J. Traditional, Complementary and Alternative Medicines 2009
Abstract
Traditional Chinese Medicine (TCM) has significant advantages in treating gynaecological disorders. The paper has provided a brief introduction on the current progress of treating some gynaecological disorders including endometriosis, infertility, dysmenorrhea, abnormal uterine bleeding, premenstrual syndrome, menopausal syndrome, uterine fibroids, chronic pelvic inflammation, polycystic ovarian syndrome (PCOS), cervicitis and vaginitis with Chinese Herbal Medicine (CHM) and acupuncture. The use of TCM in the field of assisted reproductive techniques (ART) has also been included in the review. In addition, thirty-two commonly used Chinese medicinal formulas in treating gynaecological disorders have been introduced.
Australian Journal of Acupuncture and Chinese Medicine
9(1):5-12 · January 2014
L.-E. Grant, S. Cochrane
Abstract
One in six Australian couples currently struggle with impaired fertility. In vitro fertilisation (IVF) has become the assisted reproductive technology (ART) of choice. The IVF process has inherent stresses: the invasive procedures; medication; knowledge that it might be the last possibility for pregnancy; and the high cost. Both authors have observed in different settings (one clinical and the other during a clinical trial) that women often reported an improved sense of wellbeing and emotional health due to the acupuncture intervention. This paper summarises the reported benefits of acupuncture treatment for mental and emotional health during IVF identified in published peer-reviewed research papers – both theoretically (pathogenesis and physiology) and clinically (with reference to acupuncture treatment and the therapeutic encounter). The trials reviewed, investigating mental and emotional health during IVF treatment, indicate acupuncture had positive outcomes including: reduced anxiety; reduced stress; less social and relationship concern and improved psychological coping. This paper suggests that reflecting on and valuing the therapeutic alliance, including its collaborative nature, the patient feeling cared for and a perception that practitioners are empathetic, could improve fertility outcomes and the emotional health of infertile women through the process of IVF treatment.
Andrew Flower1 , Jian Ping Liu2 , George Lewith3 , Paul Little4 , Qing Li2
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1 Complementary Medicine Research Unit, Dept Primary Medical Care, Southampton University, Ringmer, UK.
2 Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
3 Department of Primary Care, University of Southampton, Southampton, UK.
4 Primary Care and Population Sciences, Faculty of Medicine, Aldermoor Health Centre, University of Southampton, Southampton, UK
Background
Endometriosis is characterized by the presence of tissue that is morphologically and biologically similar to normal endometrium in locations outside the uterus. Surgical and hormonal treatment of endometriosis have unpleasant side effects and high rates of relapse. In China, treatment of endometriosis using Chinese herbal medicine (CHM) is routine and considerable research into the role of CHM in alleviating pain, promoting fertility, and preventing relapse has taken place. This review is an update of a previous review published in the Cochrane Database of Systematic Reviews 2009, issue No 3.
Objectives
To review the effectiveness and safety of CHM in alleviating endometriosis-related pain and infertility.
Search methods
We searched the Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library) and the following English language electronic databases (from their inception to 31/10/2011): MEDLINE, EMBASE, AMED, CINAHL, and NLH. We also searched Chinese language electronic databases: Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Sci & Tech Journals (VIP), Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), and Chinese Medical Current Contents (CMCC).
Selection criteria
Randomised controlled trials (RCTs) involving CHM versus placebo, biomedical treatment, another CHM intervention; or CHM plus biomedical treatment versus biomedical treatment were selected. Only trials with confirmed randomisation procedures and laparoscopic diagnosis of endometriosis were included.
Data collection and analysis
Risk of bias assessment, and data extraction and analysis were performed independently by three review authors. Data were combined for meta-analysis using relative risk (RR) for dichotomous data. A fixed-effect statistical model was used, where appropriate. Data not suitable for meta-analysis were presented as descriptive data.
Main results
Two Chinese RCTs involving 158 women were included in this review. Although both these trials described adequate methodology they were of limited quality. Neither trial compared CHM with placebo treatment. There was no evidence of a significant difference in rates of symptomatic relief between CHM and gestrinone administered subsequent to laparoscopic surgery (RR 1.04, 95% CI 0.91 to 1.18). There was no significant difference between the CHM and gestrinone groups with regard to the total pregnancy rate (69.6% versus 59.1%; RR 1.18, 95% CI 0.87 to 1.59, one RCT). CHM administered orally and then in conjunction with a herbal enema resulted in a greater proportion of women obtaining symptomatic relief than with danazol (RR 5.06, 95% CI 1.28 to 20.05; RR 5.63, 95% CI 1.47 to 21.54, respectively). Oral plus enema administration of CHM resulted in a greater reduction in average dysmenorrhoea pain scores than did danazol (mean difference (MD) -2.90, 95% CI -4.55 to -1.25). For lumbosacral pain, rectal discomfort, or vaginal nodules tenderness, there was no significant difference between CHM and danazol. Overall, 100% of women in both studies showed some improvement in their symptoms. Women taking CHM had fewer side effects than those taking either gestrinone or danazol.
Authors’ conclusions
Post-surgical administration of CHM may have comparable benefits to gestrinone. Oral CHM may have a better overall treatment effect than danazol and it may be more effective in relieving dysmenorrhoea when used in conjunction with a CHM enema. CHM appears to have fewer side effects than either gestrinone or danazol. However, more rigorous research is required to accurately assess the potential role of CHM in treating endometriosis.
Plan Language Summary
Chinese herbs for endometriosis
Endometriosis is a common gynaecological condition causing menstrual and pelvic pain. Treatment involves surgery and hormonal drugs, with potentially unpleasant side effects and high rates of reoccurrence of endometriosis. The two small studies in this review suggest that Chinese herbal medicine (CHM) may be as effective as gestrinone and may be more effective than danazol in relieving endometriosis-related pain, with fewer side effects than experienced with conventional treatment. However, the two trials included in this review were small and of limited quality so these findings must be interpreted cautiously. Better quality randomised controlled trials are needed to investigate a possible role for CHM in the treatment of endometriosis
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.
Check your ovulation is very important if you want to conceive naturally. by checking your ovulation, you know whether you ovulate, and when you ovulate.
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When women ovulate, subtle changes may occur in the body both physically and psychologically. By observing the signs and symptoms, you may know whether you ovulate and when you ovulate.
As we know the best and most accurate way to check ovulation is blood testing and ultrasound. Your doctor may give you a blood testing for raising progesterone after ovulation. Transvaginal Ultrasound is the most accurate way to check whether you ovulate or not. However it’s not always convenient to have blood test and ultrasound every cycle. It will be much easier to check ovulation at home.
So, how to test ovulation naturally at home?
Listed 6 ways to check or test you ovulation naturally at home
1. Check your ovulation by counting menstrual cycle:
check ovulation
Ovulation usually happens two weeks before your period starts. If you have a regular 28 days’ cycle, you may ovulate on day 14. If you only have a 21 days cycle, you may ovulate on day 7 – right just after you finish bleeding!
2. Check your Basal Body Temperature (BBT)
Basal Body Temperature (BBT) is the temperature when you are in fully rest. BBT is sensitive to hormone change, especially after ovulation the progesterone increase your BBT 0.3 ~0.5 degrees.
Although BBT doesn’t predict your ovulation, it is a great tool to check whether you ovulate or not. And it is a great tool to check whether you have good quality ovulation or not. Here is how to check your BBT.
3. Check cervical mucus
Before and during ovulation, you may have more clear and stretching mucus – the egg white like fertile mucus. Fertile mucus change the environment of vagina and cervix. It provide an optimal environment for sperm to swim and survive. Therefore make it ready for fertilisation. Fertile mucus usually present from 2 to 5 days.
4. Saliva Ferning Test:
Saliva-based kits analyse dried saliva under a microscope. During ovulation, eastrogen levels rise, causing a fern-like pattern in dried saliva.
5. Ovulation Predictor Kits (OPKs):
These kits detect the surge in luteinising hormone (LH) in your urine, indicating that ovulation is likely to occur within the next 24-36 hours.
Ovulation kit
6. Chart record other changes or symptoms during ovulation:
Feels have more energy, more feminine, and more confident in yourself; You may notice increased libido before and during ovulation period.
Ovulation pain
Some people may have slightly discomfort or pain at either side of lower abdomen. The pain is a dull or stitching, sharp pain.
Ovulation bleeding or spotting
Ovulation bleeding or spotting happens due to the sudden withdrawal of oestrogen at the time of ovulation.
If you know that you are ovulating, having sexual intercourse before and during the time gives you the chance to conceive naturally.
This study did not use acupuncture or herbs, but it is interested to include it here as a way of managing early pregnancy in women who have had previous miscarriages. There is currently no known prevention therapy for unexplained recurrent miscarriage, but this study showed that emotional support and close supervision helped improve outcomes in subsequent pregnancies.
Abstract
One hundred and thirty three couples were investigated at a recurrent miscarriage clinic. In their next pregnancy 42 women (Group 1) with unexplained recurrent miscarriage were managed with a programme of formal emotional support and close supervision at an early pregnancy clinic. Two women were seen in 2 pregnancies (44 supervised pregnancies); 86% (38 of 44) of these pregnancies were successful. Four of the 6 miscarriages had an identifiable causal factor. Nine women (Group 2), also with unexplained recurrent miscarriage, acted as a control group. After initial investigation they were reassured and returned to the care of their family practitioner and did not receive formal supportive care in their subsequent pregnancy; 33% (3 of 9) of these pregnancies were successful (p = 0.005; Fishers Exact Test). Whilst acknowledging that there is a significant spontaneous cure rate in this condition, emotional support seems to be important in the prevention of unexplained recurrent miscarriage, giving results as good as any currently accepted therapy.
Lian Fang et al, Zhong Xi Yi He Xue Bao 2009 Feb;15(1):42-46 Chinese Journal of Integrated Medicine
A chinese herb formula for endometriosis was given to women with long term infertility and endometriosis before and during an IVF cycle and various ovarian parameters were compared with a group of women with endometriosis who embarked on IVF directly without taking the herbs. The group who took the herbs produced more eggs and had a higher fertilisation rate (although a difference in pregnancy rate was not reported). Additionally the follicles of the women who took the herbs showed a reduced level of inflammatory cytokines compared to the women in the control group.
Abstract
Objective
To observe the effect of Quyu Jiedu Granules (QJG) on the microenvironment of ova in patients with endometriosis (EM).
Methods
Twenty EM patients who received in vitro fertilization and embryo transfer (IVF-ET) were randomized equally into a treated group and a control group.Further, 20 patients who received IVF-ET due to oviduct factors were enrolled into a non-endometriosis group.The dosage of gonadotrophic hormone used, the number of ova attained, fertilization rate and clinical pregnancy rate were all observed, and the levels of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) in follicular fluid as well as their mRNA expressions in ovarian granular cells were detected by RT-PCR on the very day of ovum attainment.
Results
The ova attainment (13.80±6.87) and fertilization rate (0.69±0.31) in the treated group were all higher than the corresponding values in the control group (9.80±5.32 and 0.47±0.22); the follicular fluid contents of TNF-α and IL-6 in the treated group were 1.38±0.21 ng/mL and 130.56±12.81 pg/mL, respectively, which were lower than those in the control group (1.98±0.34 ng/mL and 146.83±17.65 pg/mL, respectively). Further, the treated group showed much lower mRNA expressions of TNF-α and IL-6 in ovarian granular cells.
Conclusions
The elevation of TNF-α and IL-6 contents in follicular fluid and their mRNA expressions in ovarian granular cells are possibly related to the low quality of ova in EM; QJG might raise the ova quality by reducing TNF-α and IL-6 levels to improve the living micro-environment for the ova.
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.
Liddell HS et al, 
Fu Yu and Xia Tian, Shanghai Jnl Acup Moxa, 2005, Vol 3 Shanghai Journal of Acupuncture and Moxibustion