Acupuncture for polycystic ovarian syndrome

Background: PCOS is where women have multiple cysts (fluid-filled sacs) on their ovaries (organs that produce eggs) and is characterised by the clinical signs of infrequent or very light menstruation (periods), failure to conceive (become pregnant) and excessive hair growth. Women may or may not have symptoms. The current standard western treatments for women with PCOS are prescription medicines, surgery and lifestyle changes. There has been evidence suggesting acupuncture may influence ovulation (release of the egg) by affecting levels of various hormones. Acupuncture is a Chinese therapy where fine needles are inserted into the skin in certain places. The exact mechanism of how acupuncture works for PCOS is not known and we aimed to explore the use of it for PCOS in this review. Study characteristics: We searchedmedical databases for clinical studies where people were randomly put into one of two or more treatment groups including acupuncture treatment for women with PCOS who were infrequently or never ovulating. Acupuncture was compared with pretend acupuncture (sham), no treatment, lifestyle changes (e.g. relaxation) and conventional treatment. We included eight studies with 1546 women in this review. The studies compared true acupuncture versus sham acupuncture, clomiphene (medicines to induce ovulation), relaxation and Diane-35 (combined oral contraceptive pill); and low-frequency electroacupuncture (where small electrical currents are passed through the acupuncture needles) versus physical exercise. We included women who wanted to get pregnant and women who wanted regular ovulation and symptom control as our two main populations of interest. Key results: Ourmain interests were live birth rate,multiple pregnancy rate (for women who wanted to get pregnant) and ovulation rate (for women who wanted regular ovulation/symptom control). Due to the very low quality of the evidence and imprecise results, we were uncertain of the effect of acupuncture on live birth rate, multiple pregnancy rate and ovulation rate compared to sham acupuncture. For the same reasons, we were also uncertain of the effect of acupuncture on clinical pregnancy and miscarriage rate. Acupuncture may have improved restoration of regular menstrual periods. Acupuncture probably worsened side effects when compared to sham acupuncture. No studies reported data on live birth rate and multiple pregnancy rate for the other comparisons: physical exercise or no intervention, relaxation and clomiphene. Studies including Diane-35 did not measure fertility outcomes as women were only interested in symptom control. We were uncertain whether acupuncture improved ovulation rate compared to relaxation or Diane-35 (measured by ultrasound, which uses high-frequency sound waves to create an image, threemonths after treatment). The other comparisons did not report on ovulation rate. Side effects were recorded in the acupuncture group for the comparisons physical exercise or no intervention, clomiphene and Diane- 35. These included dizziness, nausea (feeling sick) and bruising. The overall evidence was low or very low quality. There is currently insufficient evidence to support the use of acupuncture for treatment of ovulation disorders in women with PCOS. Quality of the evidence: The evidence ranged from very low to moderate quality, the main limitations were not reporting important clinical results and not enough data.