Heal Endo

View Original

Acupuncture for Endometriosis

Katie Edmonds

By Dr. Merritt Jones, LAc, DAIM, MS, CNC

Endometriosis may fall under the label of a "chronic" condition, but I firmly believe it doesn't have to dictate the course of your life. In fact, with the right interventions, it's entirely possible to craft a life that is rich, fulfilling, and well-rounded, even while navigating the challenges of endo.

The question that arises, then, is which interventions? With many of us suffering not just from endometriosis itself but also from (very real) time and budget constraints, being told to add another healing modality can seem overwhelming. Many will absolutely need a properly-done surgery, others an ever-evolving nutritional strategy, consistent pelvic floor physical therapy, gut healing, or a proficient team for mental and emotional well-being. For some of us, managing endometriosis truly “takes a village."

However, after experiencing the complexities of living with advanced-stage endometriosis and adenomyosis firsthand—and having established a thriving integrative reproductive health clinic centered around holistic well-being—I can confidently state that acupuncture is an incredible option for many with endo to at least consider.

Research is right there in tow, supporting acupuncture as a sought-after tool in the arsenal against endometriosis. And for good reason – its potential to address some of the most prevalent symptoms is remarkable. From pain management to chronic bloating, fatigue, anxiety, depression, and more, acupuncture has demonstrated its capacity to restore balance and promote comfort.

Curious about how acupuncture accomplishes this? Join me as we delve into the transformative ways in which acupuncture can alleviate the challenges posed by endometriosis and contribute to your overall well-being.

How Does Acupuncture Help Endometriosis?

Acupuncture is a branch of Traditional Chinese Medicine developed thousands of years ago that is still practiced worldwide today. It involves gently inserting very small needles into specific areas on the body, usually along “meridians” (areas of the body that closely mirror the nervous, vascular, and musculoskeletal systems). When you receive acupuncture, your acupuncturist will choose points based on what patterns and symptoms you present with.

Although this may sound like an unusual treatment (needles in my skin to help my endo?!), there is abundant research supporting that acupuncture is indeed an effective tool for a variety of common symptoms, including those commonly associated with endometriosis, such as:

  • Dysmenorrhea (extreme period pain)

  • Gastrointestinal issues including bloating, nausea, constipation, diarrhea + IBS type symptoms

  • Chronic stress, anxiety + depression

  • Infertility (often related to inflammation + scarring)

  • Fatigue

  • Pelvic pain

  • Anxiety + depression

  • Scar tissue

Sounds a lot like endometriosis symptoms! Let me explain some of the specifics of how acupuncture helps manage these symptoms:

1) Acupuncture Can Promote Blood Flow + Improve Circulation.

By gently placing needles at strategic points on the body, we are able to “direct” the body’s resources to the area(s) in need.

To help simplify this concept, think about how your body handles a cut, bug bite, or bruise — your body will temporarily increase circulation and immune activity at that area to promote healing.

Although the insertion of acupuncture needles does not hurt the way that a cut or bite might, when an acupuncture needle is gently inserted into a specific point, it creates a kind of stimulation that similarly engages the body systems to promote healing.

This is especially helpful for those with endometriosis, as we know that many living with endo deal chronic pain, poor circulation, irregular vascularization in the pelvis and chronic inflammation. Acupuncture can help to promote more regular blood flow and a healthy immune response, thus reducing chronic inflammation and overall symptoms.

2) Acupuncture Can Reduce Stress + Promote a Sense of Calm

Stress management is perhaps one of the things that acupuncture is most well-known for. When receiving acupuncture, it is common to fall asleep while on the treatment table, or at least slip into a deeply restful place. Often this peaceful sensation lasts for a few days or longer after treatment.

This is because acupuncture engages the “parasympathetic” nervous system, aka the part of the nervous system that helps us to feel calm and relaxed. It also boosts the production of calming brain chemicals like serotonin, dopamine and endorphins.

3) Acupuncture for Endometriosis-Related Fertility, Infertility, and Hormone Balance

Acupuncture can help promote more regular ovulation, which leads to more predictable cycles and better hormone balance. This is largely due to the beneficial effect that regular acupuncture can have on the nervous system and the hypothalamus-pituitary-ovarian axis, or the “HPO” axis.

Essentially, acupuncture can help strengthen the “communication line” between the part of your brain responsible for signaling ovulation and your ovaries, where ovulation occurs.

In addition to promoting more regular ovulation, acupuncture is also effective for promoting better blood flow to the pelvis, which also brings better blood flow to the ovaries and uterus, thus potentially promoting improved egg quality and improved uterine lining. For this reason, acupuncture is often sought out as a tool to promote improved fertility.

In addition to supporting healthy ovulation (and thus supporting progesterone production), acupuncture may also help with to balance hormones like cortisol, insulin, DHEA, estrogen and testosterone. It may also help to balance the production of prostaglandins, a hormone like substance which can promote inflammation, pain, heavy periods and cramping.

4) Acupuncture for Endometriosis and Menstrual Pain

Regular acupuncture can help to manage chronic inflammation which, for those living with endometriosis, is often a huge contributor to chronic pain and dysmenorrhea. One primary way in which acupuncture helps to reduce pain is by reducing inflammation and promoting healthy blood circulation.

Also, as mentioned above, acupuncture helps to promote a parasympathetic nervous system response, essentially helping to signal your body to move into a calmer place. This can help to reduce pain, even endometriosis-related pain. A chronically “up-regulated” nervous system (that is essentially stuck in the “fight or flight” response, something many of us with endometriosis experience) makes it challenging to get out of a rather vicious cycle of pain.

Similarly to how it works for stress and mood, those same soothing neurochemicals that are released when needles are placed also support your body in better handling pain.

5) Acupuncture Can Support Better Gut Health

Most of us living with endometriosis unfortunately know how often gut issues come with the territory. Acupuncture can be a helpful tool in promoting better gut health and help address issues like nausea, constipation, loose stool, bloating, gas and heartburn (the basics of “endo belly”). It can be especially useful while undergoing treatment for SIBO, the notorious gut microbiome imbalance commonly seen with endometriosis. This is in large part because acupuncture can help to promote better gut motility, which is often a key component of SIBO treatment that gets overlooked.

How to Find an Acupuncturist for Endometriosis

When looking for an acupuncturist to support you with your endometriosis symptoms, it’s important to do a little homework. You want to look for someone who holds a master's degree or doctorate degree in the field and who is currently licensed to practice (you can check licenses via the acupuncture board websites).

Beyond that, you’ll ideally want to find a practice specializing in reproductive health. In smaller or more rural areas, this might not be possible, and it’s ok to see the acupuncturist you have access to, though you may have to provide some education on the complexities of endometriosis. In more urban areas, however, you should be able to find a provider or practice that exclusively works with reproductive health and thus sees many endometriosis patients.

A few questions that might be helpful to ask include:

“Do you specialize in reproductive health?”

      • Ideally, the answer is simply yes.

“Can you share a quick summary of your understanding of endometriosis?”

      • While it’s not life or death if your acupuncturist has a perfect understanding of endometriosis, knowing the basics is important so they can best formulate a treatment plan for you. Understanding “what” endometriosis is speaks to the overall knowledge of the provider. Since acupuncturists often work with other modalities too (nutrition, herbs, supplements), it’s a good way to screen if they have really done their homework before you take all their diet/lifestyle/herbal recommendations to heart.

“How many endometriosis patients do you typically work with in a week?”

      • The response here will depend on the size and volume of the practice, but ideally a significant portion of their patient base would be endometriosis patients. In our practice, we work exclusively with reproductive health issues, and about 40%-50% of our patients are endo patients.

“Can you explain your approach to endometriosis?”

      • Ideally, a practitioner would mention such facets as bringing blood flow back to the pelvis, strengthening the HPO axis, regulating the nervous system, reducing pain, bloating, etc.

      • Hopefully, the acupuncturist has a strong referral relationship with a qualified excision surgeon and a trusted network of endo experts to refer to! If not, that’s okay, but we can dream.

What to Expect When Receiving Acupuncture

Listen, I know that the idea of lying on a table while a stranger sticks needles in you might sound… scary. But here’s the thing — the needles that an acupuncturist uses are soooooo small compared to the needles you’re used to seeing in your regular doctor’s office.

While there is a wide spectrum of acupuncture techniques ranging from very gentle to more heavy-handed, acupuncture shouldn’t hurt. If it does, you must ask your acupuncturist to use a gentler hand, or find a different acupuncturist.

I always tell my first-time patients that “acupuncture may feel a bit unusual, but it shouldn’t hurt. It’s common to experience sensations of heaviness, a gentle achy sensation where the needle is placed, or a tingly sensation. If anything is uncomfortable, let me know, and I’ll adjust it.”

Your provider will first need to perform an intake, which typically takes 30-60 minutes, depending on the practice. This is where they gather your history and collect info to create a treatment plan for you. After that, most acupuncture sessions take 30-60 minutes, depending on how your provider practices.

For endo, we typically advise weekly acupuncture for at least 3-4 months and then as needed to help with symptoms as they arise. Scheduling sessions in the days before you expect you might experience a flare of symptoms or during an acute/active flare is also a good idea.

If you’ve been considering adding acupuncture to your endo routine, I hope this article helped to answer any questions you may have. For most, living with endo means there will be some significant “village building” required. You deserve to find a care team that feels deeply supportive. This disease can be a beast, but it doesn’t have to dominate your life. You’ve got this.

With love and gratitude,
Dr. Merritt Jones

LAc, DAIM, MS, CNC

NaturalHarmonyHealth.com

References

Acupuncture  for blood flow + dysmenorrhea:

Yu YP, Ma LX, Ma YX, Ma YX, Liu YQ, Liu CZ, Xie JP, Gao SZ, Zhu J. Immediate effect of acupuncture at Sanyinjiao (SP6) and Xuanzhong (GB39) on uterine arterial blood flow in primary dysmenorrhea. J Altern Complement Med. 2010 Oct;16(10):1073-8. doi: 10.1089/acm.2009.0326. Epub 2010 Oct 9. PMID: 20932189.

Acupuncture for pain management:

Patel M, Urits I, Kaye AD, Viswanath O. The role of acupuncture in the treatment of chronic pain. Best Pract Res Clin Anaesthesiol. 2020 Sep;34(3):603-616. doi: 10.1016/j.bpa.2020.08.005. Epub 2020 Aug 8. PMID: 33004170.

Acupuncture for endometriosis symptoms:

Mira TAA, Buen MM, Borges MG, Yela DA, Benetti-Pinto CL. Systematic review and meta-analysis of complementary treatments for women with symptomatic endometriosis. Int J Gynaecol Obstet. 2018 Oct;143(1):2-9. doi: 10.1002/ijgo.12576. Epub 2018 Jul 9. PMID: 29944729.

Acupuncture for endometriosis pain:

Lund I, Lundeberg T. Is acupuncture effective in the treatment of pain in endometriosis? J Pain Res. 2016 Mar 24;9:157-65. doi: 10.2147/JPR.S55580. PMID: 27069371; PMCID: PMC4818044.

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 May;119(5):815-823. doi: 10.1016/j.fertnstert.2023.01.034. Epub 2023 Jan 27. PMID: 36716811.

Acupuncture for fertility

Quan K, Yu C, Wen X, Lin Q, Wang N, Ma H. Acupuncture as Treatment for Female Infertility: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Alternat Med. 2022 Feb 16;2022:3595033. doi: 10.1155/2022/3595033. PMID: 35222669; PMCID: PMC8865966.

Guven PG, Cayir Y, Borekci B. Effectiveness of acupuncture on pregnancy success rates for women undergoing in vitro fertilization: A randomized controlled trial. Taiwan J Obstet Gynecol. 2020 Mar;59(2):282-286. doi: 10.1016/j.tjog.2020.01.018. PMID: 32127151.

Mo X, Li D, Pu Y, Xi G, Le X, Fu Z. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med. 1993 Jun;13(2):115-9. PMID: 8412285.

Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril. 2002 Apr;77(4):721-4. doi: 10.1016/s0015-0282(01)03273-3. PMID: 11937123.

Acupuncture nausea

Morehead A, Salmon G. Efficacy of Acupuncture/Acupressure in the Prevention and Treatment of Nausea and Vomiting Across Multiple Patient Populations: Implications for Practice. Nurs Clin North Am. 2020 Dec;55(4):571-580. doi: 10.1016/j.cnur.2020.07.001. Epub 2020 Oct 14. PMID: 33131633.

Acupuncture for gut motility

Yu Z. Neuromechanism of acupuncture regulating gastrointestinal motility. World J Gastroenterol. 2020 Jun 21;26(23):3182-3200. doi: 10.3748/wjg.v26.i23.3182. PMID: 32684734; PMCID: PMC7336328.

Acupuncture for gut symptoms

Song G, Fiocchi C, Achkar JP. Acupuncture in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2019 Jun 18;25(7):1129-1139. doi: 10.1093/ibd/izy371. PMID: 30535303.

Acupuncture nervous system

Stratton, Pamela MD; Khachikyan, Izabella MD; Sinaii, Ninet PhD; Ortiz, Robin BS; Shah, Jay MD. Association of Chronic Pelvic Pain and Endometriosis With Signs of Sensitization and Myofascial Pain. Obstetrics & Gynecology 125(3):p 719-728, March 2015. | DOI: 10.1097/AOG.0000000000000663Li

YW, Li W, Wang ST, Gong YN, Dou BM, Lyu ZX, Ulloa L, Wang SJ, Xu ZF, Guo Y. The autonomic nervous system: A potential link to the efficacy of acupuncture. Front Neurosci. 2022 Dec 8;16:1038945. doi: 10.3389/fnins.2022.1038945. PMID: 36570846; PMCID: PMC9772996.

Acupuncture for anxiety

Amorim D, Amado J, Brito I, Fiuza SM, Amorim N, Costeira C, Machado J. Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the clinical research. Complement Ther Clin Pract. 2018 May;31:31-37. doi: 10.1016/j.ctcp.2018.01.008. Epub 2018 Jan 31. PMID: 29705474.

Hullender Rubin LE, Smith CA, Schnyer RN, Tahir P, Pasch LA. Effect of acupuncture on IVF-related anxiety: a systematic review and meta-analysis. Reprod Biomed Online. 2022 Jul;45(1):69-80. doi: 10.1016/j.rbmo.2022.02.002. Epub 2022 Feb 10. PMID: 35570176.