This Covid-19 menstrual irregularity study examined acupuncture’s effect on restoring regular cycles following an illness. Since the outbreak of COVID-19, many women have suffered from menstrual irregularity following infection. A recent retrospective, cross-sectional study showed that among 237 patients with confirmed COVID-19, 28% had adverse changes in their menstrual cycle, with a decrease in volume (20%) and a prolonged cycle (19%). These results confirm the relationship between COVID-19 and menstrual disturbances.
Another cross-sectional study revealed that COVID-19 affected the menstrual cycles in women between 21 and 42 years old in the following ways:
- Unpredictable periods (the dates and length changed each month).
- Dysfunctional blood volume changes (from light to heavy or vice versa).
- The number of days of bleeding varied significantly.
- There was random spotting throughout the month.
- Premenstrual syndrome (PMS) worsened.
Normal Menstrual Cycle
By definition, a regular menstrual cycle occurs every 21 to 35 days lasting two to seven days for most women. The average menstrual cycle is 28 days, whereas an irregular menstrual cycle can be defined as follows:
- Amenorrhea is the absence of menstruation for one or more menstrual periods.
- An early menstrual cycle is at least seven days premature, while a delayed cycle is seven or more days late.
- Menstrual irregularities come from an imbalance of hormones, particularly estrogen and progesterone.
- Ongoing irregular menstruation can make it difficult to conceive.
- The adverse effects of irregular periods often disrupt patients’ everyday life and work.
Acupuncture Treats Menstrual Irregularities
Acupuncturists have treated gynecological diseases to remedy these problems for thousands of years in China. This randomized controlled trial (RCT) evaluated the benefits and safety of acupuncture in treating Covid-19 menstrual irregularity.
Previous clinical studies have demonstrated the efficacy and safety of acupuncture in improving menstrual frequency. Further studies show that acupuncture helps regulate reproductive issues, including irregular menstruation and hormonal imbalances. In addition, acupuncture can reduce stress, enhance blood flow in the pelvic area, and thicken the endometrium, all of which improve the menstrual cycle.
How Acupuncture Works
Acupuncture promotes menstrual cycle recovery by selecting specific acupoints. Artificial-cycle therapy with acupuncture is remarkably successful in regulating menstrual cycles. Modern studies confirm that stimulating relevant acupoints can regulate the function of the hypothalamic-pituitary-adrenal axis and promote the development and secretion of follicles to improve hormone levels. Acupuncture also relieves the clinical symptoms of PMS as it regulates endocrine hormones.
Covid-19 Menstrual Irregularity Study
Investigators collected data from 40 female patients at the Montreal at Acuenergie Acupuncture Clinic from June 2020 to May 2022. Their primary reason for seeking acupuncture was due to changes in their menstrual cycle after a COVID-19 infection. Among the 40 cases, 12 developed early menstruation, 15 had delayed menstruation, and 13 developed amenorrhea (no period). Patients ranged in age between 22 and 45, and the breakdown of case distribution according to age was: age 22 to 25, 5 cases; age 26 to 30, 8 cases; age 31 to 35, 11 cases; age 36-40, 6 cases; age 41-45, 10 cases. The average age was (33.9 ± 6.7) years.
Patients’ most common adverse menstrual changes included:
- Irregular menstruation (early or delayed).
- Abdominal pain or cramps.
- Heavy bleeding or scant blood flow.
- Cycles that are too short or too long.
- Unusual clotting of the blood.
- Headaches.
- Dizziness.
- Tiredness.
- Poor memory.
- Lower back pain.
- Irritability.
- Tender breasts.
- Night sweats.
- Bloating.
- Sugar cravings.
- Anxiety.
- Depression.
- Anemia.
- Emotional distress.
- Sadness or crying.
- Weight gain.
- Hair loss.
TCM Pattern Imbalances
Investigators in this Covid-19 menstrual irregularity study assigned the 40 patients into three patterns based on whether their main symptoms were related to liver qi stagnation, qi and blood deficiency, or spleen and kidney yang deficiency.
Liver Qi Stagnation Symptoms and Strategy
Irregular menstruation (early or delayed), heavy or light menstrual volume, dark red blood with clots, the blood flow is not smoothy, accompanied by chest, epigastrium or abdomen distension, premenstrual tension, anger, sighing, anxiety, depression, mood swings, moodiness, melancholy, hypochondria, a persistent feeling of a lump in the throat, premenstrual breast distension, dysmenorrhea, a red tongue with a thin coating, and a wiry pulse.
The Liver Qi Stagnation treatment strategy was to soothe the liver and invigorate the liver qi.
Qi and Blood Deficiency Symptoms and Strategy
Menstrual irregularity (early or delayed), heavy or light menstrual volume, light red blood with no clots, increased or decreased menstrual volume, accompanied by palpitations, fatigue, dizziness, anemia, insomnia, pale or sallow complexion, poor appetite, loose stools, weak voice, poor memory, general weakness, shortness of breath, numbness in the skin and limbs, a pale tongue with a white coating, a thin and deep pulse.
The qi and blood deficiency strategy was to nourish qi and blood, invigorate blood and qi circulation, and strengthen the spleen and kidney qi.
Spleen and Kidney Yang Deficiency Symptoms and Strategy
Irregular menstruation (early or delayed), heavy menstrual flow, light red blood, accompanied by fatigue, tinnitus, dizziness, weak legs, gassiness, bloating, abdominal fullness, lack of appetite, lower back pain, frequent nocturnal urination, cold limbs, sensitive to cold, pale or sallow complexion, a puffy, pale and wet tongue with a slippery coating and tooth marks on the sides, a deep, weak and slow pulse.
The spleen and kidney yang deficiency treatment strategy included tonifying and warming the kidney and spleen yang, invigorating the spleen and kidney qi, and nourishing qi and blood.
Acupuncture Treatment Methods
Practitioners in this Covid-19 menstrual irregularity study applied the following acupoints to all patients using three types of acupuncture:
- Electro-Acupuncture Points: Tianshu (ST25), Zigong (EX-CA1), Sanyinjiao (SP6), Xuehai (SP10).
- Auricular (Ear) Acupuncture Points: Gomadptropin, Endocrine, Uterus, Kidney, Liver, Pituitary, Ovary.
- Body Acupoints without Electroacupuncture: Guanyuan (REN4), Zusanli (ST36), Neiguan (PC6), Gongsun (SP4), Hegu (LI4), Taichong (LIV3).
In addition, patients received specific points based on their pattern diagnosis.
- Liver qi stagnation patients also received Ganshu (BL18) and Qimen (LIV14).
- Qi and blood deficiency patients also received Pishu (BL20), Geshu (BL17), and Qihai (REN6).
- Spleen and kidney yang deficiency received Diji (SP8) and Taixi (KID3).
Practitioners manipulated the acupoints to elicit a “Deqi” sensation of soreness, numbness, and heaviness at the needle site and retained needles for 30 minutes once a week for 12 weeks.
Treatment Outcomes
Of the 40 patients in this Covid-19 menstrual irregularity study, 33 achieved full recovery (clinically cured), while 7 had less than full recovery (clinically not cured). The overall effectiveness rate was 82.5%. For the 33 cured patients, their menstrual duration, volume, and length had completely returned to normal following 12 sessions of acupuncture. In addition, acupuncture healed the associated main symptoms, decreased premenstrual syndrome (PMS), and improved quality of life.
Discussion
From a TCM etiology and pathology perspective, COVID-19 results from an invasion of the body by “Cold-Damp with Toxins” primarily located in the lungs and spleen. As a result, COVID-19 not only damages the respiratory system but also damages the brain, lungs, heart, liver, kidneys, blood system, nervous system, and reproductive system. In addition, contracting COVID-19 can impact both menstruation and the menstrual cycle.
The Importance of the Kidneys
According to Traditional Chinese Medicine (TCM) theory, menstrual blood comes from the kidneys. The Yellow Emperor’s Classic of Internal Medicine (475 to 221 BC) states: “In general, the reproductive physiology of woman is such that at seven years of age, her kidney energy is strong. At fourteen years, Tian Gui, her fertility essence is mature, the Ren meridian and Chong meridian are flourishing, menstruation begins, and conception is possible.”
Fu Shan (1607-1684 AD) stated in his famous treatise Fu Qingzhu’s Obstetrics and Gynecology: “Kidney is the original source of menstruation.” and “The spleen is acquired, the kidney is innate. The spleen cannot generate without innate qi.” Therefore, TCM believes that menstrual disorders are related to the function of the kidneys as well as to the spleen, liver, qi, and blood in the uterus, and disharmony between the Chong meridian and the Ren meridian.
Acupuncture Treats Menstrual Irregularity
Acupuncture treats menstrual irregularities by using specific acupoints to improve the flow of blood and qi to the ovaries and uterus, nourishing the blood and qi, soothing the liver, invigorating liver qi, invigorating the spleen and kidney qi, and restoring harmony between the Chong and Ren meridians.
Acupuncture Points and their Effects
This Covid-19 menstrual irregularity study utilized electro-acupuncture at acupoints Tianshu (ST25), Zigong (EXCA1), Sanyinjiao (SP6), and Xuehai (SP10). The functions of each acupoint are as follows.
Electroacupuncture Points
- Tian Shu (ST25) belongs to the stomach meridian and is the front mu point of the large intestine meridian. It treats menstrual irregularities, amenorrhea, painful menstruation, fibroids, cysts, leukorrhea, and infertility. Furthermore, ST25 addresses intestinal issues such as constipation, diarrhea, dysentery, distension, abdominal pain or distension, bloating, indigestion, acute and chronic gastritis, and acute and chronic enteritis.
- Zigong (EX-CA1) is one of the extraordinary points and treats gynecological diseases. Zigong’s primary functions are to lift and regulate qi in the lower burner to regulate menstruation and reduce pain. It primarily treats prolapse of the uterus, menstrual irregularities, dysmenorrhea, lower abdominal pain, lumbar pain, hernia, pyelonephritis, cystitis, and orchitis.
- Sanyinjiao (SP6) is the meeting point of the three yin meridians of the foot, which strengthens the spleen, soothes the liver, and benefits the kidneys. It’s an essential point in treating gynecological conditions such as menstrual irregularities, dysmenorrhea, metrorrhagia, leukorrhea, amenorrhea, prolapse of the uterus, dystocia, postpartum faintness, persistent lochia, and infertility.
- Xuehai (SP10) means the “Sea of Blood.” As the name implies, SP 10 is the point for treating disorders relating to the blood (Blood Stasis, Heat in the Blood). It invigorates and cools the blood to treat menstrual irregularities, metrorrhagia, urticaria, eczema, and erysipelas.
Regular Acupoints
- Guanyuan (REN4) is the front-mu point of the small intestine, the intersection of the Ren vessel, and the three yin meridians of the foot (spleen, liver, and kidney). Guanyuan (REN4) tonifies kidney qi, nourishes blood and yin, strengthens the uterus and regulates menstruation. It treats gynecological diseases such as menstrual irregularities, leukorrhea, dysmenorrhea, prolapse of the uterus, infertility, and postpartum bleeding.
- Zusanli (ST36) is the most essential point on the stomach meridian, which regulates the spleen and stomach, and qi and blood. It has the special function of invigorating the spleen and qi, which strengthens the body’s immune system.
- Hegu (LI4) is the yuan-source point of the large intestine meridian, which dispels wind, relieves superficies syndrome, clears heat, opens the orifices, dredges the meridians, and activates the collaterals, and sedates and relieves pain.
- Taichong (LIV3) is the yuan-source point of the liver meridian, which calms the liver and shock, soothes the liver, and regulates qi. Hegu (LI4) and Taichong (LIV3) are compatible acupoints. The combination of Liv3 and LI4 is classically known as “The Four Gates” of the body, which promote qi circulation.
- Neiguan (PC6) is crucial for moving qi and blood in the chest. It nourishes heart qi, nourishes the blood, calms the mind, and stops dizziness.
- Gongsun (SP4) is the luo-connecting point of the spleen meridian and master point of the Chong vessel. Gongsun (SP4) pairs with Neiguan (PC6) to treat menstrual irregularities, retention of the placenta, and postpartum faintness. Gongsun (SP4) also treats epigastric pain, chest congestion, acute gastric pain, gastric distention, poor appetite, pain around the umbilical region, and diarrhea.
Additional Acupoints
- Taixi (KID3) is the yuan-source point of the kidney meridian. Therefore, KID 3 is important to use for kidney deficiency patterns. Clinically, yuan-source points are of great significance in treating diseases of the internal organs, including menstrual irregularities, impotence, spermatorrhea, frequent need to urinate, deafness, tinnitus, lumbar pain, headache, dizziness, blurring of vision, toothache, swelling of pharynx, cough, asthma, diabetes, and insomnia.
- Qihai (REN-6) is one of the essential points for tonifying yang and primordial qi.
- Diji (SP8) is the xi-cleft point of the spleen meridian. It removes blood stagnation, regulates menstrual irregularities, and stops bleeding.
- Qimen (LIV14) is the front-mu point of the Liver Meridian, the intersection of the liver and spleen meridians and the Yin Wei vessel. The clinical applications are depression, chest pain, abdominal distension, hiccups, and acid regurgitation.
Acupuncture improves the activity of the hypothalamic-pituitary-ovarian (HPO) axis, which is the dominant system controlling ovulation. In addition, electro-acupuncture has both anti-inflammatory and cardio-protective effects. Electro-acupuncture also has a significant therapeutic effect in improving the menstrual cycle.
Conclusions
This Covid-19 menstrual irregularity study shows that electro-acupuncture not only restores the menstrual cycle of patients but also adjusts and improves hormone levels (E2, FSH, LH). In addition, the continuous wave of an electro-acupuncture device enhances the effects of regulating qi and blood. It dilates the blood vessels in the body, which increases blood circulation, improves a hypoxic-ischemic state, and regulates blood flow, all of which result in regulating the menstrual cycle.
Furthermore, the study indicates that electro-acupuncture is an effective treatment for menstrual irregularities after a COVID-19 infection. It restores the menstrual duration, volume, and length of the cycle. The study also shows that acupuncture is effective for naturally improving a patient’s health outcomes.
Next Steps
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Covid-19 Menstrual Irregularity Reverence
Xiangping Peng, Guanhu Yang (2022) Effectiveness of electro-acupuncture for the treatment of long covid menstrual irregularities. Medical & Clinical Research 7(9):01-05. Medical & Clinical Research Med Clin Res, 2022 Volume 7 | Issue 9 | 01 ISSN: 2577 – 8005 Xiangping Peng, Acuenergie Clinic, Canada. www.medclinres.org
Focus Keyphrase: Covid-19 Menstrual Irregularity
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