Acupuncture for dysmenorrhoea

Caroline A Smith, Mike Armour, Xiaoshu Zhu, Xun Li, Zhi Yong Lu, Jing Song, Caroline A Smith, Mike Armour, Xiaoshu Zhu, Xun Li, Zhi Yong Lu, Jing Song

Abstract

Background: Primary dysmenorrhoea is the most common form of period pain and affects up to three-quarters of women at some stage of their reproductive life. Primary dysmenorrhoea is pain in the absence of any organic cause and is characterised by cramping pain in the lower abdomen, starting within the first eight to 72 hours of menstruation.This review examines the currently available evidence supporting the use of acupuncture (stimulation of points on the body using needles) and acupressure (stimulation of points on the body using pressure) to treat primary dysmenorrhoea.

Objectives: To determine the effectiveness and safety of acupuncture and acupressure in the treatment of primary dysmenorrhoea when compared with a placebo, no treatment, or conventional medical treatment.

Search methods: We searched the following databases: the Cochrane Menstrual Disorders and Subfertility Group Trials Register (to September 2015), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, EMBASE, PsycINFO, CINAHL and Chinese databases including Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP database and registers of ongoing trials.

Selection criteria: We included all published and unpublished randomised controlled trials (RCTs) comparing acupuncture with sham acupuncture or placebo control, usual care, pharmacological treatment or no treatment. We included the following modes of treatment: acupuncture, electro-acupuncture, and acupressure. Participants were women of reproductive age with primary dysmenorrhoea during the majority of the menstrual cycles or for three consecutive menstrual cycles, and moderate to severe symptoms.

Data collection and analysis: We calculated odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, with 95% confidence intervals (CIs). We pooled the data where appropriate. Our primary outcomes was pain. Secondary outcomes included menstrual symptoms, quality of life, and adverse effects.

Main results: We included 42 RCTs (4640 women). Acupuncture or acupressure was compared with a sham/placebo group, medication, no treatment or other treatment. Many of the continuous data were not suitable for calculation of means, mainly due to evidence of skew.1. Acupuncture studies Acupuncture versus sham or placebo control (6 RCTs)Findings were inconsistent and inconclusive. However, the only study in the review that was at low risk of bias in all domains found no evidence of a difference between the groups at three, six or 12 months. The overall quality of the evidence was low. No studies reported adverse events. Acupuncture versus NSAIDs Seven studies reported visual analogue scale (VAS) pain scores, but were unsuitable for pooling due to extreme heterogeneity (I² = 94%). In all studies the scores were lower in the acupuncture group, with the mean difference varying across studies from 0.64 to 4 points on a VAS 0 - 10 scale (low-quality evidence). Four RCTs reported rates of pain relief, and found a benefit for the acupuncture group (OR 4.99, 95% CI 2.82 to 8.82, 352 women, I² = 0%, low-quality evidence). Adverse events were less common in the acupuncture group (OR 0.10, 95% CI 0.02 to 0.44, 4 RCTs, 239 women, 4 trials, I² = 15%, low-quality evidence). Acupuncture versus no treatment Data were unsuitable for analysis, but pain scores were lower in the acupuncture group in all six studies reporting this outcome. The quality of the evidence was low. No studies reported adverse events.2. Acupressure studiesNo studies of acupressure reported adverse events. Acupressure versus sham or placebo controlData were unsuitable for pooling, but two studies reported a mean benefit of one to three points on a 0 - 10 VAS pain scale. Another four studies reported data unsuitable for analysis: all found that pain scores were lower in the acupuncture group. No studies reported adverse events. The quality of the evidence was low. Acupressure versus NSAIDsOne study reported this outcome, using a 0 - 3 pain scale. The score was higher (indicating more pain) in the acupressure group (MD 0.39 points, 95% CI 0.21 to 0.57, 136 women, very low-quality evidence). Acupressure versus no treatmentThere was no clear evidence of a difference between the groups on a VAS 0 - 10 pain scale (MD -0.96 points, 95% CI -2.54 to 0.62, 2 trials, 140 women, I² = 83%, very low-quality evidence).

Authors' conclusions: There is insufficient evidence to demonstrate whether or not acupuncture or acupressure are effective in treating primary dysmenorrhoea, and for most comparisons no data were available on adverse events. The quality of the evidence was low or very low for all comparisons. The main limitations were risk of bias, poor reporting, inconsistency and risk of publication bias.

Conflict of interest statement

CS recently completed a randomised controlled trial of acupuncture to treat primary dysmenorrhoea.

MA recently completed a randomised controlled trial of acupuncture to treat primary dysmenorrhoea.

XZ, XL, ZL and JS have no conflicts of interest..

Figures

1
1
Study flow diagram: 2016 update
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 2 Acupuncture versus medication, outcome: 2.1 Pain score.
5
5
Forest plot of comparison: 8 Acupressure versus no treatment, outcome: 8.1 Pain score (VAS 0 ‐ 10).
1.1. Analysis
1.1. Analysis
Comparison 1 Acupuncture versus sham/placebo acupuncture, Outcome 1 Pain score.
1.2. Analysis
1.2. Analysis
Comparison 1 Acupuncture versus sham/placebo acupuncture, Outcome 2 Improvement in menstrual symptoms.
1.3. Analysis
1.3. Analysis
Comparison 1 Acupuncture versus sham/placebo acupuncture, Outcome 3 Use of additional medication.
1.4. Analysis
1.4. Analysis
Comparison 1 Acupuncture versus sham/placebo acupuncture, Outcome 4 Restriction of daily living activities.
1.5. Analysis
1.5. Analysis
Comparison 1 Acupuncture versus sham/placebo acupuncture, Outcome 5 Quality of life: physical health.
1.6. Analysis
1.6. Analysis
Comparison 1 Acupuncture versus sham/placebo acupuncture, Outcome 6 Quality of life: mental health.
1.7. Analysis
1.7. Analysis
Comparison 1 Acupuncture versus sham/placebo acupuncture, Outcome 7 Quality of life: bodily pain.
1.8. Analysis
1.8. Analysis
Comparison 1 Acupuncture versus sham/placebo acupuncture, Outcome 8 Quality of life: general health.
1.9. Analysis
1.9. Analysis
Comparison 1 Acupuncture versus sham/placebo acupuncture, Outcome 9 Quality of life: vitality.
1.10. Analysis
1.10. Analysis
Comparison 1 Acupuncture versus sham/placebo acupuncture, Outcome 10 Quality of life: social function.
1.11. Analysis
1.11. Analysis
Comparison 1 Acupuncture versus sham/placebo acupuncture, Outcome 11 Quality of life: role emotional.
2.1. Analysis
2.1. Analysis
Comparison 2 Acupuncture versus medication, Outcome 1 Pain score.
2.2. Analysis
2.2. Analysis
Comparison 2 Acupuncture versus medication, Outcome 2 Pain relief.
2.3. Analysis
2.3. Analysis
Comparison 2 Acupuncture versus medication, Outcome 3 Menstrual symptom score.
2.4. Analysis
2.4. Analysis
Comparison 2 Acupuncture versus medication, Outcome 4 Use of additional medication.
2.5. Analysis
2.5. Analysis
Comparison 2 Acupuncture versus medication, Outcome 5 Quality of life.
2.6. Analysis
2.6. Analysis
Comparison 2 Acupuncture versus medication, Outcome 6 Adverse events.
3.1. Analysis
3.1. Analysis
Comparison 3 Acupuncture versus Chinese herbs, Outcome 1 Pain score.
3.2. Analysis
3.2. Analysis
Comparison 3 Acupuncture versus Chinese herbs, Outcome 2 Menstrual symptom improvement.
4.1. Analysis
4.1. Analysis
Comparison 4 Acupuncture versus no treatment, Outcome 1 Pain score.
4.2. Analysis
4.2. Analysis
Comparison 4 Acupuncture versus no treatment, Outcome 2 Severity of menstrual symptoms.
5.1. Analysis
5.1. Analysis
Comparison 5 Acupuncture versus usual care, Outcome 1 Pain score.
5.2. Analysis
5.2. Analysis
Comparison 5 Acupuncture versus usual care, Outcome 2 Absence from work or school.
5.3. Analysis
5.3. Analysis
Comparison 5 Acupuncture versus usual care, Outcome 3 Quality of life physical health.
5.4. Analysis
5.4. Analysis
Comparison 5 Acupuncture versus usual care, Outcome 4 Quality of life: mental health.
5.5. Analysis
5.5. Analysis
Comparison 5 Acupuncture versus usual care, Outcome 5 Quality of life: bodily pain.
5.6. Analysis
5.6. Analysis
Comparison 5 Acupuncture versus usual care, Outcome 6 Quality of life: general health.
5.7. Analysis
5.7. Analysis
Comparison 5 Acupuncture versus usual care, Outcome 7 Quality of life: vitality.
5.8. Analysis
5.8. Analysis
Comparison 5 Acupuncture versus usual care, Outcome 8 Quality of life: social function.
5.9. Analysis
5.9. Analysis
Comparison 5 Acupuncture versus usual care, Outcome 9 Qualit of life: role emotional.
5.10. Analysis
5.10. Analysis
Comparison 5 Acupuncture versus usual care, Outcome 10 Adverse events.
6.1. Analysis
6.1. Analysis
Comparison 6 Acupressure versus sham/placebo, Outcome 1 Pain score (VAS 0 ‐ 10).
6.2. Analysis
6.2. Analysis
Comparison 6 Acupressure versus sham/placebo, Outcome 2 Severity of menstrual symptoms.
7.1. Analysis
7.1. Analysis
Comparison 7 Acupressure versus medication (NSAIDs), Outcome 1 Pain score.
8.1. Analysis
8.1. Analysis
Comparison 8 Acupressure versus no treatment, Outcome 1 Pain score (VAS 0 ‐ 10).
8.2. Analysis
8.2. Analysis
Comparison 8 Acupressure versus no treatment, Outcome 2 Menstrual symptoms (MDQ).

References

References to studies included in this review Aghamiri 2005 {published data only}

    1. Aghamiri Z, Vigeh M, Latifnezhead R, Nabavi S. Study of effect of acupuncture methods on pain in primary dysmenorrhea. Hayat 2005;11(4):19‐28.
Bazarganipour 2010 {published data only}
    1. Bazarganipour F, Lamyian M, Heshmat R, Abadi MAJ, Taghavi A. A randomized clinical trial of the efficacy of applying a simple acupressure protocol to the Taichong point in relieving dysmenorrhea. International Journal of Gynecology and Obstetrics 2010;111(2):105‐9.
Bu 2011 {published data only}
    1. Bu YQ, Du GZ, Chen SZ. Clinical study on the treatment of primary dysmenorrhea with preconditioning acupuncture. Clinical Journal of Integrated Medicine 2011;17(3):224‐7.
Cao 2011 {published data only}
    1. Cao Y. Acupuncture Clinical Analysis of Primary Dysmenorrhoea. Shandong: Shandong TCM University, 2010.
Charandabi 2011 {published data only}
    1. Charandabi SMA, Nashtaei MS, Kamali S, Majlesi R. The effect of acupressure at the Sanyinjiao point (SP6) on primary dysmenorrhea in students residents in dormitories of Tabriz. Iranian Journal of Nursing and Midwifery Research 2011;16(4):309‐17.
Chen 2004 {published data only}
    1. Chen HM, Chen CH. Effects of acupressure at the Sanyinjiao on primary dysmenorrhoea. Journal of Advanced Nursing 2004;48(4):380‐7.
Chen 2010 {published data only}
    1. Chen HM, Chen CH. Effects of acupressure on menstrual distress in adolescent girls: a comparison between Hegu‐Sanyinjiao matched points and Hegu, Zusanli single point. Journal of Clinical Nursing 2010;19(7‐8):998‐1007.
Darabi 2010 {published data only}
    1. Darabi R, Aghamohammadi H, Jafari A, Sadeghi F, Haccopian G. Efficacy of acupuncture in control of primary dysmenorrhea related pain in 15‐30 years old women at the Gynecology clinic of Bouali Hospital between 2007‐2008. Medical Science Journal of Islamic Azad University‐ Tehran Branch 2010;3:170‐4.
Han 2012 {published data only}
    1. Han TJ, Wei ML, Li WL, Huang JY, Ke H, Sun F, et al. Study on methods of combination of acupuncture with moxibustion for primary dysmenorrhoea. Chinese Journal of Basic Medicine in Traditional Chinese Medicine 2012;18(12):1383‐4.
Helms 1987 {published data only}
    1. Helms JM. Acupuncture for the management of primary dysmenorrhea. Obstetrics and Gynecology 1987;69(1):51‐6.
Hu 2005 {published data only}
    1. Hu P, Chen SJ. Clinical observation of warm acupuncture for primary dysmenorrhea. Practical Clinical Journal of Integrated Chinese and Western Medicine 2005;6:21‐2.
Kashefi 2010 {published data only}
    1. Kashefi F, Ziyadlou S, Khajehei M, Ashraf AR, Fadaee AR, Jafari P. Effect of acupressure at the Sanyinjiao point on primary dysmenorrhea: a randomized controlled trial. Complementary Therapies in Clinical Practice 2010;16(4):198‐202.
Lee 2007 {published data only}
    1. Lee IS, Youn HM, Jung KK, Kim SM, Min YK, Kim CH, et al. Effect of sa‐am acupuncture treatment on dysmenorrhea pilot study, single blind, randomised sham acupuncture, controlled clinical trial. Journal of the Korean Acupuncture and Moxibustion Society 2007;24(3):63‐79.
Li 2008 {published data only}
    1. Li CH, Wang YZ, Ge XX. Clinical observation of the use of acupuncture on 4 gate points for primary dysmenorrhoea. Journal of Chinese Acupuncture and Moxibustion 2008;28:187‐90.
Li 2012b {unpublished data only}
    1. Li XJ. The Study of Acupuncture and Moxibustion Treatment of Primary Dysmenorrhea with Cold Coagulation and Blood Stasis. 2012.
Ma 2010 {published data only}
    1. Ma Y‐X, Ma L‐X, Liu X‐L, Ma Y‐X, Wang D, Liu J‐P, et al. A comparative study on the immediate effects pf electro‐acupuncture at Sanyinjia (SP6), Xuanzhong (GB39) and a non‐ meridian point, on menstrual pain and uterine arterial blood flow in primary dysmenorrhea patients. Pain Medicine 2010;11:1564‐75.
Ma 2013 {published data only}
    1. Ma Y‐X, Ye X‐N, Liu C‐Z, Li Z‐F, Du D‐Q, Guo G, et al. A clinical trial of acupuncture about time varying treatment and points selection in primary dysmenorrhea. Journal of Ethnopharmacology 2013;148:498‐504.
Mirbagher‐Ajorpaz 2011 {published data only}
    1. Mirbagher‐Ajorpaz N, Adib‐Hajbaghery M, Mosaebi F. The effects of acupressure on primary dysmenorrhea: a randomized controlled trial. Complementary Therapies in Clinical Practice 2011;17(1):33‐6.
Peng 2012 {unpublished data only}
    1. Peng M. Clinical Observation on Treating Primary Dysmenorrhea by Acupuncture Xi Acupoints of Three Foot Yin Meridians. Guangzhou: Guangzhou University of Chinese Medicine, 2012.
Qiao 2013 {unpublished data only}
    1. Qiao Li. The Optimum Scheme Selection and Preliminary Mechanism Discussion of Primary Dysmenorrhoea. Shanxi: Shanxi University of Chinese Medicine, 2013.
Ruan 2011 {unpublished data only}
    1. Ruan JX. A Randomised Controlled Trial of the Effects of Acupuncture on Treatment of Primary Dysmenorrhoea. Guangzhou University of Chinese Medicine, 2011.
Shi 2011 {published data only}
    1. Shi GX1, Liu CZ, Zhu J, Guan LP, Wang DJ, Wu MM. Effects of acupuncture at Sanyinjiao (SP6) on prostaglandin levels in primary dysmenorrhea patients. Clinical Journal of Pain 2011;27(3):258‐61.
Smith 2010 {published data only}
    1. Smith CA, Crowther CA, Petrucco O, Beilby J, Dent H. Acupuncture to treat primary dysmenorrhea in women: a randomised controlled trial. Evidence‐Based Complementary and Alternative Medicine 2010; Vol. 612464. [DOI: 10.1093/ecam/nep239]
Song 2013 {published data only}
    1. Song JS, Liu YQ, Liu CZ, Xie JP, MA LX, Wang LP, et al. Cumulative analgesic effects of electroacupuncture stimulation of Sanyoinjiao (Sp6) in primary dysmenorrhea patients: a multi‐centre randomised controlled trial. Acupuncture Research 2013;38(5):393‐8.
Sriprasert 2015 {published data only}
    1. Sriprasert I, Suerungruang S, Athilarp P, Matanasarawoot A, Teekchunhatean. Efficacy of acupuncture versus combined oral contraceptive pill in treatment of moderate to severe dysmenorrhea: a randomised controlled trial. Evidence‐Based Complementary and Alternative Medicine August 4th 2015 [Epub ahead of print]; Vol. 735690. [DOI: ]
Sun 2011 {unpublished data only}
    1. Sun J. Clinical and Experimental Research on the Effects of Shenque Moxibustion and Warming Needles with Moxibustion Treating Primary Dysmenorrhoea. Guangzhou University of Chinese Medicine, 2011.
Wang 2005b {published data only}
    1. Wang K, Pan WY, Duan YH. Clinical study of effect of ear acupuncture on treating primary dysmenorrhea. Guangdong Medical Journal 2005;26(2):1728‐9.
Wang 2009a {published data only}
    1. Wang MC, Hsu MC, Chein LW, Kao CH, Liu CF. Effects of auricular acupressure on menstrual symptoms and nitric oxide for women with primary dysmenorrhea. Journal of Alternative and Complementary Medicine 2009;15(3):235‐42.
Wang 2013b {published data only}
    1. Wang H, Zhao S, Li X, Ma SX, Li Q, Cui J. Efficacy observation on wrist‐ankle needle for primary dysmenorrhea in undergraduates. Zhong Guo Zhen Jiu 2013;33:996‐9.
Wang 2014a {published data only}
    1. Wang HB, Cui JM, Ahao S, Li XQ, Ma SX, Li Q, et al. Effect on primary dysmenorrhea treated by acupuncture and moxibustion. Chinese Archives of Traditional Chinese Medicine 2014;32(4):869‐70.
Witt 2008 {published data only}
    1. Witt CM, Reinhold T, Brinkhaus B, Roll S, Jena S, Willich SN. Acupuncture in patients with dysmenorrhea: a randomized study of clinical effectiveness and cost‐effectiveness in usual care. American Journal of Obstetrics and Gynecology 2008;198:166.e1‐166.e8.
Wong 2010 {published data only}
    1. Wong CL, Lai KY, Tse HM. Effects of acupressure on pain and menstrual distress in young women with dysmenorrhea. Complementary Therapies in Clinical Practice 2010;16(2):64‐9.
Xu 2013 {published data only}
    1. Xu SW, Yu C, Zhao J, Yang Q, Zhang R, Li G, et al. Clinical observation on use of pre‐acupuncture intervention for primary dysmenorrhea. Chinese Journal of Information on TCM 2013;20(8):76‐7.
Xu 2014 {published data only}
    1. Xu SW, Yu C, Zhao JP, Tan C, Yang QR, Zhang R, et al. Effect on primary dysmenorrhea treated by acupuncture. Beijing Journal of Traditional Chinese Medicine 2014;33(1):41‐2.
Yeh 2013a {published data only}
    1. Yeh M‐L, Hung Y‐L, Chen H‐H, Wang Y‐J. Auricular acupressure for pain relief in adolescents with dysmenorrhea: a placebo controlled study. Journal of Alternative and Complementary Medicine 2013;19(4):313‐8.
Youn 2008 {published data only}
    1. Youn HM, Kim CH, Park JH. Effect of acupuncture treatment on primary dysmenorrhea: a study on single blind sham acupuncture, randomised controlled clinical trial. Journal of the Korean Acupuncture and Moxibustion Society 2008;25:139‐62.
Yu 2014 {published data only}
    1. Yu C. Clinical observation on pre‐menstrual acupuncture for improving symptoms. Shanghai Journal of Acupuncture and Moxibustion 2014;33:738‐40.
Zafari 2011 {published data only}
    1. Zafari M, Tofighi M, Aghamohammady A, Behmanesh F, Rakhshaee Z. Comparison of the effect of acupressure, fish oil capsules, and ibuprofen on treatment of primary dysmenorrheal. African Journal of Pharmacy and Pharmacology 2011;5(8):115‐9.
Zhang 2012 {published data only}
    1. Zhang LM, Yang HY. Effect on primary dysmenorrhea treated by acupuncture. Journal of Traditional Chinese Medicine 2012;43(2):25‐6.
Zhang 2013a {published data only}
    1. Zhang Y. Acupuncture in the treatment of primary dysmenorrhea randomised parallel controlled study. Journal of Practical Traditional Chinese Internal Medicine 2013;11(27):69‐71.
Zhang 2013b {published data only}
    1. Zhang XN. The Influence of Symptomatic Marking of SF‐MPQ for Primary Dysmenorrhea on Pricking Shiqizhu (EX‐B8) in Different Intervention Time. Shandong: Shandong TCM University, 2013.
Zhi 2007 {published data only}
    1. Zhi L. Randomised controlled study on superficial needling for treatment of primary dysmenorrhea. Chinese Acupuncture and Moxibustion 2007;27(1):18‐21.
References to studies excluded from this review Bing 2011 {published data only}
    1. Bing C, Xiaaohua T. Acupuncture for primary dysmenorrhea: a randomised controlled trial. Journal of Acupuncture and Tuina Science 2011;9(5):295‐7.
Chao 2012 {published data only}
    1. Chao M. Acupoint injection of vitamin K for primary dysmenorrhoea: feasibility and acceptability results of a pilot cross over trial. European Journal of Integrative Medicine 2012;4:135‐6.
Chao 2014 {published data only}
    1. Chao MT, Wade CM, Abercrombie PD, Gomolak D. An innovative acupuncture treatment for primary dysmenorrhea: a randomized crossover pilot study. Alternative Therapies in Health and Medicine 2014;20(1):49‐56.
Chen 2008 {published data only}
    1. Chen B, Tu XH. Clinical observation on the efficacy of acupuncture in treating primary dysmenorrhoea. Shanghai Journal of Acupuncture and Moxibustion 2008;27(6):15‐6.
Chen 2011 {published data only}
    1. Chen SZ, Cong Q, Zhang BF. Preliminary comparison on the time effect rule of pain relieving in the treatment of moderate dysmenorrhoea between acupuncture on a single point and acupuncture on a multi point.. Chinese Acupuncture and Moxibustion 2011;31(4):305‐8.
Chen 2014 {published data only}
    1. Chen CL, Deng C. Clinical observation of acupuncture for primary dysmenorrhea. Journal of New Chinese Medicine 2014;46(7):161‐2.
Gao 2014a {published data only}
    1. Gao Y, Huang Z. Theraputic effect analysis of warm acupuncture for primary dysmenorrhea. Asia‐Pacific Traditional Medicine 2014;10(14):60‐1.
Gao 2014b {published data only}
    1. Gao XY. Effect of observation of acupuncture with TCM nursing for primary dysmenorrhea. Chinese Journal of Clinical Rational Drug Use 2014;7(9B):115‐6.
Geng 2008 {published data only}
    1. Geng S. Effect of observation of 60 primary dysmenorrhea treated with Chinese medicine. Beijing Journal of Traditonal Chinese Medicine 2008;27(1):30‐2.
Gharloghi 2012 {published data only}
    1. Gharloghi G, Torkzahrani S, Akbarzadeh AR, Heshmat R. The effects of acupressure on severity of primary dysmenorrhea. Patient Preference and Adherence 2012;6:137–42.
Guo 2008 {published data only}
    1. Guo A, Meng Q. Acupuncture combined with spinal Tui Na for treatment of primary dysmenorrhea in 30 cases. Journal of Traditional Chinese Medicine 2008;28(1):7‐9.
Habek 2003 {published data only}
    1. Habek D, Cerkez Habek JC, Bobić‐Vuković, Vujić B. Efficacy of acupuncture for the treatment of primary dysmenorrhoea. Gynakologisch‐Geburtshilifiche Rundschau 2003;43(4):250‐3.
He 2005 {published data only}
    1. He JW, Chang JT, Zhao JM. Clinical observation of acupuncture and moxibustion therapy for primary dysmenorrhea. Chinese Contempory Medicine 2005;3(3):10‐1.
Hu 2011 {published data only}
    1. Hu Y, Lin Q, Li Y, Zheng X. Effects on PGF2alpha in plasma in primary dysmenorrhea treated with eye acupuncture. Zhong Guo Zhen Jiu 2011;31:683‐6.
Hu 2014 {published data only}
    1. Hu TM, Cai J, Xiong FL, Zhu GQ. Theraputic observation of acupoint injection and moxibustion for dysmenorrhea with pattern of cold retention. Yunnan Journal of Traditional Chinese Medicine 2014;35(10):58‐9.
Huang 2013 {published data only}
    1. Huang T, Yang L, Jia S, Mu X, Wu M, Ye H, et al. Capillary blood flow in patients with dysmenorrhea treated with acupuncture. Journal of Traditional Chinese Medicine 2013;33(6):757‐60.
Huyou‐Ping 2013 {published data only}
    1. Huyou‐Ping, Zhang X, Zhang LX, Wu J, Wang Z, Jia XF, et al. Time effect study on instant analgesic effect of the dragon‐tiger fighting needling method on primary dysmenorrhea. Zhongguo Zhen Jiu [Chinese Acupuncture and Moxibustion] 2013;33(11):1005‐9.
Jiang 2007 {published data only}
    1. Jiang LY. Clinical experience for the treatment of 34 cases of primary dysmenorrhoea. Journal of Emergency TCM 2007;16:620‐1.
Jun 2004 {published data only}
    1. Jun EM. Effects of SP6 acupressure on dysmenorrhea, skin temperature of CV2 acupoint and temperature in the college student. Journal of Korean Academic Nursing 2004;34(7):1343‐50.
Jun 2007 {published data only}
    1. Jun EM, Chang S, Kang DH, Kim S. Effects of acupressure on dysmenorrhea and skin temperature changes in college students: a non randomised controlled trial. International Journal of Nursing Studies 2007;44(6):973‐81.
Kempf 2009 {published data only}
    1. Kempf D, Berger D, Ausfeld‐Hafter B. Laser needle acupuncture in women with dysmenorrhoea: a randomised controlled double blind pilot trial. Forschende Komplementarmedizin [Research in Complementary Medicine] 2009;16(1):6‐12.
Kim 2011 {published data only}
    1. Kim E, Cho JH, Jung WS, Lee S, Pak SC. Effect of acupuncture on heart rate variability in primary dysmenorrheic women. American Journal of Chinese Medicine 2011;39(2):243‐9.
Kiran 2013 {published data only}
    1. Kiran G, Gumusalan Y, Ekerbicer HC, Kiran H. A randomized pilot study of acupuncture treatment for primary dysmenorrhea. European Journal of Obstetrics, Gynecology and Reproductive Biology 2013;169(2):292‐5.
Li 2006 {published data only}
    1. Li W, Liu L, Sun Li. Analysis on therapeutic effect of substance‐partitioned moxibustion at Guanyuan (CV4) and Shenque (CV8) for treatment of primary dysmenorrhea of cold damp type. Chinese Acupuncture and Moxibustion 2006;26(7):481‐2.
Li 2007 {published data only}
    1. Li CH, Guo XX. Acupuncture in combination with herbal plaster on umbilicus for 58 cases of primary dysmenorrhoea. China Medical Herald 2007;12(4):100‐1.
Li 2011 {published data only}
    1. Li YM, Bu YQ, Hou WJ, Chen SZ, Gao SZ. Observation on immediate analgesic effect on acupuncture at Shiqizhui (EX‐B 8)only or multi acupoints in patients with dysmenorrhoea: a randomised controlled trial. Chinese Acupuncture and Moxibustion 2011;31(3):199‐202.
Li 2012a {published data only}
    1. Li M‐G, Li D‐C, Li S‐R. Acupuncture and moxibustion combined with cupping for primary dysmenorrhea in 66 cases. World Journal of Acupuncture‐Moxibustion 2012;22(2):68‐70.
Lin 2008 {published data only}
    1. Lin LL, Liu CZ, Huang BY. Clinical observation on treatment of primary dysmenorrhea with acupuncture and massage. Zhongguo Zhong Xi Yi Jie He Za Zhi [Chinese Journal of Integrated Traditional and Western Medicine] 2008;28(5):418‐20.
Liu 2005 {published data only}
    1. Liu YL. Clinical observation of acu‐point injection with vitamin K3 on SP6 for primary dysmenorrhea. Journal of Chinese Medicine Liaoning 2005;32(11):1185‐6.
Liu 2014a {published data only}
    1. Liu CZ, Xie JP, Wang LP, Liu YQ, Song JS, Chen YY, et al. A randomized controlled trial of single point acupuncture in primary dysmenorrhea. Pain Medicine 2014;15(6):910‐20.
Liu 2014b {published data only}
    1. Liu CM, Ma YX, Guo ZP, Gong CR. Real‐time analgesic effect of acupuncture at Shiqizhui (EX‐B8) for primary dysmenorrhea with different needle‐retaining time. Shanghai Journal of Acupuncture and Moxibustion 2014;33(10):901‐2.
Lui 1999 {published data only}
    1. Lui AZ, Zhang CM. Study of acupuncture versus psychological therapy for dysmenorrhea. Zhongguop Zhen Jiu [Chinese Acupuncture and Moxibustion] 1999;19:209‐10.
Luo 2014 {published data only}
    1. Luo XW. Electronic acupuncture with moxibustion for primary dysmenorrhea with pattern of cold retention in 45 cases. Yunnan Journal of Chinese Medicine and Herbal Medicine 2014;35(12):44‐5.
Mahoney 1993 {unpublished data only}
    1. Mahoney DS. Acupressure and its use for dysmenorrhoea. Texas Women's University, 1993.
Miao 2014 {published data only}
    1. Miao EY, Miao MY, Kildea DG, Lao YW. Effects of electroacupuncture and electroacupuncture plus Tao Hong Si Wu Wan in treating primary dysmenorrhea. Journal of Acupuncture and Meridian Studies 2014;7(1):6‐14.
Pouresmail 2002 {published data only}
    1. Pouresmail Z, Ibrahimzadeh R. Effects of acupressure and Ibuprofen on the severity of primary dysmenorrhea. Journal of Traditional Chinese Medicine 2002;23(3):205‐10.
Pu 2011 {published data only}
    1. Pu Y. Observation on therapeutic effect of acupuncture at Shiqizhui (extra) for primary dysmenorrhoea at different time. Zhongguo Zhen Jui [Chinese Acupunsture and Moxibustion] 2011;31(2):110‐2.
Reyes‐Campos 2013 {published data only}
    1. Reyes‐Campos MD, Díaz‐Toral LG, Verdín‐Terán SL, Orozco‐Suárez ES, López‐Ramírez P, Pineda‐Carranza A, et al. Acupuncture as an adjunctive treatment for primary dysmenorrhoea: a comparative study. Medical Acupuncture 2013;25(4):291‐4.
Ro 2013 {published data only}
    1. Ro SO, Lee HY, Lee J, Kim M. Effects of auricular acupuncture on menstrual pain, dysmenorrhea and academic stress in women college students. Korean Journal of Adult Nursing 2013;25(3):356‐364.. [DOI: 10.7475/kjan.2013.25.3.356]
She 2008 {published data only}
    1. She YF, Sun L, Yang J, Ge J, Li X. Effects of substance partioned moxibustion on plasma Beta‐EP content in the patient with primary dysmenorrhea of cold damp stagnation type in the menstrual period. Chinese Acupuncture and Moxibustion 2008;28(10):719‐21.
Shi 1994 {published data only}
    1. Shi XL, Yang AM, Li FZ. Acupuncture of San Yin Jiao for the treatment of 120 cases of primary dysmenorrhoea. Chinese Acupuncture and Moxibustion 1994;14(5):17‐8.
Song 1992 {published data only}
    1. Song XZ, Ji Y. Clinical observation on the efficacy of ear seed pressing on dysmenorrhea. Journal of Beijing College of Traditional Chinese Medicine 1992;2:58‐9.
Sun 2004 {published data only}
    1. Sun LH, Ge JJ, Yang JJ, She YF. Effect observation of substance partitioned moxibustion for 42 cases of primary dysmenorrhea. Journal of Herbei TCM and Pharmacology 2004;19(3):37.
Sun 2008 {published data only}
    1. Sun LH, Ge JJ, She YF, Yang JJ, Li WL, Li XH. Therapeutic effect of substance partitioned moxibustion on 103 cases of primary dysmenorrhea of cold damp stagnation type. Hebei Journal of TCM 2008;30(2):170‐1.
Wang 2002 {published data only}
    1. Wang HY. Auricular acupuncture for the treatment of 68 cases of primary dysmenorrhoea. Journal of Zhejiang Traditional Chinese Medicine 2002;6:249.
Wang 2005a {published data only}
    1. Wang SM, Li XG, Zhang LQ. Clinical observation on 96 cases of primary dysmenorrhea treated by medicine‐separated moxibustion and investigation on its mechanisms. World Journal of Acupuncture‐Moxibustion 2005;15(3):13‐7.
Wang 2009b {published data only}
    1. Wang SX, Lu DJ, Li YH. [Observation on therapeutic effect of acupoint application on dysmenorrhea of excess syndrome and effect on prostaglandins]. Chinese Acupuncture and Moxibustion 2009;29(4):265‐8.
Wang 2013a {published data only}
    1. Wang YJ, Hsu CC, Yeh ML, Lin JG. Auricular acupressure to improve menstrual pain and menstrual distress and heart rate variability for primary dysmenorrhea in youth with stress. Evidence‐Based Complementary and Alternative Medicine 2013; Vol. 138537. [DOI: 10.1155/2013/138537]
Wang 2014b {published data only}
    1. Wang GF, Yuan Y, Cui H. Clinical effect of electric acupuncture combined with ginger‐isolated moxibustion on treating primary dysmenorrhea of 30 cases. Journal of Clinical Acupuncture and Moxibustion 2014;30(1):30‐1.
Wu 2007 {published data only}
    1. Wu RD, Zhang HD, Lin LF. Observation on ear point taping and pressing therapy for treatment of primary dysmenorrhea. Chinese Acupuncture and Moxibustion 2007;27(11):815‐7.
Xie 2003 {published data only}
    1. Xie GT, Tan LY, Lu QQ, Zhao CJ. Clinical research on Ling Gui Ba Fa for the treatment of primary dysmenorrhoea. Journal of Clinical Acupuncture 2003;8:59‐60.
Xiong 2012 {published data only}
    1. Xiong J, Liu F, Zhang M, Wang W, Huang GY. De‐qi, not psychological factors, determines the therapeutic efficacy of acupuncture treatment for primary dysmenorrhea. Chinese Journal of Integrated Medicine 2012;18(1):7‐15.
Yang 2008a {published data only}
    1. Yang JJ, Sun LH, She YF, Ge JJ, Li XH, Zhang RJ. Influence of ginger partioned moxibustion on serum NO and plasma endothelin‐1 contents in patients with primary dysmenorrhea of cold‐damp stagnation types. Acupuncture Research 2008;33(6):409‐12.
Yang 2014 {published data only}
    1. Yang SX. Theraputic effect observation of acupuncture and ear acupuncture for primary dysmenorrhea. Ningxia Medical Journal 2014;36(8):755‐6.
Yeh 2013 {published data only}
    1. Yeh ML, Hung YL, Chen HH, Lin JG, Wang YJ. Auricular acupressure combined with an internet‐based intervention or alone for primary dysmenorrhea: a control study. Evidence‐Based Complementary and Alternative Medicine 2013; Vol. 316212. [DOI: 10.1155/2013/316212]
Yi 2005 {published data only}
    1. Yi LH, Chen Y. Clinical observation on use of acupuncture in combination with massage for 55 cases of primary dysmenorrhoea. Chinese Journal of Clinical Healthcare 2005;8(2):140‐1.
Yu 2010 {published data only}
    1. Yu YP, Ma LX, Ma YX, Ma YX, Liu YQ, Liu CZ, et al. Immediate effect of acupuncture at Sanyinjiao (SP6) and Xuanzhong (GB39) on uterine arterial blood flow in primary dysmenorrhea. Journal of Alternative and Complementary Medicine 2010;16(10):1073‐8.
Yuk 2005 {published data only}
    1. Yuk SS, Lim EM. A clinical study on the effect of crossing over treatment of acupuncture and herbal medication for primary dysmenorrhea. Journal of Oriental Obstetrics and Gynecology 2005;18:144‐52.
Zhang 2004 {published data only}
    1. Zhang XH, Fang RD. Clinical observation on the use of Shao Fu Zhu Yu Tang in combination with acupuncture for 65 cases of primary dysmenorrhoea. Heilongjiang Journal of Traditional Chinese Medicine 2004;33(3):39‐41.
Zhang 2014 {published data only}
    1. Zhang SR. Clinical observation of acupuncture for primary dysmenorrhea. Chinese Journal of Clinical Rational Drug Use 2014;7(12):125‐6.
Zheng 2006 {published data only}
    1. Zheng Z. Observation of therapeutic effect of acupuncture on treating primary dysmenorrhea. Zhejjang Journal of ITCWM 2006;16(2):78‐81.
Zheng 2014 {published data only}
    1. Zheng YF, Wang ZH. Clinical observation of warm acupuncture combined with electronic acupuncture for primary dysmenorrhea. Liaoning Journal of Traditional Chinese Medicine 2014;41(7):1510‐1.
Zhou 2003 {published data only}
    1. Zhou LS. Clinical observation on the efficacy of acupuncture of Ciliao (BL32) point on primary dysmenorrhea. Hubei Journal of Traditional Chinese Medicine 2003;8:47.
Zhou 2014 {published data only}
    1. Zhou Y. Acupuncture with moxibustion therapy of primary dysmenorrhea: a random parallel control study. Journal of Practical Traditional Chinese Internal Medicine. 2014;28(12):133‐5.
References to studies awaiting assessment Han 2015 {published data only}
    1. Han Y, Zhou Y, Guo X, Liu Y, Li H, Chen X. Analgesis effect on primary dysmenorrhoeal treated with conventional and sham acupuncture at Sanyinjiao (SP6). Chinese Acupuncture and Moxibustion 2015;35:318‐22.
Zhang 2003 {published data only}
    1. Zhang M, Sun ST. Clinical observation of acupuncture therapy for 32 cases of primary dysmenorrhea. Journal of Chinese Science, Technology and Traditional Chinese Medicine 2003;10:322.
References to ongoing studies Armour 2013 {published data only}
    1. Acupuncture primary dysmenorrhoea: examining the role of frequency of treatment and mode of stimulation on clinical outcomes. Ongoing study May 2013.
Huang 2010 {published data only}
    1. Randomised controlled trial of acupuncture for dysmenorrhoea. Ongoing study May 2010.
Witt 2012 {published data only}
    1. Effectiveness of additional self‐care acupressure for women with menstrual pain compared to usual care. Ongoing study December 2012.
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