Effects and mechanisms of acupuncture on women related health

Abstract

Globally, public health interventions have resulted in a 30-year increase in women’s life expectancy. However, women’s health has not increased when socioeconomic status is ignored. Women’s health has become a major public health concern, for those women from developing countries are still struggling with infectious and labor-related diseases, and their counterparts in developed countries are suffering from physical and psychological disorders. In recent years, complementary and alternative medicine has attracted wide attentions with regards to maintaining women’s health. Acupuncture, a crucial component of traditional Chinese medicine, has been used to treat many obstetric and gynecological diseases for thousands of years due to its analgesic and anti-inflammatory effects and its effects on stimulating the sympathetic/parasympathetic nervous system. To fully understand the mechanism through which acupuncture exerts its effects in these diseases would significantly extend the list of available interventions and would allow for more reasonable advice to be given to general practitioners. Therefore, by searching PubMed and CNKI regarding the use of acupuncture in treating obstetric and gynecological diseases, we aimed to summarize the proven evidence of using acupuncture in maintaining women’s health by considering both its effectiveness and the underlying mechanisms behind its effects.

Keywords

acupuncture / women health / clinical efficacy / mechanism

References

[1] Blumenthal SJ. Critical women’s health issues in the 21st century. JAMA 2000; 283(5): 667

[2] Stuenkel CA, Manson JE. Women’s health—traversing medicine and public policy. N Engl J Med 2021; 384(22): 2073–2076

[3] Fejzo MS, Trovik J, Grooten IJ, Sridharan K, Roseboom TJ, VikanesÅ, Painter RC, Mullin PM. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Primers 2019; 5(1): 62

[4] O’Heney J, McAllister S, Maresh M, Blott M. Fetal monitoring in labour: summary and update of NICE guidance. BMJ 2022; 379: o2854

[5] Duralde ER, Sobel TH, Manson JE. Management of perimenopausal and menopausal symptoms. BMJ 2023; 382: e072612

[6] Qiu J. China plans to modernize traditional medicine. Nature 2007; 446(7136): 590–591

[7] Williams H, Sweet L, Graham K. Acupuncture during pregnancy and the perinatal period: women’s attitudes, beliefs and practices. Women Birth 2020; 33(3): e286–e294

[8] Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann Intern Med 2002; 136(5): 374–383

[9] Chang S. The meridian system and mechanism of acupuncture—a comparative review. Part 1: the meridian system. Taiwan J Obstet Gynecol 2012; 51(4): 506–514

[10] Reverby SM. Acupuncture’s radical roots and political branches. Am J Public Health 2021; 111(5): 760–761

[11] WHO. WHO global report on traditional and complementary medicine 2019. 2019. Available at the website of WHO (accessed September 11, 2023)

[12] Chen T, Zhang WW, Chu YX, Wang YQ. Acupuncture for pain management: molecular mechanisms of action. Am J Chin Med 2020; 48(4): 793–811

[13] Feng J, Wang J, Zhang Y, Zhang Y, Jia L, Zhang D, Zhang J, Han Y, Luo S. The efficacy of complementary and alternative medicine in the treatment of female infertility. Evid Based Complement Alternat Med 2021; 2021: 6634309

[14] Lu L, Zhang Y, Tang X, Ge S, Wen H, Zeng J, Wang L, Zeng Z, Rada G, Ávila C, Vergara C, Tang Y, Zhang P, Chen R, Dong Y, Wei X, Luo W, Wang L, Guyatt G, Tang C, Xu N. Evidence on acupuncture therapies is underused in clinical practice and health policy. BMJ 2022; 376: e067475

[15] Zuarez-Easton S, Erez O, Zafran N, Carmeli J, Garmi G, Salim R. Pharmacologic and nonpharmacologic options for pain relief during labor: an expert review. Am J Obstet Gynecol 2023; 228(5 5S): S1246–S1259

[16] Fletcher SG, Zimmern PE. Differential diagnosis of chronic pelvic pain in women: the urologist’s approach. Nat Rev Urol 2009; 6(10): 557–562

[17] Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update 2015; 21(6): 762–778

[18] Sinaii N, Cleary SD, Younes N, Ballweg ML, Stratton P. Treatment utilization for endometriosis symptoms: a cross-sectional survey study of lifetime experience. Fertil Steril 2007; 87(6): 1277–1286

[19] Teal S, Edelman A. Contraception selection, effectiveness, and adverse effects: a review. JAMA 2021; 326(24): 2507–2518

[20] Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet 2021; 397(10276): 839–852

[21] Shipman PL. Why is human childbirth so painful?. American Scientist 2013; 101(6): 426

[22] Smith CA, Collins CT, Levett KM, Armour M, Dahlen HG, Tan AL, Mesgarpour B. Acupuncture or acupressure for pain management during labour. Cochrane Database Syst Rev 2020; 2(2): CD009232

[23] Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 177: obstetric analgesia and anesthesia. Obstet Gynecol 2017; 129(4): e73–e89

[24] Bucstain C, Garmi G, Zafran N, Zuarez-Easton S, Carmeli J, Salim R. Risk factors and peripartum outcomes of failed epidural: a prospective cohort study. Arch Gynecol Obstet 2017; 295(5): 1119–1125

[25] Armour M, Dahlen HG, Zhu X, Farquhar C, Smith CA. The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: an exploratory randomised controlled trial. PLoS One 2017; 12(7): e0180177

[26] Ma YX, Ye XN, Liu CZ, Cai PY, Li ZF, Du DQ, Guo G, Chen SZ, Zhao JP, Liu JJ, Yi HQ, Gao SZ. A clinical trial of acupuncture about time-varying treatment and points selection in primary dysmenorrhea. J Ethnopharmacol 2013; 148(2): 498–504

[27] Wade C, Wang L, Zhao WJ, Cardini F, Kronenberg F, Gui SQ, Ying Z, Zhao NQ, Chao MT, Yu J. Acupuncture point injection treatment of primary dysmenorrhoea: a randomised, double blind, controlled study. BMJ Open 2016; 6(1): e008166

[28] Li PS, Peng XM, Niu XX, Xu L, Hung Yu Ng E, Wang CC, Dai JF, Lu J, Liang RN. Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial. Fertil Steril 2023; 119(5): 815–823

[29] Armour M, Cave AE, Schabrun SM, Steiner GZ, Zhu X, Song J, Abbott J, Smith CA. Manual acupuncture plus usual care versus usual care alone in the treatment of endometriosis-related chronic pelvic pain: a randomized controlled feasibility study. J Altern Complement Med 2021; 27(10): 841–849

[30] Jin Y, Yu X, Hu S, Liu L, Wang B, Feng Y, Li Y, Xiong B, Wang L. Efficacy of electroacupuncture combined with intravenous patient-controlled analgesia after cesarean delivery: a randomized clinical trial. Am J Obstet Gynecol MFM 2023; 5(2): 100826

[31] Usichenko TI, Henkel BJ, Klausenitz C, Hesse T, Pierdant G, Cummings M, Hahnenkamp K. Effectiveness of acupuncture for pain control after cesarean delivery: a randomized clinical trial. JAMA Netw Open 2022; 5(2): e220517

[32] Wu L, Zhao H, Zhang Z, Huang M, Wu S, Fang C, Wang R, Li S, Yi W, Zhou A. Combined spinal-epidural anesthesia with acupoint injection for labor anesthesia reduces IL-1β/IL-10 ratio in maternal peripheral blood, umbilical cord blood and improves the labor outcomes: a prospective randomized controlled trial. Clin Immunol 2022; 236: 108935

[33] Bishop KC, Ford AC, Kuller JA, Dotters-Katz S. Acupuncture in obstetrics and gynecology. Obstet Gynecol Surv 2019; 74(4): 241–251

[34] Kho KA, Shields JK. Diagnosis and management of primary dysmenorrhea. JAMA 2020; 323(3): 268–269

[35] Horne AW, Missmer SA. Pathophysiology, diagnosis, and management of endometriosis. BMJ 2022; 379: e070750

[36] Lee JH, Jang KJ, Lee YT, Choi YH, Choi BT. Electroacupuncture inhibits inflammatory edema and hyperalgesia through regulation of cyclooxygenase synthesis in both peripheral and central nociceptive sites. Am J Chin Med 2006; 34(6): 981–988

[37] Liu S, Wang Z, Su Y, Qi L, Yang W, Fu M, Jing X, Wang Y, Ma Q. A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis. Nature 2021; 598(7882): 641–645

[38] Mingfu L, Xiaotong D, Xiaojing S, Jin J, Jinling Z, Ying H. Study on the dynamic compound structure composed of mast cells, blood vessels, and nerves in rat acupoint. Evid Based Complement Alternat Med 2013; 2013: 160651

[39] Li Y, Yu Y, Liu Y, Yao W. Mast cells and acupuncture analgesia. Cells 2022; 11(5): 860

[40] Boadas-Vaello P, Castany S, Homs J, Álvarez-Pérez B, Deulofeu M, Verdú E. Neuroplasticity of ascending and descending pathways after somatosensory system injury: reviewing knowledge to identify neuropathic pain therapeutic targets. Spinal Cord 2016; 54(5): 330–340

[41] Hu ML, Zhou FY, Liu JJ, Ding Y, Zhong JM, Ding MX. Electroacupuncture inhibits the activation of p38MAPK in the central descending facilitatory pathway in rats with inflammatory pain. Evid Based Complement Alternat Med 2017; 2017: 7531060

[42] Lyu Z, Guo Y, Gong Y, Fan W, Dou B, Li N, Wang S, Xu Y, Liu Y, Chen B, Guo Y, Xu Z, Lin X. The role of neuroglial crosstalk and synaptic plasticity-mediated central sensitization in acupuncture analgesia. Neural Plast 2021; 2021: 8881557

[43] Huang T, Yang L, Jia S, Mu X, Wu M, Ye H, Liu W, Cheng X. Capillary blood flow in patients with dysmenorrhea treated with acupuncture. J Tradit Chin Med 2013; 33(6): 757–760

[44] Ma YX, Ma LX, Liu XL, Ma YX, Lv K, Wang D, Liu JP, Xing JM, Cao HJ, Gao SZ, Zhu J. A comparative study on the immediate effects of electroacupuncture at Sanyinjiao (SP6), Xuanzhong (GB39) and a non-meridian point, on menstrual pain and uterine arterial blood flow, in primary dysmenorrhea patients. Pain Med 2010; 11(10): 1564–1575

[45] Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev 2018; 5: CD000331

[46] Wang JJ, Yang FG, Tsai CC, Chao AS. The neural basis of pain during labor. Am J Obstet Gynecol 2023; 228(5 5S): S1241–S1245

[47] Wang W, Sung N, Gilman-Sachs A, Kwak-Kim J. T helper (Th) cell profiles in pregnancy and recurrent pregnancy losses: Th1/Th2/Th9/Th17/Th22/Tfh Cells. Front Immunol 2020; 11: 2025

[48] Yu WY, Ma LX, Tian Y, Mu JD, Zhang Z, Sun TY, Qian X, Wang JX. Acupuncture alleviates menstrual pain in rat model via suppressing eotaxin/CCR3 axis to weak EOS-MC activation. Evid Based Complement Alternat Med 2022; 2022: 4571981

[49] Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol 2018; 14(5): 270–284

[50] Palomba S. Is fertility reduced in ovulatory women with polycystic ovary syndrome? An opinion paper. Hum Reprod 2021; 36(9): 2421–2428

[51] Azziz R, Carmina E, Chen Z, Dunaif A, Laven JSE, Legro RS, Lizneva D, Natterson-Horowtiz B, Teede HJ, Yildiz BO. Polycystic ovary syndrome. Nat Rev Dis Primers 2016; 2(1): 16057

[52] Calcaterra V, Verduci E, Cena H, Magenes VC, Todisco CF, Tenuta E, Gregorio C, De Giuseppe R, Bosetti A, Di Profio E, Zuccotti G. Polycystic ovary syndrome in insulin-resistant adolescents with obesity: the role of nutrition therapy and food supplements as a strategy to protect fertility. Nutrients 2021; 13(6): 1848

[53] Jedel E, Labrie F, Odén A, Holm G, Nilsson L, Janson PO, Lind AK, Ohlsson C, Stener-Victorin E. Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab 2011; 300(1): E37–E45

[54] Johansson J, Redman L, Veldhuis PP, Sazonova A, Labrie F, Holm G, Johannsson G, Stener-Victorin E. Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab 2013; 304(9): E934–E943

[55] Wu XK, Stener-Victorin E, Kuang HY, Ma HL, Gao JS, Xie LZ, Hou LH, Hu ZX, Shao XG, Ge J, Zhang JF, Xue HY, Xu XF, Liang RN, Ma HX, Yang HW, Li WL, Huang DM, Sun Y, Hao CF, Du SM, Yang ZW, Wang X, Yan Y, Chen XH, Fu P, Ding CF, Gao YQ, Zhou ZM, Wang CC, Wu TX, Liu JP, Ng EHY, Legro RS, Zhang H; PCOSAct Study Group. Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial. JAMA 2017; 317(24): 2502–2514

[56] Legro RS, Brzyski RG, Diamond MP, Coutifaris C, Schlaff WD, Casson P, Christman GM, Huang H, Yan Q, Alvero R, Haisenleder DJ, Barnhart KT, Bates GW, Usadi R, Lucidi S, Baker V, Trussell JC, Krawetz SA, Snyder P, Ohl D, Santoro N, Eisenberg E, Zhang H; NICHD Reproductive Medicine Network. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med 2014; 371(2): 119–129

[57] Legro RS, Barnhart HX, Schlaff WD, Carr BR, Diamond MP, Carson SA, Steinkampf MP, Coutifaris C, McGovern PG, Cataldo NA, Gosman GG, Nestler JE, Giudice LC, Leppert PC, Myers ER; Cooperative Multicenter Reproductive Medicine Network. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med 2007; 356(6): 551–566

[58] Chen X, Lan Y, Yang L, Liu Y, Li H, Zhu X, Zhao Y, Long C, Wang M, Xie Q, Li Z, Wu J. Acupuncture combined with metformin versus metformin alone to improve pregnancy rate in polycystic ovary syndrome: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13: 978280

[59] Dong HX, Wang Q, Wang Z, Wu XK, Cheng L, Zhou ZM, Yang L, Yi P, Huang DM. Impact of low frequency electro-acupuncture on glucose and lipid metabolism in unmarried PCOS women: a randomized controlled trial. Chin J Integr Med 2021; 27(10): 737–743

[60] Wang Z, Dong H, Wang Q, Zhang L, Wu X, Zhou Z, Yang L, Huang D. Effects of electroacupuncture on anxiety and depression in unmarried patients with polycystic ovarian syndrome: secondary analysis of a pilot randomised controlled trial. Acupunct Med 2019; 37(1): 40–46

[61] Stener-Victorin E, Holm G, Janson PO, Gustafson D, Waern M. Acupuncture and physical exercise for affective symptoms and health-related quality of life in polycystic ovary syndrome: secondary analysis from a randomized controlled trial. BMC Complement Altern Med 2013; 13(1): 131

[62] Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF; Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess, PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009; 91(2): 456–488

[63] Stener-Victorin E, Deng Q. Epigenetic inheritance of polycystic ovary syndrome—challenges and opportunities for treatment. Nat Rev Endocrinol 2021; 17(9): 521–533

[64] Stener-Victorin E, Maliqueo M, Soligo M, Protto V, Manni L, Jerlhag E, Kokosar M, Sazonova A, Behre CJ, Lind M, Ohlsson C, Højlund K, Benrick A. Changes in HbA_1c and circulating and adipose tissue androgen levels in overweight-obese women with polycystic ovary syndrome in response to electroacupuncture. Obes Sci Pract 2016; 2(4): 426–435

[65] Xu G, Zhang A, Liu J, Wang X, Feng J, Chen Y. Effects of electroacupuncture on ovarian expression of the androgen receptor and connexin 43 in rats with letrozole-induced polycystic ovaries. Evid Based Complement Alternat Med 2020; 2020: 3608062

[66] Sun J, Jin C, Wu H, Zhao J, Cui Y, Liu H, Wu L, Shi Y, Zhu B. Effects of electro-acupuncture on ovarian P450arom, P450c17α and mRNA expression induced by letrozole in PCOS rats. PLoS One 2013; 8(11): e79382

[67] Feng Y, Johansson J, Shao R, Mannerås-Holm L, Billig H, Stener-Victorin E. Electrical and manual acupuncture stimulation affect oestrous cyclicity and neuroendocrine function in an 5α-dihydrotestosterone-induced rat polycystic ovary syndrome model. Exp Physiol 2012; 97(5): 651–662

[68] Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 2012; 33(6): 981–1030

[69] Dunaif A, Segal KR, Shelley DR, Green G, Dobrjansky A, Licholai T. Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diabetes 1992; 41(10): 1257–1266

[70] Kokosar M, Benrick A, Perfilyev A, Nilsson E, Källman T, Ohlsson C, Ling C, Stener-Victorin E. A single bout of electroacupuncture remodels epigenetic and transcriptional changes in adipose tissue in polycystic ovary syndrome. Sci Rep 2018; 8(1): 1878

[71] Benrick A, Kokosar M, Hu M, Larsson M, Maliqueo M, Marcondes RR, Soligo M, Protto V, Jerlhag E, Sazonova A, Behre CJ, Højlund K, Thorén P, Stener-Victorin E. Autonomic nervous system activation mediates the increase in whole-body glucose uptake in response to electroacupuncture. FASEB J 2017; 31(8): 3288–3297

[72] Benrick A, Pillon NJ, Nilsson E, Lindgren E, Krook A, Ling C, Stener-Victorin E. Electroacupuncture mimics exercise-induced changes in skeletal muscle gene expression in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2020; 105(6): 2027–2041

[73] Wu J, Chen X. Acupuncture therapy protects PCOS patients with diabetes by regulating miR-32-3p/PLA2G4A pathway. Am J Transl Res 2021; 13(8): 8819–8832

[74] Zhang F, Ma T, Tong X, Liu Y, Cui P, Xu X, Shi J, Hu W, Lu W, Pei Z, Xu M, Li X, Xu C, Feng Y. Electroacupuncture improves metabolic and ovarian function in a rat model of polycystic ovary syndrome by decreasing white adipose tissue, increasing brown adipose tissue, and modulating the gut microbiota. Acupunct Med 2022; 40(4): 347–359

[75] Zhang HL, Huo ZJ, Wang HN, Wang W, Chang CQ, Shi L, Li D, Li R, Qiao J. Acupuncture ameliorates negative emotion in PCOS patients: a randomized controlled trial. Chin Acupunct Moxibustion (Zhongguo Zhen Jiu) 2020; 40(4): 385–390

[76] Chaudhari N, Dawalbhakta M, Nampoothiri L. GnRH dysregulation in polycystic ovarian syndrome (PCOS) is a manifestation of an altered neurotransmitter profile. Reprod Biol Endocrinol 2018; 16(1): 37

[77] Busnelli A, Reschini M, Cardellicchio L, Vegetti W, Somigliana E, Vercellini P. How common is real repeated implantation failure? An indirect estimate of the prevalence.. Reprod Biomed Online 2020; 40(1): 91–97

[78] Hong YL, Tan Y, Yin YY, Zou YJ, Guo YH, Nie XW. Effect of electro-acupuncture on clinical outcomes and ovarian hyperstimulation syndrome in in vitro fertilization and embryo transplantation. Chin J Integr Tradit West Med (Zhongguo Zhong Xi Yi Jie He Za Zhi) 2014; 34(11): 1292–1296

[79] Wang RR, Su MH, Liu LY, Lai YY, Guo XL, Gan D, Zheng XY, Yang H, Yu SY, Liang FR, Wei W, Zhong Y, Yang J. Systematic review of acupuncture to improve ovarian function in women with poor ovarian response. Front Endocrinol (Lausanne) 2023; 14: 1028853

[80] Liu X, Shi W, Liu Z, Shi S, Ke C, Zhang P, Tan Z, Zhang W. Effects of acupuncture on luteinized unruptured follicle syndrome: a meta-analysis of randomized controlled trials. Complement Ther Med 2020; 49: 102319

[81] Stener-Victorin E, Waldenström U, Nilsson L, Wikland M, Janson PO. A prospective randomized study of electro-acupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization. Hum Reprod 1999; 14(10): 2480–2484

[82] Stener-Victorin E. The pain-relieving effect of electro-acupuncture and conventional medical analgesic methods during oocyte retrieval: a systematic review of randomized controlled trials. Hum Reprod 2005; 20(2): 339–349

[83] Humaidan P, Brock K, Bungum L, Stener-Victorin E. Pain relief during oocyte retrieval—exploring the role of different frequencies of electro-acupuncture. Reprod Biomed Online 2006; 13(1): 120–125

[84] Smith CA, de Lacey S, Chapman M, Ratcliffe J, Norman RJ, Johnson NP, Boothroyd C, Fahey P. Effect of acupuncture vs sham acupuncture on live births among women undergoing in vitro fertilization: a randomized clinical trial. JAMA 2018; 319(19): 1990–1998

[85] Feng X, Zhu N, Yang S, Wang L, Sun W, Li R, Gong F, Han S, Zhang R, Han J. Transcutaneous electrical acupoint stimulation improves endometrial receptivity resulting in improved IVF-ET pregnancy outcomes in older women: a multicenter, randomized, controlled clinical trial. Reprod Biol Endocrinol 2022; 20(1): 127

[86] Zhu C, Xia W, Huang J, Zhang X, Li F, Yu X, Ma J, Zeng Q. Effects of acupuncture on the pregnancy outcomes of frozen-thawed embryo transfer: a systematic review and meta-analysis. Front Public Health 2022; 10: 987276

[87] Ramezanzadeh F, Aghssa MM, Abedinia N, Zayeri F, Khanafshar N, Shariat M, Jafarabadi M. A survey of relationship between anxiety, depression and duration of infertility. BMC Womens Health 2004; 4(1): 9

[88] Domar AD, Meshay I, Kelliher J, Alper M, Powers RD. The impact of acupuncture on in vitro fertilization outcome. Fertil Steril 2009; 91(3): 723–726

[89] Smith CA, de Lacey S, Chapman M, Ratcliffe J, Norman RJ, Johnson NP, Fahey P. The effects of acupuncture on the secondary outcomes of anxiety and quality of life for women undergoing IVF: a randomized controlled trial. Acta Obstet Gynecol Scand 2019; 98(4): 460–469

[90] Smith C, Coyle M, Norman RJ. Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril 2006; 85(5): 1352–1358

[91] Zhu F, Zhao B, Wu J, Yin S, Ma T, Li Z, Zhu X, Wang T, Yang B, Che D. Effect of transcutaneous electrical acupoint stimulation on pregnancy outcomes in women with in vitro fertilization-embryo transfer: a systematic review and meta-analysis. Front Cell Dev Biol 2022; 10: 1068894

[92] Yang H, Hu WH, Xu GX, Yin ZH, Yu SY, Liu JJ, Xiao ZY, Zheng XY, Yang J, Liang FR. Transcutaneous electrical acupoint stimulation for pregnancy outcomes in women undergoing in vitro fertilization-embryo transfer: a systematic review and meta-analysis. Front Public Health 2022; 10: 892973

[93] You F, Du X, Zhang T, Wang Y, Lv Y, Zeng L. High-frequency electroacupuncture improves endometrial receptivity via regulating cell adhesion molecules and leukemia inhibitory factor/signal transducer and activator of transcription signaling pathway. Bioengineered 2021; 12(2): 10470–10479

[94] Dong H, Zhong Z, Chen W, Wu X, Zhang Q, Huang G, Yang W. Effect of acupuncture on endometrial angiogenesis and uterus dendritic cells in COH rats during peri-implantation period. Evid Based Complement Alternat Med 2017; 2017: 3647080

[95] Chen W, Chen J, Xu M, Zhong Z, Zhang Q, Yang W, Huang G. Electroacupuncture facilitates implantation by enhancing endometrial angiogenesis in a rat model of ovarian hyperstimulation. Biol Reprod 2019; 100(1): 268–280

[96] Han JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 2003; 26(1): 17–22

[97] Andersson S, Lundeberg T. Acupuncture—from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses 1995; 45:

[98] Jiang YL, Yin XH, Shen YF, He XF, Fang JQ. Low frequency electroacupuncture alleviated spinal nerve ligation induced mechanical allodynia by inhibiting TRPV1 upregulation in ipsilateral undamaged dorsal root ganglia in rats. Evid Based Complement Alternat Med 2013; 2013: 170910

[99] Xu GY, Li G, Liu N, Huang LYM. Mechanisms underlying purinergic P2X3 receptor-mediated mechanical allodynia induced in diabetic rats. Mol Pain 2011; 7: 60

[100] Tang NM, Dong HW, Wang XM, Tsui ZC, Han JS. Cholecystokinin antisense RNA increases the analgesic effect induced by electroacupuncture or low dose morphine: conversion of low responder rats into high responders. Pain 1997; 71(1): 71–80

[101] White PF, Craig WF, Vakharia AS, Ghoname E, Ahmed HE, Hamza MA. Percutaneous neuromodulation therapy: does the location of electrical stimulation effect the acute analgesic response?. Anesth Analg 2000; 91(4): 949–954

[102] Ghoname ES, Craig WF, White PF, Ahmed HE, Hamza MA, Gajraj NM, Vakharia AS, Noe CE. The effect of stimulus frequency on the analgesic response to percutaneous electrical nerve stimulation in patients with chronic low back pain. Anesth Analg 1999; 88(4): 841–846

[103] Ho M, Huang LC, Chang YY, Chen HY, Chang WC, Yang TC, Tsai HD. Electroacupuncture reduces uterine artery blood flow impedance in infertile women. Taiwan J Obstet Gynecol 2009; 48(2): 148–151

[104] Chang R, Chung PH, Rosenwaks Z. Role of acupuncture in the treatment of female infertility. Fertil Steril 2002; 78(6): 1149–1153

[105] Stener-Victorin E, Waldenström U, Andersson SA, Wikland M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod 1996; 11(6): 1314–1317

[106] Kim J, Shin KH, Na CS. Effect of acupuncture treatment on uterine motility and cyclooxygenase-2 expression in pregnant rats. Gynecol Obstet Invest 2000; 50(4): 225–230

[107] Han JS, Chen XH, Sun SL, Xu XJ, Yuan Y, Yan SC, Hao JX, Terenius L. Effect of low- and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF. Pain 1991; 47(3): 295–298

[108] Han JS, Terenius L. Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol 1982; 22(1): 193–220

[109] Niebyl JR. Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med 2010; 363(16): 1544–1550

[110] Jarvis S, Nelson-Piercy C. Management of nausea and vomiting in pregnancy. BMJ 2011; 342(jun17 1): d3606

[111] Carlsson CP, Axemo P, Bodin A, Carstensen H, Ehrenroth B, Madegård-Lind I, Navander C. Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study. J Pain Symptom Manage 2000; 20(4): 273–279

[112] Smith C, Crowther C, Beilby J. Acupuncture to treat nausea and vomiting in early pregnancy: a randomized controlled trial. Birth 2002; 29(1): 1–9

[113] Tara F, Bahrami-Taghanaki H, Amini Ghalandarabad M, Zand-Kargar Z, Azizi H, Esmaily H, Azizi H. The effect of acupressure on the severity of nausea, vomiting, and retching in pregnant women: a randomized controlled trial. Complement Med Res 2020; 27(4): 252–259

[114] Jamigorn M, Phupong V. Acupressure and vitamin B6 to relieve nausea and vomiting in pregnancy: a randomized study. Arch Gynecol Obstet 2007; 276(3): 245–249

[115] Negarandeh R, Eghbali M, Janani L, Dastaran F, Saatchi K. Auriculotherapy as a means of managing nausea and vomiting in pregnancy: a double-blind randomized controlled clinical trial. Complement Ther Clin Pract 2020; 40: 101177

[116] McParlin C, O’Donnell A, Robson SC, Beyer F, Moloney E, Bryant A, Bradley J, Muirhead CR, Nelson-Piercy C, Newbury-Birch D, Norman J, Shaw C, Simpson E, Swallow B, Yates L, Vale L. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review. JAMA 2016; 316(13): 1392–1401

[117] Roscoe JA, Matteson SE. Acupressure and acustimulation bands for control of nausea: a brief review. Am J Obstet Gynecol 2002; 186(5 Suppl 2): S244–S247

[118] Wu XK, Gao JS, Ma HL, Wang Y, Zhang B, Liu ZL, Li J, Cong J, Qin HC, Yang XM, Wu Q, Chen XY, Lu ZL, Feng YH, Qi X, Wang YX, Yu L, Cui YM, An CM, Zhou LL, Hu YH, Li L, Cao YJ, Yan Y, Liu L, Liu YX, Liu ZS, Painter RC, Ng EHY, Liu JP, Mol BWJ, Wang CC. Acupuncture and doxylamine-pyridoxine for nausea and vomiting in pregnancy : a randomized, controlled, 2 × 2 factorial trial. Ann Intern Med 2023; 176(7): 922–933

[119] Tan MY, Shu SH, Liu RL, Zhao Q. The efficacy and safety of complementary and alternative medicine in the treatment of nausea and vomiting during pregnancy: a systematic review and meta-analysis. Front Public Health 2023; 11: 1108756

[120] Sato A, Sato Y, Suzuki A, Uchida S. Neural mechanisms of the reflex inhibition and excitation of gastric motility elicited by acupuncture-like stimulation in anesthetized rats. Neurosci Res 1993; 18(1): 53–62

[121] Li Y, Tougas G, Chiverton SG, Hunt RH. The effect of acupuncture on gastrointestinal function and disorders. Am J Gastroenterol 1992; 87(10): 1372–1381

[122] Lu H, Zheng C, Zhong Y, Cheng L, Zhou Y. Effectiveness of acupuncture in the treatment of hyperemesis gravidarum: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2021; 2021: 2731446

[123] Lu MJ, Yu Z, He Y, Yin Y, Xu B. Electroacupuncture at ST36 modulates gastric motility via vagovagal and sympathetic reflexes in rats. World J Gastroenterol 2019; 25(19): 2315–2326

[124] Su YS, He W, Wang C, Shi H, Zhao YF, Xin JJ, Wang XY, Shang HY, Hu L, Jing XH, Zhu B. “Intensity-response” effects of electroacupuncture on gastric motility and its underlying peripheral neural mechanism. Evid Based Complement Alternat Med 2013; 2013: 535742

[125] Takeshige C, Sato T, Mera T, Hisamitsu T, Fang J. Descending pain inhibitory system involved in acupuncture analgesia. Brain Res Bull 1992; 29(5): 617–634

[126] Zou D, Chen WH, Iwakiri K, Rigda R, Tippett M, Holloway RH. Inhibition of transient lower esophageal sphincter relaxations by electrical acupoint stimulation. Am J Physiol Gastrointest Liver Physiol 2005; 289(2): G197–G201

[127] Nutaitis AC, Meckes NA, Madsen AM, Toal CT, Menhaji K, Carter-Brooks CM, Propst KA, Hickman LC. Postpartum urinary retention: an expert review. Am J Obstet Gynecol 2023; 228(1): 14–21

[128] Lauterbach R, Ferrer Sokolovski C, Rozenberg J, Weissman A. Acupuncture for the treatment of post-partum urinary retention. Eur J Obstet Gynecol Reprod Biol 2018; 223: 35–38

[129] Zhu Y, Wang F, Zhou J, Gu S, Gong L, Lin Y, Hu X, Wang W, Zhang A, Ma D, Hu C, Wu Y, Guo L, Chen L, Cen L, He Y, Cai Y, Wang E, Chen H, Jin J, Huang J, Jin M, Sun X, Ye X, Jiang L, Zhang Y, Zhang J, Lin J, Zhang C, Shen G, Jiang W, Zhong L, Zhou Y, Wu R, Lu S, Feng L, Guo H, Lin S, Chen Q, Kong J, Yang X, Tang M, Liu C, Wang F, Hu XM, Lee HW, Xu X, Zhang R, Robinson N, Lee MS, Han J, Qu F. Effect of acupoint hot compress on postpartum urinary retention after vaginal delivery: a randomized clinical trial. JAMA Netw Open 2022; 5(5): e2213261

[130] Li D, Wu X, Xiao S. Study on the regularity of acupoint selection for acupuncture treatment of postpartum urinary retention. Guiding J Tradit Chin Med Pharm (Zhong Yi Yao Dao Bao) 2021; 27: 151–154, 159

[131] Perú Biurrun G, Gonzalez-Díaz E, Fernández Fernández C, Fernández Corona A. Post partum urinary retention and related risk factors. Urology 2020; 143: 97–102

[132] Chen PD, Yang ZX, Zhou C, Wu QX, Liu F, Ning Y. Clinical research thinking of acupuncture and moxibustion intervention on postpartum urinary retention. West J Tradit Chin Med (Xi Bu Zhong Yi Yao) 2019; 32(9): 38–40

[133] Zhang YJ. Clinical research progress of acupuncture in treating postpartum urinary retention. Shanghai J Acupunct Moxibustion (Shanghai Zhen Jiu Za Zhi) 2011; 30: 504–507

[134] Zhang JP, Wang YQ, Yan MQ, Li ZA, Du XP, Wu XQ. Menopausal symptoms and sleep quality during menopausal transition and postmenopause. Chin Med J (Engl) 2016; 129(7): 771–777

[135] Crandall CJ, Mehta JM, Manson JE. Management of menopausal symptoms: a review. JAMA 2023; 329(5): 405–420

[136] Tang SS, Yin XJ, Yu W, Cui L, Li ZX, Cui LJ, Wang LH, Xia W. Prevalence of osteoporosis and related factors in postmenopausal women aged 40 and above in China. Chin J Epidemiol (Zhonghua Liu Xing Bing Xue Za Zhi) 2022; 43(4): 509–516

[137] Farquhar C, Marjoribanks J, Lethaby A, Suckling JA, Lamberts Q. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2009; (2): CD004143

[138] Flores VA, Pal L, Manson JE. Hormone therapy in menopause: concepts, controversies, and approach to treatment. Endocr Rev 2021; 42(6): 720–752

[139] Pan M, Pan X, Zhou J, Wang J, Qi Q, Wang L. Update on hormone therapy for the management of postmenopausal women. Biosci Trends 2022; 16(1): 46–57

[140] Avis NE, Coeytaux RR, Isom S, Prevette K, Morgan T. Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial. Menopause 2016; 23(6): 626–637

[141] Nedeljkovic M, Tian L, Ji P, Déglon-Fischer A, Stute P, Ocon E, Birkhäuser M, Ausfeld-Hafter B. Effects of acupuncture and Chinese herbal medicine (Zhi Mu 14) on hot flushes and quality of life in postmenopausal women: results of a four-arm randomized controlled pilot trial. Menopause 2014; 21(1): 15–24

[142] Lund KS, Siersma V, Brodersen J, Waldorff FB. Efficacy of a standardised acupuncture approach for women with bothersome menopausal symptoms: a pragmatic randomised study in primary care (the ACOM study). BMJ Open 2019; 9(1): e023637

[143] Fu C, Zhao N, Liu Z, Yuan LH, Xie C, Yang WJ, Yu XT, Yu H, Chen YF. Acupuncture improves peri-menopausal insomnia: a randomized controlled trial. Sleep 2017; 40(11):

[144] Di YM, Yang L, Shergis JL, Zhang AL, Li Y, Guo X, Xue CC, Lu C. Clinical evidence of Chinese medicine therapies for depression in women during perimenopause and menopause. Complement Ther Med 2019; 47: 102071

[145] Liu Z, Ai Y, Wang W, Zhou K, He L, Dong G, Fang J, Fu W, Su T, Wang J, Wang R, Yang J, Yue Z, Zang Z, Zhang W, Zhou Z, Xu H, Wang Y, Liu Y, Zhou J, Yang L, Yan S, Wu J, Liu J, Liu B. Acupuncture for symptoms in menopause transition: a randomized controlled trial. Am J Obstet Gynecol 2018; 219(4): 373.e1–373.e10

[146] Hassan ES, Maged AM, Kotb A, Fouad M, El-Nassery N, Kamal WM. Effect of laser acupuncture on pain and density of bone in osteoporotic postmenopausal women: a randomized controlled trial. Menopause 2023; 30(5): 545–550

[147] Huang WY, Hsin IL, Chen DR, Chang CC, Kor CT, Chen TY, Wu HM. Circulating interleukin-8 and tumor necrosis factor-α are associated with hot flashes in healthy postmenopausal women. PLoS One 2017; 12(8): e0184011

[148] Xu Y, Hong S, Zhao X, Wang S, Xu Z, Ding S, Zhang K, Zhang Y, Xu L, Yu N, Zhao T, Yan Y, Yang F, Liu Y, Yu K, Liu B, Guo Y, Pang G. Acupuncture alleviates rheumatoid arthritis by immune-network modulation. Am J Chin Med 2018; 46(5): 997–1019

[149] Li X, Wu K, Dong Q, Chen H, Li C, Ren Z, Liu F, Yue X, Xia C, Wang Y, Luo Y, Li L, Zhao R, Wang Z, Qin D. Overall adjustment acupuncture improves osteoporosis and exerts an endocrine-modulating effect in ovariectomized rats. Front Endocrinol (Lausanne) 2022; 13: 1074516

[150] Zheng X, Wu G, Nie Y, Lin Y. Electroacupuncture at the governor vessel and bladder meridian acupoints improves postmenopausal osteoporosis through osteoprotegerin/RANKL/RANK and Wnt/β-catenin signaling pathways. Exp Ther Med 2015; 10(2): 541–548

[151] Fan H, Ji F, Lin Y, Zhang M, Qin W, Zhou Q, Wu Q. Electroacupuncture stimulation at CV4 prevents ovariectomy-induced osteoporosis in rats via Wnt-β-catenin signaling. Mol Med Rep 2016; 13(3): 2485–2491

[152] Zheng X, Nie Y, Sun C, Wu G, Cai Q, Huang S, Lin Y. Long-term electroacupuncture stimulation prevents osteoporosis in ovariectomised osteopaenic rats through multiple signalling pathways. Acupunct Med 2018; 36(3): 176–182

[153] Priebe T, Stumpf SH, Zalunardo R. Can a science-based definition of acupuncture improve clinical outcomes?. J Integr Med 2017; 15(3): 165–171

[154] No authors listed. Acupuncture. NIH Consens Statement 1997; 15(5): 1–34

Acknowledgements

This work was supported by grants from the National Key R&D Program of China (No. 2019YFC1709500), the Project of Heilongjiang Province “TouYan” Innovation Team and the Project of Traditional Chinese Medicine Evidence-Based Capacity Improvement in 2023.

Compliance with ethics guidelines

Conflicts of interest Huichao Qin, Jiaxing Feng, and Xiaoke Wu declare that they have no conflict of interest.

This manuscript is a review article and does not involve a research protocol requiring approval by the relevant institutional review board or ethics committee.

RIGHTS & PERMISSIONS

2023 Higher Education Press