as the traditional acupuncture group. All group received their treatment from the same acupuncturist. The outcomes of treatment were measured in terms of nausea, dry retching, vomiting and health status.

When compared to the women who received no treatment, the traditional acupuncture group reported less nausea throughout the study and less dry retching from the second week. The Neiguan P-6 acupuncture group reported less nausea from the second week and less dry retching from the third week. The sham acupuncture group reported less nausea and dry retching from the third week.
So while all three acupuncture groups reported improvement with nausea and dry retching, it was the traditional acupuncture group that had the fastest response. Patients receiving traditional acupuncture also reported improvement in five aspects of general health status (vitality, social function, physical function, mental health and emotional role function) compared to improvement in two aspects with both the Neiguan P-6 and sham acupuncture groups. In the no treatment group there was improvement in only one aspect.

Although there were no differences in vomiting found in any of the treatment groups the authors speculated that more frequent treatments might have produced greater benefits. In assessing the safety of acupuncture in early pregnancy data was collected on perinatal outcome, congenital abnormalities, pregnancy complications and problems of the newborn. No differences were found between study groups in the incidence of these outcomes suggesting that there are no serious adverse effects from the use of acupuncture treatment in early pregnancy.

Conclusion
Acupuncture is a safe and effective treatment for women who experience nausea and dry retching in early pregnancy.

Breech Presentation

Cardini et al. in 1998[4] had the following randomized controlled trial published in the Journal of American Association (JAMA).

Summary
The objective was to evaluate the efficacy and safety of moxibustion on Zhiyin BL-67 to correct breech presentation. 130 women with a breech presentation and having their first baby (primigravidas) at 33 weeks gestation received moxibustion to Zhiyin BL-67 while 130 women, also with a breech presentation and who were also primigravidas, received no intervention. The moxibustion was administered for seven days. Women were then assessed and a further seven days of moxibustion treatment given if the baby's position had not changed. Outcomes were measured in terms of fetal movements, as counted by the mother for one hour each day for one week, and the number of cephalic presentations both at 35 weeks gestation and at delivery.
At 35 weeks gestation 75.4% in the intervention group had changed to cephalic (47.7% in the control). In terms of fetal movement the moxibustion group experienced a greater number of movements (a mean of 48.45 compared to the control group with a mean of 35.35).

Conclusion
In prigravidas at 33 weeks gestation with breech presentation, moxibustion treatment for one to two weeks at Zhiyin BL-67 increased fetal activity during the treatment period and cephalic presentation at 35 weeks and at delivery.

Prebirth acupuncture

Research on the use of acupuncture to prepare women for labor first appeared in 1974 with a study by Kubista and Kucera.[5] Their research concluded that acupuncture once a week from 37 weeks gestation using the acupuncture points Zusanli ST-36, Yanglingquan GB-34, Jiaoxin KID-8 and Shenmai BL-62 was successful in reducing the mean labor time of the women treated. They calculated the labor time in two ways. The first was the mean time between a cervical dilation of 3-4 cm and delivery. In the acupuncture group this was 4 hours and 57 minutes compared to five hours and 54 minutes in the control group. The second was the mean subjective time of labor, taken from the onset of regular (10-15 minute) contractions until delivery. The acupuncture group had a labor time of 6 hours and 36 minutes compared to eight hours and 2 minutes in the controls.

In 1998 Zeisler et al.[6] used the acupuncture points Baihui DU-20, Shenmen HE-7 and Neiguan P-6, treating from 36 weeks gestation. This study concluded that acupuncture treatment had a positive effect on the duration of labor by shortening the first stage of labor, defined as the time between 3cm cervical dilation and complete dilation. The acupuncture group had a median duration of 196 minutes compared to the control group time of 321 minutes.

In 2004 Debra Betts was involved in an observational study looking at the effect of prebirth acupuncture together with Sue Lennox, a midwife[7]. 169 women who received prebirth acupuncture were compared to local population rates for gestation at onset of labor, incidence of medical induction, length of labor, use of analgesia and type of delivery In the acupuncture group there was an overall 35% reduction in the number of inductions (for women having their first baby this was a 43% reduction), 31% reduction in the epidural rate. When comparing midwifery only care there was a 32% reduction in emergency caesarean delivery and a 9% increase in normal vaginal births. Our conclusion was that prebirth acupuncture appeared to provide some promising therapeutic benefits in assisting women to have normal vaginal births and that a further randomized controlled study is warranted.

Cervical ripening

A randomized controlled trial into the effects of acupuncture on cervical ripening was published by Rabl in 2001.[8]

Summary
The objective was to evaluate whether acupuncture at term can influence cervical ripening and thus reduce the need for postdates induction. On their due dates 45 women were randomized into either an acupuncture group (25) or a control group (20). The acupuncture group received acupuncture every two days at the acupuncture points Hegu L.I.-4 and Sanyinjiao SP-6. The women in both groups were examined every other day for cervical length (measured by vaginal trasonography, cervical mucus and cervical stasis according to Bishop’s score). If women had not delivered after 10 days labor was induced by administering vaginal prostaglandin tablets. The time from the woman’s due date to delivery was an average of 5 days in the acupuncture group compared to 7.9 days in the control group, and labor was medically induced in 20% of women in the acupuncture group compared to 35% in the control group. There were no differences between overall duration of labor or of the first and second stages of labor.

Conclusion
Acupuncture at the points Hegu L.I.-4 and Sanyinjiao SP-6 supports cervical ripening and can shorten the time interval between the woman's expected date of delivery and the actual time of delivery.
References
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[1] Elden H, Ladfors l, Fagevik Olsen M, Ostaard H, Hagberg H. Effects of acupuncture and stabilizing exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomized singleblind controlled trail. BMJ 2005;330:761.
[2] Smith C, Crowther C, Beilby J. Acupuncture to treat nausea and vomiting in early pregnancy: a randomized trial. Birth.2002, Mar:29 (1):1-9.
[3] Smith C, Crowther C, Beilby J. Pregnancy outcome following women's participation in a randomized controlled trial of acupuncture to treat nausea and vomiting in early pregnancy. Complement Ther Med. 2002 Jun; 10(2):78-83.
[4] Cardini F, Weixin H. Moxibustion for correction of breech presentation. JAMA 1998; 280:1580-1584.
[5] Kubista E, Kucera H. Geburtshilfe Perinatol 1974; 178 224-9.
[6] Zeisler H, Tempfer C, Mayerhofe Kr, Barrada M, Husslein P. Influence of acupuncture on duration of labor Gynecol Obstet Invest 1998; 46:22-5.
[7] Betts D, Lennox S. Acupuncture for prebirth treatment: An observational study of its use in midwifery practice. Medical acupuncture 2006 May; 17(3):17-20
[8] Rabl M, Ahner R, Bitschnau M, Zeisler H, Husslein P. Acupuncture for cervical ripening and induction of labor at term – a randomized controlled trail. Wien Klin Wochenschr 2001; 113 (23-24): 942-6. Acupuncture Research

* Research Compiled by Debra Betts author of The Essential Guide to Acupuncture in Pregnancy and Childbirth © 2006 acupuncture.rhizome.net.nz

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