Long Term Effects of Acupuncture for Primary Dysmenorrhea: A Systematic Review and Meta-Analysis

Xinyu Shen,1,2,* Sixing Liu,3,* He Chen,2 Wei Wang,1,2 Jiufei Fang,2 Zhishun Liu2 1Graduate College, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 2Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China; 3School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhishun Liu, Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange St., Xicheng District, Beijing, 100053, People’s Republic of China, Tel +8613651016313, Email [email protected]: Primary dysmenorrhea (PD) is a recurrent disease. The current treatments for PD often fail to provide long-lasting effects, underscoring the necessity for new treatment options that can offer durable benefits. Previous studies have indicated that the durable effect of acupuncture for PD remains uncertain. In this review, we aimed to evaluate the durable effect after completion of treatment.Methods: Both English and Chinese literature were comprehensively retrieved from eight databases up to January 24, 2025. Two independent reviewers conducted screening and data extraction. The risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool. Meta-analysis was conducted where applicable. Pooled continuous data were expressed as mean differences (MD) and the safety outcomes were expressed through odds ratio (OR).Results: Fourteen randomized controlled trials enrolled 970 patients met the inclusion and exclusion criteria. Acupuncture outperformed no intervention in reducing pain intensity measured by visual analogue scale (VAS) (MD − 47.80; 95% CI − 48.63 to − 46.97; p < 0.0001) and Short-Form McGill Pain Questionnaire (MD − 8.55; 95% CI − 11.46 to − 5.64; p < 0.0001), Cox Menstrual Symptom Scale (CMSS) duration score (MD − 18.24; 95% CI − 22.39 to − 14.09; p < 0.0001) and severity score (MD − 12.96; 95% CI − 16.41 to − 9.51; p < 0.0001) at 3 menstrual cycles post-treatment. Compared to non-steroidal anti-inflammatory drugs (NSAIDs), acupuncture showed superior pain relief measured by VAS (MD − 29.89; 95% CI − 37.63 to − 22.15; p < 0.0001), and symptom amelioration measured by CMSS (MD − 3.00; 95% CI − 5.92 to − 0.08; p = 0.0043) at 3 cycles post-treatment. Acupuncture also enhanced NSAIDs’ analgesic effect measured by VAS (MD − 19.95; 95% CI − 24.23 to − 15.66; p < 0.0001). However, acupuncture presented no superiority over sham acupuncture at 3 menstrual cycles post-treatment.Conclusion: Acupuncture might provide durable post-treatment effects to primary dysmenorrhea patients up to three menstrual cycles, which was limited by high risk of bias and low certainty evidence.Keywords: acupuncture, long term effects, meta-analysis, primary dysmenorrhea, systematic review