Herbal medicine is commonly used in clinics in China to treat the symptoms of endometriosis. And recently clinical research in Australia is indicating that acupuncture may have a role in reducing associated pain. Some studies have been carried out on IVF patients with endometriosis.
Effects of acupuncture for the treatment of endometriosis-related pain:A systematic review and meta-analysis
Yang Xu et al 2107 PLOS ONE doi.org/10.1371/journal.pone.0186616
While further studies are warranted before clinical recommendations are made, this systematic review found in the trials analysed (involving 589 women) that acupuncture reduces endometriosis pain and serum CA-125 levels
Background: Endometriosis is a multifactorial, oestrogen-dependent, inflammatory, gynaecological condition that can result in long-lasting visceral pelvic pain and infertility. Acupuncture could be an effective treatment for endometriosis and may relieve pain. Our aim in the present study was to determine the effectiveness of acupuncture as a treatment for endometriosis-related pain.
Methods:In December 2016, six databases were searched for randomised controlled trials that determined the effectiveness of acupuncture in the treatment of endometriosis-related pain. Ultimately, 10 studies involving 589 patients were included. The main outcomes assessed were variation in pain level, variation in peripheral blood CA-125 level, and clinical effective rate. All analyses were performed using comprehensive meta-analysis statistical software.
Results: Of the 10 studies included, only one pilot study used a placebo control and assessed blinding; the rest used various controls (medications and herbs), which were impossible to blind. The sample sizes were small in all studies, ranging from 8 to 36 patients per arm. The mean difference (MD) in pain reduction (pre- minus post-interventional pain level—measured on a 0–10-point scale) between the acupuncture and control groups was 1.36 (95% confidence intervals [CI] = 1.01–1.72, P<0.0001). Acupuncture had a positive effect on peripheral blood CA-125 levels, as compared with the control groups (MD = 5.9, 95% CI = 1.56–10.25, P = 0.008). Similarly, the effect of acupuncture on clinical effective rate was positive, as compared with the control groups (odds ratio = 2.07; 95% CI = 1.24–3.44, P = 0.005).
Few randomised, blinded clinical trials have addressed the efficacy of acupuncture in treating endometriosis-related pain. Nonetheless, the current literature suggests that acupuncture reduces pain and serum CA-125 levels, regardless of the control intervention used. To confirm these findings, additional, blinded studies with proper controls and adequate sample sizes are needed.
Controlling the Recurrence of Pelvic Endometriosis after A Conservative Operation: Comparison between Chinese Herbal Medicine and Western Medicine
Zhao RH et al, Chin J Integr Med 2013 Nov;19(11):820-825
Chinese Journal of Integrated Medicine
A randomised and controlled trial (involving 200 women) studied the prevention of recurrence of endometriosis after surgery and showed that Chinese medicine was as effective a therapy as western pharmaceuticals in preventing recurrence but had significantly fewer side effects. Chinese medicine achieved a higher conception rate in women who had previously been infertile.
Objective: To compare the clinical effect of Chinese medicine (CM) and Western medicine (WM)
for controlling the recurrence of pelvic endometriosis after a conservative operation. Methods: The study was a multi-center, randomized, parallel controlled and prospective clinical trial. Patients were randomly divided into two groups: CM group (106 cases) and WM group (102 cases). Drugs were given to patients during 1–5 days of the first menstruation after a conservative operation in both groups. Patients with stages Ⅰ and Ⅱ (revised American Fertility Society) were treated for 3 months, while the patients with stages Ⅲ and Ⅳ were treated for 6 months.
The patients in the CM group were treated using three types of Chinese herbal medicine based on syndrome differentiation. Patients in the WM group were treated using gonadotropin releasing hormone agonist (GnRH-a) or gestrinone. Patients treated with GnRH-a received add-back therapy of Tibolone Tablets once a day after 4 months of treatment. Any cases of dysmenorrheal chronic pelvic pain, menstruation and any adverse reactions of patients were recorded once a month during the preoperative and postoperative periods and once every 3 months during the follow-up period. During the preoperative, postoperative and the follow-up periods, patients underwent
type B ultrasonography of the pelvis and measurements of serum CA125 levels, gynecologic examination, routine evaluations of blood, urine, hepatic function (glutamate pyruvate transaminase), renal function (blood urea nitrogen) and electrocardiograms. During the follow-up period they underwent type B pelvic ultrasonography, measurement of serum CA125 levels and further gynecologic examinations. The two treatments were compared for clinical recurrence rates, pregnancy rates and the incidence of adverse reactions.
Results: The incidence and timing of recurrence of endometriosis were not significantly different between the two groups. The first pregnancy achieved by the patient in the CM group was significantly earlier than that in the WM group (P<0.05). Moreover, the incidence of adverse reactions in the WM group was significantly higher than in the CM group (P<0.01).
Conclusions: Treatment with Chinese herbal medicines prevented the recurrence of endometriosis after a conservative operation, improved the conception rate and showed fewer and lighter adverse reactions than did treatment with WM therapy. Treatment with Chinese herbal medicine meets the need of patients wishing to have a child following endometriosis and is an appropriate form of clinical treatment.
Complementary and Alternative Medicine for Endometriosis: A Review of Utilization and Mechanism
Kong S et al, Volume (2014), Article ID 146383, 16 pages Evidence-Based Comp and Altern Med
Evidence-Based Complementary and Alternative Medicine
This lengthy review compares results of treatment of endometriosis with acupuncture or herbal therapies and pharmaceutical or surgical approaches. A number of therapies, including using Chinese herbs per rectum, were found to obtain relief from symptoms of endometriosis, but without the side effects caused by drugs or surgery.
The authors conclude that the active principle of such therapies has a strong foundation but that standardisation of techniques and larger RCTs are needed.