Endometriosis and Acupuncture

I've noticed a pattern in clinic that might give a little hope to people suffering with endometriosis or adenomyosis. What I've seen is that we start to notice a shift within just a handful of sessions, sometimes within a single month of consistent treatment (ie: one time per week). In full transparency, symptoms don't vanish in one month's time. What I'm seeing within one cycle, though, is less pain- be it back pain prior to, or during, the bleed, or lower abdominal pain, better sleep with less anticipatory anxiety, fewer flare days at the start of a menstrual cycle, and less mood fluctuations.

Endometriosis can be so frustrating, given that most of the women I see have been for multiple ultrasounds, pelvic exams, multiple referrals to the OB, and many times there are either no answers, no diagnosis, or a diagnosis with no clear path forward. The front line treatment for endometriosis is a trial of NSAIDS, which is oftentimes not very helpful. Secondary to that is hormonal therapy such as the pill to suppress ovarian activity, since endometriosis is an oestrogen driven issue. Nowhere do we have an option for correcting the issue; what we have is simply masking. When NSAIDS are stopped or when birth control is stopped, the problem remains, and the symptoms come back as before. For someone with debilitating pain, there is always the surgical options of excision or ablation, but where fertility needs to be preserved, this can be a scary option. I have known women to go on different hormonal treatments that put them in menopause, sometimes at the age of 30. The issue with these treatments is that they are not approved for long term use, so in 2 years time when the hormones need to be stopped once again, the symptoms are back and the issue is as it always has been. I have also known women who do not wish to have children, or who have already had children, to have a full or partial hysterectomy. Surgical options are quite serious, so if there is hope that something as non-invasive (and even enjoyable dare I say?) intervention such as acupuncture can alleviate symptoms, why would it not be considered?

As someone who studied both western and eastern medicine, I really love to look to the literature for confirmation. I know that in practice I have seen and charted numerous cases of women finding pain relief with as little as 2 treatments. Within 3 months time, the progress we can get with acupuncture is really quality-of-life-changing. To support this information, lets have a look at a meta analysis (this one specifically is a compilation of 14 studies, including 1,991 different research articles) entitled, Acupuncture for the clinical improvement of endometriosis-related pain.

This is a pooled analysis of research studies and clinical trials (and please remember that one singular research study makes not conclusive evidence! This is why we look towards meta analyses and systamatic reviews.) Researchers gathered data from multiple studies on acupuncture for endometriosis-related pain and found that, compared to patients who didn't receive it, those treated with acupuncture had significantly less pain and were significantly more likely to feel real improvement.

Even more interestingly, the research also picked up something happening on a more physiological level: CA-125 is a marker in the blood that tends to rise with endometriosis activity, and while it isn't used as a stand-alone diagnostic tool, doctors do use it to help track how active the disease is over time. In this study, they found that CA-125 dropped in patients receiving acupuncture. This is meaningful because it suggests that acupuncture may be influencing some of the underlying inflammatory activity driving the condition in the first place, in addition to how we know acupuncture can change how pain in perceived in the brain (see my last post: Pain lives in your brain, not just in your bad shoulder). The proposed mechanisms include shifts in prostaglandins, beta-endorphins, dynorphins, and substance P, which are all chemical messengers involved in how the body generates and processes pain and inflammation.

A few different approaches of how the practitioners were using acupuncture came up in these pooled trials:

Electroacupuncture adds a gentle, low-level electrical current to the needles once they're placed, which appears to intensify the stimulation. This came out as one of the strongest approaches specifically for reducing pain.

Auricular acupuncture works entirely through points in the ear, and stood out as effective for both pain relief and overall clinical response, making it a good option for patients who want a gentler entry point into treatment.

Warm needling where a small amount of heat is added to the needle during treatment (most often moxibustion, or mugwort), also showed strong results for overall improvement, and fits well with how Chinese medicine has traditionally viewed endometriosis, as a condition tied to stagnation that benefits from warming and moving.

If you've come in for treatment, you'll likely have had a combination of a few of the above, if not all of the above treatments. Of course the points themselves matter as well, and I time different protocols to the different times of your cycle so that the correct principles are being used for all 4 of the hormonal phases. Personally, I want to make sure that I see my patients 2x during the luteal phase, or the premenstrual window, after ovulation. This is when inflammatory and hormonal activity really begin to build right before symptoms begin.

If you're curious about acupuncture for the management of endometriosis, adenomyosis, or simply dysmenorrhea (painful periods without either of the above diagnoses), do reach out, let's have a chat!

Reference: Chen C, Li X, Lu S, Yang J, Liu Y. Acupuncture for clinical improvement of endometriosis-related pain: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics. 2024;310(4):2101-2114. doi:10.1007/s00404-024-07675-z