2021 Cureus Journal of Medical Science

Based on beneficial effects and minimal side effects, ginger may be a potential adjunct treatment for primary dysmenorrhea.

This review has shown that ginger can minimize pain in one or two periods. The present analysis provides compelling proof of the impact of ginger on relieving menstrual pain.

The finding in this study has verified the possibility of ginger efficacy in the treatment of primary dysmenorrhea, though no/small side effects have been identified and its use is associated with health benefits. Ginger is easily accessible due to its low cost. It can also be commonly used in the treatment of primary dysmenorrhea. The use of ginger is very useful and effective as NSAIDs because of the increasing trend in the use of traditional medicine and herbal medicine, particularly for people who do not want to use chemical drugs with more side effects. We strongly recommend that further research be performed with a greater number of patients regarding the effectiveness and protection of various doses of ginger.

Efficacy of Ginger in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-analysis Negi R, Sharma DS, Gaur DR, Bahadur A, Jelly P

2021 Cureus Journal of Medical Science

A systematic analysis indicates that ginger has a higher safety profile than NSAIDs for pain relief, with a smaller number of gastric side effects and fewer kidney risks.

The use of ginger is very useful and effective as NSAIDs because of the increasing trend in the use of traditional medicine and herbal medicine, particularly for people who do not want to use chemical drugs with more side effects.

Efficacy of Ginger in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-analysis Negi R, Sharma DS, Gaur DR, Bahadur A, Jelly P

2021 Frontiers in Medicine

Adding acupuncture to conventional therapy may decrease the subsequent endometriosis risk in female rheumatoid arthritis patients.

Between 1998 and 2010, female subjects with RA were recruited from a nationwide database (5,736 patients; age ≥20 years). Enrolled patients included 2,407 acupuncture users and 2,407 nonusers randomly selected using propensity scores. The occurrence of endometriosis was recorded through the end of 2012. Cox proportional hazards regression was used to estimate the adjusted hazard ratio (HR) associated with acupuncture use.

Results: During the follow-up period, 35 acupuncture users and 94 non-users developed endometriosis, with incidence rates of 2.36 and 4.91 per 1,000 person-years, respectively. Acupuncture use was associated with a 55% lower endometriosis risk. Those who received high intensity acupuncture (≥15 packages) had the greatest benefit.

The results of multivariable analysis demonstrated that the use of acupuncture was related to a significantly reduced risk of endometriosis. In the subgroup analysis, the medium- to high-level intensity acupuncture use was found to possibly lessen the risk of having endometriosis for more than 70%. We discovered that the post-rheumatoid arthritis acupuncture use would significantly reduce the risk of endometriosis in a dose-dependent manner.

The Relationship of Acupuncture Use to the Endometriosis Risk in Females With Rheumatoid Arthritis: Real-World Evidence From Population-Based Health Claims Chen Wei-Jen, Livneh Hanoch, Hsu Chien-Hui, Hu Ying-To, Lai Ning-Sheng, Guo How-Ran, Tsai Tzung-Yi

2021 Journal of Complementary and Integrative Medicine

Fennel intake decreased significantly the intensity of dysmenorrhea compared to placebo and was similar to non-steroidal anti-inflammatory drugs such as mefenamic acid.

Meta-analysis of these trials showed that F. vulgare intake decreased significantly the intensity of dysmenorrhea compared to the placebo. However, the effect of Mefenamic acid with F. vulgare was not different from each other.

The F. vulgare alleviates dysmenorrhea. Regarding the same effect of F. vulgare with NSAIDs, it is highly recommend to the women suffered from dysmenorrhea specifically the ones who have high tendency toward herbal medicine.

Effect of fennel on primary dysmenorrhea: a systematic review and meta-analysis Hadis Shahrahmani, Masumeh Ghazanfarpour, Nasim Shahrahmani, Fatemeh Abdi, Robert D. E. Sewell and Mahmoud Rafieian-Kopaei

2020 Evidence-Based Complementary and Alternative Medicine

The current evidence suggests that acupuncture and moxibustion is more effective than ibuprofen or Fenbid in the treatment of primary dysmenorrhoea.

This overview provided a comprehensive overview of the evidence on the effectiveness and safety of acupuncture and moxibustion for PD. Evidence of moderate quality suggested that acupuncture and moxibustion had a positive effect on indomethacin or Fenbid in treating PD. Low-quality evidence showed that compared to NSAIDs, acupuncture and moxibustion could relieve PD related pain with less adverse effects, which needs to be further researched. The adverse effects related to the acupuncture and moxibustion were mild, and they included dizziness, fainting, or minimal bleeding after acupuncture.

Effectiveness and Safety of Acupuncture and Moxibustion for Primary Dysmenorrhea: An Overview of Systematic Reviews and Meta-Analyses Jun Yang, Jun Xiong, Ting Yuan, Xue Wang, Yunfeng Jiang, Xiaohong Zhou, Kai Liao, Lingling Xu

2020 Journal of Maternal and Child Health

Acupuncture therapy can affect pain reduction in dysmenorrhea patients.

7 articles from South Korea, Taiwan, Spain, China, India, and Hong Kong were reviewed in this meta-analysis. This study showed that acupuncture therapy was -1.16 better in reducing pain in dysmenorrhea patients.

Effect of Acupuncture Therapy on Pain Reduction in Dysmenorrhea Patients: A Meta-Analysis Novitasari, E., Soemanto, R., & Prasetya, H.

2020 Nutrients

Fennel is as effective as conventional drug therapies in alleviating pain in primary dysmenorrhea.

A total of 12 studies were included in this review. The pooled results of seven trials showed that the effect of fennel is similar to that of conventional drug therapies in alleviating pain. In comparison with placebo, fennel was seen to have favorable effects on reducing pain in primary dysmenorrhea. Only three studies assessed adverse events (AEs), and one study reported minor AEs. Although the risk of bias for all the included studies was moderate, potential publication bias was observed due to the presence of a greater number of small studies with favorable effects.

Fennel for Reducing Pain in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Hye Won Lee ,Lin Ang ,Myeong Soo Lee ,Zainab Alimoradi and Eunseop Kim

2020 Journal of International Medical Research

For primary dysmenorrhoea, cinnamon/fennel/ginger effectively reduced pain intensity, and cinnamon shortened the duration of pain.

Nine studies with 647 patients were selected. Compared with the results in the control group, pain intensity was significantly relieved in the trial group when assessed by the intervention, observation period, and study quality. Pain duration was significantly shorter in the trial group. No publication bias was observed for either outcome.

Efficacy of herbal medicine (cinnamon/fennel/ginger) for primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials Xu Y, Yang Q, Wang X

2018 Medicine

Acupuncture might reduce menstrual pain and associated symptoms more effectively compared to no treatment or NSAIDs.

The results of this study suggest that acupuncture might reduce menstrual pain and associated symptoms more effectively compared to no treatment or NSAIDs, and the efficacy could be maintained during a short-term follow-up period. Despite limitations due to the low quality and methodological restrictions of the included studies, acupuncture might be used as an effective and safe treatment for females with primary dysmenorrhea.

The efficacy and safety of acupuncture in women with primary dysmenorrhea Woo HL, Ji HR, Pak YK, Lee H, Heo SJ, Lee JM, Park KS

2018 International Journal of Gynecology & Obstetrics

Acupuncture showed a significant benefit in pain reduction for women with endometriosis as compared with placebo.

The complementary interventions studied were acupuncture, exercise, electrotherapy, and yoga. All were inconclusive in affirming benefit, but demonstrated a positive trend in the treatment of symptoms of endometriosis. Meta-analysis of acupuncture showed a significant benefit in pain reduction as compared with placebo.

Numerous complementary treatments have been used to alleviate the symptoms of endometriosis, but only acupuncture has demonstrated a significant improvement in outcomes.

Systematic review and meta-analysis of complementary treatments for women with symptomatic endometriosis Mira, T.A., Buen, M.M., Borges, M.G., Yela, D.A. and Benetti-Pinto, C.L.

2018 Reproductive Health

Traditional Chinese medicine that is often used for infertility treatment has shown successful results in controlling the recurrence of endometriosis following surgery thereby providing symptomatic pain relief and improving Health Related Quality of Life.

Traditional Chinese medicine is used in Chinese patients to control the recurrence of endometriosis following surgery, provide symptomatic pain relief, and improve Health Related Quality of Life (HRQoL). It is also often used to treat infertility.

Though several treatment regimens are available for the management of patients with endometrial lesions, alternative strategies are used in China. In conclusion, although Western medicine has been studied and validated more extensively for the treatment of endometriosis, both TCM and Western medicine are used equally in the treatment of endometriosis in Chinese women.

A review of the risk factors, genetics and treatment of endometriosis in Chinese women: a comparative update Dai Y, Li X, Shi J, Leng J

2018 Evidence-Based Complementary and Alternative Medicine

Acupuncture may help to alleviate pain caused by primary dysmenorrhea.

While five systematic reviews reported contradictory results, the three of higher quality suggested that individuals who received acupuncture experienced lower levels of pain than their counterparts who received sham treatments. And two studies on acupressure also reported positive results and improved pain measured with VAS. The highest quality study showed that EA at SP6 was better in pain relief compared to EA at GB39. Cho et al. found that acupuncture was associated with a significant reduction in pain compared with pharmacological treatment or herbal medicine. Besides, one study found acupuncture at different acupoint had no difference in the mean VAS score reduction. Due to the study design, it only demonstrated the effects of difference meridian acupoints on primary dysmenorrhea, which, however, could not rule out the role of acupuncture therapy for the disease.

Only two studies reported adverse events, such as fainting during acupuncture, a hematoma, and a needling sensation after acupuncture. There were no serious adverse events. But these can be avoided with caution. Therefore, with the correct management and application, acupuncture is a safe technique for PD treatment.

Acupuncture for Primary Dysmenorrhea: An Overview of Systematic Reviews Zhang F, Sun M, Han S, Shen X, Luo Y, Zhong D, Zhou X, Liang F, Jin R

2017 PLOS One

The current literature suggests that acupuncture reduces endometriosis-related pain and serum CA-125 levels, regardless of the control intervention used.

Of the 10 studies included, only one pilot study used a placebo control and assessed blinding; the rest used various controls (medications and herbs), which were impossible to blind. The sample sizes were small in all studies, ranging from 8 to 36 patients per arm. The mean difference (MD) in pain reduction (pre- minus post-interventional pain level—measured on a 0–10-point scale) between the acupuncture and control groups was 1.36. Acupuncture had a positive effect on peripheral blood CA-125 levels, as compared with the control groups. Similarly, the effect of acupuncture on clinical effective rate was positive, as compared with the control groups.

Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S

2017 BMC Complementary Medicine and Therapies

Acupoint-stimulation can relieve pain effectively in the treatment of primary dysmenorrhea and offers advantages compared with treatment by NSAIDs.

The current evidence reveals that acupoint-stimulation in the treatment of primary dysmenorrhea has some obvious advantages compared with treatment by NSAIDs. The advantages are that acupoint-stimulation can alleviate the symptoms of dysmenorrhoea, reduce the level of peripheral blood PGF2α and has fewer side effect, so it can be used to treat primary dysmenorrhea patients, especially individuals with NSAIDs contraindication.

Effects of acupoint-stimulation for the treatment of primary dysmenorrhoea compared with NSAIDs: a systematic review and meta-analysis of 19 RCTs Xu, Y., Zhao, W., Li, T. et al.

2017 Evidence-Based Complementary and Alternative Medicine

Electroacupuncture can provide considerable immediate analgesia effect for primary dysmenorrhea.

Our findings indicated that EA at SP6 can provide considerable immediate analgesic effect for primary dysmenorrhea and its immediate effect of pain relieving seems to be superior to control interventions. Moreover, there was greater prevalence of curative rate in the EA treatment group compared with the pharmacological treatments after a course of treatment. These results appear to be encouraging, but it should be considered at the same time that they are based on relatively low number of trials and relatively poor methodological quality of the primary studies. Hence, future research should be designed strictly and comprehensively to provide unbiased evidence about the efficacy of EA in the treatment of PD.

Electroacupuncture is Beneficial for Primary Dysmenorrhea: The Evidence from Meta-Analysis of Randomized Controlled Trials Si-yi Yu, Zheng-tao Lv, Qing Zhang, Sha Yang, Xi Wu, You-ping Hu, Fang Zeng, Fan-rong Liang, Jie Yang

2016 Journal of Pain Research

Acupuncture could be tried as a complement in the treatment of pain in endometriosis as it is an overall safe treatment.

Based on the analysis in the presented review, there are grounds to believe that acupuncture can relieve pain in some patients. The effects of acupuncture as a pain-relieving treatment has in various studies been presented as an overall safe alternative treatment with very few and small (harmless) side effects, and furthermore with no effect on the environment. It could therefore also be regarded as a ‘sustainable’ treatment. In the future, studies designed for evaluating effectiveness between different types of treatment strategies, rather than efficacy design would be preferred to analyze treatment effects in individual patients.

Is acupuncture effective in the treatment of pain in endometriosis? Lund I, Lundeberg T

2016 Maturitas

Meta-analysis showed that Danggui Shaoyao San had superior effects compared to analgesics for treating primary dysmenorrhea.

A total of 746 potentially relevant studies were identified, and four RCTs met our inclusion criteria. All of the included RCTs had a high risk of bias across their domains. Three RCTs showed favourable effects of DSS on response rate compared with conventional medicine, and a meta-analysis showed that DSS had superior effects compared to analgesics. One RCT showed a beneficial effect of DSS on pain compared with placebo control. Our systematic review and meta-analysis provided suggestive evidence of the superiority of DSS over analgesics or placebo for dysmenorrhea. The quality of evidence for this finding was low to moderate because of a high risk of bias.

Herbal medicine (Danggui Shaoyao San) for treating primary dysmenorrhea: A systematic review and meta-analysis of randomized controlled trials Hye Won Lee, Ji Hee Jun, Ki-Jung Kil, Byong-Seob Ko, Choong Hwan Lee, Myeong Soo Lee

2016 Cochrane Database of Systematic Reviews

The review found limited consistent evidence supporting the effectiveness of acupuncture for relieving menstrual pain compared to sham treatments or other interventions.

This passage provides a summary of the main results of a review on the effectiveness of acupuncture and acupressure in managing primary dysmenorrhoea (menstrual pain) in women. The review includes 42 trials involving 4640 women. The primary outcome, which is pain relief, showed no consistent difference between women receiving acupuncture and those receiving a sham control (simulated treatment). However, limited evidence suggested a benefit for acupuncture compared to NSAIDs, Chinese herbs, and other treatments. Acupressure had limited evidence of benefit compared to a sham control. Secondary outcomes, including menstrual symptoms and quality of life, did not consistently show a benefit from acupuncture. The trials had various limitations, such as incomplete reporting of outcomes, short follow-up periods, and variations in eligibility criteria. The quality of reporting was generally poor, and many trials were at high risk of bias. The overall quality of evidence for pain relief and menstrual symptoms was considered low. Other reviews on this topic found promising evidence for acupuncture, but results were influenced by methodological flaws in the trials.

Acupuncture for dysmenorrhoea Smith CA, Armour M, Zhu X, Li X, Lu ZY, Song J

2015 Journal of Acupuncture and Meridian Studies

Acupressure showed evidence of pain relief while acupuncture improved both the mental and the physical components of quality of life associated with primary dysmenorrhea.

This study involved three reviewers who dependently and independently performed study selection, quality assessment, and data extraction and management. Several interventions indicated statistical significance. Insights into the efficacies of the interventions were identified in correlation to themselves and with one another. The systematic review highlighted promising evidence in the form of studies done to establish the effectiveness of acupuncture and acupressure in the management of primary dysmenorrhea. However, the results were limited and had methodological flaws. The review and the meta-analysis indicated that acupressure significantly reduced the pain associated with primary dysmenorrhea and that acupuncture improved both the physical and the mental components of quality of life. The magnitude of these effects may or may not be clinically worthwhile, but as the costs and the risks of these interventions is low, these results may be clinically useful.

As Acupressure Decreases Pain, Acupuncture May Improve Some Aspects of Quality of Life for Women with Primary Dysmenorrhea: A Systematic Review with Meta-Analysis Abaraogu UO, Tabansi-Ochuogu CS

2013 Evidence-Based Complementary and Alternative Medicine

Our findings suggest that acupressure at the SP6 acupoint may provide more effective pain relief than that of control treatment.

This is the first systematic review to evaluate the effectiveness of acupuncture or acupressure at the SP6 acupoint for relieving pain associated with primary dysmenorrhea. Our findings suggest that acupuncture at the SP6 acupoint may not be more effective than acupuncture at an unrelated (GB39) acupoint for the relief of dysmenorrhea-associated pain (assessed using a VAS). In contrast, our findings suggest that acupressure at the SP6 acupoint may provide more effective relief from dysmenorrhea-associated pain than control interventions.

Clearly, there is a need for high-quality, randomized controlled trials to clarify the effectiveness of acupuncture/acupressure at the SP6 acupoint for the treatment of pain resulting from primary dysmenorrhea.

Acupuncture or Acupressure at the Sanyinjiao (SP6) Acupoint for the Treatment of Primary Dysmenorrhea: A Meta-Analysis Chen MN, Chien LW, Liu CF

2011 Cochrane Database of Systematic Reviews

Acupuncture shows potential for reducing dysmenorrhoea scores in endometriosis patients.

Endometriosis is a prevalent gynaecological condition that significantly affects women's lives, often leading to chronic pelvic pain and dysmenorrhoea. However, the current management of pain in endometriosis is inadequate. Acupuncture has been studied in gynaecological disorders, but its effectiveness for pain in endometriosis remains uncertain. Researchers conducted a systematic review to determine the effectiveness and safety of acupuncture for pain in endometriosis. Out of twenty-four identified studies on acupuncture for endometriosis, only one trial met the inclusion criteria. The study showed that acupuncture, particularly auricular acupuncture, may reduce dysmenorrhoea scores and be more effective than Chinese herbal medicine. However, due to the limited evidence from only one study, more well-designed, double-blinded, randomized controlled trials comparing various types of acupuncture with conventional therapies are needed to draw stronger conclusions about acupuncture's efficacy in managing pain in endometriosis.

Acupuncture for pain in endometriosis Zhu X, Hamilton KD, McNicol ED

2010 BJOG: An International Journal of Obstetrics & Gynaecology

Acupuncture shows promise for reducing pain in primary dysmenorrhea compared to pharmacological treatment or herbal medicine.

This study aimed to evaluate the effectiveness of acupuncture for treating primary dysmenorrhea through a review of randomized controlled trials (RCTs). A comprehensive search was conducted across multiple databases up to July 2008, encompassing English, Korean, Japanese, and Chinese sources. The review included 27 RCTs, of which only nine described randomization methods clearly, and none provided details about allocation concealment. Acupuncture demonstrated a significant reduction in pain compared to pharmacological treatment or herbal medicine. While some studies reported reduced pain within groups, two trials found no significant difference between acupuncture and sham acupuncture. The review suggests promising evidence from RCTs supporting acupuncture's efficacy in treating primary dysmenorrhea when compared to pharmacological treatment or herbal medicine. However, the results were hindered by methodological limitations. The study emphasizes the need for more rigorous nonpenetrating placebo-controlled RCTs to establish the effectiveness of acupuncture for primary dysmenorrhea treatment.

Acupuncture for primary dysmenorrhoea: a systematic review Cho SH, Hwang EW

2010 Acta Obstetricia et Gynecologica Scandinavica

Acupuncture-related therapies may have potential as an intervention for primary dysmenorrhea.

This passage provides a systematic review of studies on acupuncture-related therapies for primary dysmenorrhea (menstrual pain). The review included 32 trials with a total of 3,910 patients. These trials compared acupuncture, acupressure, and moxibustion to various control treatments. The results showed conflicting findings regarding the effectiveness of acupuncture-related therapies, with one trial suggesting acupuncture was significantly more effective than control groups. However, the review also identified several limitations in the trials, including issues with study design, outcome measures, trial heterogeneity, and potential publication bias. The authors suggest that while acupuncture-related therapies may hold promise for treating dysmenorrhea, further well-designed trials are needed to provide more definitive evidence. They also recommend improvements in study methodologies and the application of international outcome measures for more accurate and comparable results.

Systematic review of clinical trials of acupuncture-related therapies for primary dysmenorrhea Yang, H., Liu, C.-Z., Chen, X., Ma, L.-X., Xie, J.-P., Guo, N.-N., Ma, Z.-B., Zheng, Y.-Y., Zhu, J., & Liu, J.-P.