Microsoft word - pre_menstrual_syndrome_april_2012.docx
ACUPUNCTURE AND PRE-MENSTRUAL SYNDROME
About pre-menstrual syndrome 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.
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). Surgery is indicated only if there are coexisting gynecological problems.
Freeman EW, Rickels K, Yonkers KA, et al. Venlafaxine in the treatment of premenstrual dysphoric disorder. Obstet
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
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Rapkin AJ, Morgan M, Goldman L, et al. Progesterone metabolite allopregnanolone in women with premenstrual
syndrome. Obstet Gynecol
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
Wittchen H-U et al. Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psych Med
2002; 32: 119-32.
How acupuncture can help A systematic review (Cho 2010) located 10 randomised controlled trials and found some evidence to suggest acupuncture reduces PMS symptoms. However, trial quality was generally poor and further studies are needed to confirm this. (see Table overleaf)
Acupuncture may help reduce 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).
About the British Acupuncture Council With over 3000 members, the British Acupuncture Council (BAcC) is the UK's largest professional body for traditional acupuncturists. Membership of the BAcC guarantees excellence in training, safe practice and professional conduct. To find a qualified traditional acupuncturist, contact the BAcC on 020 8735 0400 or visit www.acupuncture.org.uk
Pre menstrual syndrome/April 2012
ACUPUNCTURE AND PRE MENSTRUAL SYNDROME
Cho SH, Kim J. Efficacy of acupuncture in
A systematic review including 9 randomised controlled trials that assessed the
management of premenstrual syndrome: A
effectiveness and adverse effects of acupuncture for the symptomatic treatment of
systematic review. Complementary Therapies in
PMS. Four studies reported a significant difference in reduction of PMS symptoms for
2010; 18: 104-11.
acupuncture treatment compared with pharmacological treatment. Two studies
reported improvements in primary symptoms within acupuncture and herbal
medications groups compared with baseline. Only two trials reported information
regarding acupuncture-related adverse events, which included one case of a small
subcutaneous haematoma. The reviewers concluded that, although the included trials
showed that acupuncture may be beneficial to patients with PMS, there is insufficient
evidence to support this conclusion due to methodological flaws in the studies.
Shin KR et al. The effect of hand acupuncture therapy
A pilot study that compared the effects of hand acupuncture and hand moxibustion
and hand moxibustion therapy on premenstrual
therapy with a control group (no treatment) 22 women with PMS. After acupuncture
syndrome among Korean women. Western Journal of
and moxibustion treatment, there were significant reductions in overall symptom
2009; 31: 171-86.
reports, and in abdominal pain and bloating, compared with both pre-treatment levels
and relative to controls. Rapid mood changes were also reduced in the post-treatment
period in both the hand acupuncture and hand moxibustion groups, but not in the
control group. The researchers concluded that hand acupuncture and hand
moxibustion therapy may be effective strategies for women to reduce PMS
Research on mechanisms for acupuncture
Cheng KJ. Neuroanatomical basis of acupuncture
A review that looked at acupuncture treatment for some common conditions. It is
treatment for some common illnesses. Acupunct Med
found that, in many cases, the acupuncture points traditionally used have a
neuroanatomical significance from the viewpoint of biomedicine. From this, the
reviewers hypothesize that plausible mechanisms of action include intramuscular
Pre menstrual syndrome/April 2012
stimulation for treating muscular pain and nerve stimulation for treating neuropathies.
In animal studies, acupuncture has been found to significantly reduce anxiety-like
Lee B et al. Effects of acupuncture on chronic
behaviour, and increase brain levels of neuropeptide Y, the brain levels of which
corticosterone-induced depression-like behavior and
appear to correlate with reported anxiety.
expression of neuropeptide Y in the rats.
2009; 453: 151-6.
Samuels N et al. Acupuncture for psychiatric illness: a
A literature review of acupuncture for psychiatric illness, which presents research that
literature review. Behav Med
2008; 34: 55-64
found acupuncture to increase central nervous system hormones, including ACTH,
beta-endorphins, serotonin, and noradrenaline. It concludes that acupuncture can
have positive effects on depression and anxiety.
A study of the regulatory effect of electro-acupuncture on the imbalance between
Zhou Q et al. The effect of electro-acupuncture on the
monoamine neurotransmitters and GABA in the central nervous system of rats with
imbalance between monoamine neurotransmitters
chronic emotional stress-induced anxiety. The levels of serotonin, noradrenaline and dopamine fell significantly, while GABA levels were significantly higher in the rats
and GABA in the CNS of rats with chronic emotional
given acupuncture (P<0.05, or P<0.0). The researchers concluded that the anti-anxiety effect of electro-acupuncture may relate to its regulation of the imbalance of
stress-induced anxiety. Int J Clin Acupunct
Kavoussi B, Ross BE. The neuroimmune basis of
A review that suggests the anti-inflammatory actions of traditional and electro-
anti-inflammatory acupuncture. Integr Cancer Ther
acupuncture are mediated by efferent vagus nerve activation and inflammatory
2007; 6: :251-7.
Zijlstra FJ et al. Anti-inflammatory actions of
A review that suggests a hypothesis for the anti-inflammatory action of acupuncture.
acupuncture. Mediators Inflamm
Insertion of acupuncture needle initially stimulates production of beta-endorphins,
calcitonin gene-related peptide (CGRP) and substance P, leading to further
stimulation of cytokines and nitric oxide (NO). While high levels of CGRP have been
shown to be pro-inflammatory, CGRP in low concentrations exerts potent anti-
inflammatory actions. Therefore, a frequently applied 'low-dose' treatment of
acupuncture could provoke a sustained release of CGRP with anti-inflammatory
activity, without stimulation of pro-inflammatory cells.
Pomeranz B. Scientific basis of acupuncture. In: Stux
Needle activation of A delta and C afferent nerve fibres in muscle sends signals to
G, Pomeranz B, eds. Acupuncture Textbook and
the spinal cord, where dynorphin and enkephalins are released. Afferent pathways
Atlas. Heidelberg: Springer-Verlag; 1987:1-18.
continue to the midbrain, triggering excitatory and inhibitory mediators in spinal cord.
Ensuing release of serotonin and norepinephrine onto the spinal cord leads to pain
transmission being inhibited both pre- and postsynaptically in the spinothalamic tract.
Finally, these signals reach the hypothalamus and pituitary, triggering release of
adrenocorticotropic hormones and beta-endorphin.
Pre menstrual syndrome/April 2012
Volumen 12, N.º 2 · Diciembre 2012 Separata de la Revista de Fitoterapia 2012; 12 (2): 119-133 Revista de El fruto de sabal mejora los síntomas de la hiperplasia benigna de próstata y la disfunción sexual. Resultados de un Andreas Suter Reinhard Saller Eugen Riedi Michael Heinrich Edición especial para
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