Acupuncture and Primary Dysmenorrhea

Acupuncture and Primary Dysmenorrhea

By Dr. Krystal Couture, DPT, LAc

Introduction

Primary dysmenorrhea—painful menstrual cramps without underlying pathology—is one of the most common gynecological complaints among women of reproductive age. While nonsteroidal anti-inflammatory drugs (NSAIDs) remain the standard first-line treatment, many individuals seek alternative therapies such as acupuncture for symptom relief with fewer side effects.

This literature review explores the efficacy of acupuncture in the management of primary dysmenorrhea, comparing outcomes with NSAIDs, sham acupuncture, and no treatment. While research in English is somewhat limited, three relevant randomized controlled trials (RCTs) were reviewed for this discussion.

Study Summaries

Kiran et al., 2013

This preliminary study included 35 women divided into two groups. Group 1 (n=24) received naproxen sodium 550 mg twice daily beginning two days before menstruation and continuing through the first two days of menstruation. Group 2 (n=11) received bilateral acupuncture at the following points: HT7, PC6, LI4, LI10, SP6, LR3, ST36, GB26, SP15, Zigong, and Ren4. Treatments lasted 15 minutes, included three manual stimulations, and were administered five days and two days prior to menstruation as well as three days into the bleed.

Both groups demonstrated reduced pain scores on the Visual Analog Scale (VAS) following treatment. The authors concluded that acupuncture was as effective as NSAID use for managing primary dysmenorrhea.

While promising, the study’s small and uneven sample size, along with its short follow-up window, limits the strength of the findings. Larger studies with longer follow-up periods would provide more definitive evidence.

Smith et al., 2011

This randomized controlled trial enrolled 92 women with primary dysmenorrhea. Participants were assigned either to a control group receiving sham acupuncture or to a treatment group receiving true acupuncture. Treatments occurred over three menstrual cycles: nine sessions total (three per cycle), each lasting 30–40 minutes.

Standard acupuncture points included SP4, ST29, Ren3, BL32, SP8, and SP6, with additional points selected according to Traditional Chinese Medicine (TCM) pattern diagnosis (e.g., qi and blood stagnation, deficiency patterns, damp heat, or cold stagnation).

Outcomes were measured through subjective tools including VAS and the McGill Pain Questionnaire. Although the study noted improved mood during treatment, there was no significant long-term difference between the acupuncture and sham acupuncture groups in pain reduction.

The use of multiple practitioners and varied point prescriptions may have affected consistency. Future studies could benefit from a larger sample size and a standardized treatment protocol.

Shetty et al., 2018

Sixty participants were divided into two groups: a no-treatment control group and an acupuncture treatment group. The acupuncture protocol included KI3, SP8, ST25, ST29, ST30, ST36, CV4, CV6, BL62, HT7, LI4, and PC6, with 20-minute needle retention. Treatments were conducted over a 90-day period with assessments on days 1, 30, 60, and 90.

Participants completed 45 acupuncture sessions, and outcomes were measured using numerical scales for pain, cramping, and systemic symptoms. The results demonstrated a significant reduction in pain severity, muscle cramps, and systemic symptoms in the acupuncture group compared to the control group.

As with the other studies, the sample size was relatively small and follow-up duration was limited.

Discussion

All three studies reviewed were randomized and controlled, with low dropout rates and no reported adverse effects—supporting acupuncture’s safety profile. Both Kiran et al. (2013) and Shetty et al. (2018) found meaningful reductions in symptoms of primary dysmenorrhea, suggesting that acupuncture may be as effective as or superior to conventional management options like NSAIDs or no treatment.

However, Smith et al. (2011) did not find long-term clinical improvement beyond mood enhancement, highlighting the need for greater standardization and study consistency. Across all studies, sample sizes were small (fewer than 100 participants), and subjective outcomes such as VAS dominated the data.

Objective physiological measures—such as uterine blood flow changes or prostaglandin (PGF2α) levels—were not assessed. Additionally, quality of life measures were not included, which could have provided more insight into the holistic impact of treatment.

To strengthen future research, larger studies with consistent protocols, appropriate blinding, and extended follow-up periods are needed. Incorporating validated tools such as the Menstrual Distress Questionnaire (MEDI-Q) or the Menstrual Health Symptom Questionnaire would also enhance study rigor and relevance.

Clinical Reflections

The acupuncture point selections and treatment methods across these studies are both practical and clinically relevant. Notably, Shetty et al. (2018) avoided needling during menstruation—a choice that aligns with traditional TCM principles and may support patient comfort.

Based on these findings, the point prescriptions from Kiran et al. (2013) and Shetty et al. (2018) appear particularly compelling for managing primary dysmenorrhea and may serve as useful protocols for clinical application.

References

• Kiran, G., Gumusalan, Y., Ekerbicer, H. C., Kiran, H., Coskun, A., & Arikan, D. C. (2013). A randomized pilot study of acupuncture treatment for primary dysmenorrhea. European Journal of Obstetrics & Gynecology and Reproductive Biology, 169(2), 292–295. https://doi.org/10.1016/j.ejogrb.2013.02.016

• Smith, C. A., Crowther, C. A., Petrucco, O., Beilby, J., & Dent, H. (2011). Acupuncture to treat primary dysmenorrhea in women: A randomized controlled trial. Evidence-Based Complementary and Alternative Medicine, 2011(1). https://doi.org/10.1093/ecam/nep239

• Shetty, G. B., Shetty, B., & Mooventhan, A. (2018). Efficacy of acupuncture in the management of primary dysmenorrhea: A randomized controlled trial. Journal of Acupuncture and Meridian Studies, 11(4), 153–158. https://doi.org/10.1016/j.jams.2018.04.001

• Xu, Y., Zhao, W., Li, T., Bu, H., Zhao, Z., Zhao, Y., & Song, S. (2017). Effects of acupoint-stimulation for the treatment of primary dysmenorrhoea compared with NSAIDs: A systematic review and meta-analysis of 19 RCTs.BMC Complementary and Alternative Medicine, 17(1). https://doi.org/10.1186/s12906-017-1924-8