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Jinna Yu1 , Baoyan Liu2 , Zhishun Liu3 , Vivian Welch4 , Taixiang Wu5 , Jane Clarke6 , Caroline A Smith7
1 Acupuncture Department, Guang An Men Hospital of China Academy of Chinese Traditional Medicine, Beijing, China. 2 China
Academy of Traditional Chinese Medicine, Beijing, China. 3 Department of Acupuncture and Moxibustion, Chinese Academy of
Traditional Chinese Medicine, Beijing, China. 4 Centre for Global Health, Institute of Population Health, University of Ottawa,
Ottawa, Canada. 5 Chinese Cochrane Centre, Chinese Clinical Trial Registry, Chinese Evidence-Based Medicine Centre, INCLEN
Resource and Training Centre, West China Hospital, Sichuan University, Chengdu, China. 6 Obstetrics and Gynaecology, University
of Auckland, Auckland, New Zealand. 7 Centre for Complementary Medicine Research, The University of Western Sydney, Penrith
South DC, Australia
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.
Citation: 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.
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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:
(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.
gories:
BACKGROUND
Premenstrual syndrome (PMS) is a group of symptoms that con- (1) behavioral symptoms including fatigue, insomnia, dizziness,
sistently occur in young and middle-aged women during the luteal changes in sexual interest, food cravings or overeating;
phase of the menstrual cycle. In order to diagnose PMS, the symp-
toms should abate when menstruation starts or stops and not re- (2) psychological symptoms including irritability, anger, depressed
cur until ovulation two weeks before the next period (Backstorm mood, crying and tearfulness, anxiety, tension, mood swings, lack
1991; Dickerson 2004). More than 200 premenstrual symptoms of concentration, confusion, forgetfulness, restlessness, loneliness,
have been recorded and are usually divided into three broad cate- decreased self-esteem, tension;
Acupuncture for premenstrual syndrome (Protocol) 1
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
(3) physical symptoms including headaches, breast tenderness and element alone was indicated by the highly significant high? Mg/
swelling, back pain, abdominal pain and bloating, weight gain, Ca ratio in blood cells in women with severe PMS. The signifi-
swelling of extremities, water retention, nausea, muscle and joint cantly lower calcium level in blood cells found in studies may pro-
pain (Dickerson 2004; Reid 1986). vide additional evidence that PMS may be involved in a calcium-
deficiency state or a metabolic maladjustment involving calcium
Premenstrual dysphoric disorder (PMDD) is a more severe form
(Shamberger 2003). One cross-sectional study reported that high
of PMS. It is a condition characterized by intense emotional symp-
intake of fats and low intake of foods with high concentration
toms that occur between ovulation and menstruation. Symptoms
of carbohydrate may be associated with premenstrual symptoms
associated with PMDD are similar to those experienced with PMS;
(Nagata 2004).
however, they are much more severe. Symptoms include severe de-
pression, irritability and/or mood swings which interfere with rela-
tionships, social functioning, and work or school (Bancroft 1993;
Medem 2004). PMDD should be diagnosed only when mood Description of the intervention
symptoms seriously impact on relationships and impair function- Many different treatments have been suggested as possible thera-
ing at work or school (Medem 2004). pies for PMS due to the uncertainty of its pathogenesis and the
range of its manifestations. Because serotonin has been implicated
It is reported that approximately 95% of women have one or
in the pathogenesis of PMS, luteal phase dosing of selective sero-
more premenstrual symptoms. Fifty percent of these women have
tonin reuptake inhibitors (SSRIs) have been tested in these dis-
slight symptoms, 30% have moderate symptom, with about 5%
orders (Freeman 2004; OBrien 2000). The U.S. Food and Drug
of women reporting severe PMS symptoms that disrupt their lives
Administration (FDA) has labelled fluoxetine (sarafem and ser-
in the two weeks before their periods (Hylan 1999). It is estimated
traline (Zoloft, Pfizer Inc.)) for the treatment of PMS (Halbreich
that only 3% to 8% of women are affected by PMDD (Medem
2003).
2004).
Ovarian function appears to play a fundamental role in PMS, ac-
cordingly, treatment strategies designed to suppress ovulation have
generally been found to be effective for treatment of menstru-
Description of the condition ally-related syndromes and symptoms. Gonadotrophin-releasing
The etiology of PMS is still not completely understood. Sex hor- hormone analogues (GnRHa) appear to be an effective treatment
mones produced by the corpus luteum are thought to be crucial of premenstrual syndrome (Backstrom 2003; Kouri 1998; Wyatt
since the cyclical nature of the symptoms disappears in anovula- 2004).
tory cycles. The theory that PMS might simply result from a rel- In other studies, women with PMS who practiced aerobic ex-
ative excess of either progesterone or oestrogen during the luteal ercise reported fewer symptoms than participants in the control
phase no longer seems tenable since progesterone, oestrogens and group (OBrien 2000; Steege 1993). Dietary restrictions or sup-
progestogens can induce similar symptoms to those seen in PMS; plements may also be useful in women with PMS (Kessel 2000;
the severity of symptoms is dose sensitive (Backstrom 2003). Moline 2000). Sodium restriction has been proposed to minimize
In recent years, it has been found that the sexual hormones are bloating, fluid retention, and breast swelling and tenderness. Caf-
neuroactive and modulate neural excitability and brain function. feine restriction is recommended because caffeine intake is related
Some progesterone metabolites, in particular allo pregnenolone, to premenstrual irritability and insomnia. A systematic review of
are GABA-A agonists, with anxiolytic and anticonvulsant prop- placebo-controlled trials of evening primrose oil suggested lack of
erties. By contrast, pregnenolone-sulphate and DHEAS-sulphate benefit in PMS, although mild relief was demonstrated in women
are anxiogenic and pro-convulsant (Reddy 2003). with breast tenderness (Budeiri 1996).
There is recent evidence that levels of oestrogens and progesterone A randomised placebo-controlled study reported there were sig-
affect the transport of serotonin in the CNS, profoundly affect- nificant improvements in the symptoms of negative feeling, pain,
ing the brain serotonergic system (Cameron 2004), and that, con- water retention, and total PMS symptoms in women receiving
versely, serotonin might affect ovarian levels of oestrogens and pro- qigong therapy compared to placebo controls (Jang 2004). Qigong
gesterone. consists primarily of meditation, relaxation, physical movement,
Some evidence suggests that an underlying serotonin deficiency mind-body integration, and breathing exercises. Practitioners of
makes women more sensitive to progesterone (OBrien 2000). De- qigong develop an awareness of qi sensations (energy) in their body
ficiencies in prostaglandins, which cause an inability to convert and use their mind to guide the qi. When the practitioners achieve
linoleic acid to prostaglandin precursors, may be related to the on- a sufficient skill level (master), they can direct or emit external qi
set of PMS (Daugherty 1998). Genetic factors also seem at work for the purpose of healing others.
as the concordance rate is two times higher in monozygotic twins Some studies also indicate Chinese herbs (particularly preparations
than in dizygotic twins (Kendler 1998). A more complex rela- containing the herbs Paeonia lactiflora and Dong Quai), home-
tionship between PMS and magnesium and calcium than either opathy, aromatherapy, reflexology, Gingko biloba, kava kava, black
REFERENCES
ADDITIONAL TABLES
Table 1. Acupuncture Points
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
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
Acupuncture for premenstrual syndrome (Protocol) 8
Copyright 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
WHATS NEW
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.