This uterine bleeding case report involved a 17-year-old girl with a history of dysfunctional uterine bleeding (DUB) and severe dysmenorrhoea. She was treated with different conventional hormone therapies for 16 months without improvement.
Acupuncture treatment began while she was taking oral contraceptives. She received a total of 27 treatments in 17 weeks. Her menstrual cycle normalized after four weeks (10 treatments), with significantly less bleeding and pain. Furthermore, her cycle continued to improve throughout her remaining treatments. A six-month follow-up revealed that her menstrual cycle was completely regular, with no excess bleeding or pain. This uterine bleeding case report summarizes the acupuncture treatment for DUB in this adolescent girl.
Dysfunctional Uterine Bleeding
Dysfunctional uterine bleeding (DUB) is common in adolescent girls. Up to 30% of reproductive-aged women have menstrual irregularities requiring medical attention. Although Metformin and oral contraceptives may reduce irregular bleeding, these medications have only a moderate strength of evidence for effectiveness. However, Traditional Chinese acupuncture may provide benefits as an adjunctive or alternative treatment in cases where medical therapies have not been successful.
Case Presentation
A 17-year-old girl came to her pediatrician’s office reporting abnormal uterine bleeding since age 14. Her menstrual bleeding occurred 1–3 times a month, lasting 3–7 days each time, and was painful. At age 15, she was referred to a gynecologist for management because her irregularities worsened. A pelvic ultrasound and bloodwork were all normal. For the next 15 months, she received Depo-Provera (progestin) injections and OrthoEvra (estrogen) patches without improvement.
At the time of re-presentation to her pediatrician’s office, despite being on birth control, she had four periods of bleeding in the month prior, with breaks lasting 1–4 days in between periods. She used up to 10 heavy pads per day, with frequent flooding. In addition, she reported pain of 8/10 with menstruation, large clots up to 2 cm in size, headaches, dizziness, and five episodes of syncope. Furthermore, she shared that despite good compliance with medication, she had seen no improvement in her menses and was becoming hopeless about ever improving her symptoms. She asked what else she could try to regulate her menstruation.
Acupuncture for Uterine Bleeding
The author of this uterine bleeding case report, the patient’s pediatrician and fully trained and licensed acupuncturist, offered acupuncture treatment to manage her DUB and severe dysmenorrhoea. Based on traditional Chinese medicine (TCM) diagnostic criteria, the patient had abnormal uterine bleeding due to ‘heat and phlegm with blood stasis.’
The treatment principle involved clearing heat, transforming phlegm, reducing stress, invigorating blood, and unblocking her conception (menstrual) channels. The patient had not heard of acupuncture prior to the treatment, but after a trial of one needle, she was willing to try the treatment.
Acupuncture Treatment Protocol
The practitioner based the acupuncture treatment point selection on her TCM diagnosis. Acupoint selection included scalp points, ear points, distal points, and low abdominal points. The plan was to treat her three times a week, then reduce sessions to two times weekly after a few weeks, and gradually wean her off treatment depending on her response. After that, she was to continue her medications.
Acupuncture started three times weekly on day two of her period. Her period lasted for six days. Then, on the thirteenth day of treatment, during the placebo week of her oral contraceptives, she had another period that lasted six days. Notable was the fact that this period had less pain and blood volume. At this point, the practitioner reduced sessions to twice weekly while continuing her medications. On the twenty-ninth day of treatment, she had a five-day menstrual period, this time with minor pain. She did not have a period on day 21 of the second oral contraceptive pack.
Thirty-two days after her last period, on day sixty-one of treatment, her next period started and lasted for five days. Because she was not having menses corresponding to placebo weeks of her oral contraceptives, her doctor discontinued the medication. Two weeks later, she reduced acupuncture to once a week, continuing for another five weeks, totaling twenty-seven sessions. She continued having regular periods every 26–37 days without pain.
Acupoint Selection for Uterine Bleeding
The practitioner utilized the following body acupoints:
LU7, ST44, SP9, SP10, LV3, LV4, LV6, Zi Gong, ST29.
Ear points included: Shen Men, Kidney, Spleen, and Pituitary.
Patient Follow-Up
Four months after the last weekly treatment, the patient in this uterine bleeding case report continued to have regular menstruation every 23–25 days, with each period lasting 4–5 days. In addition, her bleeding was normal, and there was no pain.
Uterine Bleeding Discussion
Menstrual disorders are common complaints among adolescent girls. The most common cause is DUB from an ovulation cycle leading to irregular bleeding. During the first year of menstruation, 50% of young women experience irregular cycles. However, by the third year, 95% of cycles have a regular duration and normal blood volume levels.
There are many causes of abnormal uterine bleeding. Therefore, DUB is a diagnosis of exclusion. The workup should rule out pregnancy, von Willebrand disease, thyroid dysfunction, uterine structural abnormalities, Polycystic Ovary Syndrome (PCOS), and other systemic, hormonal, and coagulation dysfunctions.
After excluding other diagnoses, the provider will determine a treatment method for DUB based on its severity. For example, observation with a menstrual calendar is appropriate for mild cases, while hospitalization with blood transfusion may be necessary for severe cases. Conventional treatment typically involves hormonal therapy and iron supplementation for most cases of moderate DUB.
DUB Treatment Options
Conventional Western medical treatment consists of non-steroidal anti-inflammatory drugs, progestins, combined oral contraceptives, IUDs, danazol, and tranexamic acid.
Two acupuncture treatment studies for delayed menstrual cycles have shown promising results as a treatment for DUB. One study showed improvement in menstrual irregularities after 14 electroacupuncture treatments in PCOS patients. At the same time, another demonstrated a more significant improvement by using mind-calming and menstruation-regulating needling techniques every other day for three cycles.
Acupuncture has been widely used for women’s menstrual disorders in China and Taiwan for centuries. However, modern research on its mechanism and effectiveness remains scarce. Nevertheless, for selected patients, acupuncture can be an excellent alternative treatment for women suffering from DUB and dysmenorrhoea.
Patient’s Perspective
The patient in this uterine bleeding case report gave an encouraging testimonial afterward. “I started the acupuncture treatment for my problem with my doctor for a good period of time, and my results were amazing! Now it all has been going really great. She helped me a lot. I appreciate her a lot for helping me after the main hospital couldn’t. She could! I’m sure this treatment can help more girls with the same problem out there. Thank you, doctor!”
Next Steps
Try acupuncture if you or a loved one struggle with excessive uterine bleeding, irregular periods, or dysmenorrhea (painful periods). Treatments are safe, and the benefits are long-lasting.
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Reference
Penn YY, Acupuncture treatment for dysfunctional uterine bleeding in an adolescent, Case Reports 2018;2018:bcr-2018-224725.
Focus keyphrase: Uterine Bleeding Case Report
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