1 Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
2 Rehabilitation Medicine University Clinic Stockholm, Danderyds Hospital AB, Stockholm, Sweden.
Abstract
Introduction
Endometriosis is a multifactorial, estrogen-dependent, inflammatory gynecological condition – often with long-lasting visceral pelvic pain of different origin, and infertility among women. Current management options for patients’ are often inadequate, with side effects for many for whom acupuncture techniques could be an alternative. Earlier studies have discussed the efficacy of acupuncture, but not its methodological aspects.
Objectives
To summarize the documented clinical effects of acupuncture on rated visceral pelvic endometriosis-related pain, and associated variables among individuals, within and between studied groups, and to discuss the methodological treatment aspects.
Methods
Published full text clinical studies, case reports, and observational studies with abstracts written in English were searched by using the keywords “Acupuncture and Endometriosis” in databases such as PubMed, Web of Science, and CINAHL. The reporting guidelines, Standards for Reporting Interventions in Clinical Trials of Acupuncture was used for the methodological report.
Results
Three studies were found including 99 women, 13-40 years old, with diagnosed endometriosis. The studies were different in research design, needle stimulation techniques, and evaluation instruments. Methodological similarities were seven to12 needle insertions per subject/session, and 15-25 minutes of needle retention time. The needles were placed in lower back/pelvic-abdominal area, in the shank, feet, and hands. Treatment numbers varied from nine to 16 and patients received one to two treatments per week. Similarity in reported treatment effects in the quoted studies, irrespective of research design or treatment technique, was reported decrease of rated pain intensity.
Discussion
Meta-analysis is the standard procedure for the evaluation of evidence of treatment effects, ie, on a group level, usually without analysis of the individual responses even with obvious spread in the results leading to lack of guidance for treatment of the individual patient. By conceptualizing pain as subjective, the individual aspect should serve as the basis for the analysis to allow clinical recommendations. From a physiological and a western medical perspective, acupuncture can be regarded as a type of sensory stimulation that induces changes in the function of the central nervous system that partly can explain the decrease of perceived pain in response to acupuncture treatment irrespective of the technique.
Conclusion
Endometriosis is often painful, although with various origin, where standard treatments may be insufficient or involve side effects. Based on the reported studies, acupuncture could be tried as a complement as it is an overall safe treatment. In the future, studies designed for evaluating effectiveness between treatment strategies rather than efficacy design would be preferred as the analyses of treatment effects in the individual patients.
Fu Yu and Xia Tian, Shanghai Jnl Acup Moxa, 2005, Vol 3 Shanghai Journal of Acupuncture and Moxibustion
This is just one trial of many carried out in China which looks at the clinical effectiveness of treatment of endometriosis with acupuncture and Chinese herbs. The investigators report that symptoms and signs of the disease are treated effectively without side effects.
Abstract
Objective
To compare the clinical efficacy of combined acupuncture and herbs with danazol for treatment of endometriosis.
Methods
Seventy-eight patients were randomly divided into a combined acupuncture and herbs treatment group (40 cases) and a Westerm medicine control group (38 cases). Observation was made of changes in clinical symptoms, signs, serum CA 125, β-EP, PGE 2 and PGF 2α, and adverse reaction to the medicine in the two group.
Results
The overall efficacy was similar in the two groups, but the effects on lumbosacral pain, anal downbearing distention, irregular menstruation and infertility were significantly better in the treatment group than in the control group(P < 0.05), and in the treatment group serum CA 125, PGE 2 and PGF 2α were significantly lower and serum β-EP was significanly higher after treatment than before (P < 0.05).
Conclusion
Combined use of acupuncture and herbs has a marked effect on endometriosis and the adverse reaction is lower than the control group.
Australian Journal of Acupuncture and Chinese Medicine
Lim CED et al, Aust J Acupunct Chin Med 2009;4(2):12-17. Australian Journal Acupuncture and Chinese Medicine
Those of us who have experience in treating endometriosis with Chinese medicine are familiar with the benefits it brings patients in terms of reduced pain and possibly increased rates of conception. This pilot study, a collaboration between Guangzhou Medical University in China and RMIT university in Melbourne, is particularly interesting to us since it measured objective parameters such as immune factors (antigens and antibodies) shown to be abnormally raised in patients with endometriosis. A course of treatment with Chinese herbs not only improved pain but significantly reduced the levels of these immune factors. This is one way that Chinese medicine may improve fertility in endometriosis.
Abstract
Background
Secondary dysmenorrhoea associated with endometriosis affects many women and is the leading cause of work and school absenteeism, with considerable impact on quality of life. This study evaluates the possible role of Chinese medicinal herbs in relieving the menstrual pain associated with endometriosis.
Methods
A prospective clinical observational pilot study involving twenty-five patients with endometriosis with Chinese medical diagnosis of stagnation of qi and blood who were recruited at the Guangdong Women’s and Children’s Hospital during the period of January 2004 to December 2006 to participate in a three-month Chinese medicinal herbs study.
Results
Sixteen patients reported nil dysmenorrhoea during the treatment period. The mean CA125 at the study entry was 59.67 ±28.32 u/ml, compared to 34.83 ±16.34 u/ml post-treatment. The positive EMAb before the commencement of treatment was noted in 22 of 25 cases (88%), while 5 of 25 cases (20%) remained positive after treatment.
Conclusion
Short-term administration of Chinese medicinal herbs may be effective in alleviating secondary dysmenorrhoea associated with endometriosis in qi and blood stagnation pattern. It may provide an alternative treatment option for the management of pelvic pain associated with endometriosis and further research in the area is required.
Fluid retention over period time? Eat the right food helps.
When menstrual period is due, some women find that their faces, fingers, calves and feet are swelling. It is because their body retains fluid. The fluid retention can increase their weight up to 2~4 kilos. At the same time, many women have abdominal bloating, sore or tender breasts.
What causes the fluids retention?
Fluid retention over period is due to the imbalance of hormone, mostly due to increasing of estrogen, which result in sodium and fluid stay in the body.
Often the feeling of swollen during period can be reduced via right diet and light exercise. For instance, stay away from sodium salty food, have more food such as, potato or cucumber.
Foods to reduce fluid retention over period
cucumber
Cucumber
90% of cucumber is water, it is a good source of food to get hydrated. The skin of cucumber contains a substance called isoquercitrin which is diuretic. Cucumber has been used in helping people reduce the excess fluid in the body since ancient China. There were records from traditional Chinese medicine (TCM) that cucumber was used in assisting treating cystitis and acute urine tract infection.
potato
Potato
Potato has been known for long as “the apple grows in the ground” in the East. There are plenty of organic sodium and potassium in potato. It can help our body to get rid of the extra culinary sodium and fluid. In order to get the best effect from potato, do not peel its skin.
red beans
Red Beans (azuki beans)
Red azuki beans is rich in potassium and saponin which is diuretic. It has been used to treat water retention in TCM. In order to maximise the best nutritious from red bean, it is better to cook it slowly.
winter melon
Winter melon (white gourd)
Winter melon is rich in potassium. It is a food well known as a natural diuretic. It traditional Chinese medicine (TCM), the seeds and peel of winter melon are herbs both used for edema or water retention. It has a cooling effect and mostly importantly, taste good.
According to Chinese medicine theory, the menstrual cycle involves not only changes in reproductive physiology but also energetic shifts, encompassing yin, yang, qi, and blood, which are reflected in the different phases of the cycle.
In some cases, infertility patients may appear healthy and robust, often at a relatively young age, yet experience difficulties conceiving. Chinese medicine practitioners are trained to detect subtle signs of imbalance during evaluations. One such subtle clue is the state of cervical mucus. Within Chinese medicine, tracking cervical mucus is highly valued as it represents the Yin energy, which supports the growth of the follicle and promotes a healthy endometrial tissue.
It is very important for women who are trying to conceive to understand the best time for conceiving. There are various methods to help determine when the best time for conception is. One of the most effective and cost-efficient techniques is observing changes in cervical mucus.
It’s important to acknowledge that external factors can influence cervical mucus, including:
Stress
Medications or drugs (inc. Clomid)
If you may be pre-menopausal
Illness
Dieting, weight change or fasting
Travel
It is crucial to report any changes in cervical mucus to your Chinese medicine doctor or acupuncturist so that they can adjust the treatment plan to enhance mucus production. Typically, when a client exhibits favourable fertile mucus and experiences a successful ovulation, it indicates a positive outcome.
So, How Do You Observe Cervical Mucus?
There are three methods you can choose from, depending on your comfort level:
Toilet Paper: Observe the mucus found after wiping.
External Observation: Use your fingers to feel for mucus around the opening of your vagina.
Internal Observation: Insert your index and third fingers into your vagina, reaching the cervix, and gently sweep to check the mucus from the cervix.
Once you have some mucus on your fingers, place it between your thumb and index finger, then press them together and stretch the mucus. Pay attention to its behaviour:
Does it stretch?
Does it retain its shape and feel sticky?
Is it slippery?
Is it clear, yellow, or cloudy?
Take note of these characteristics.
Infertile mucus
After your period for 3 to five days, you may find that you have no mucus (dry). Any mucus that is seen at this time is infertile. If you do find mucus, it will likely be sticky and may come out as a blob.
Words women use to describe their infertile mucus at this time include:
Thick
Dense
Sticky
Flaky
Tacky
Infertile mucus feels drier to touch than fertile mucus. It may be yellow, white or opaque. Upon observation by touch between your thumb and index finger, you will find that it does not stretch or move – it is quite thick.
Fertile mucus
Cervical mucus will become moist but sticky, about the consistency of a hand lotion product, just days before you ovulate. At this stage, the colour will range from white to cream-coloured. If your cervical mucus appears this way, there is some chance for conception.
When you are ovulating, you will have the most cervical mucus. The cervical mucus should be about the same texture and have a similar appearance to an egg white; at this stage, it is often referred to as “egg-white cervical mucus.” Finger testing will allow the mucus to stretch quite a ways (several centimetres) before it breaks (if it breaks at all). This is the time, during ovulation, when you are most likely to become pregnant.
Words women use to describe their fertile mucus include:
Wet
Slippery
Watery
Clear
Thin
Fluid
After ovulation
If your cervical mucus resembles an egg white but is less slippery, it indicates that you have recently completed ovulation. This typically occurs between the end of ovulation and the start of your next period. While there is still a chance for conception during this time, it is relatively low.
Regularly checking your cervical mucus can help you determine your current position in the menstrual cycle. By tracking changes in your cervical mucus over several months, you can gain a better understanding of the number of days from the end of your period until ovulation occurs. This information allows you to identify the optimal time for conception.
Best time for conception
It is best for couples to have unprotected sex every few days throughout the cycle, however studies have shown that most couple conceive through sex two to three days prior to ovulation. So as soon as the mucous become fertile is a good time to start.
Cycle
-8
-7
-6
-5
-4
-3
-2
-1
Rise in temperature
+1
+2
Probability
0.3
1.4
2.7
6.8
17.6
23.7
25.5
21.2
10.3
0.8
0.38
Study
3175 cycles with 434 pregnancies. Reference point is the first day of elevated temperatures; ovulation itself usually occurs on the day before the rise in temperature.
Fu Yu and Xia Tian, Shanghai Jnl Acup Moxa, 2005, Vol 3 Shanghai Journal of Acupuncture and Moxibustion
