The effectiveness of acupuncture in the treatment of primary dysmenorrhea : a mixed methods study

Western Sydney University thesis: Doctoral thesis

Abstract

Primary dysmenorrhea is the most common gynaecological complaint amongst adolescents. It affects up to three quarters of women at some stage of their reproductive life. Primary dysmenorrhea is also responsible for a significant number of days absent from work or school each month. Women often do not seek medical attention for primary dysmenorrhea and instead use self-care to manage their symptoms. If they do consult a medical practitioner, women are usually advised to take non-steroidal anti-inflammatory (NSAIDs) medication or go on the oral contraceptive pill (COC), however, for at least a quarter of all women there is a lack of efficacy with these medications. Traditional Chinese medicine (TCM) acupuncture has shown promise in the treatment of primary dysmenorrhea, however, several important questions remain. The overarching aim of this thesis is to examine the treatment of primary dysmenorrhea in contemporary clinical acupuncture practice, and examine the therapeutic effects of acupuncture treatment on the symptoms of primary dysmenorrhea. A mixed methods research (MMR) approach was used to undertake four studies. Quantitative methods were used for an online and postal practitioner survey examining how gynaecological conditions were treated in contemporary clinical practice and a randomised controlled trial (RCT) examining the effect of timing and mode of stimulation of acupuncture on primary dysmenorrhea. Qualitative methods, using thematic analysis, were used for practitioners in the form of semi-structured interviews and focus groups discussing treatment of primary dysmenorrhea in the community, and for trial participants in the form of semi-structured interviews examining their experiences as part of the RCT. NIVO was used to manage and code these datasets. These methods were used to answer five research questions. The first research question examined how acupuncture treatment for primary dysmenorrhea was delivered in clinical practice in New Zealand and Australia. The survey of 377 New Zealand and Australian acupuncture practitioners found use of a variety of methods when treating primary dysmenorrhea in clinical practice, with diet and lifestyle advice being rated by practitioners as an important adjunct to acupuncture and moxibustion itself. The second research question explored what components of the acupuncture treatment do practitioners and patients consider important for successful treatment? Analysis of data from two focus groups and semi-structured interviews of nine practitioners and 12 study participants found both practitioners and study participants strongly valued the partnership that occurred, characterised by trust, support and shared decision making. Both moxibustion and self-care advice were recommended by practitioners and participants commented on the therapeutic benefits they received from these co-interventions. The third study question examined the effect of changing the timing of treatment or the mode of acupuncture stimulation on pain and quality of life for women with primary dysmenorrhea,? A pilot randomised controlled trial of 74 women with primary dysmenorrhea was performed with four groups: 1) low frequency manual acupuncture (LF""MA), 2) high frequency manual acupuncture (HF""MA), 3) low frequency electro-acupuncture (LF""EA) and 4) high frequency electro-acupuncture (HF""EA). Participants were randomly assigned to one of the four groups (LF""MA n=19, HF""MA n=18, LF""EA n=18, HF""EA n=19). Twelve treatments were performed over three menstrual cycles, either once per week (LF groups), or three times in the week prior to menses (HF groups). All groups received a treatment in the first 48 hours of menses. Primary outcomes found the reduction in peak and average menstrual pain measured via numeric rating scale at one, two, three and four months from trial entry. At four months post-trial entry all groups showed statistically (p
Date of Award2015
Original languageEnglish

Keywords

  • primary dysmenorrhea
  • premenstrual syndrome
  • polycystic ovary syndrome
  • alternative treatment
  • medicine
  • Chinese
  • acupuncture

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