ACUPUNCTURE FOR WOMEN’S PROBLEMS
Prof. Koosnadi Saputra, MD., PhD.
ABSTRACT
Women’s health problems include gynecological problems such as endometriosis, infertility, dysmenorrhea, dysfunctional uterine bleeding (DUB), premenstrual syndrome, uterine fibroids, pelvic inflammation disease (PID), polycystic ovaries syndrome (PCOS), cervicitis, vaginitis, and degeneration problems such as menopausal syndrome and osteoporosis.
Physical and psychological symptoms that arise from these conditions usually are treated with medications and sometimes with physical as well as psychological approaches. Many studies regarding acupuncture for women’s health problems that has been published. Some of these studies are clinical studies. These studies show that acupuncture is very effective in certain conditions.
Acupuncture can treat women’s health problems through its effect on regulating central nervous system, endocrine system, and immune system. The common acupuncture methods used in these conditions are body acupuncture, ear acupuncture, and SCALP acupuncture. The additional stimulations that commonly used are electrical stimulation, LASER, and heating. Results of the treatments usually evaluated by physical examination, psychological examination, laboratory examination, and imaging techniques (Ultrasound, CT SCAN, MRI and sometimes PET SCAN).
INTRODUCTION
Women’s health problems include gynecological problems such as endometriosis, infertility, dysmenorrhea, dysfunctional uterine bleeding (DUB), premenstrual syndrome, uterine fibroids, pelvic inflammation disease (PID), polycystic ovaries syndrome (PCOS), cervicitis, vaginitis, and degeneration problems such as menopausal syndrome and osteoporosis. Acupuncture has been used to treat these problems (Zhou & Qu 2009; Cochrane et al. 2014).
ACUPUNCTURE FOR PREMENSTRUAL SYNDROME
Premenstrual syndrome (PMS) defined as any mood, behavioral or physical symptoms that occur recurrently and cyclically during the luteal phase of the menstrual cycle (Halbreich 2007). Clinical presentation of PMS are diverse and range over mood, behavioral, cognitive, autonomic, allergy, gastrointestinal, fluid retention, and pain domains (Freeman 2007). Recent review showed that acupuncture treatments for premenstrual syndrome and premenstrual dysphoric disorder showed a 50% or better reduction of symptoms compared to the initial state (Jang et al. 2014). Acupuncture to treat premenstrual syndrome can be considered as an effective treatment modality (Anil et al. 2012).
ACUPUNCTURE FOR DYSMENORRHEA
Studies has showed that acupuncture can reduce pain in primary dysmenorrhea (Lillah et al. 2007; Shi et al. 2011; Wu et al. 2012). Acupuncture treatment succeed to reduce pain and discomfort in primary dysmenorrhea such as nausea, vomiting and decrease daily analgesic consumption. (Witt et al. 2008)
ACUPUNCTURE FOR MENOPAUSE WOMEN
The term menopause refers to a point in time that follows 1 year after the cessation of menstruation. During the menopausal transition, more erratic fluctuations in female reproductive hormones can lead to an array of physical and psychological symptoms (Schorge et al. 2008). Meta-analysis confirms that acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause (Chiu et al. 2015).
ACUPUNCTURE FOR PCOS
Review Johansson & Stener-Victorin (2013) proposed that acupuncture as a potential treatment option for reproductive and endocrine disturbances in women with PCOS. Several clinical and animal experimental studies indicate that acupuncture is beneficial for ovulatory dysfunction in PCOS. This is also related to decreased levels of sex steroids.
ACUPUNCTURE FOR GYNECOLOGIC CANCER
Until now cancer is one of the diseases that difficult to be totally cured. Therefore, the treatment goals for cancer patients should also be directed to increase the quality of life. Acupuncture gives good result to improve quality of life in cancer patients through its effect on sleep, appetite, pain, and anxiety (Saputra 1999; Vinjamury et al. 2013).
Cachexia is one of late-stage cancer complication which is characterized by decrease in body weight, fatigue, lethargy, weakness, and anemia. Cachexia occurs due to increase of systemic inflammation which will increase catabolism. Acupuncture can be used to treat cancer cachexia through its mechanism on CNS and regulation of immune system (Saputra 2000; Yoon et al. 2015).
Previous study at YKW Indonesia in 2000 showed low frequencies and high intensity stimulation at ST36, KI3, LI4, P6, and SP6 induces central effect based on neuro acupuncture theory to cancer pain problem, immunologic problem and circulatory problem. Sixty patients with cancer cachexia were included in this study. This study showed that acupuncture can reduce pain, nausea – vomiting, and increase body weight in patients with cancer cachexia. (Table 1)
Table 1. Study at YKW Indonesia on Patients with Cancer Cachexia
Symptom | Treatment Frequency | Result | ||
Pain Release | 2 x | Good 60% | Fair 10 % | Minimal 30% |
Naucea Vomiting | 4 x | Good 70% | Fair 10 % | Minimal 20% |
Body Weight | 8 x | Increase 40 % | Stable 25 % | Decrease 35 % |
ACUPUNCTURE FOR OSTEOPOROSIS
Osteoporosis can be caused by living habits, menopause, endocrine disease (such as diabetes mellitus, thyroid/ parathyroid disorders) and medications. Acupuncture can help patients with osteoporosis through increasing estrogen level (Zhou et al. 2013), reduce bone mass loss and increase bone mass formation (Saputra 2003; Saputra 2011). Acupuncture can significantly increase osteocalcin which is a biomarker for bone foramen (Xu 2003)
ACUPUNCTURE TO REDUCE LABOR PAIN
Many studies showed that acupuncture can be used to reduce labor pain (Saraswati 2002; Lee et al. 2004; Hjelmstedt et al. 2010; Yesilcicek Calik & Komurcu 2014). Acupuncture produces impulses which travel along the peripheral nerves to lateral funiculus of the spinal cord and finally to the brain. This will interact with pain impulses from uterus and result in pain relief. Acupuncture also stimulates the body to release neurotransmitters that raise the pain threshold (Arif & Hashman 2008).
ACUPUNCTURE FOR LACTATION
Acupressure can increase prolactin hormone in lactation period. One study showed that simple acupressure method that carried out twice a day for 11 days can significantly increase prolactin hormone in breastfeeding mother (Wiludjeng et al. 1998).
CONCLUSION
REFERENCE
Anil, A. et al., 2012. Importance of acupuncture on premenstrual syndrome. Clinical and Experimental Obstetrics and Gynecology, 39(2), pp.209–213.
Arif, S.K. & Hashman, A., 2008. Acupuncture Analgesia for Painless Labour. Meridian (Indonesian Journal of Acupuncture), XV(1), pp.22–31.
Chiu, H.-Y. et al., 2015. Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials. Menopause (New York, N.Y.), 22(2), pp.234–44. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25003620\nhttp://journals.lww.com/menopausejournal/Fulltext/publishahead/Effects_of_acupuncture_on_menopause_related.98349.aspx.
Cochrane, S. et al., 2014. Acupuncture and women’s health: An overview of the role of acupuncture and its clinical management in women's reproductive health. International Journal of Women’s Health, 6(1), pp.313–325.
Freeman, E.W., 2007. The clinical presentation and course of premenstrual symptoms. In P. S. O’Brien, A. J. Rapkin, & P. J. Schmidt, eds. The Premenstrual Syndromes: PMS and PMDD. London: Informa UK Ltd, pp. 55–61.
Halbreich, U., 2007. The diagnosis of PMS/PMDD – the current debate. In P. S. O’Brien, A. J. Rapkin, & P. J. Schmidt, eds. The Premenstrual Syndromes: PMS and PMDD. London: Informa UK Ltd, pp. 9–20.
Hjelmstedt, A. et al., 2010. Acupressure to reduce labor pain: a randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica, 89(11), pp.1453–1459. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20822474.
Jang, S.H., Kim, D. Il & Choi, M.-S., 2014. Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: systematic review. BMC complementary and alternative medicine, 14, p.11. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3898234&tool=pmcentrez&rendertype=abstract.
Johansson, J. & Stener-Victorin, E., 2013. Polycystic Ovary Syndrome: Effect and Mechanisms of Acupuncture for Ovulation Induction. Evidence-based complementary and alternative medicine : eCAM, 2013, pp.1–16.
Lee, M.K., Chang, S.B. & Kang, D.-H., 2004. Effects of SP6 acupressure on labor pain and length of delivery time in women during labor. Journal of alternative and complementary medicine (New York, N.Y.), 10(6), pp.959–965.
Lillah, K., Suyanto, E. & Wiyono, S.A., 2007. Acupuncture for Primary Dysmenorrhea: A Pilot Study. Meridian (Indonesian Journal of Acupuncture), XIV(2), pp.89–100.
Saputra, K., 1999. Acupuncture for Cancer. Meridian (Indonesian Journal of Acupuncture), VI(2), pp.49–57.
Saputra, K., 2000. Acupuncture Treating Cancer Cachexia. Meridian (Indonesian Journal of Acupuncture), VII(2), pp.76–92.
Saputra, K., 2003. Osteoporosis and Traditional Chinese Medicine. Meridian (Indonesian Journal of Acupuncture), X(3).
Saputra, K., 2011. The Role of Acupuncture to Support Osteoporotic Treatment of the Spine. Meridian (Indonesian Journal of Acupuncture), XVIII(2), pp.47–52.
Saraswati, W., 2002. The Use of Electro Acupuncture to Reduce Labor Pain. Meridian (Indonesian Journal of Acupuncture), IX(1), pp.13–21.
Schorge, J.O. et al. eds., 2008. Menopausal Transition. In Williams Gynecology. The McGraw-Hill Companies.
Shi, G.-X. et al., 2011. Effects of acupuncture at Sanyinjiao (SP6) on prostaglandin levels in primary dysmenorrhea patients. The Clinical journal of pain, 27(3), pp.258–61. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21358291.
Vinjamury, S.P. et al., 2013. Effects of acupuncture for cancer pain and quality of life - a case series. Chinese medicine, 8(1), p.15. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3734160&tool=pmcentrez&rendertype=abstract.
Wiludjeng, L.K. et al., 1998. Acupressure Method to Increase Prolactin Hormone in Lactation Period. Meridian (Indonesian Journal of Acupuncture), V(2), pp.84–90.
Witt, C.M. et al., 2008. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. American Journal of Obstetrics and Gynecology, 198(2).
Wu, L.L., Su, C.H. & Liu, C.F., 2012. Effects of noninvasive electroacupuncture at Hegu (LI4) and Sanyinjiao (SP6) acupoints on dysmenorrhea: a randomized controlled trial. Journal of alternative and complementary medicine (New York, N.Y.), 18(2), pp.137–42. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22339102.
Xu, H., 2003. Effect of Exercise and Traditional Chinese Medicine on Bone Structure and Function. Victoria University.
Yesilcicek Calik, K. & Komurcu, N., 2014. Effects of SP6 Acupuncture Point Stimulation on Labor Pain and Duration of Labor. Iranian Red Crescent Medical Journal, 16(10), p.e16461. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4270652&tool=pmcentrez&rendertype=abstract.
Yoon, S.L. et al., 2015. Novel intervention with acupuncture for anorexia and cachexia in patients with gastrointestinal tract cancers: a feasibility study. Oncology nursing forum, 42(2), pp.E102–9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25806891.
Zhou, J. & Qu, F., 2009. Treating gynaecological disorders with traditional Chinese medicine: A review. African Journal of Traditional, Complementary and Alternative Medicines, 6(4), pp.494–517.
Zhou, K. et al., 2013. Electroacupuncture Modulates Reproductive Hormone Levels in Patients with Primary Ovarian Insufficiency : Results from a Prospective Observational Study. Evidence-based Complementary and Alternative Medicine, 2013. Available at: http://www.hindawi.com/journals/ecam/2013/657234/.