Gynaecology is one of the most understood aspects of Chinese medicine. This is principally because the menses gives us a great deal of information about how the body is behaving, on a regular basis!
We treat all manner of gynaecological issues, from first period to last, from menarche to menopause. Understanding women's bodies can be an intuitive process, and defining how a body is behaving according to test results can sometimes miss a significant part of the picture. We are subtle beings and the interplay between our emotions and our hormonal balance can be a fine balance indeed; one that can be all too easily tipped.
Modern life also takes its toll on how our bodies behave. It is impossible to underestimate the effect of the additives in our diet. That, combined with the stresses and strains of our busy scheduled lives, can have a strong influence on our hormone balance and hence impact on our gynaecological health.
Acupuncture for gynaecology is effective treatment for many conditions:
Premenstrual syndrome (PMS) is the name given to the physical, psychological and behavioural symptoms that can occur in the two weeks before a woman's monthly period. It's also known as premenstrual tension (PMT).
Most women of reproductive age experience at least mild premenstrual symptoms at some time in their lives (O’Brien 1987). However, around 2–10% of women have premenstrual symptoms that severely disrupt daily living (O’Brien 1987, DTB 1992, Wittchen 2002). These more troublesome symptoms are usually termed ‘premenstrual syndrome’ (PMS), if they comprise recurrent psychological and/or physical symptoms that occur specifically during the luteal phase of the menstrual cycle and usually resolve by the end of menstruation (O’Brien 1987).
Diagnosis of PMS is based on the presence of at least five symptoms, including one of four core psychological symptoms, from a list of 17 physical and psychological symptoms (Steiner 2001; Freeman 2001). The 17 symptoms are depression, feeling hopeless or guilty, anxiety/tension, mood swings, irritability/persistent anger, decreased interest, poor concentration, fatigue, food craving or increased appetite, sleep disturbance, feeling out of control or overwhelmed, poor coordination, headache, aches, swelling/bloating/weight gain, cramps, and breast tenderness.
What causes PMS?
The cause of PMS is unknown, but hormonal and other factors (possibly neuroendocrine) probably contribute (Rapkin 19917; O’Brien 1993). The aim of conventional treatment is to improve or eliminate physical and psychological symptoms; to minimise the impact on normal functioning, interpersonal relationships, and quality of life; and to minimise adverse effects of treatment (Kwan 2009).
Drugs such as spironolactone, valprazolam, metolazone, NSAIDs, buspirone and gonadorelin analogues are used to treat the main physical and psychological symptoms of PMS (Kwan 2009). Changing the diet (eg, increasing protein, decreasing sugars) and supplementing with vitamin B complex (especially pyridoxine, sometimes with magnesium) may help. Fluid retention may be relieved by reducing sodium intake and using a diuretic. Surgery is indicated only if there are coexisting gynecological problems.
How acupuncture can help
A systematic review (Cho 2010) located ten randomised controlled trials and found acupuncture reduces PMS symptoms.
Acupuncture reduces symptoms of PMS by:
• increasing relaxation and reducing tension (Samuels 2008). Acupuncture can alter the brain’s mood chemistry, reducing serotonin levels (Zhou 2008) and increasing endorphins (Han, 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states.
• stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987, Zijlstra 2003, Cheng 2009);
• reducing inflammation, by promoting release of vascular and immunomodulatory factors Kavoussi 2007, Zijlstra 2003).
Acupuncture and PMS Research
In a recent acupuncture and PMS study, the success rate of acupuncture in treating PMS symptoms was 77.8%, whereas it was 5.9% in the placebo group. The positive influence of acupuncture in treating PMS symptoms was ascribed to its effects on the serotoninergic and opioidergic neurotransmission that modulates various psychosomatic functions. 
Freeman EW, Rickels K, Yonkers KA, et al. Venlafaxine in the treatment of premenstrual dysphoric disorder. Obstet Gynecol 2001;98:737–44.
Kwan I, Onwude JL. Premenstrual syndrome. Clinical Evidence. Search date July 2009
Managing the premenstrual syndrome. DTB 1992; 30: 69-72.
O’Brien PMS. Premenstrual syndrome. Oxford: Blackwell Scientific Publications, 1987.
O'Brien PMS. Helping women with premenstrual syndrome. BMJ 1993;307:1471–1475.
Rapkin AJ, Morgan M, Goldman L, et al. Progesterone metabolite allopregnanolone in women with premenstrual syndrome. Obstet Gynecol 1997;90:709–14.
Steiner M, Romano SJ, Babcock S, et al. The efficacy of fluoxetine in improving physical symptoms associated with premenstrual dysphoric disorder. Br J Obstet Gynaecol 2001;108:462–8.
Wittchen H-U et al. Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psych Med 2002; 32: 119-32.
 Habek D, Habek JC, Barbir A. Using acupuncture to treat premenstrual syndrome. Arch Gynecology and Obstetrics. 2002 Nov;267(1):23-6.
Painful Periods - Dysmenorrhoea is painful cramps originating in the uterus just prior to or during menstruation. It can be primary (i.e. without any organic pathology) or secondary (i.e. associated with a pathological condition, such as endometriosis or ovarian cysts). The pain usually lasts between 8 and 72 hours.(Fraser 1992)
Adolescent girls are more likely than older women to have primary dysmenorrhoea because the condition can get better with age. Secondary dysmenorrhoea tends to be less common in adolescents, as onset of causative conditions may not have occurred yet. Estimates suggest that around 25-50% of adult women and about 75% of adolescents experience pain with menstruation, and some 5-20% report severe pain that prevents them from carrying on with their usual activities.(Zondervan 1998; Harlow 2004) The longer the mean duration of menstruation the more severe the dysmenorrhoea. Also, younger age at menarche and cigarette smoking have been associated with dysmenorrhoea.(Harlow 1996; Sundell 1990)
Causes of Painful Periods
The pain is thought to result from uterine contractions and ischemia (impaired blood flow to uterus), probably mediated by prostaglandins, hormones produced in secretory endometrium (the womb lining).
Conventional treatment is aimed at relieving pain and includes NSAIDs, the oral contraceptive pill, depo-medroxyprogesterone acetate, levonorgestrel-releasing intrauterine device, danazol and leuprolide acetate.
How acupuncture can help
Acupuncture can treat painful periods and provide symptom management. In a randomised control trial of 43 women with primary dysmenorrhoea found that acupuncture significantly increased the proportion of women with reduced pain compared with other treatment (10/11 [91%] with acupuncture v 4/11 [36%] with placebo acupuncture v 1/10 [10%] with monthly medical visits v 2/11 [18%] with no medical treatment.  The most compelling evidence comes from a large, high quality German trial that also found acupuncture to be cost-effective (Witt 2008).
Acupuncture reduces symptoms of dysmenorrhoea by:
• regulating neuroendocrine activities and the related receptor expression of the hypothalamus-pituitary-ovary axis (Liu 2009; Yang 2008)
• increasing nitric oxide levels, which relaxes smooth muscle and inhibits uterine contractions (Wang 2009)
• increasing relaxation and reducing tension (Samuels 2008). Acupuncture can alter the brain's mood chemistry, reducing serotonin levels (Zhou 2008) and increasing endorphins (Han, 2004) and neuropeptide Y levels (Lee 2009), which helps to combat negative affective states
• stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Zijlstra 2003; Cheng 2009);
• reducing inflammation, by promoting release of vascular and immunomodulatory factors
• (Zijlstra 2003; Kavoussi 2007)
Fraser I. Prostaglandins, prostaglandin inhibitors and their roles in gynaecological disorders. Bailliere's Clinical Obstet Gynaecol 1992;6:829-57.
Harlow SD, Campbell OM. Epidemiology of menstrual disorders in developing countries: a systematic review. BJOG 2004;111:6-16.
Harlow SD, Park M. A longitudinal study of risk factors for the occurrence, duration and severity of menstrual cramps in a cohort of college women. Br J Obstet Gynaecol 1996;103:1134-42.
Sundell G et al. Factors influencing the prevalence and severity of dysmenorrhoea in young women. Br J Obstet Gynaecol 1990;97:588-94.
Zondervan KT et al. The prevalence of chronic pelvic pain in the United Kingdom: a systematic review. Br J Obstet Gynaecol 1998;105:93-9.
 Helms JM. Acupuncture for the management of primary dysmenorrhea. Obstet Gynecol 1987;69:51–56.
Heavy Bleeding - Menorrhagia is the excessive duration and/or amount of blood loss during a period. Normal periods last three to seven days and involve a blood loss of about 4-12 teaspoonfuls (20-60ml). Menorrhagia is defined as a loss of blood of more than 80ml. A period is defined as heavy if it leads to frequent changes of sanitary towels (every two hours or more), the need to use double sanitary protection (tampons plus towels), passing of large blood clots, flooding clothes or bedding at night, prevention of normal activities and/or anaemia.
Causes of Heavy Periods
Usually, this condition is not due to an underlying medical condition but it can be caused by a hormone imbalance, the use of an IUCD (intra-uterine contraceptive device), uterine fibroids or polyps, endometriosis, infection, uterine cancer, injury to the reproductive organs, or hypothyroidism (an underactive thyroid).
The combined oral contraceptive pill, progestogen-releasing IUCD (Mirena coil), Tranexamic acid (Cyklokapron) are sometimes prescribed by the medical profession to reduce heavy bleeding or Mefenamic acid (eg Ponstan) as a painkiller.
How acupuncture can help
Acupuncture offers an natural alternative to medical intervention in the treatment of heavy periods. Often a very heavy menstrual flow leaves a woman feeling drained and tired after the period. Anaemia can also follow. Acupuncture can be used to reduce the menstrual flow and associated symptoms. Commonly occurring in the run up to menopause, this is often a main reason for hysterectomy. Successful treatment can prevent the need for surgery. Heavy bleeding can also be linked to other conditions such as fibroids or endometriosis and therefore appropriate testing and treatment may be required.
In Chinese medicine, any irregularities in a woman’s reproductive cycle whether they be PMS, painful periods, irregular periods, or heavy periods, are a sign of a health imbalance that requires addressing. Menorrhagia is considered a type of abnormal bleeding and may be caused by heat (which interferes with the body’s function of storing blood and controlling blood flow), empty qi-energy (which may be caused by damage to the spleen so that it is unable to perform its function of restraining the blood), or blood stasis. Or it could be that the body is constantly trying to expel some form of blockage. The most common causes for these imbalances are emotional stress, especially depression and excessive emotions, excessive worry and anxiety, poor diet, particularly too much hot, spicy, or greasing foods or consuming alcohol, or lack of exercise. Imbalances can also arise due to excessive fatigue or due to a deficiency of kidney yin energy. In finding the cause for the excessive bleeding Chinese medicine can often provide a more long lasting solution to the problem.
The good news is that acupuncture can treat menorrhagia quite effectively and regardless of the causes, it responds positively to treatment. We will first work on treating the immediate symptoms, we call this treating the branch. Once the heavy bleeding is under control, we focus treatment on the root cause, whether it is heat, empty qi-energy, or blood stasis, and address this imbalance in order to prevent menorrhagia in the future and to break the pattern of a chronic condition. As the body becomes healthier, we can expect other symptoms to lessen or resolve as well, such as problems sleeping, period cramps or lower back pain, fatigue, and physical and emotional symptoms that relate to the cycle. Ideally, in a woman in perfect health, there should be no cycle-related symptoms and the resolution of these symptoms are a sign of improving health.
Absent Periods - Amenorrhea (uh-men-o-REE-uh) is the absence of menstruation — one or more missed menstrual periods. Women who have missed at least three menstrual periods in a row have amenorrhea, as do girls who haven't begun menstruation by age 16. If no menstruation occurs by age 16, it is called “primary amenorrhea.” Whereas “secondary amenorrhea” is the stoppage of menstruation for more than three months when there is no confirmed pregnancy, menopause, or breast feeding involved. The most common cause of amenorrhea is pregnancy.
Absent periods indicates failure of hypothalamus-pituitary gland-ovaries axis as well as the cyclical changes in the womb lining to sex hormones, resulting in periods
Causes of Absent Periods
May be due to anatomic abnormalities, hypothalamic dysfunction, chronic anovulation (absent ovulation), pituitary dysfunction
How acupuncture can help
Amenorrhea is a condition we commonly see at the Bexley Acupuncture Clinic where women often come to seek help in reestablishing their menstrual cycle. Often these patients have not been too concerned about missing their period until they decide to try to conceive. However, amenorrhea can be a sign of an underlying issue and should always be addressed. Women are rhythmic in nature and any disruption to that rhythm can have consequences for their general health.
The most common causes of amenorrhea we see are the following:
• Low body weight
• Too much exercise
• A failure to reestablish a cycle after stopping the birth control pill
• A thyroid imbalance
• A side effect of medication e.g. corticosteroids
• A hormone imbalance
• Polycystic ovarian Syndrome
• Premature ovarian Failure
• A Pituitary tumor
Some of these conditions are more serious than others so we always advise our patients to see their OB/GYN to find out why they are missing their periods and rule out a serious disorder.
Most of the patients who seek our help do go on to get their period again after 2 – 4 months of treatment with regular acupuncture.
In Chinese medicine the most important organs that regulate blood and menstruation are the liver, spleen, and kidneys. The kidneys are responsible for conception, reproduction, and egg quality. The spleen and liver control the amount of nutrients and the smooth flow of the hormones. Bexley Acupuncture Clinic treats patients with Amenorrhea based on an individualized assessment of their particular condition and custom tailors an appropriate and effective treatment plan.
Acupuncture treatment focuses on balancing hormones, improving blood circulation and promoting ovulation as well as treating any underlying condition. It also relaxes the body and reduces stress levels (elevated stress can prohibit menstruation by blocking blood flow to the reproductive organs and causing an imbalance in hormonal production).
Research has looked at the effect of acupuncture on women who were not ovulating and found that acupuncture seems to adjust FSH, LH, and E2 in two directions and raises progesterone levels. The study also looked at animal experiments which confirmed the results found in women.
Another reason why acupuncture is so beneficial in treating symptoms of amenorrhea is because the therapy involved focuses on treating the root of the problem rather than just the present symptoms. With a little investigation into your medical history and an accurate description of what you’re experiencing, we can get to the root of the problem.
With acupuncture, the return of regular periods happens naturally and without side effects, utilizing the body’s own healing powers
As for how to help yourself, here’s Bexley Acupuncture Clinic’s tips we give our patients when dealing with amenorrhea :
• Make sure you maintain a healthy body weight. Often in women who are underweight gaining just 2 -5 lbs can make all the difference when it comes to getting regular periods. Likewise if you are overweight and in particular if you have a diagnosis of PCOS, losing weight can help you to ovulate.
• Limit your aerobic exercise to 30 minutes 4 x a week, until your cycle has been reestablished
• Make sure you include plenty of protein and healthy fats in your diet
• B6 (200 mg per day) may reduce high prolactin levels. Prolactin is a hormone released by the pituitary gland, and women with amenorrhea often have higher levels of prolactin. Acupuncture has also been shown to lower prolactin levels.
• Which brings us to our next piece of advice. Get regular acupuncture (once a week) from an experienced practitioner to improve blood flow, balance hormones, reduce inflammation, promote ovulation and offset the effects of stress on reproductive hormones.
• Limit raw and cold foods and prioritize warming foods such as soup
• Take an essential fatty acid supplement to promote hormone balance.
• Include some go ji berries in your diet as well as some ground flax seed
• Eat calcium rich foods to maintain bone density and supplement with vitamin D to help with calcium absorption.
• See your doctor to rule out the more serious underlying causes of amenorrhea
• Get enough rest
And…. take a pregnancy test. One of the most common causes of amenorrhea is pregnancy. You’ll be surprised by how many times patients have sought our help because they are not having regular periods only to find out that they are pregnant.
PCOS (Polycystic Ovary Syndrome) is a benign gynaecological disorder characterised by multiple abnormal cysts in the ovaries. It may cause absent periods (amenorrhea) or irregular periods (oligomenorrhoea) and infertility. Luteinising Hormone (LH) is often elevated higher than FSH in a woman with PCOS, and remains elevated throughout the cycle.
Polycystic ovarian syndrome (PCOS) is characterised by the clinical signs of oligo-amenorrhoea (infrequent or very light menstruation), irregular ovulation or absent ovulation (anovulation), infertility (failure to conceive), acne, male patterned baldness and hirsutism (excessive hair growth), weight gain, acne/oily skin.
Polycystic ovarian syndrome (PCOS) is the most common female endocrine disorder. Up to one-third of women in the UK have polycystic ovaries (i.e. 10 or more follicles per ovary detected on ultrasound), and around a third of these are thought to have the syndrome.(DTB 2001) PCOS is strongly associated with hyperandrogenism, ovulatory dysfunction and obesity.(Stener-Victorin 2008) The syndrome also increases the risk for metabolic disturbances such as hyperinsulinaemia and insulin resistance, which can lead to type 2 diabetes, hypertension and an increased likelihood of developing cardiovascular risk factors and impaired mental health later in life.(Stener-Victorin 2008)
Causes of PCOS
Despite extensive research, little is known about the aetiology of PCOS, but the syndrome is associated with peripheral and central factors that influence sympathetic nerve activity.(Stener-Victorin 2008) Thus, the sympathetic nervous system may be an important factor in the development and maintenance of PCOS
PCOS is often caused by a hormonal imbalance brought on by insulin resistance. A report released in the British Journal of Obstetrics and Gynecology in 2000 indicated that up to 40 percent of women with PCOS have either impaired glucose tolerance or Type 2 Diabetes by age 40.
Treatment of PCOS
Many women with PCOS require prolonged treatment The current conventional medical treatments for women with PCOS are prescription medications, surgery, and lifestyle changes aimed at controlling symptoms.
Birth control pills For women who don’t want to become pregnant, birth control pills can regulate menstrual cycles, reduce male hormone levels, and help to clear acne but they do not cure PCOS.
Diabetes Medications Metformin, also called Glucophage, used to treat type 2 diabetes, also helps with PCOS symptoms. Metformin affects the way insulin regulates glucose and decreases the testosterone production.
Fertility Medications The main fertility problem for women with PCOS is the lack of ovulation or infrequent ovulation. Clomiphene (clomid) and Gonadotropins can be used to stimulate the ovary to ovulate. IVF is sometimes recommended.
Healthy Weight Since obesity is common with PCOS, a healthy diet and physical activity help maintain a healthy weight, which will help the body lower glucose levels, use insulin more efficiently, and may help restore a normal period. A loss of 10% of her body weight can help make a woman's cycle more regular.
How acupuncture can help
In a study of twenty-four women (age 24-40) with PCOS and oligo-/amenorrhea research shows that repeated electro-acupuncture treatments induced regular ovulations in 9 women (38%), more than one third of the women with PCOS. 
A review concluded that acupuncture is a safe and effective treatment for PCOS, and may have a role: increasing blood flow to the ovaries, reducing ovarian volume and the number of ovarian cysts, controlling hyperglycaemia by increasing insulin sensitivity and decreasing blood glucose and insulin levels, reducing cortisol levels and assisting in weight loss and anorexia.(Lim 2010)
Several randomised controlled trials have been published since the systematic reviews. One trial found that acupuncture can improve the clinical pregnancy rate in patients with PCOS undergoing IVF-ET.(Cui 2011) Another found that abdominal acupuncture treatment can improve the endocrine and metabolic function of patients with obesity-type PCOS.(Lai 2010) A third found low-frequency electroacupuncture and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS, and that it was superior to physical exercise.(Jedel 2011)
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.
Research has shown that acupuncture treatment specifically helps with symptoms of PCOS by:
• impacting on beta-endorphin production, which may affect gonadotropin-releasing hormone (GnRH) secretion (Lim 2010; Stener-Victorin 2009; Feng 2009; Manneras 2009);
• a regulatory effect on follicle stimulation hormone (FSH), luteinising hormone ( LH) and androgens (Lim 2010; Feng 2009);
• modulating the activity of the sympathetic nervous system and improving blood flow to the ovaries (Stener-Victorin 2006, 2009);
• regulating steroid hormone/peptide receptors (Feng 2012);
• downregulating the expressions of serum levels of testosterone and oestradiol (Zang 2009);
• controlling hyperglycaemia by increasing insulin sensitivity and decreasing blood glucose and insulin levels (Lim 2010);
• acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);
• increasing the release of adenosine, which has antinociceptive properties (Goldman 2010), and;
• reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007).
Stener-Victorin E et al. Acupuncture in polycystic ovary syndrome: Current experimental and clinical evidence. Journal of Neuroendocrinology 2008; 20: 290-8.
Tackling polycystic ovary syndrome. DTB 2001; 39: 1-3
 Stener-Victorin E, Waldenstrom U, Tagnfors U, Lundeberg T, Lindstedt G, Janson PO: Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2000, 79:180-188.
Endometriosis is a chronic condition characterised by growth of endometrial tissue in sites other than the uterus, most commonly in the pelvic cavity, but also in other parts of the body (RCOG 2006).
This ectopic tissue responds to the hormonal changes of the menstrual cycle, with subsequent bleeding, inflammation, and pain. If the ovaries are affected, endometriotic ovarian cysts may develop (Bulun 009). Although the condition may be asymptomatic, common symptoms include dysmenorrhoea, dyspareunia, non-cyclical pelvic and abdominal pain, and subfertility (RCOG 2006). When endometriosis remains untreated, the disease progresses in around a third of women, but seems either to resolve or does not progress in the rest (DTB 1999). The prevalence is estimated to vary from 2-22% of women and, in women with dysmenorrhoea, the incidence of endometriosis is 40-60% (Johnson 2007).
Causes of Endometriosis
The cause of endometriosis is not known, but several factors are thought to be involved in its development. These include retrograde menstruation; embryonic cells giving rise to depositsin distant sites around the body; an abnormal quantity or quality of endometrial cells; failure of immunological mechanisms; angiogenesis; and the production of antibodies against endometrial cells (Gazvani 2002, Rock 1992, Seli 2003, Kyama 2003, Oral 1996).
Treatment of Endometriosis
Pain due to endometriosis can be functional, neuropathic, due to inflammation, or result from a combination of these. It may be evoked by a low intensity, normally innocuous stimulus (allodynia), it may be an exaggerated and prolonged response to a noxious stimulus (hyperalgesia), or it may be spontaneous in the absence of any apparent peripheral stimulus (Lundeberg 2008). In addition, oestrogens and prostaglandins probably play key modulatory roles in endometriosis and the pain it causes (Lundeberg 2008).
Consequently, current medical treatments for the condition include drugs such as NSAIDs, combined oral contraceptives, progestogens, androgenic agents and gonadotrophin releasing hormone analogues, as well as surgical excision of endometriotic lesions. However, management of pain in women with endometriosis is often inadequate. Surgery is often used where there are adhesions or endometrial cysts and/or fertility treatment where there is infertility.
How acupuncture can help
Acupuncture can significantly reduce endometriosis symptoms and support fertility where the endometriosis is not impairing the physical anatomy of the womb.
In a study published in the December 2002 issue of The Journal of Traditional Chinese Medicine researchers selected 67 women diagnosed with dysmenorrhea (painful periods) due to endometriosis. It was reported that 81% of these women had less painful periods after receiving the acupuncture treatments. Research shows that acupuncture promotes blood circulation, regulates the endocrine system and suggests that acupuncture could act as an analgesic by elevating levels of endorphins in the blood.
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Wu 1999).
There is preliminary evidence to support acupuncture as an effective treatment for endometriosis, with one small sham controlled trial (Wayne 2008) and a few comparative studies against Western medication (Yan 2008, Xia 2006, Sun 2006).
It has been shown that acupuncture treatment may specifically be of benefit in people with endometriosis by:
• providing pain relief - by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Zhao 2008, Han 2004, Zijlstra 2003, Pomeranz 1987).
• reducing inflammation - by promoting release of vascular and immunomodulatory factors Kavoussi 2007, Zijlstra 2003).
• regulating levels of prostaglandins (Jin 2009)
• combining acupuncture with Chinese herbal medicine for endometriosis has been shown in animal studies to down-regulate the abnormal increase of matrix metalloproteinase-2 (MMP-2) levels that is associated with ectopic activity of endometrial cells. The treated rats had reduced areas of ectopic tissue (Chen 2008). MMP-2 is required for the anchoring of the placenta to the uterine wall in pregnancy but over-production can lead to endometriosis.
Bulun, S.E. (2009) Mechanisms of disease: endometriosis. New England Journal of Medicine 360(3), 268-279.
Gazvani R. Templeton A. Peritoneal environment, cytokines and angiogenesis in the pathophysiology of endometriosis. Reproduction 2002; 123(2): 217-26.
Kyama C et al. Potential involvement of the immune system in the development of endometriosis. Reproductive Biology and Endocrinology 2003 1; 123.
Johnson N, Farquhar C, 2007. Endometriosis. Clinical Evidence. BMJ Publishing Group Ltd. www.clincalevidence.com
Lundeberg T, Lund I. Is there a role for acupuncture in endometriosis pain, or 'endometrialgia'? Acupunct Med 2008; 26 (2): 94-110.
Managing endometriosis. Drug & Therapeutics Bulletin 1999; 37: 25-32.
Orl E et al. The peritoneal environment in endometriosis. Human Reproduction Update 1996; 2: 385-98.
RCOG, 2006. The investigation and management of endometriosis. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk
Rock JA, Markham SM. Pathogenesis of endometriosis. Lancet 1992; 340:1264-7.
Seli E et al. Pathogenesis of endometriosis. Obstet Gynecol Clin North Am 2003; 30: 41-61.
There are many types of ovarian cysts and it is important for your doctor to look at a cyst closely with an ultrasound examination in order to identify if it is fluid-filled, solid or mixed. The shape, size and location are all important factors in determining if it can be left alone or if it should be removed or biopsied. Sometimes cysts can be related to endometriosis or PCOS. Fibroids can be associated with heavy bleeding or flooding and sometimes pain.
Most cysts are harmless fluid-filled sacs that resolve spontaneously within one or two menstrual cycles. However a small percentage of cysts are filled with solid, dense matter, and constitute more of a problem. Less than one per cent of these ‘non-functional’ cysts are malignant, and therefore any cyst that is larger then five millimetres and made of solid matter, and that does not disperse by itself needs to be carefully investigated.
Cysts are problematic because they cause pain and menstrual irregularities, and adversely affect fertility. They can also be a frustrating cause of delays during fertility treatment. Conventional diagnosis of cysts is by ultrasound scan, which can also distinguish whether they are purely fluid-filled or whether there is solid matter within. Conventional treatment is either via the contraceptive pill to shut down the menstrual cycle, or laparascopic surgery. Neither option is desirable for women who are trying to conceive.
How acupuncture can help
Cysts are a common condition seen at the Bexley Acupuncture Clinic, and are particularly frequent amongst women who are receiving conventional fertility treatment. From a Chinese medicine perspective, cysts are seen as a type of obstruction due to thick fluids, which can be caused by a variety of imbalances. For instance, a build-up of fluids can be due to the body’s physiology being excessively cold causing poor circulation (warmth in the body facilitates movement, just as with convection currents in the sea). On the other hand, thick fluids can also be due to the condensing effects of excessive heat on the normal physiological fluids.
At the Bexley Acupuncture Clinic we consistently find that for patients who are trying to conceive – whether naturally via conventional fertility treatment – regular acupuncture treatment reduces the occurrence of cysts. For those patients who are experiencing pain, irregular cycles or infertility due to cysts, and where malignancy has been ruled out, acupuncture and constitutes an effective treatment. Unlike conventional medicine treatment, the Chinese medical approach is holistic, and thus not only treats the cyst, but also simultaneously focuses on enhancing fertility and overall health.
 Borgfeldt, C. & E. Andolf (1999). “Transvaginal sonographic ovarian findings in a random sample of women 25–40 years old.” Ultrasound in Obstetrics and Gynecology, 13(5): 345-350.
Fibroids is the most common structural abnormality of the uterus and estimates are that between 20 and 50 percent of women aged 35 to 50 have them. Fibroids, also referred to as fibromyomas, may form in the endometrium of the uterus or protrude into the uterine cavity. They may be completely asymptomatic, but they may cause pelvic pain, pressure, constipation, recurrent bladder infections or bleeding between the periods (metrorrhagia) or excessive bleeding during the period (menorrhagia).
Fibroids and polyps can also interfere with fertility and conception as they can have the same effect as an intrauterine device in interfering with the development of the endometrial lining, thus making embryo implantation difficult. In addition, when fibroids and polyps are very large, they can interfere with the front and back walls of the uterus pressing together to help an embryo to implant. When fibroids grow outside of the uterus they can get in the way as the fallopian tube tries to pick up an egg after ovulation. Fibroids may also cause difficulties during pregnancy if they push against blood vessels, inhibiting the normal development of the foetus.
Western treatments for fibroids — hormone therapy (such as the birth control pill), myomectomy (surgical removal of the fibroids), hysterectomy (surgical removal of the uterus and fibroids) — do not cure the condition and don’t prevent their recurrence. Most of these treatments also make it difficult to conceive.
How acupuncture can help
Chinese medicine views fibroids as stagnation of Blood which is not moving freely as it should and which accumulates in places where it shouldn’t. Acupuncture points are used to move and regulate Blood inside and around the uterus and increase the circulation in the area in order to resolve the fibroid masses. In so doing, acupuncture can be very effective in clearing fibroid growths.
What makes acupuncture treatment different from other therapies is that it acts by correcting the hormonal imbalances that cause fibroid formation and promoting the body’s self regulatory mechanisms. Acupuncture treatment for fibroids can lessen symptoms and decrease fibroid size, all while facilitating hormonal balance and actually enhancing fertility. By treating the root cause of fibroid formation, acupuncture can help the body heal itself and help you to conceive naturally.
In the event that fibroids are extremely large or numerous, surgery may be necessary. In such cases, acupuncture treatment can promote fast recovery from surgery and prevent future fibroids.
The menopause, defined as the end of the last menstrual period, occurs at a median age of 53 years (Hardy 2005). The change in hormone levels during the perimenopause and menopause, particularly the decline in levels of oestrogen, can cause acute menopausal symptoms; for example, about 30-70% of women in Western countries will experience vasomotor symptoms, such as hot flushes and night sweats (Freeman 2007; Melby 2005).
Some women also report vaginal dryness and psychological symptoms, including tiredness, sleep disturbances, mood swings, forgetfulness and loss of libido (Melby 2005; Bachmann 1999). The median duration of menopausal vasomotor symptoms is about 4 years but, in around 10% of women, they last longer than 12 years (Polity 2008).
The most commonly used conventional medical treatment for such symptoms is hormone replacement therapy (HRT), comprising an oestrogen alone (in women who have had a hysterectomy) or in combination with a progestogen. HRT is now only indicated for short-term treatment of menopausal symptoms in the UK (MHRA 2007).
Acupuncture for menopause is helpful for:
• hot flushes
• night sweats
• vaginal dryness
• mood swings
• treating symptoms due to tamoxifen treatment
From 1997 to 1999, in one of the first studies in the US to explore the effectiveness of acupuncture in alleviating hot flashes, insomnia and nervousness, conducted by Dr. Susan Cohen, D.S.N., APRN, it was found that during the course of acupuncture treatments, hot flashes decreased by 35% and insomnia decreased by 50%. A follow-up study revealed hot flashes significantly decreased in those receiving acupuncture, compared to those receiving routine care.
A 2002 pilot study in England found that acupuncture reduced the frequency and severity of hot flashes in women being treated with tamoxifen for breast cancer.
Acupuncture helps reduce symptoms of the menopause and perimenopause by:
• regulating serum estradiol, follicle stimulating hormone and luteotrophic hormone (Xia 2008);
• increasing relaxation and reducing tension (Samuels 2008). Acupuncture can alter the brain's mood chemistry, reducing serotonin levels (Zhou 2008) and increasing endorphins (Han, 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states.
• stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987, Zijlstra 2003, Cheng 2009).
Menopause is a right of passage that can have a very strong impact on how a woman is feeling about herself and her life. We have a healthy respect for how important it is to move forward into this new phase of life with the strongest sense of self confidence possible. The symptoms and emotional swings at this time can be tremendously distracting and have an unhealthy over-ride in a woman's life. We strongly advocate the balancing power of acupuncture treatment at this special time.
At the Bexley Acupuncture Clinic we will take a full health history and create a plan specifically for you. Our patients report not only having an easier journey during menopause, but also feeling great in themselves.
Testimonial for Menopause
Being a woman of a certain age, I went to see Anita to see if acupuncture could help with my hot flushes. Anita took detailed notes of my medical history before starting my treatment. I feel that the treatment provided by Anita has certainly helped reduce the severity and frequency of my hot flushes. In addition she has also treated me for stress which has helped a great deal. Having tried all sorts of over the counter remedies for these symptoms that had little or no effect, I would certainly recommend the acupuncture treatments by Anita.
Bachmann GA (1999) Vasomotor flushes in menopausal women. Am J Obstet Gynecol 180: 312-6.
Freeman EW, Sherif K. Prevalence of hot flushes and night sweats around the world: a systematic review. Climacteric 2007; 10: 197-214.
Hardy R, Kuh D. Social and environmental conditions across the life course and age at menopause in a British birth cohort study. BJOG 2005; 112: 346-54.
Medicines and Healthcare products Regulatory Agency. Hormone-replacement therapy: updated advice. Drug Safety Update 2007; 1: 2-4.
Melby MK et al. Culture and symptom reporting at menopause. Hum Reprod Update 2005; 11: 495-512.
Politi MC et al. Revisiting the duration of vasomotor symptoms of menopause: a meta-analysis. J Gen Intern Med 2008; 23: 1507-13.