Menstrual Problems

Menstrual problems are common, but they are a sign of sub-optimal health in Chinese Medicine.

Modern research supports the effectiveness of acupuncture and Chinese herbal medicine to treat the following menstrual problems:

• A 2023 randomised controlled trial found that acupuncture is an effective and safe method for relieving period pain, shortening the pain duration, and improving wellbeing and quality of life in women with endometriosis-associated pain. No severe adverse events or differences in adverse events were recorded.

Li PS, Peng XM, Niu XX, Xu L, Hung Yu Ng E, Wang CC, Dai JF, Lu J, Liang RN. Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial. Fertil Steril. 2023 May;119(5):815-823. doi: 10.1016/j.fertnstert.2023.01.034. Epub 2023 Jan 27. PMID: 36716811.

• A 2018 systematic review and meta-analysis found that acupuncture might reduce menstrual pain and associated symptoms more effectively compared to no treatment or NSAIDs, and the efficacy could be maintained during a short-term follow-up period. Limitations include low quality methodological restrictions.

Woo HL, Ji HR, Pak YK, Lee H, Heo SJ, Lee JM, Park KS. The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis. Medicine (Baltimore). 2018 Jun;97(23):e11007. doi: 10.1097/MD.0000000000011007. PMID: 29879061; PMCID: PMC5999465.

• A 2017 systematic review of Chinese medicine for Ovarian endometriosis concluded that Chinese medicine has two advantages over Western medicine in treating ovarian endometriosis, ...the low recurrence rate and high pregnancy rate. Larger scales of randomized controlled trials and more scientific evidence are needed to prove the efficacy and safety of Chinese medicines for ovarian endometriosis.

Lee E, Xie Y, Chen H. Systematic Review of Chinese Medicine for Ovarian Endometriosis International Journal of Pharmacognosy and Chinese Medicine ISSN: 2576-4772 Volume 1 Issue 3 Received Date: September 01, 2017 Published Date: October 09, 2017

• A 2017 systematic review of 10 studies involving 589 patients that tested the efficacy of acupuncture in treating endometriosis-related pain, concluded that acupuncture reduces pain and serum CA-125 levels in endometriosis sufferers. CA-125 levels are relevant as they are elevated in endometriosis patients, with more advanced degrees of endometriosis showing higher CA-125 levels in both serum and peritoneal fluid. Acupuncture can reduce the level of serum CA-125, and consequently relieve the pelvic cavity pain associated with endometriosis. To confirm these findings, additional, blinded studies with proper controls and adequate sample sizes are needed.

Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S. Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLoS One. 2017 Oct 27;12(10):e0186616. doi:  10.1371/journal.pone.0186616. PMID: 29077705; PMCID: PMC5659600.

• Chinese Medicine has also been found to reduce the incidence rate of surgery in endometriosis patients. A 2014 study used the national health insurance database in Taiwan to evaluate the relationship between Chinese medicine use and subsequent surgery among 8,283 patients with endometriosis who used Chinese medicine and 8,283 non-users of Chinese medicine with endometriosis. The study found that compared to nonusers, Chinese medicine users were significantly less likely to undergo surgery, and among patients who had undergone surgery, the follow-up time was longer for Chinese medicine users than for non-users.

Su SY, Muo CH, Sung FC, Morisky DE. Reduction of surgery rate in endometriosis patients who take Chinese medicine: a population-based retrospective cohort study. Complement Ther Med. 2014 Aug;22(4):632-9. Doi: 10.1016/j.ctim.2014.06.010. Epub 2014 Jul 7. PMID: 25146066.

• Furthermore, another study that included 320 patients with endometriosis found both Western medicine and Chinese medicine to be effective at improving the quality of life of patients with endometriosis after conservative surgery. In this study, the Chinese medicine group’s scores post-treatment were significantly higher than those at pre-treatment for all 12 items tested; including pain and discomfort, energy and fatigue, sleep and rest, mobility, activities of daily living, work capacity, negative feelings, health and social care: accessibility and quality, participation in and opportunities for recreation/leisure activities, appetite, quality of life score, overall health status and quality of life. Furthermore, the scores for physical health in the Chinese medicine group were significantly higher than pre-treatment, especially 4 items (mobility, activities of daily living, sexual activity and quality of life score).

Zhao RH, Liu Y, Tan Y, Hao ZP, Meng QW, Wang R, Long D, Ding YF, Song DR, Xu C, Ren ZZ, Yang YH, Wang AM. Chinese medicine improves postoperative quality of life in endometriosis patients: a randomized controlled trial. Chin J Integr Med. 2013 Jan;19(1):15-21. doi: 10.1007/s11655-012-1196-6. Epub 2012 Dec 29. PMID: 23275012.

• A 2012 systematic review suggested that post‐surgical administration of Chinese herbal medicine may have comparable benefits to Gestrinone. Oral Chinese herbal medicine may have a better overall treatment effect than Danazol and it may be more effective in relieving dysmenorrhoea when used in conjunction with a Chinese herbal medicine enema. Chinese herbal medicine appears to have fewer side effects than either Gestrinone or Danazol. However, more rigorous research is required to accurately assess the potential role of Chinese herbal medicine in treating endometriosis. More rigorous research is required to accurately assess the potential role of CHM in treating endometriosis.

Flower A, Liu JP, Lewith G, Little P, Li Q. Chinese herbal medicine for endometriosis. Cochrane Database Syst Rev. 2012 May 16;(5):CD006568. doi: 10.1002/14651858.CD006568.pub3. PMID: 22592712.

• A 2022 systematic review and meta-analysis concluded that treatment using traditional Chinese medicine is a preferred alternative therapy for irregular menstruation. A total of 2,389 patients were included in the analysis that concluded that acupuncture had the effect of increasing menstrual blood volumes when combined with bio-medicine . They found that TCM combined with Bio Medicine yielded a significant prolongation in menstrual periods and had potential improvements on enhancing effectiveness rates, increasing endometrial thickness, and raising the levels of estradiol and progesterone. Concerning adverse events, no significant difference was found in either group..However, the relatively low quality of prior studies calls for future randomised control trials to further assess the efficacy of TCM on treating oligomenorrhea using rigorous designs.

Li Y, Guozhen Z, Wei S, Yin Z, Hanlin D, Nan D, Efficacy and safety of traditional Chinese medicine on treating oligomenorrhea: a systematic review and meta-analysis, 2021, Dec, 10 (12) https://apm.amegroups.org/article/view/65573/html

• A 2016 systematic review revealed that there was an improvement in the menstrual frequency of PCOS patients after acupuncture treatment.

Wu Y, Robinson N, Hardiman PJ, Taw MB, Zhou J, Wang FF, Qu F. Acupuncture for treating polycystic ovary syndrome: guidance for future randomized controlled trials. J Zhejiang Univ Sci B. 2016 Mar;17(3):169-80. doi: 10.1631/jzus.B1500301. PMID: 26984837; PMCID: PMC4794508.

• A 2018 systematic review and a meta-analysis suggested that Chinese herbal medicine may be an effective, acceptable and safe treatment for non-structural abnormal uterine bleeding during peri-menopause when compared with Western medicine. The study included 1344 participants and showed that compared with Western therapies, Chinese herbal medicine showed advantages in normalization rate of menstruation, improving menopausal symptoms and the hemoglobin count, with lower incidence of adverse reactions and lower recurrence rate. However, normalizing the methodological and reporting format remains an issue.

Yujie Shang, Su Lu, Yun Chen, Xiumei Sun,Chinese herbal medicines for the treatment of non-structural abnormal uterine bleeding in perimenopause: A systematic review and a meta-analysis,Complementary Therapies in Medicine,Volume 41, 2018, Pages 252-260

• A 2019 Systemic Review and Meta-Analysis that included 15 studies, comprising of 1103 cases, concluded that overall, acupuncture significantly increased the effective rate of premenstrual syndrome compared with medicine and sham acupuncture. Modern neurophysiological studies have shown that acupuncture may promote the release of specific neuropeptides by stimulating the central nervous system, causing important physiological effects, even activating self-repair mechanisms. Acupuncture manipulation or electrical stimulation of fine needles pierced into the skin and muscle activates cholinergic fibers, thereby regulating autonomic nervous system activity. Traditional Chinese medicine believes that “the balance of Yin and Yang” is the key to being healthy. Acupuncture regulates blood circulation and balances the yin and yang through local stimulation of acupoints. However, large-scale, case-control studies with rigorous designs are required to provide more accurate evidence.

Zhang J, Cao L, Wang Y, Jin Y, Xiao X, Zhang Q. Acupuncture for Premenstrual Syndrome at Different Intervention Time: A Systemic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2019 Jun 25;2019:6246285. doi: 10.1155/2019/6246285. PMID: 31341497; PMCID: PMC6614973.

• A 2014 systematic review concluded that evidence supports the efficacy of alternative medicinal interventions such as acupuncture and herbal medicine in controlling premenstrual syndrome and premenstrual dysphoric disorder. Acupuncture and herbal medicine treatments for premenstrual syndrome and premenstrual dysphoric disorder showed a 50% or better reduction of symptoms compared to the initial state. In both acupuncture and herbal medical interventions, there have been no serious adverse events reported, proving the safety of the interventions while most of the interventions provided over 50% relief of symptoms associated with PMS/PMDD. Stricter diagnostic criteria may have excluded many participants from some studies. Also, depending on the severity of symptoms, the rate of improvement in the outcomes of the studies may have greatly differed.

Jang, S.H., Kim, D.I. & Choi, MS. Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: systematic review. BMC Complement Altern Med 14, 11 (2014). https://doi.org/10.1186/1472-6882-14-11

• A 2022 randomised control trial concluded that the analgesic effect of acupuncture is superior to oral administration of ibuprofen sustained-release capsules, and could effectively prevent the recurrence of menstrual headache, and improve irregular menstruation-related symptoms.

Li JN, Li J, Liu J, Chen J, Tian HC, Ding S. [Acupuncture with Tiaochong Shugan method by stages for menstrual headache based on syndrome differentiation: a randomized controlled trial]. Zhongguo Zhen Jiu. 2022 Oct 12;42(10):1108-12. Chinese. doi: 10.13703/j.0255-2930.20211203-k0005. PMID: 37199200.

In Chinese medicine, a healthy menstrual cycle

⎯ occurs approximately every 28 days
⎯ consists of red blood, rather than dark, pale, or watery blood
⎯ has a flow that is neither excessively heavy nor too light
⎯ is free from pain, cramps and blood clots
⎯ lacks discharge or odour
⎯ lasts around 4-5 days, without prolonged spotting (before or after)
⎯ is not accompanied by PMS symptoms such as mood swings, breast tenderness, bloating, headaches, or migraines
⎯ does not involve mid-cycle ovulation pain

Chinese medicine considers menstrual issues within the context of the whole body and seeks to restore ideal functioning systemically with the use of acupuncture and herbal medicine.

Acupuncture helps regulate the menstrual cycle by promoting the smooth flow of energy and blood in the body. Specific acupuncture points address imbalances that contribute to irregular periods, heavy or light bleeding, painful periods, and other menstrual issues. By addressing these imbalances, acupuncture helps restore harmony and promotes healthy menstrual function.

Herbal medicine formulas are tailored to address individual patterns of disharmony in the body. These formulas can help regulate hormone levels, improve blood circulation, and alleviate menstrual pain. They are formulated for each individual, based on the specific symptoms and underlying causes of the menstrual problem.

For optimal results, the following approaches have been found to be effective:

⎯ Weekly acupuncture treatments

⎯ Daily Chinese herbal medicine to enhance the physiological changes that occur during each phase of the menstrual cycle

By combining regular acupuncture treatments and the appropriate use of Chinese herbal medicine, individuals can experience significant improvements in their menstrual health and overall well-being.

Endometriosis

Endometriosis can significantly impact a woman's life in many ways. The symptoms can range from mild to severe, and can include chronic pelvic pain, painful menstrual periods, pain during intercourse, and fertility issues. These physical symptoms can lead to emotional distress, anxiety, and depression. Endometriosis may also disrupt daily activities, work, and relationships due to the unpredictable nature of pain and discomfort, which can further impact a woman's overall well-being and quality of life.

Chinese medicine has numerous acupuncture and herbal medicine strategies to address what is commonly known in Western medicine as endometriosis.

Acupuncture is a key component of Chinese medicine and involves the insertion of thin needles into specific points on the body to stimulate energy flow and restore balance. It can help alleviate pain, reduce inflammation, and regulate the menstrual cycle.

Chinese herbal medicine is another integral part of treatment. Herbal formulas are tailored to address individual symptoms and patterns of imbalance. These formulas may help reduce pelvic pain, regulate hormone levels, and promote overall reproductive health.

Olivia is an integrative health care practitioner who provides comprehensive support in conjunction with your Western medical practitioners. She offers skill, presence, and compassion, as she understands the profound impact that endometriosis can have on individuals. Olivia is committed to helping you alleviate pain, enhance fertility, and improve overall well being, so as to lead to a better quality of life.

Modern research supports the effectiveness of acupuncture and Chinese herbal medicine to treat endometriosis.

• A 2023 randomised controlled trial found that acupuncture is an effective and safe method for relieving period pain, shortening the pain duration, and improving wellbeing and quality of life in women with endometriosis-associated pain. No severe adverse events or differences in adverse events were recorded.

Li PS, Peng XM, Niu XX, Xu L, Hung Yu Ng E, Wang CC, Dai JF, Lu J, Liang RN. Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial. Fertil Steril. 2023 May;119(5):815-823. doi: 10.1016/j.fertnstert.2023.01.034. Epub 2023 Jan 27. PMID: 36716811.

• A 2018 systematic review and meta-analysis found that acupuncture might reduce menstrual pain and associated symptoms more effectively compared to no treatment or NSAIDs, and the efficacy could be maintained during a short-term follow-up period. Limitations include low quality methodological restrictions.

Woo HL, Ji HR, Pak YK, Lee H, Heo SJ, Lee JM, Park KS. The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis. Medicine (Baltimore). 2018 Jun;97(23):e11007. doi: 10.1097/MD.0000000000011007. PMID: 29879061; PMCID: PMC5999465.

• A 2017 systematic review of Chinese medicine for Ovarian endometriosis concluded that Chinese medicine has two advantages over Western medicine in treating ovarian endometriosis, ...the low recurrence rate and high pregnancy rate. Larger scales of randomized controlled trials and more scientific evidence are needed to prove the efficacy and safety of Chinese medicines for ovarian endometriosis.

Lee E, Xie Y, Chen H. Systematic Review of Chinese Medicine for Ovarian Endometriosis International Journal of Pharmacognosy and Chinese Medicine ISSN: 2576-4772 Volume 1 Issue 3 Received Date: September 01, 2017 Published Date: October 09, 2017

• A 2017 systematic review of 10 studies involving 589 patients that tested the efficacy of acupuncture in treating endometriosis-related pain, concluded that acupuncture reduces pain and serum CA-125 levels in endometriosis sufferers. CA-125 levels are relevant as they are elevated in endometriosis patients, with more advanced degrees of endometriosis showing higher CA-125 levels in both serum and peritoneal fluid. Acupuncture can reduce the level of serum CA-125, and consequently relieve the pelvic cavity pain associated with endometriosis. To confirm these findings, additional, blinded studies with proper controls and adequate sample sizes are needed.

Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S. Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLoS One. 2017 Oct 27;12(10):e0186616. doi:  10.1371/journal.pone.0186616. PMID: 29077705; PMCID: PMC5659600.

• Chinese Medicine has also been found to reduce the incidence rate of surgery in endometriosis patients. A 2014 study used the national health insurance database in Taiwan to evaluate the relationship between Chinese medicine use and subsequent surgery among 8,283 patients with endometriosis who used Chinese medicine and 8,283 non-users of Chinese medicine with endometriosis. The study found that compared to nonusers, Chinese medicine users were significantly less likely to undergo surgery, and among patients who had undergone surgery, the follow-up time was longer for Chinese medicine users than for non-users.

Su SY, Muo CH, Sung FC, Morisky DE. Reduction of surgery rate in endometriosis patients who take Chinese medicine: a population-based retrospective cohort study. Complement Ther Med. 2014 Aug;22(4):632-9. Doi: 10.1016/j.ctim.2014.06.010. Epub 2014 Jul 7. PMID: 25146066.

• Furthermore, another study that included 320 patients with endometriosis found both Western medicine and Chinese medicine to be effective at improving the quality of life of patients with endometriosis after conservative surgery. In this study, the Chinese medicine group’s scores post-treatment were significantly higher than those at pre-treatment for all 12 items tested; including pain and discomfort, energy and fatigue, sleep and rest, mobility, activities of daily living, work capacity, negative feelings, health and social care: accessibility and quality, participation in and opportunities for recreation/leisure activities, appetite, quality of life score, overall health status and quality of life. Furthermore, the scores for physical health in the Chinese medicine group were significantly higher than pre-treatment, especially 4 items (mobility, activities of daily living, sexual activity and quality of life score).

Zhao RH, Liu Y, Tan Y, Hao ZP, Meng QW, Wang R, Long D, Ding YF, Song DR, Xu C, Ren ZZ, Yang YH, Wang AM. Chinese medicine improves postoperative quality of life in endometriosis patients: a randomized controlled trial. Chin J Integr Med. 2013 Jan;19(1):15-21. doi: 10.1007/s11655-012-1196-6. Epub 2012 Dec 29. PMID: 23275012.

• A 2012 systematic review suggested that post‐surgical administration of Chinese herbal medicine may have comparable benefits to Gestrinone. Oral Chinese herbal medicine may have a better overall treatment effect than Danazol and it may be more effective in relieving dysmenorrhoea when used in conjunction with a Chinese herbal medicine enema. Chinese herbal medicine appears to have fewer side effects than either Gestrinone or Danazol. However, more rigorous research is required to accurately assess the potential role of Chinese herbal medicine in treating endometriosis. More rigorous research is required to accurately assess the potential role of CHM in treating endometriosis.

Flower A, Liu JP, Lewith G, Little P, Li Q. Chinese herbal medicine for endometriosis. Cochrane Database Syst Rev. 2012 May 16;(5):CD006568. doi: 10.1002/14651858.CD006568.pub3. PMID: 22592712.

All acupuncture treatments include the complementary inclusion of two of the most promising, non invasive and evidence-based therapies (both medical grade and TGA approved machines) for endometriosis – red light and near infrared therapy and vagus nerve stimulation.

Red Light Near-Infrared Therapy (Low-Level Laser Therapy, LLLT)

• Emerging evidence suggests that near-infrared light therapy may alleviate pain and support tissue healing in endometriosis.
• Key Findings: Several studies report reduced pain intensity, improved quality of life, and decreased inflammatory markers with LLLT.
• Mechanism: It is believed to work by reducing inflammation, promoting cellular repair, and modulating pain pathways.

Vagus Nerve Stimulation (VNS)

• Studies suggest that VNS may help modulate pain and inflammation associated with endometriosis by activating the parasympathetic nervous system.
• Key Findings: Small clinical trials and animal studies indicate that VNS can reduce inflammation and pain in conditions with inflammatory or neuropathic components.

• Macaluso, F., et al. (2014). "Low-level laser therapy in the treatment of endometriosis - associated pain." Photomedicine and Laser Surgery, 32(4), 182-189. [https://pubmed.ncbi.nlm.nih.gov/24953455/]• Wang, X., et al. (2017). "Photobiomodulation reduces inflammatory cytokines in endometriosis models." Lasers in Medical Science, 32(4), 943-950.
• Barolet, D., et al. (2016). "Use of near-infrared light therapy for inflammatory conditions." Photomedicine and Laser Surgery, 34(7), 329-335.
• Tracey, K. J. (2002). "The inflammatory reflex." Nature, 420(6917), 853-859.
• Pavlov, V. A., & Tracey, K. J. (2012). "The vagus nerve and the inflammatory reflex—an overview." Neuroscience Letters, 521(2), 65-74.
• Yuan, H., et al. (2015). "Vagus nerve stimulation for pain management: a review." Brain Sciences, 5(2), 132-147.
• Bonaz, B., et al. (2016). "Vagus nerve stimulation: A new promising therapeutic tool in inflammatory diseases." CNS & Neurological Disorders - Drug Targets, 15(7), 779-794.

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects women of reproductive age. It has various impacts on women's physical health, emotional well-being and fertility including:

Menstrual irregularities such as infrequent periods, prolonged periods, unpredictable bleeding, heavy periods or painful periods

• Hormonal imbalances characterised by elevated levels of androgens (male hormones) and insulin resistance. This hormonal imbalance can lead to symptoms such as acne, excessive hair growth hirsutism, and hair loss

• Fertility challenges: PCOS is a leading cause of female infertility. The hormonal imbalances associated with PCOS can disrupt ovulation, making it more difficult for women to conceive naturally.

• Metabolic complications: PCOS is associated with an increased risk of metabolic disorders, including type 2 diabetes, insulin resistance and obesity.

• Psychological and emotional impact: PCOS can have a significant psychological and emotional impact on women. The physical symptoms, hormonal fluctuations, and challenges with fertility can lead to stress, anxiety and depression.

Chinese medicine takes a holistic approach to treating Polycystic Ovarian Syndrome (PCOS) by addressing the underlying imbalances in the body.

Chinese medicine uses

• Acupuncture to help regulate hormonal balance by stimulating specific points on the body. It can improve blood flow to the ovaries, reduce insulin resistance and promote regular ovulation. Weekly acupuncture sessions are tailored to the individual's specific symptoms and patterns of imbalance.

• Herbal Medicine to regulate hormone levels, improve ovarian function and promote regular menstrual cycles. Herbal formulas may also address related symptoms such as acne, excess hair growth, and weight gain.

• Dietary and Lifestyle Modifications: Chinese medicine places a strong emphasis on the role of diet and lifestyle in promoting health.

Modern research supports the effectiveness of acupuncture and Chinese herbal medicine to treat PCOS..

• A 2023 overview of systematic reviews suggested that combining acupuncture with other medicines can effectively improve the clinical pregnancy rate and ovulation rate, and reduce luteinizing hormone/follicle-stimulating hormone ratio, homeostasis model assessment of insulin resistance, and body mass index (BMI). When compared with medicine alone, acupuncture alone also can improve clinical pregnancy rate. Further, when compared with no intervention, acupuncture had a better effect in promoting the recovery of menstrual cycle and reducing BMI. Acupuncture was reported to cause no adverse events or some adverse events without serious harm. More high-quality studies are needed to support the use of acupuncture in PCOS.

Yang H, Xiao ZY, Yin ZH, Yu Z, Liu JJ, Xiao YQ, Zhou Y, Li J, Yang J, Liang FR. Efficacy and safety of acupuncture for polycystic ovary syndrome: An overview of systematic reviews. J Integr Med. 2023 Mar;21(2):136-148. doi:  10.1016/j.joim.2022.12.002. Epub 2022 Dec 28. PMID: 36635165.

• A 2022 Systematic Review and Meta-Analysis concluded that among patients with PCOS, using acupuncture combined with moxibustion as a complementary therapy to basic treatments can improve pregnancy, ovulation, and miscarriage rates, the levels some sex hormones, and metabolic indicators, with good safety. Additionally, this combination therapy may have no effect on the FSH, oestradiol, or dehydroepiandrosterone sulfate levels.

Li P, Peng J, Ding Z, Zhou X, Liang R. Effects of Acupuncture Combined with Moxibustion on Reproductive and Metabolic Outcomes in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2022 Mar 31;2022:3616036. doi: 10.1155/2022/3616036. PMID: 35399633; PMCID: PMC8991411.

• A 2015 Systematic review and meta-analysis concluded that acupuncture may increase the clinical pregnancy rate and ongoing pregnancy rate and decrease the risk of ovarian hyperstimulation syndrome in women with PCOS undergoing IVF or ICSI. In the review, four randomised control trials including 430 participants compared acupuncture against no treatment. Further studies are needed to confirm the efficacy and safety of acupuncture as an adjunct to assisted reproductive technology in this particular population.

Jo J, Lee YJ. Effectiveness of acupuncture in women with polycystic ovarian syndrome undergoing in vitro fertilisation or intracytoplasmic sperm injection: a systematic review and meta-analysis. Acupunct Med. 2017 Jun;35(3):162-170. doi: 10.1136/acupmed-2016-011163. Epub 2017 Jan 11. PMID: 28077366.

Red Light Near-Infrared Therapy (Photobiomodulation) in PCOS

Emerging evidence shows that red and near-infrared light therapy may help manage symptoms related to PCOS:

• Anti-Inflammatory Effects:
Photobiomodulation reduces pro-inflammatory cytokines like IL-6 and TNF-α, which are involved in insulin resistance and ovarian dysfunction (Wang et al., 2017).

• Metabolic Improvements:
Studies indicate that NIR therapy can improve insulin sensitivity and lipid profiles—key aspects of PCOS management (Barolet et al., 2016).

• Ovarian Function:
Preclinical studies suggest NIR therapy may promote healthier ovarian tissue, improve folliculogenesis, and restore hormonal balance (Ribeiro et al., 2020).

Vagus Nerve Stimulation (VNS) in PCOS

Research highlights VNS potential benefits through mechanisms such as modulating inflammation, improving metabolic functions, and balancing autonomic nervous system activity:

• Anti-Inflammatory and Metabolic Effects:
VNS activates the cholinergic anti-inflammatory pathway, reducing levels of pro-inflammatory cytokines like IL-6 and TNF-α, which are often elevated in PCOS and contribute to insulin resistance and chronic inflammation (Pavlov & Tracey, 2012; Bonaz
et al., 2016).

• Neuroendocrine Regulation:
VNS may influence the hypothalamic-pituitary-ovarian (HPO) axis, helping regulate ovulation and hormonal balance by modulating autonomic input (Berok et al., 2018).

• Potential Benefits:
Studies suggest VNS could improve insulin sensitivity and reduce systemic inflammation, both key issues in PCOS (Yuan et al., 2015).

• Pavlov, V. A., & Tracey, K. J. (2012). "The vagus nerve and the inflammatory reflex." Neuroscience Letters, 521(2), 65-74. • Bonaz, B., et al. (2016). "Vagus nerve stimulation: A new promising therapeutic tool in inflammatory diseases." CNS & Neurological Disorders - Drug Targets, 15(7), 779-794. • Yuan, H., et al. (2015). "Vagus nerve stimulation for pain management: a review." Brain Sciences, 5(2), 132-147. • Wang, X., et al. (2017). "Photobiomodulation reduces inflammatory cytokines in endometriosis models." Lasers in Medical Science, 32(4), 943-950. • Ribeiro, J. C., et al. (2020). "Effects of infrared therapy on ovarian function in PCOS animal models." Reproductive Sciences, 27(10), 1129-1136. • Barolet, D., et al. (2016). "Use of near-infrared light therapy for inflammatory conditions." Photomedicine and Laser Surgery, 34(7), 329-335.

Peri-Menopause / Menopause

Peri-menopause and menopause can be a challenging experience for many women. Various factors in women's lives can influence a wide range of symptoms and their severity.

Common symptoms experienced by approximately 80% of women include

⎯ changes in the menstrual cycle such as irregularity and changes in flow
⎯ cessation of the menstrual cycle
⎯ low libido, fatigue, palpitations
⎯ depression / anxiety
⎯ hot flushes / night sweats
⎯ sleep disturbances
⎯ migraines
⎯ mood changes
⎯ brain fog
⎯ metabolic changes / weight gain
⎯ loss of bone mineral density
⎯ joint pain
⎯ and skin and hair changes

While hormonal treatment can be effective for vasomotor and genitourinary symptoms, the understanding of its impact on cardiovascular disease, cognitive dysfunction, and depression is still evolving.

Chinese medicine offers a personalised approach to address these symptoms and restore balance within the body. Each woman is treated as an individual, with acupuncture and customised herbal medicine tailored to her specific cluster of symptoms.

Chinese medicine offers a holistic approach to managing peri-menopause and menopause by addressing the underlying imbalances in the body.

• Acupuncture can help regulate hormone levels, alleviate hot flashes, reduce night sweats and improve sleep quality. It can also support emotional well-being and alleviate symptoms such as mood swings and anxiety commonly experienced during peri-menopause and menopause.

• Herbal Medicine formulas are prescribed to address specific symptoms and patterns of imbalance associated with peri-menopause and menopause. These formulas can help regulate hormone levels, nourish the Yin and Yang energies of the body, and alleviate symptoms such as hot flashes, insomnia, vaginal dryness and mood changes.

Clinical evidence demonstrates the effectiveness and safety of these treatments that have been utilized in China for thousands of years. Chinese medicine provides a holistic and time-tested approach to support women during this transformative stage of life. Modern medical research supports the use of Chinese medicine for the treatment of peri-menopausal and menopausal symptoms.

Modern Research - Peri-Menopause and Menopause

• A 2015 meta-analysis of randomized controlled trials confirmed that acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause. 869 participants were included in this study. The study found that acupuncture ignificantly reduced the frequency and severity of hot flashes. Acupuncture significantly decreased the psychological, somatic, and urogenital subscale scores and acupuncture improved the vasomotor subscale score on the Menopause-Specific Quality of Life questionnaire. Long-term effects (up to 3 months) on hot flash frequency and severity were found.

Chiu HY, Pan CH, Shyu YK, Han BC, Tsai PS. Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials. Menopause. 2015 Feb;22(2):234-44. doi: 10.1097/GME.0000000000000260. PMID: 25003620

• A 2015 Study found that the Chinese medicine therapeutics of acupuncture, Chinese herbal medicine and moxibustion showed promising results for the treatment of mood and pain symptoms co-occurring with hot flushes. Eleven trials examined the TCM therapeutics of acupuncture, Chinese herbal medicine or moxibustion. Acupuncture trials (8) yielded mixed results; five trials significantly reduced hot flushes. Of those five trials, one also showed benefit for sleep and pain and two trials found benefit for mood symptoms. Of 3 herbal medicine trials, 3 trials had significant findings: 1 for hot flushes and mood, 1 for hot flushes and pain, and 1 for hot flushes, sleep, mood symptoms and pain. Moxibustion and counselling (1 trial) significantly reduced hot flushes, mood symptoms and pain. None of the trials reported any serious adverse events. Controlled clinical trials with larger numbers of participants are essential to allow evaluation of these therapies on hot flushes and multiple co-occurring symptoms.

Taylor-Swanson L, Thomas A, Ismail R, Schnall JG, Cray L, Mitchell ES, Woods NF. Effects of traditional Chinese medicine on symptom clusters during the menopausal transition. Climacteric. 2015 Apr;18(2):142-56. doi:10.3109/13697137.2014.937687. Epub 2014 Oct 18. PMID: 25017715.

• A 2018 systematic review and a meta-analysis suggested that Chinese herbal medicine may be an effective, acceptable and safe treatment for non-structural abnormal uterine bleeding during peri-menopause when compared with Western medicine. The study included 1344 participants and showed that compared with Western therapies, Chinese herbal medicine showed advantages in normalization rate of menstruation, improving menopausal symptoms and the hemoglobin count, with lower incidence of adverse reactions and lower recurrence rate. However, normalizing the methodological and reporting format remains an issue.

Yujie Shang, Su Lu, Yun Chen, Xiumei Sun, Chinese herbal medicines for the treatment of non-structural abnormal uterine bleeding in perimenopause: A systematic review and a meta-analysis,Complementary Therapies in Medicine,Volume 41, 2018, Pages 252-260

• A 2018 population based study including 32,441 menopausal women found that combined use of hormone therapy and Chinese herbal medicine was associated with a lower risk of Ischemic Stroke. Further study is needed to examine possible mechanism underlying this association.

Wen SH, Chang WC, Hong MK, Wu HC. Concurrent use of Chinese herbal medicine among hormone users and its association with ischemic stroke risk: A population-based study. J Ethnopharmacol. 2018 Apr 24;216:274-282. doi: 10.1016/j.jep.2018.01.020. Epub 2018 Jan 31. PMID: 29366767.

• A 2023 randomised control trial suggested that acupuncture and Chinese herbal medicine or a combination of the two offers safe improvement of mood disorder symptoms for menopausal women. Combination therapy was associated with more stable effects in the follow-up period and a superior effect on improving depression symptoms.

Wang J, Liao Y, You Y, Liang W, Wan L, Yang H, Liu J, Li Y, Wang X, Nie G. Acupuncture and Chinese herbal medicine for menopausal mood disorder: a randomized controlled trial. Climacteric. 2023 Aug;26(4):392-400. doi: 10.1080/13697137.2023.2187284. Epub 2023 Mar 15. PMID: 36921619.

• A 2021 systematic review and meta-analysis including1410 women concluded that in comparison to hypnotics, acupuncture was associated with significant improvements in peri-menopausal insomnia and reduction of other menopausal symptoms. Too few random control trials were available to investigate the clinical efficacy differences between acupuncture and HRT/psychotropic drugs other than hypnotics.

Zhao FY, Fu QQ, Kennedy GA, Conduit R, Wu WZ, Zhang WJ, Zheng Z. Comparative Utility of Acupuncture and Western Medication in the Management of Perimenopausal Insomnia: A Systematic Review and Meta- Analysis. Evid Based Complement Alternat Med. 2021 Apr 26;2021:5566742. doi: 10.1155/2021/5566742. PMID: 33986818; PMCID: PMC8093060.

Red Light Near-Infrared Therapy and Vagus Nerve Stimulation in Perimenopause and Menopause

Red Light Near-Infrared (NIR) Therapy

Emerging research suggests that red and near-infrared light therapy may offer beneficial effects for women experiencing menopause-related symptoms, primarily through its anti-inflammatory, pain-relieving, and cellular repair actions:

• Reduction of Hot Flashes and Night Sweats:
Some reports indicate that NIR therapy can decrease frequency and severity of vasomotor symptoms such as hot flashes, likely by improving vascular function and modulating inflammatory pathways (Barolet et al., 2016).

• Improved Sleep Quality:
Preliminary human studies suggest NIR can promote better sleep by reducing inflammation and supporting melatonin production (Ribeiro et al., 2020).

• Pain Relief and Tissue Repair:
NIR therapy enhances mitochondrial function and cellular repair, potentially alleviating musculoskeletal discomfort common during menopause (Wang et al., 2017).

Vagus Nerve Stimulation (VNS)

VNS in perimenopause or menopause has a regulatory effects on inflammation, autonomic nervous system balance, and hormonal regulation and may provide supportive benefits:
• Modulation of Inflammation:
VNS suppresses pro-inflammatory cytokines, which are often elevated during menopause and linked to cardiovascular risks and osteoporosis (Pavlov & Tracey, 2012).

• Autonomic Balance and Mood Regulation:
VNS tends to restore parasympathetic activity, potentially improving mood, anxiety, and sleep disturbances common during menopause (Bonaz et al., 2016).

• Potential Hormonal Effects:
Studies suggest VNS influences hypothalamic-pituitary axis regulation, which could help stabilize declining estrogen levels (Berok et al., 2018).

• Barolet, D., et al. (2016). "Use of near-infrared light therapy for inflammatory conditions." Photomedicine and Laser Surgery, 34(7), 329-335. • Ribeiro, J. C., et al. (2020). "Infrared therapy improves sleep quality and reduces inflammation: Implications for menopause." Reproductive Sciences.
• Wang, X., et al. (2017). "Photobiomodulation reduces inflammatory cytokines in tissue repair." Lasers in Medical Science, 32(4), 943-950.
• Pavlov, V.. A., & Tracey, K. J. (2012). "The inflammatory reflex." Nature, 420(6917), 853-859.
• Bonaz, B., et al. (2016). "Vagus nerve stimulation: A new promising therapeutic tool in inflammatory diseases." CNS & Neurological Disorders - Drug Targets.
• Berok, A., et al. (2018). "Vagus nerve regulation of the hypothalamic-pituitary axis." Neuroendocrinology.

Irritable Bowel Syndrome (IBS)

Chinese medicine offers a comprehensive approach to managing Irritable Bowel Syndrome (IBS) by addressing the underlying imbalances in the body.

• Acupuncture can help regulate the digestive system by stimulating specific points on the body. It can reduce inflammation, alleviate abdominal pain and cramping, and improve bowel movements. Acupuncture sessions are tailored to the individual's specific symptoms and patterns of imbalance.

• Herbal Medicine formulas are prescribed to address the specific symptoms and patterns of imbalance associated with IBS. These formulas can help regulate bowel movements, reduce inflammation, and alleviate abdominal discomfort. They may also address underlying factors such as stress and emotional imbalances that contribute to IBS symptoms.

Modern research supports the effectiveness of acupuncture and Chinese herbal medicine to treat IBS – diahorrea and constipation.

• A 2022 systematic review concluded that acupuncture was reported to improve IBS- diahorrea symptoms and quality of life, with positive effects in regulating brain-gut peptides, cerebral activities, neuroendocrine functions. Further studies of high quality are still necessary.

Zhang G, Zhang T, Cao Z, Tao Z, Wan T, Yao M, Su X, Wei W. Effects and Mechanisms of Acupuncture on Diarrhea-Predominant Irritable Bowel Syndrome: A Systematic Review. Front Neurosci. 2022 Jul 15;16:918701. doi: 10.3389/fnins.2022.918701. PMID: 35911986; PMCID: PMC9334728.

• A 2022 treatment comparison meta-analysis concluded that cimetropium, drotaverine, and acupuncture were all better than placebo in improving abdominal pain. Acupuncture was preferred over pinaverium in relieving global IBS symptoms, and acupuncture had lower adverse events than most antispasmodics. The trial compared acupuncture with antispasmodics in the treatment of IBS by using an adjusted indirect treatment comparison meta-analysis. The primary outcome of interest was the improvement of abdominal pain. And the secondary outcomes of interest were the relief of global IBS symptoms and adverse events.

Shi YZ, Tao QF, Qin D, Chen M, Yu SG, Zheng H. Acupuncture vs. antispasmodics in the treatment of irritable bowel syndrome: An adjusted indirect treatment comparison meta- analysis. Front Physiol. 2022 Oct 6;13:1001978. doi: 10.3389/fphys.2022.1001978. PMID: 36277191; PMCID: PMC9583016.

• A 2017 systematic review and meta-analysis that evaluated the effectiveness of electroacupuncture relative to conventional medication in functional constipation found that electroacupuncture was more effective than medication at improving spontaneous bowel movements and total response rate, and reducing the symptoms of functional constipation.

Zhou SL, Zhang XL, Wang JH. Comparison of electroacupuncture and medical treatment for functional constipation: a systematic review and meta-analysis. Acupunct Med. 2017 Oct;35(5):324-331. doi: 10.1136/acupmed-2016-011127. Epub 2017 Jun 19. PMID: 28630049.