Acupuncture for Dysmenorrhea

Dysmenorrhea, or painful menstruation, affects a significant portion of the female population, leading to substantial impairment in daily life. Acupuncture, a traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body, has been proposed as a potential therapeutic intervention for dysmenorrhea. Numerous randomized controlled trials (RCTs) have investigated the efficacy of acupuncture in managing this condition, providing a body of evidence to assess its potential benefits.

Protocols Studied in Research

[1] Acupuncture for endometriosis-associated pain. (Cited by: 12) (pmid: 36716811)

• Protocol: A multicenter, randomized, single-blind, placebo-controlled trial of 106 women (20-40 years) with endometriosis-associated pain. Participants received either real or sham acupuncture for 12 weeks, with treatment adjusted for menstrual cycles.
• Outcome: Acupuncture significantly reduced dysmenorrhea and pain duration during the 12-week treatment period, improving overall well-being. Benefits were not sustained 12 weeks post-treatment. No serious adverse events were reported.

[2] Acupuncture for primary dysmenorrhea. (Cited by: 18) (pmid: 29654840)

• Protocol: A randomized controlled trial comparing acupuncture (20 minutes daily for 15 days/month over 90 days) to no acupuncture in 60 women (aged 17-23) with primary dysmenorrhea. Assessments were at baseline and 30, 60, and 90 days.
• Outcome: Acupuncture significantly reduced pain (VAS score), menstrual cramps, headache, dizziness, diarrhea, fainting, mood changes, tiredness, nausea, and vomiting compared to the control group, suggesting efficacy in managing primary dysmenorrhea.

[3] Electroacupuncture at specific acupoints for primary dysmenorrhea. (Cited by: 21) (pmid: 24636695)

• Protocol: A randomized, controlled, multicenter trial in China compared electroacupuncture at a classic acupoint (SP6), an unrelated acupoint (GB39), and a non-acupoint in 501 women with primary dysmenorrhea. Three sessions were given.
• Outcome: Specific acupoint acupuncture showed a statistically significant, but not clinically significant, reduction in immediate pain compared to unrelated acupoint and non-acupoint controls. No significant differences were found for longer-term outcomes.

[4] Buccal acupuncture therapy for primary dysmenorrhea (PD). (Cited by: 2) (pmid: 38213252)

• Protocol: A randomized controlled trial (RCT) of 90 women with PD compared buccal acupuncture to Saridon (control) and placebo. VAS and CMSS scores were assessed at multiple time points.
• Outcome: Buccal acupuncture demonstrated short-term and long-term efficacy in reducing PD pain and symptom severity, showing immediate analgesic effects and sustained benefit.

[5] Moxibustion robots (MR) and manual moxibustion (MM) for primary dysmenorrhea (PD). (Cited by: 0) (pmid: 33837481)

• Protocol: A randomized controlled pilot trial comparing MR and MM in 70 women with PD. Participants received treatment for 3 menstrual cycles, followed by 3 cycles of follow-up. The Guanyuan (CV 4) acupoint was treated daily for 5 days per session.
• Outcome: Both MR and MM significantly reduced pain and dysmenorrhea symptoms. However, MR demonstrated a significantly lower rate of adverse events compared to MM. The efficacy between the two methods was comparable.

[6] Electroacupuncture (EA) and Laser Acupuncture (LA) for dysmenorrhea. (Cited by: 0) (pmid: 38364185)

• Protocol: A randomized crossover trial compared EA and LA in 43 participants with dysmenorrhea. Treatments were administered twice weekly for three months, followed by a two-month washout period before switching treatments.
• Outcome: Both EA and LA significantly improved autonomic function, pain, and quality of life, with no significant difference between them. EA showed a stronger effect on prostaglandin levels and vagal tone in a subgroup.

[7] Acupressure at LIV3 or LI4 acupoints for primary dysmenorrhea. (Cited by: 6) (pmid: 28917360)

• Protocol: A randomized, single-blinded trial of 90 women with dysmenorrhea received 20-minute daily acupressure at LIV3, LI4, or placebo points for five days before menstruation over three cycles. Pain and QOL (SF-12) were assessed.
• Outcome: Acupressure significantly reduced pain intensity and duration compared to placebo. It also improved most QOL domains, except for mental health and general health.

[8] Acupuncture (single point Shiqizhui or multi-point) for primary dysmenorrhea. (Cited by: 19) (pmid: 23684618)

• Protocol: A randomized controlled trial of 600 women with primary dysmenorrhea comparing acupuncture at different points (single vs. multiple) and timing (before menstruation vs. at pain onset) against no treatment.
• Outcome: Acupuncture effectively relieved pain compared to the control group. Preemptive multi-point acupuncture was most effective; for immediate pain relief, single-point acupuncture was superior to multi-point.

[9] Acupuncture for dysmenorrhea (painful menstruation). (Cited by: 36) (pmid: 18226614)

• Protocol: A randomized controlled trial (RCT) with a non-randomized cohort of 649 women with dysmenorrhea. The RCT compared acupuncture (15 sessions over 3 months) to usual care. Non-randomized participants received acupuncture.
• Outcome: Acupuncture significantly reduced pain intensity and improved quality of life compared to usual care alone after three months. Although more costly, it was deemed cost-effective.

[10] 2 Hz continuous wave and 2 Hz/100 Hz dilatational wave electroacupuncture (EA) for Polycystic Ovary Syndrome (PCOS) with abdominal obesity. (Cited by: 0) (pmid: 38146250)

• Protocol: A randomized controlled trial comparing two EA frequencies (2 Hz continuous and 2 Hz/100 Hz dilatational) in 58 PCOS patients with abdominal obesity. Treatment involved stimulating specific acupuncture points for 30 minutes, three times weekly for 12 weeks.
• Outcome: Both EA frequencies improved ovulation and reduced several parameters (weight, BMI, etc.). The 2 Hz/100 Hz dilatational wave EA showed superior waist circumference reduction and improved hormonal markers (AMH, SHBG) and PCOS symptoms (acne, fatigue, dysmenorrhea).

[11] Radial extracorporeal shock wave therapy (rESWT) for primary dysmenorrhea (PD). (Cited by: 2) (pmid: 33592837)

• Protocol: A randomized controlled trial of 44 young women with PD. Participants received rESWT on lower abdominal acupuncture points (during follicular or luteal phase) or a heat patch (control) for three menstrual cycles. Pain severity, duration, prostaglandin levels, anxiety, and menstrual blood loss were measured.
• Outcome: rESWT significantly reduced pain severity compared to the control group, regardless of menstrual cycle phase. The reduction in pain was not attributed to changes in prostaglandin levels. Heat patch also reduced pain, suggesting improved blood flow may alleviate pain.

[12] Wrist-ankle acupuncture (WAA) for primary dysmenorrhea (PD) in young females. (Cited by: 6) (pmid: 28830511)

• Protocol: A randomized, single-blind, sham-controlled trial comparing WAA to sham acupuncture in 60 young women with PD. Participants received either real or sham WAA, and pain levels were assessed using the SF-MPQ.
• Outcome: This abstract describes the study protocol; no outcomes are reported as it is a protocol for a future trial designed to evaluate the immediate analgesic effect of WAA on PD.

[13] Acupuncture at different points (SP6, GB39, or non-acupoint) for primary dysmenorrhea. (Cited by: 18) (pmid: 24555788)

• Protocol: A randomized controlled trial (RCT) with 60 participants randomly assigned to three acupuncture groups. Pain was measured using a visual analogue scale (VAS), and Deqi sensations were assessed using a modified MASS scale.
• Outcome: Acupuncture reduced pain in all groups, but there were no significant differences in pain reduction or Deqi sensations between the three acupuncture groups.

[14] Acupressure wrist-ankle strap for primary dysmenorrhea. (Cited by: 4) (pmid: 32195949)

• Protocol: A randomized controlled trial (RCT) comparing an acupressure wrist-ankle strap to a control strap in 78 students with primary dysmenorrhea. Participants wore the straps for 30 minutes on the first day of menstruation.
• Outcome: The abstract is a study protocol and therefore does not present findings. The study aims to evaluate the immediate analgesic effect of the acupressure strap, measuring pain intensity and other related outcomes.

[15] Manual and electroacupuncture (varying frequency) for primary dysmenorrhea. (Cited by: 23) (pmid: 28700680)

• Protocol: A randomized controlled trial (RCT) with four acupuncture groups (low/high-frequency manual and electroacupuncture) across 74 women. Treatment involved 12 sessions over three menstrual cycles, with frequency varying by group.
• Outcome: All acupuncture groups showed significant pain reduction lasting a year, but no significant differences existed between groups. High-frequency acupuncture improved quality of life more, and manual acupuncture reduced analgesic use. Larger trials are needed.

[16] Penetrating acupuncture (BL54 to ST28 with long needle) for primary dysmenorrhea. (Cited by: 6) (pmid: 31929849)

• Protocol: A randomized controlled trial comparing acupuncture to ibuprofen in 62 women with primary dysmenorrhea over three menstrual cycles. Pain intensity was the primary outcome, measured using a visual analogue scale.
• Outcome: Acupuncture resulted in significantly lower pain intensity, reduced symptom severity, and a higher responder rate compared to ibuprofen, with no serious adverse events reported.

[17] Acupuncture (at SP6, GB39, or non-acupoint) for primary dysmenorrhea. (Cited by: 25) (pmid: 21166767)

• Protocol: A randomized controlled trial comparing acupuncture at a specific acupoint (SP6), an unrelated acupoint (GB39), a non-acupoint, and no acupuncture in women with primary dysmenorrhea. Electro-acupuncture was administered once daily for 3 days.
• Outcome: Acupuncture (regardless of point location) significantly reduced pain intensity compared to no acupuncture in the short-term. However, there was no significant difference in pain reduction between true acupuncture, sham acupuncture, and non-acupoint stimulation.

[18] Thunder-fire moxibustion combined with mifepristone for ovarian chocolate cyst dysmenorrhea with kidney deficiency and blood stasis. (Cited by: 2) (pmid: 33788463)

• Protocol: A randomized controlled trial (RCT) of 70 patients with the specified condition. The control group received mifepristone; the observation group received mifepristone plus thunder-fire moxibustion for 3 months.
• Outcome: The combined intervention showed significantly greater improvement in dysmenorrhea symptoms, reduced cyst size, and lower TGF-beta1 and IL-17 levels compared to mifepristone alone, suggesting a beneficial effect.

[19] SP6 acupressure for primary dysmenorrhea. (Cited by: 27) (pmid: 16782102)

• Protocol: A non-equivalent control group pre-post-test design compared SP6 acupressure to a placebo touch in 58 college women with primary dysmenorrhea. Acupressure was applied within 8 hours of menstruation.
• Outcome: SP6 acupressure significantly reduced dysmenorrhea severity for up to 2 hours post-treatment, associated with increased skin temperature at the CV2 acupoint. The intervention is suggested as an effective non-invasive treatment.

[20] Acupressure at SP6 for primary dysmenorrhea. (Cited by: 19) (pmid: 21168112)

• Protocol: A randomized controlled trial compared acupressure at SP6 versus light touch at SP6 in 30 female students with primary dysmenorrhea. Pain was measured using a Visual Analog Scale before and after intervention.
• Outcome: Acupressure at SP6 significantly reduced dysmenorrhea pain compared to light touch, with effects lasting up to 3 hours post-treatment.

[21] Vitamin K1 injection at acupuncture point SP-6 for primary dysmenorrhea. (Cited by: 9) (pmid: 24445356)

• Protocol: A blinded, randomized, crossover pilot study of 14 women (18-25 years old) with primary dysmenorrhea. Participants received bilateral injections of either vitamin K1 at SP-6 or saline at a non-acupuncture point, with a 2-month washout period between treatments.
• Outcome: Vitamin K1 injections at SP-6 showed a trend towards greater pain reduction compared to saline injections, with high acceptability among participants. Pain decreased significantly with both treatments.

[22] Moxibustion for primary dysmenorrhea (menstrual pain). (Cited by: 44) (pmid: 28170396)

• Protocol: A 3-month, open-label, randomized controlled trial comparing moxibustion to conventional drug treatment for primary dysmenorrhea in 152 women. Pain was measured using a Visual Analogue Scale and menstrual diaries.
• Outcome: Both moxibustion and conventional drugs significantly reduced menstrual pain. While initially similar, moxibustion showed superior sustained pain relief three months post-treatment. No adverse events were reported.

[23] Noninvasive electroacupuncture at Hegu (LI4) and Sanyinjiao (SP6) acupoints for primary dysmenorrhea. (Cited by: 9) (pmid: 22339102)

• Protocol: A randomized controlled trial (RCT) of 66 women with primary dysmenorrhea. The experimental group (n=34) received electroacupuncture at LI4 and SP6 twice weekly for 8 weeks; the control group (n=32) received electroacupuncture at non-acupoints. Pain was assessed using the McGill Questionnaire and numerical rating scale.
• Outcome: Electroacupuncture at LI4 and SP6 significantly reduced pain scores compared to sham electroacupuncture in women with primary dysmenorrhea. The intervention resulted in a statistically significant reduction in pain intensity and severity.

[24] Acupuncture and NSAID therapy for primary dysmenorrhea. (Cited by: 9) (pmid: 23522721)

• Protocol: A randomized pilot study comparing acupuncture and NSAID treatment in 35 young women with primary dysmenorrhea. Pain was assessed using a visual analog scale (VAS) before and after one month of treatment.
• Outcome: Both acupuncture and NSAID significantly reduced pain scores. Acupuncture showed a slightly larger reduction (69.5% vs 52.2%), suggesting comparable effectiveness, although a larger study is needed.

[25] Auricular intradermal needling and auricular point sticking for primary dysmenorrhea. (Cited by: 4) (pmid: 34259404)

• Protocol: A randomized controlled trial comparing auricular intradermal needling, auricular point sticking, and placebo in 90 women with primary dysmenorrhea. Treatment involved stimulation of specific auricular points for three menstrual cycles.
• Outcome: Both auricular intradermal needling and point sticking significantly improved dysmenorrhea symptoms and reduced anxiety compared to placebo. Intradermal needling showed superior efficacy to point sticking, possibly by modulating PGF2α and PGE2 levels.

[26] Herb-separated moxibustion for dysmenorrhea in ovarian endometriosis. (Cited by: 2) (pmid: 32648394)

• Protocol: A randomized controlled trial comparing herb-separated moxibustion (30 min weekly for 3 months) to a waiting list in 54 patients with ovarian endometriosis and dysmenorrhea. Ibuprofen was allowed as needed in both groups.
• Outcome: Herb-separated moxibustion significantly reduced dysmenorrhea pain (VAS score), duration, and analgesic use compared to the waiting list, with benefits sustained at 3-month follow-up.

[27] Acupuncture at tender points versus regular points on the Spleen meridian for primary dysmenorrhea. (Cited by: 1) (pmid: 29888566)

• Protocol: A randomized controlled trial of 72 primary dysmenorrhea patients comparing acupuncture at tender points versus regular points (SP6, SP8, SP9) on the Spleen meridian for 3 months. Pain was assessed using VAS and CMSS scores.
• Outcome: Acupuncture at tender points showed a significantly stronger analgesic effect than regular point acupuncture for primary dysmenorrhea, particularly in the second and third menstrual cycles. No significant difference was found in overall discomfort.

[28] Preconditioning acupuncture (PA) and immediate acupuncture (IA) for primary dysmenorrhea. (Cited by: 4) (pmid: 21359925)

• Protocol: A randomized controlled trial comparing PA, IA, and a control group (no acupuncture) in 80 patients with primary dysmenorrhea over three menstrual cycles. Treatment involved acupuncture sessions.
• Outcome: Preconditioning acupuncture demonstrated superior short-term and long-term efficacy in reducing dysmenorrhea symptoms compared to immediate acupuncture. Both acupuncture groups showed improvement over the control group.

[29] Fu's subcutaneous needling combined with monkshood cake-separated moxibustion for primary dysmenorrhea with cold congealing and blood stasis. (Cited by: 0) (pmid: 39111789)

• Protocol: A randomized controlled trial comparing the combined intervention to monkshood cake-separated moxibustion alone in 58 women with primary dysmenorrhea. Treatment was administered for 3 menstrual cycles.
• Outcome: The combined intervention showed significantly greater improvements in pain (VAS, CMSS scores), TCM syndrome scores, and PGF2alpha levels compared to moxibustion alone, resulting in a higher total effective rate.

[30] Acupuncture with and without *de qi* (needling sensation) for primary dysmenorrhea (PD). (Cited by: 1) (pmid: 36804818)

• Protocol: A randomized controlled trial comparing deep needling with manipulation (*de qi* group) versus shallow needling without manipulation (*non-de qi* group) at SP6 in 68 PD patients. Acupuncture-related anxiety and expectations were also assessed.
• Outcome: Patient expectations significantly influenced *de qi* sensation. In the *non-de qi* group, a substantial percentage experienced *de qi*, and expectations correlated with *de qi* intensity and other sensations. Anxiety showed less consistent relationships with *de qi*.

[31] Acupuncture at Shiqizhui (EX-B 8) alone or with multiple acupoints for dysmenorrhea. (Cited by: 3) (pmid: 21644298)

• Protocol: A randomized controlled trial comparing single-acupoint (Shiqizhui) acupuncture versus multi-acupoint acupuncture (adding SP6, SP8, BL32) in 38 women with dysmenorrhea over three menstrual cycles. Treatment was daily for three days per cycle.
• Outcome: Both single- and multi-acupoint acupuncture groups showed significant pain reduction and improvement in dysmenorrhea symptoms (p<0.001), with no significant difference in effectiveness between the groups (p>0.05). Acupuncture at Shiqizhui alone was found to be as effective as multi-acupoint acupuncture.

[32] Acupuncture with Tiaochong Shugan method versus ibuprofen for menstrual headache. (Cited by: 1) (pmid: 37199200)

• Protocol: A randomized controlled trial comparing acupuncture (based on syndrome differentiation, with varying acupoints depending on pain stage) to ibuprofen in 90 women with menstrual headache over three menstrual cycles.
• Outcome: Acupuncture demonstrated superior analgesic effects and a higher total effective rate compared to ibuprofen in reducing headache severity and dysmenorrhea symptoms, particularly in the long term (2 and 3 menstrual cycles post-treatment).

[33] Low-level light therapy (LLLT) and ethinyl estradiol/desogestrel (Marvelon) oral contraceptive pills for primary dysmenorrhea. (Cited by: 0) (pmid: 35028764)

• Protocol: A randomized, active-comparator controlled, multicenter trial compared LLLT applied to acupoints CV4 and CV6 with Marvelon in 156 women with primary dysmenorrhea over three menstrual cycles.
• Outcome: Both LLLT and Marvelon provided comparable pain relief, although Marvelon showed a statistically significantly greater reduction in pain scores. Both treatments resulted in clinically meaningful pain reduction.

[34] SP6 acupuncture with and without de qi (a sensation associated with acupuncture) for primary dysmenorrhea in patients with cold and dampness stagnation (a TCM diagnosis). (Cited by: 13) (pmid: 28698243)

• Protocol: A randomized controlled trial comparing SP6 acupuncture with deep needling and manipulation (de qi group) versus shallow needling without manipulation (no de qi group) in 88 patients with primary dysmenorrhea and cold and dampness stagnation. Pain was measured using a visual analogue scale.
• Outcome: While both groups experienced pain reduction, patients who experienced de qi showed significantly greater pain reduction than those who did not, regardless of assigned group. The presence or absence of intentionally induced de qi did not significantly affect the overall outcome.

[35] Moxibustion treatment for primary dysmenorrhea. (Cited by: 11) (pmid: 25633584)

• Protocol: A randomized controlled trial (RCT) with 222 participants assigned to three groups: moxibustion before menstruation, moxibustion at menstruation onset, and a waiting list control. Treatment involved suspended moxibustion at SP6 and CV4 acupoints.
• Outcome: The abstract is a study protocol and therefore does not contain outcome data; the study aims to determine the efficacy and safety of moxibustion for primary dysmenorrhea and the optimal treatment timing.

[36] Acupuncture and massage for primary dysmenorrhea. (Cited by: 4) (pmid: 18672768)

• Protocol: A randomized controlled trial comparing acupuncture, massage, and a control group (Somiton tablets) in 90 patients with primary dysmenorrhea over three menstrual cycles. Pain was measured using a numerical rating scale (NRS), and prostaglandin F2alpha (PGF2alpha) levels in menstrual fluid were assessed.
• Outcome: Both acupuncture and massage significantly reduced pain (NRS scores) and PGF2alpha levels compared to the control group. No significant difference was found between acupuncture and massage. The results suggest both interventions are effective treatments for primary dysmenorrhea.

[37] Ginger-partitioned moxibustion for primary dysmenorrhea (PD) of cold-damp stagnation type. (Cited by: 5) (pmid: 20209976)

• Protocol: A randomized controlled trial compared ginger-partitioned moxibustion at CV8 and CV4 to Yueyueshu Granules in 209 women with primary dysmenorrhea. Moxibustion was applied for 3 days in cycle 1, and 6 days in cycles 2 & 3.
• Outcome: Moxibustion demonstrated significantly better therapeutic effects than medication for primary dysmenorrhea, with superior symptom relief across all severity levels, and lasting effects three months post-treatment.

[38] Acupuncture at Sanyinjiao (SP 6) for primary dysmenorrhea with a cold and dampness stagnation pattern. (Cited by: 1) (pmid: 32186050)

• Protocol: A randomized controlled trial comparing deep vs. shallow needling techniques (with/without manipulation) in 68 patients. Pain was assessed using a visual analogue scale. Only patients experiencing De Qi were analyzed.
• Outcome: Quicker onset of De Qi, but not longer duration, correlated with better pain relief. Active acupuncture stimulation resulted in faster De Qi onset and longer duration compared to minimal stimulation. However, overall analgesic effect didn't significantly differ between groups.

[39] Staging acupoint catgut embedment therapy for primary dysmenorrhea. (Cited by: 2) (pmid: 24796043)

• Protocol: A randomized controlled trial comparing acupoint embedment therapy to fenbid (oral medication) in 70 women with primary dysmenorrhea. Treatment involved two embedment sessions per menstrual cycle for three cycles.
• Outcome: Acupoint embedment therapy showed significantly better short-term and long-term efficacy than fenbid in reducing dysmenorrhea pain and improving quality of life, with a sustained effect three months post-treatment.

[40] Acupressure at the Taichong point for dysmenorrhea. (Cited by: 10) (pmid: 20547392)

• Protocol: A single-blind randomized controlled trial of 194 students with dysmenorrhea. Participants received acupressure at either the Taichong point or a placebo point for 3 months, starting 5 days before menstruation.
• Outcome: Acupressure at the Taichong point significantly reduced dysmenorrhea severity after 3 months (4 cycles), compared to the placebo group. The effect wasn't immediately apparent, becoming significant only by the fourth menstrual cycle.

Research Interpretation: Summary and Conclusion

Numerous randomized controlled trials (RCTs) investigated acupuncture's efficacy for dysmenorrhea, employing diverse techniques including electroacupuncture, manual acupuncture, acupressure, and moxibustion, at various acupoints and frequencies. Across these studies, acupuncture consistently demonstrated significant short-term pain reduction compared to controls (placebo, no treatment, or conventional medication), often showing superior long-term efficacy in several trials. While specific acupoints varied across studies, many found significant benefits regardless of point location. Variations in technique (e.g., deep vs. shallow needling, frequency of stimulation) yielded mixed results, with some studies finding superior outcomes with specific approaches, while others showed comparable efficacy across different methods. The presence of "De Qi" sensation was sometimes associated with improved outcomes, but this wasn't consistently reported. Overall, the evidence supports acupuncture as a potentially effective adjunctive or alternative therapy for dysmenorrhea, warranting further research to optimize treatment protocols and elucidate mechanisms of action.

Publications

[1] Li PS; Peng XM; Niu XX; Xu L; Hung Yu Ng E; Wang CC; Dai JF; Lu J; Liang RN (2023). Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial Fertility and sterility 119 (5) :815-823.

[2] Shetty GB; 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.

[3] Liu CZ; Xie JP; Wang LP; Liu YQ; Song JS; Chen YY; Shi GX; Zhou W; Gao SZ; Li SL; Xing JM; Ma LX; Wang YX; Zhu J; Liu JP (2014). A randomized controlled trial of single point acupuncture in primary dysmenorrhea Pain medicine (Malden, Mass.) 15 (6) :910-20.

[4] Yi Y; Huijun YE; Huiling Z; Lihua J (2024). Clinical observation on 90 cases of primary dysmenorrhea treated by buccal acupuncture therapy: a randomized controlled study Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan 44 (1) :172-181.

[5] Zhang HR; Tu HY; Wang Y; Xia SL; Zhao GY; Yang T; Li YK (2021). Effectiveness and Safety of Moxibustion Robots on Primary Dysmenorrhea: A Randomized Controlled Pilot Trial Chinese journal of integrative medicine 27 (8) :578-584.

[6] Chien TJ; Huang YS; Liao LL; Chu CC; Pai JH (2024). Head-to-Head Comparison of Electroacupuncture and Laser Acupuncture Effects on Autonomic Regulation and Clinical Effects in Dysmenorrhea: A Randomized Crossover Clinical Trial Journal of integrative and complementary medicine 30 (6) :560-575.

[7] Bazarganipour F; Taghavi SA; Allan H; Hosseini N; Khosravi A; Asadi R; Salari S; Dehghani R; Jamshidi Z; Rezaei M; Saberian M; Javedan F; Salari Z; Miri F (2017). A randomized controlled clinical trial evaluating quality of life when using a simple acupressure protocol in women with primary dysmenorrhea Complementary therapies in medicine 34 :10-15.

[8] Ma YX; Ye XN; Liu CZ; Cai PY; Li ZF; Du DQ; Guo G; Chen SZ; Zhao JP; Liu JJ; Yi HQ; Gao SZ (2013). A clinical trial of acupuncture about time-varying treatment and points selection in primary dysmenorrhea Journal of ethnopharmacology 148 (2) :498-504.

[9] Witt CM; Reinhold T; Brinkhaus B; Roll S; Jena S; Willich SN (2008). Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care American journal of obstetrics and gynecology 198 (2) :166.e1-8.

[10] Shen LY; Fu XF; Zeng Q; Mao XW; Hong QY; Liu XJ; Li HQ; Hu H (2023). Comparison of the efficacy of different frequency electroacupuncture in the treatment of polycystic ovary syndrome patients with abdominal obesity Zhen ci yan jiu = Acupuncture research 48 (12) :1266-1273.

[11] Xing R; Yang J; Wang R; Wang Y (2021). Extracorporeal shock wave therapy for treating primary dysmenorrhea: A randomized controlled trial Medicine 100 (5) :e23798.

[12] Chen Y; Tian S; Tian J; Shu S (2017). Wrist-ankle acupuncture (WAA) for primary dysmenorrhea (PD) of young females: study protocol for a randomized controlled trial BMC complementary and alternative medicine 17 (1) :421.

[13] Shi GX; Li QQ; Liu CZ; Zhu J; Wang LP; Wang J; Han LL; Guan LP; Wu MM (2014). Effect of acupuncture on Deqi traits and pain intensity in primary dysmenorrhea: analysis of data from a larger randomized controlled trial BMC complementary and alternative medicine 14 :69.

[14] Zhai SJ; Ruan Y; Liu Y; Lin Z; Xia C; Fang FF; Zhou QH (2020). Time-effective analgesic effect of acupressure ankle strip pressing wrist and ankle acupuncture point on primary dysmenorrhea: Study protocol clinical trial (SPIRIT compliant) Medicine 99 (12) :e19496.

[15] Armour M; Dahlen HG; Zhu X; Farquhar C; Smith CA (2017). The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: An exploratory randomised controlled trial PloS one 12 (7) :e0180177.

[16] Wang H; Cao Y; Jin X; Yan M; Wang J; Li R; Ji L (2019). Effect of an Acupuncture Technique of Penetrating through Zhibian (BL54) to Shuidao (ST28) with Long Needle for Pain Relief in Patients with Primary Dysmenorrhea: A Randomized Controlled Trial Pain research & management 2019 :7978180.

[17] Liu CZ; Xie JP; Wang LP; Zheng YY; Ma ZB; Yang H; Chen X; Shi GX; Li SL; Zhao JP; Han JX; Li JD; Wang YX; Tang L; Xue XO; Li M; Wang Y; Sun AP; Xing JM; Cao HJ; Zhu J; Liu JP (2011). Immediate analgesia effect of single point acupuncture in primary dysmenorrhea: a randomized controlled trial Pain medicine (Malden, Mass.) 12 (2) :300-7.

[18] Chen YB; Leng J; Lin BJ; Xu MH (2021). [Thunder-fire moxibustion combined with mifepristone for ovarian chocolate cyst dysmenorrhea with kidney deficiency and blood stasis: a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 41 (2) :161-4.

[19] Jun EM; Chang S; Kang DH; Kim S (2007). Effects of acupressure on dysmenorrhea and skin temperature changes in college students: a non-randomized controlled trial International journal of nursing studies 44 (6) :973-81.

[20] Mirbagher-Ajorpaz N; Adib-Hajbaghery M; Mosaebi F (2011). The effects of acupressure on primary dysmenorrhea: a randomized controlled trial Complementary therapies in clinical practice 17 (1) :33-6.

[21] Chao MT; Wade CM; Abercrombie PD; Gomolak D (2014). An innovative acupuncture treatment for primary dysmenorrhea: a randomized, crossover pilot study Alternative therapies in health and medicine 20 (1) :49-56.

[22] Yang M; Chen X; Bo L; Lao L; Chen J; Yu S; Yu Z; Tang H; Yi L; Wu X; Yang J; Liang F (2017). Moxibustion for pain relief in patients with primary dysmenorrhea: A randomized controlled trial PloS one 12 (2) :e0170952.

[23] Wu LL; Su CH; Liu CF (2012). Effects of noninvasive electroacupuncture at Hegu (LI4) and Sanyinjiao (SP6) acupoints on dysmenorrhea: a randomized controlled trial Journal of alternative and complementary medicine (New York, N.Y.) 18 (2) :137-42.

[24] Kiran G; Gumusalan Y; Ekerbicer HC; Kiran H; Coskun A; Arikan DC (2013). A randomized pilot study of acupuncture treatment for primary dysmenorrhea European journal of obstetrics, gynecology, and reproductive biology 169 (2) :292-5.

[25] Lu CX; Deng XJ; Chen M; Xiao CH; Cui J (2021). [Different stimulation methods on auricular points for primary dysmenorrhea: a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 41 (7) :737-41.

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