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.
Knowing when you ovulate is crucial if you’re trying to conceive naturally. By understanding your ovulation patterns, you can plan intercourse during your most fertile days and boost your chances of pregnancy.
While blood tests and ultrasounds are the most accurate ways to confirm ovulation, they’re not always convenient or necessary every cycle. Fortunately, there are several simple ways to check ovulation at home.
1. Count Your Menstrual Cycle
Ovulation typically occurs about 14 days before your next period. For a regular 28-day cycle, this is around Day 14. For shorter cycles (e.g. 21 days), ovulation may occur as early as Day 7 — often just after your period finishes.
Using a wall calendar or period tracking app can help you estimate your fertile window.
2. Track Your Basal Body Temperature (BBT)
Knowing ovulation from BBT chart
BBT is your body temperature at complete rest. After ovulation, progesterone causes a slight rise of 0.3–0.5 °C.
BBT doesn’t predict ovulation ahead of time, but consistent charting can confirm whether ovulation has occurred and indicate the quality of your ovulation over several cycles.
3. Observe Cervical Mucus
clear stretching mucus during ovulation
Before and during ovulation, many women notice clear, stretchy, “egg white” cervical mucus. This fertile mucus creates an optimal environment for sperm survival and transport, usually lasting 2–5 days. Tracking these changes daily can help pinpoint ovulation naturally. Click the link to see how cervical mucus changes throughout the cycle.
4. Use a Saliva Ferning Test
Saliva Ferning during ovulation
Saliva-based kits analyse dried saliva under a mini microscope. As oestrogen rises before ovulation, saliva forms a fern-like crystal pattern. This can help predict ovulation a few days in advance.
5. Try Ovulation Predictor Kits (OPKs)
OPKs detect the luteinising hormone (LH) surge in urine. A positive test typically indicates ovulation will occur within the next 24–36 hours. These kits are widely available and easy to use at home.
6. Record Other Ovulation Symptoms
Many women experience subtle physical or emotional changes around ovulation, including:
Charting these signs alongside BBT or OPKs can give you a more complete picture.
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FAQs
Q: What is the most accurate way to check ovulation?
A: Blood tests and transvaginal ultrasounds are the most accurate methods, but home methods like OPKs and BBT tracking can also be effective.
Q: Can I get pregnant if I don’t track ovulation?
A: Yes, but tracking ovulation increases your chances by helping you identify your fertile window more precisely.
Q: What if I don’t see fertile mucus or temperature changes?
A: This may indicate irregular or absent ovulation. It’s best to consult a fertility specialist or TCM practitioner for further evaluation.
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