Acupuncture for Endometriosis, Adenomyosis & Pelvic Pain Management

Acupuncture for Endometriosis,

Acupuncture can help reduce the frequency and intensity of pelvic, lower back and thigh pain occurring between and during periods. They can also help with symptoms associated with endometriosis and adenomyosis such as back pain, bloating, fatigue, heavy/clotty bleeding, bleeding between periods, pain or discomfort with sex, bladder pain/symptoms, bowel-related pain and other digestive symptoms, headaches, and other cyclic hormonal symptoms.

Acupuncture can be used as a stand-alone treatment, or in combination with other treatments such as Chinese herbal medicine, hormonal / pain medications, pelvic physiotherapy, and surgery.

“Acupuncture is an effective and safe method [for] relieving dysmenorrhea [period pain], shortening the pain duration, and improving wellbeing and quality of life in women with endometriosis-associated pain” (1)

Research on Acupuncture for Endometriosis: an Effective and Safe Way to Relieve Endometriosis-related Pelvic Pain

Research on Acupuncture for Endometriosis

I am currently updating this part of the site…

  • Pelvic pain / period pain has many potential causes (although in many cases, no cause is found).

    Modern medicine has long considered period pain (when no cause is found) to be a normal part of the cycle, and recommends pain medications to manage it. However, pain can have considerable affects on women’s lives, and not everyone wants or is able to take non-steroidal anti-inflammatories (NSAIDS).

    The Chinese medicine healing system describes the period as a vital sign - like a monthly report card for your overall health, and it does not see pain as normal.

    Modern medicine acknowledges this to a degree - a recent review noted that experiencing period pain can contribute to increased sensitivity to pain, and may increase the chance of other chronic pain conditions, including fibromyalgia.

    I approach period pain with acupuncture and/or Chinese herbal medicine depending on your needs and preferences. Studies have found that Chinese herbal medicines “improved overall response rate, pain reduction, and alleviation of symptoms compared to conventional treatments”.

  • A recent study on women with deep infiltrating endometriosis found that a protocol involving 15 acupuncture treatments over a 6 month period was safe and effective at reducing pain as well as disability related to symptoms. Some specifics:

    • It reduced period pain intensity, and number of pain days decreased (almost 60% of women had 50% less days of period pain)

    • Reduced pain between periods

    • Pain with sex steadily decreased

    • Bowel pain decreased overall

    • Less painkillers needed

    • Almost 60% women had significantly decreased disability related to their symptoms

  • If you choose surgery as a management option, I recommend acupuncture both pre- and post-surgery due to its beneficial effect on post-surgical recovery. “A growing body of evidence supports the use of perioperative acupuncture as part of an enhanced postsurgical recovery protocol” (7). Benefits include reduced anxiety before surgery, and reduced cognitive effects, nausea, vomiting and pain after surgery. (7)

  • A research review found that some Chinese herbal medicines taken long-term after surgery may reduce the chance of endometriomas (a type of cyst) from coming back, increase pregnancy rates, and inprove quality of life. It is thought to act by:

    • regulating immune function

    • modulating the endocrine system

    • inhibiting the proliferation of ectopic tissue

    A 2012 Cochrane review found that using Chinese herbal medicine post-surgically may have:

    • results comparable to gestrinone, but with less side effects

    • better overall treatment effect than danazol

    One study involved giving some patients herbal medicine (stages I and II endometriosis = 3 months of herbal treatment; stage III and IV = 6 months) and compared their results to patients receiving medications (GnRH agonists & gestrinone), and found that:

    • Chinese herbal medicine has a comparable effect to GnRH agonists or gestrinone in preventing endometriosis from coming back after surgery (assess via ultrasound)

    • the women taking herbal medicine also had less side effects than those taking medications

    Unfortunately the quality of this and the other individual studies on the topic are questionable, so it is hard to say for sure.

  • A 2012 Cochrane review found that using Chinese herbal medicine post-surgically may have:

    • results comparable to gestrinone, but with less side effects

    • better overall treatment effect than danazol

    One study involved giving some patients herbal medicine (stages I and II endometriosis = 3 months of herbal treatment; stage III and IV = 6 months) and compared their results to patients receiving medications (GnRH agonists & gestrinone), and found that:

    • Chinese herbal medicine has a comparable effect to GnRH agonists or gestrinone in preventing endometriosis from coming back after surgery (assessed via ultrasound)

    • the women taking herbal medicine also had less side effects than those taking medications

    Unfortunately the quality of this and the other individual studies on the topic are questionable, so it is hard to say for sure.

FAQ’s

  • Acupuncture relieves pelvic pain in women with endometriosis by:

    • stimulating the release of natural painkilling biochemicals (endogenous opioids)

    • modifying how the nervous system processes pain

    • reduces inflammation (by reducing the release of inflammatory biochemicals - prostaglandins, neuropeptides, cytokines) (8,9)

    • regulating reproductive hormones & the improving how the endocrine system works as a whole (8)

    • regulating immune function (8)

    • decreasing nerve growth factor (2)

  • Yes, there are now multiple studies showing acupuncture is a useful treatment for pain management (see above)

  • Endometriosis and chronic pelvic pain are complex conditions and for best results, it is important to see someone who has done extra study and has experience in this area.

    Chinese medicine is a vast field, with Chinese medicine practitioners in China having the same areas of specialisation as in modern medicine.

    In Australia, Chinese medicine practitioners do not have a formal pathway to specialisation in a particular area - so practitioners can only do this informally by completing extra training and mentoring in their chosen area.

    I have studied endometriosis and pelvic pain management:

    • as part of my Masters of Reproductive Medicine

    • mentoring with leaders in the field including Steven Clavey (Chinese herbal medicine gynaecology)

    • as part of my internship in an integrative Chinese medicine hospital in Nanjing, China

    • professional development and short courses with various practitioners

  • Acupuncture: So far we only have studies on how acupuncture helps with endometriosis-related pain and other symptoms.

    However, there is research on animals which looks at how acupuncture can affect the actual endometriosis tissue. This animal study found that acupuncture can reduce the size of endometriomas (endometrial cysts), with results comparable to progesterone therapy.

    (Remember, these are animal studies, and scientists aren’t sure whether it has the same effect on people.)

    Herbal medicine: there is evidence that some herbal medicines can have a beneficial effect on endometriosis lesions

  • Endometriosis - Unfortunately endometriosis is not currently curable, and all therapies (complementary and medical, including surgery) are aimed at managing the condition and symptoms, to reduce its impact on your fertility and life.

    Studies on acupuncture for pelvic pain management show that a maintenance approach is needed, as endometriosis is a chronic condition.

    Adenomyosis - the only way to cure this is unfortunately via a hysterectomy. All other therapies are aimed at managing it and its effect on your life.

  • The number of treatments you will need depends on how severe your symptoms are, what results you want to achieve, and what other therapies you are using,

  • I find a lot of clients who are nervous about needles find my treatments quite manageable - maybe it is worth a try. Chinese herbal medicine is another option that can be used on its own.

  • This 2018 research review looked at acupuncture, yoga, exercise, and electrotherapy, and found that “numerous complementary treatments have been used to alleviate the symptoms of endometriosis, but only acupuncture has demonstrated a significant improvement in outcomes”.

  • Many people find acupuncture useful as a solo therapy for managing pain and other symptoms.

    Other treatment options you can use to manage symptoms alongside acupuncture include Chinese herbal medicine, pelvic physiotherapy, surgery, psychotherapy / counselling, diet and lifestyle changes.

  • I look for a reduction in frequency and/or intensity of pain / other symptoms within 3 acupuncture treatments to show me that this is working for you. Most people also notice they start to feel better in themselves as well - better mood, less anxiety, better sleep etc.

  • The evidence on acupuncture (for endometriosis related pelvic pain) does show that results tend to wane after you stop acupuncture treatment (see this study). This is because endometriosis is a chronic condition, and while acupuncture can provide a lot of relief, improve your wellness and quality of life, it is not a ‘cure’.

    At the end of a treatment plan / when you are happy with your results, I will offer you either an ‘as needed’ approach, or a proactive maintenance approach (typically monthly acupuncture).

This 2023 study concluded that “acupuncture is an effective and safe method of relieving dysmenorrhea [period pain], shortening the pain duration, and improving wellbeing and quality of life in women with endometriosis-associated pain”. (1)

This 2023 research review concluded that “acupuncture treatment for endometriosis demonstrated clinically relevant improvements in pelvic pain and should be considered as a potential treatment intervention”. (2)

This 2018 research review concluded “numerous complementary treatments have been used to alleviate the symptoms of endometriosis, but only acupuncture has demonstrated a significant improvement in outcomes.” They also found that “meta-analysis [review of research] of acupuncture showed a significant benefit in pain reduction as compared with placebo”. (3)

According to the NIH Consensus Statement on Acupuncture, “considerable evidence shows that opioid peptides are released during acupuncture, which may partially explain the analgesic [pain-relieving] effects of acupuncture. Acupuncture stimulation may also activate the hypothalamus and pituitary glands. Studies have documented that acupuncture is associated with alterations in the secretion of neurotransmitters and neurohormones and changes in blood flow. Evidence also indicates that acupuncture affects immune function.” [emphasis added] (4)

The The Royal Australian and New Zealand College of Obstetricians and Gynaecologist’s (RANZCOG) 2021 Australian Clinical Practice Guideline for the Diagnosis and Management of Endometriosis (1) lists acupuncture as a non-pharmacological and non-surgical option for management of pain associated with endometriosis. (5)

Acupuncture works cumulatively, and regular acupuncture treatments over several cycles aimed at reducing inflammation, regulating hormones and modulating the immune system are typically needed.

Experts agree that the ideal acupuncture treatment frequency to manage endometriosis-related pelvic pain is one to two times per week for 2-3 months, until pain relief. Chinese herbal medicine is also recommended by experts as a useful intervention when treating pelvic pain due to endometriosis. (6)

“Acupuncture treatment for endometriosis demonstrated clinically relevant improvements in pelvic pain and should be considered as a potential treatment intervention.”(2)

References:

1. Li PS, Peng XM, Niu XX, Xu L, Hung Yu Ng E, Wang CC, et al. Efficacy of acupuncture for endometriosis-associated pain: A multicenter randomized single-blind placebo-controlled trial. Fertility and Sterility. 2023;119(5):815–23.

2. Giese N, Kwon KK, Armour M. Acupuncture for endometriosis: A systematic review and meta-analysis. Integr Med Res. 2023 Dec;12(4):101003. doi: 10.1016/j.imr.2023.101003. Epub 2023 Oct 28. PMID: 38033648; PMCID: PMC10682677.

3. Mira TAA, Buen MM, Borges MG, Yela DA, Benetti-Pinto CL. Systematic review and meta-analysis of complementary treatments for women with symptomatic endometriosis. Int J Gynaecol Obstet. 2018 Oct;143(1):2-9. doi: 10.1002/ijgo.12576. Epub 2018 Jul 9. PMID: 29944729.

4. Morey SS. NIH Issues Consensus Statement on Acupuncture. American Family Physician [Internet]. 1998 May 15;57(10):2545–6. Available from: https://www.aafp.org/pubs/afp/issues/1998/0515/p2545.html‌

5. RANZCOG. Australian clinical practice guideline for the diagnosis and management of endometriosis. Melbourne, Australia. 2021

6. Giese N, Heirs MK. Development of Provisional Acupuncture Guidelines for Pelvic Pain in Endometriosis Using an e-Delphi Consensus Process. J Integr Complement Med. 2023 Mar;29(3):169-180. doi: 10.1089/jicm.2022.0659. Epub 2022 Nov 28. PMID: 36454211; PMCID: PMC10039271.

7. Zhang W, Zhang H, Wang S-M, Guo J, Ma Y, Li Y, et al. Perioperative acupuncture optimizes surgical outcomes: Theory, clinical practice and future perspectives. The American Journal of Chinese Medicine. 2022;50(04):961–78.

8. Chen C, Li X, Lu S, Yang J, Liu Y. Acupuncture for clinical improvement of endometriosis-related pain: a systematic review and meta-analysis. Arch Gynecol Obstet. 2024 Oct;310(4):2101-2114. doi: 10.1007/s00404-024-07675-z. Epub 2024 Aug 7. PMID: 39110208; PMCID: PMC11393010.

9. McDonald JL, Cripps AW, Smith PK. Mediators, Receptors, and Signalling Pathways in the Anti-Inflammatory and Antihyperalgesic Effects of Acupuncture. Evid Based Complement Alternat Med. 2015;2015:975632. doi: 10.1155/2015/975632. Epub 2015 Aug 3. PMID: 26339274; PMCID: PMC4539069.