Beruflich Dokumente
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This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane
Library 2009, Issue 2
http://www.thecochranelibrary.com
TABLE OF CONTENTS
HEADER . . . . . . . . . .
ABSTRACT . . . . . . . . .
BACKGROUND . . . . . . .
OBJECTIVES . . . . . . . .
METHODS . . . . . . . . .
REFERENCES . . . . . . . .
APPENDICES . . . . . . . .
WHATS NEW . . . . . . . .
HISTORY . . . . . . . . . .
CONTRIBUTIONS OF AUTHORS
DECLARATIONS OF INTEREST .
SOURCES OF SUPPORT . . . .
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[Intervention Protocol]
Contact address: Jinna Yu, Acupuncture Department, Guang An Men Hospital of China Academy of Chinese Traditional Medicine,
No. 5 Bei Xian Ge, Xuan Wu Qu, Beijing, 100053, China. ayujinnaa@sina.com. (Editorial group: Cochrane Menstrual Disorders and
Subfertility Group.)
Cochrane Database of Systematic Reviews, Issue 2, 2009 (Status in this issue: Unchanged)
Copyright 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD005290
This version first published online: 20 April 2005 in Issue 2, 2005. (Help document - Dates and Statuses explained)
This record should be cited as: Yu J, Liu B, Liu Z, Welch V, Wu T, Clarke J, Smith CA. Acupuncture for premenstrual syndrome.
Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD005290. DOI: 10.1002/14651858.CD005290.
ABSTRACT
This is the protocol for a review and there is no abstract. The objectives are as follows:
To evaluate the effectiveness and safety of acupuncture or electroacupuncture in the treatment of women with premenstrual syndrome.
Comparisons between groups intended for treatment with any type of acupuncture and groups allocated to sham acupuncture, no
treatment, Chinese medicine, Western medicine or other treatments. The following hypotheses will be tested:
(1) acupuncture is superior to sham acupuncture or no treatment in treating PMS;
(2) acupuncture is superior to other treatments or Western medicine or Chinese medicine in treating PMS;
(3) there are less adverse events in the acupuncture group than in the Chinese medicine or Western medicine groups.
BACKGROUND
Premenstrual syndrome (PMS) is a group of symptoms that consistently occur in young and middle-aged women during the luteal
phase of the menstrual cycle. In order to diagnose PMS, the symptoms should abate when menstruation starts or stops and not recur until ovulation two weeks before the next period (Backstorm
1991; Dickerson 2004). More than 200 premenstrual symptoms
have been recorded and are usually divided into three broad categories:
(1) behavioral symptoms including fatigue, insomnia, dizziness,
changes in sexual interest, food cravings or overeating;
(2) psychological symptoms including irritability, anger, depressed
mood, crying and tearfulness, anxiety, tension, mood swings, lack
of concentration, confusion, forgetfulness, restlessness, loneliness,
decreased self-esteem, tension;
(3) physical symptoms including headaches, breast tenderness and
swelling, back pain, abdominal pain and bloating, weight gain,
swelling of extremities, water retention, nausea, muscle and joint
pain (Dickerson 2004; Reid 1986).
Premenstrual dysphoric disorder (PMDD) is a more severe form
of PMS. It is a condition characterized by intense emotional symptoms that occur between ovulation and menstruation. Symptoms
associated with PMDD are similar to those experienced with PMS;
however, they are much more severe. Symptoms include severe depression, irritability and/or mood swings which interfere with relationships, social functioning, and work or school (Bancroft 1993;
Medem 2004). PMDD should be diagnosed only when mood
symptoms seriously impact on relationships and impair functioning at work or school (Medem 2004).
It is reported that approximately 95% of women have one or
more premenstrual symptoms. Fifty percent of these women have
slight symptoms, 30% have moderate symptom, with about 5%
of women reporting severe PMS symptoms that disrupt their lives
in the two weeks before their periods (Hylan 1999). It is estimated
that only 3% to 8% of women are affected by PMDD (Medem
2004).
are GABA-A agonists, with anxiolytic and anticonvulsant properties. By contrast, pregnenolone-sulphate and DHEAS-sulphate
are anxiogenic and pro-convulsant (Reddy 2003).
There is recent evidence that levels of oestrogens and progesterone
affect the transport of serotonin in the CNS, profoundly affecting the brain serotonergic system (Cameron 2004), and that, conversely, serotonin might affect ovarian levels of oestrogens and progesterone.
Some evidence suggests that an underlying serotonin deficiency
makes women more sensitive to progesterone (OBrien 2000). Deficiencies in prostaglandins, which cause an inability to convert
linoleic acid to prostaglandin precursors, may be related to the onset of PMS (Daugherty 1998). Genetic factors also seem at work
as the concordance rate is two times higher in monozygotic twins
than in dizygotic twins (Kendler 1998). A more complex relationship between PMS and magnesium and calcium than either element alone was indicated by the highly significant high? Mg/Ca
ratio in blood cells in women with severe PMS. The significantly
lower calcium level in blood cells found in studies may provide
additional evidence that PMS may be involved in a calcium-deficiency state or a metabolic maladjustment involving calcium (
Shamberger 2003). One cross-sectional study reported that high
intake of fats and low intake of foods with high concentration
of carbohydrate may be associated with premenstrual symptoms (
Nagata 2004).
OBJECTIVES
Why it is important to do this review
Acupuncture is a form of therapy based on traditional Chinese
medicine (TCM) and dates back thousands of years. To bring
about healing it involves inserting fine needles into specific points
on the skin in order to stimulate corresponding meridians points,
as defined by TCM theory. Other methods of stimulation of these
points are also traditionally used, such as the burning of moxa
(the plant Artemisia vulgaris or Mugwort) and applying pressure
(acupressure). Other methods developed more recently include
electronic stimulation, laser acupuncture and medicament. The
traditional concepts involve the regulating of imbalances of qi (vital energy) along with the theories of yin and yang, the five elements, meridians, vital substances, pathogenic factors, and the
eight principle patterns (Beal 1999). As the use of acupuncture
has become more prevalent in the West these theories have been
developed to fit in with a Western understanding of physiology,
for example, needling is thought to reduce local muscle tension
or release pain-killing endorphins (Green 2004). The temperature
in the cortex can be changed by electroacupuncture; the response
To evaluate the effectiveness and safety of acupuncture or electroacupuncture in the treatment of women with premenstrual syndrome.
Comparisons between groups intended for treatment with any
type of acupuncture and groups allocated to sham acupuncture,
no treatment, Chinese medicine, Western medicine or other treatments. The following hypotheses will be tested:
(1) acupuncture is superior to sham acupuncture or no treatment
in treating PMS;
(2) acupuncture is superior to other treatments or Western
medicine or Chinese medicine in treating PMS;
(3) there are less adverse events in the acupuncture group than in
the Chinese medicine or Western medicine groups.
METHODS
Alternative name
Hegu
LI 4
Zusanli
ST 36
Sanyinjiao
SP 6
Xuehai
SP 10
Ganshu
BL 18
Pishu
BL 20
Shenshu
BL 23
Yongquan
KI 1
Taixi
KI 3
Zhengying
GB 17
Fengchi
GB20
Taichong
LR 3
Guanyuan
RN 4
Zhongwan
RN 12
Tanzhong
RN 17
Baihui
DU 20
Zigong
EX-CA 1
Qihai
RN 6
(Continued)
REFERENCES
Additional references
Backstorm 1991
Backstrom T, Hammarback S. Premenstrual syndrome--psychiatric
or gynaecological disorder. Annals of Medicine 1991;23(6):62533.
Backstrom 2003
Backstrom T, Andreen L, Birzniece V, Bjorn I, Johansson IM, Nordenstam-Haghjo M, et al.The role of hormones and hormonal treatments in premenstrual syndrome. CNS Drugs 2003;17(5):32542.
Bancroft 1993
Bancroft J. The premenstrual syndrome - a reappraisal of the concept
and the evidence. Psychological Medicine 1993;Suppl 24:147.
Beal 1999
Beal MW. Acupuncture and acupressure. Applications to womens
reproductive health care. Journal of Nurse Midwifery 1999;44(3):
21730.
Budeiri 1996
Budeiri D, Li Wan Po A, Dornan JC. Is evening primrose oil of value
in the treatment of premenstrual syndrome?. Controlled Clinical
Trials 1996;17:608.
Cameron 2004
Cameron JL. Interrelationships between hormones, behavior, and
affect during adolescence: complex relationships exist between reproductive hormones, stress-related hormones, and the activity of
neural systems that regulate behavioral affect. Annals of the New York
Academy of Science 2004;1021:13442.
Daugherty 1998
Daugherty JE. Treatment strategies for premenstrual syndrome.
American Family Physician 1998;58:18392,197-8.
Dickerson 2004
Dickerson LM, Mazyck PJ, Hunter MH. Premenstrual Syndrome.
American Family Physician 2004; Vol. 57, issue 8:174352.
Douglas 2002
Douglas S. Premenstrual syndrome. Evidence-based treatment in
family practice. Canadian Family Physician 2002;48:178997.
Egger 1997
Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis
detected by a simple, graphical test. BMJ 1997;315:62934.
Freeman 2004
Freeman EW. Luteal phase administration of agents for the treatment
of premenstrual dysphoric disorder. CNS Drugs 2004;18(7):453
68.
Girman 2003
Girman A, Lee R, Kligler B. An integrative medicine approach to
premenstrual syndrome. American Journal of Obstetrics and Gynecology 2003;188 Suppl(5):5665.
Green 2004
Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N,
et al.Acupuncture for lateral elbow pain. Cochrane Database of
Systematic Reviews 2004, Issue 3.[Art. No.: CD003527. DOI:
10.1002/14651858.CD003527]
Halbreich 2003
Halbreich U, Kahn LS. Treatment of premenstrual dysphoric disorder with luteal phase dosing of sertraline. Expert Opinion on Pharmacotherapy 2003;4(11):206578.
Hylan 1999
Hylan TR, Sundell K, Judge R. The impact of premenstrual symptomatology on functioning and treatment-seeking behavior: experience from the United States, United Kingdom, and France. Journal
of Womens Health & Gender-based Medicine 1999;8(8):104352.
Jadad 1996
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al.Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Controlled Clinical Trials 1996;17:
112.
Jang 2004
Jang HS, Li MS. Effects of qi therapy (external qigong) on premenstrual syndrome: a randomized placebo-controlled study. Journal of
Alternative and Complementary Medicine 2004;10(3):45662.
Jones 2003
Jones A. Homeopathic treatment for premenstrual symptoms. Journal of Family Planning & Reproductive Health Care 2003;29(1):258.
Juni 2001
Juni P, Altman DG, Egger M. Systematic reviews in health care:
Assessing the quality of controlled clinical trials. BMJ 2001;323:
426.
Kaptchuk 2002
Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Annals of
Internal Medicine 2002;136(5):37483.
Kendler 1998
Kendler KS, Karkowski LM, Corey LA, Neale MC. Longitudinal
population-based twin study of retrospectively reported premenstrual
symptoms and lifetime major depression. American Journal of Psychiatry 1998;155:123440.
Kessel 2000
Kessel B. Premenstrual syndrome. Advances in diagnosis and treatment. Obstetrics and Gynecology Clinics of North America 2000;27:
62539.
Kjaergard 2001
Kjaergard LL, Villumsen J, Gluud C. Reported methodologic quality
and discrepancies between large and small randomized trials in metaanalyses. Annals of Internal Medicine 2001;135:9829.
Kouri 1998
Kouri EM, Halbreich U. Hormonal treatments for premenstrual syndrome. Drugs Today (Barc) 1998;34(7):60310.
Li 2002
Li Chen. Fuliu as the acupoint for edema during menstruation.
Chinese Acupuncture & Moxibustion 2002;22(9):612.
Liu 2002
Liu Haiying, Jiao Hongbo, Jiao Nianxue. Acupuncture for edema
during menstruation in 20 women. Journal of External Therapy of
TCM 2002;11(6):30.
Loch 2000
Loch EG, Selle H, Boblitz N. Treatment of premenstrual syndrome
with a phytopharmaceutical formulation containing Vitex agnus castus. Journal of Womens Health & Gender-based Medicine 2000;9(3):
31520.
Medem 2004
Medem Inc and American Psychiatric Association. Premenstrual
Dysphoric Disorder (PMDD). http://www.medem.com/medlb/article_
detaillb.cfm?article_ID=ZZZF9KNGTRC&sub_cat=2003 accessed
at 25 July, 2004.
Moher 1998
Moher D, Pham B, Jones A, Cook DJ, Jadad A, Moher M, et al.Does
quality of reports of randomised trials affect estimates of intervention
efficacy reported in meta-analysis. Lancet 1998;352:60913.
Moline 2000
Moline ML, Zendell SM. Evaluating and managing premenstrual
syndrome. Medscape Womens Health 2000;5(2):116.
Nagata 2004
Nagata C, Hirokawa K, Shimizu N, Shimizu H. Soy, fat and other
dietary factors in relation to premenstrual symptoms in Japanese
women. BJOG: British Journal of Obstetrics and Gynaecology 2004;
111(6):5949.
Reid 1986
Reid RL. Premenstrual syndrome: a time for introspection. American
Journal of Obstetrics and Gynecology 1986;155(5):9216.
Schulz 1995
Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence
of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA: Journal of the
American Medical Association 1995;273:40812.
Shamberger 2003
Shamberger RJ. Calcium, magnesium, and other elements in the
red blood cells and hair of normals and patients with premenstrual
syndrome. Biological Trace Element Research 2003;94(2):1239.
Steege 1993
Steege JF, Blumenthal JA. The effects of aerobic exercise on premenstrual symptoms in middle-aged women: a preliminary study. Journal of Psychosomatic Research 1993;37:12733.
Sun 1999
Sun Yanming. Acupuncture and medicine for headache during menstruation in 27 women. Tian Jin Traditional Chinese Medicine 1999;
16(1):37.
Tesch 2003
Tesch BJ. Herbs commonly used by women: an evidence-based review. American Journal of Obstetrics and Gynecology 2003;188 Suppl
(5):4455.
NAPS 2004
Wyatt 2004
National
Association
for
Premenstrual
Syndrome
Wyatt KM, Dimmock PW, Ismail KM, Jones PW, OBrien PM.
(NAPS). Dr Claudines guide to complementary treatments. http:
The effectiveness of GnRHa with and without add-back therapy
//www.pms.org.uk/guidetocomplementarytreatments.php?sid=sid3e064576d7980d4bd452088c5644b336
in treating premenstrual syndrome: a meta analysis. BJOG: British
accessed at 24 July, 2004.
Journal of Obstetrics and Gynaecology 2004;111(6):58593.
OBrien 2000
You 1997
OBrien PM, Wyatt K, Dimmock PW. Premenstrual syndrome is
You Yafang. Acupuncture for premenstrual tensions in 56 women.
real and treatable. Practitioner 2000;224(1608):185-9, 191, 194-5.
Chinese Acupuncture & Moxibustion 1997;16(3):171.
Rapkin 2003
Rapkin A. A review of treatment of premenstrual syndrome and
premenstrual dysphoric disorder. Psychoneuroendocrinology 2003;28
(Suppl 3):3953.
Reddy 2003
Reddy DS. Pharmacology of endogenous neuroactive steroids. Critical Reviews in Neurobiology 2003;15(3-4):197234.
Zhang 1997
Zhang Xuexun. Electric needle therapy for peripheral facial paralysis.
Journal of Traditional Chinese Medicine 1997;17(1):479.
Zhang 2001
Zhang Fengqin, Fu Yue. Acupuncture for headache during menstruation. Chinese Acupuncture & Moxibustion 2001;21(3):190.
APPENDICES
Appendix 1. MEDLINE
#1. Premenstrual syndrome
#2. Syndrome, premenstrual
#3. Syndrome*, premenstrual
#4. Premenstrual tensions
#5. Tensions, premenstrual
#6. Tension, prem*
#7. PMT
#8. PMS
#9.or/1-8
B. Search Strategy to locate acupuncture interventions:
#10. acupuncture
#11. electroacupuncture
#12. body acupuncture
#13. acupuncture points
#14. ear acupuncture
#15. scalp acupuncture
#16. laser acupuncture
#17.abdomen-acupuncture
#18. or/#10-#17
WHATS NEW
6 November 2008
Amended
HISTORY
Protocol first published: Issue 2, 2005
CONTRIBUTIONS OF AUTHORS
Yu Jinna: was responsible for drafting the protocol and will be responsible for searching for studies, data extraction, data analysis, and
data presentation.
Vivian Robinson: contributed to protocol development and will contribute to data analysis.
Liu Zhishun: will contribute to data analysis.
Liu Baoyan: will contribute to data analysis
Wu Taixiang: contributed to protocol development and will contribute to data analysis.
DECLARATIONS OF INTEREST
None known.
SOURCES OF SUPPORT
Internal sources
Guang An Men Hospital of China Academy of Traditional Chinese Medicine, China.
External sources
Chinese Cochrane Center, Chinese Centre of Evidence-based Medicine, West China Hospital of Sichuan University, China.
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