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Supported care options

Acupuncture and acupressure for period pain

Summary
Acupuncture is a traditional treatment that was first used in China thousands of years ago. Thin needles are inserted into the skin at certain points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.

Acupressure involves pressing deeply into particular places on the body that are said to reduce pain elsewhere. One traditional pain relief point can be found by pinching the web of your hand between your thumb and first finger. You have to hold the pressure firmly for half a minute, while breathing slowly and relaxing. This method is safe, free and worth trying.

Evidence
A recent review of research into acupuncture for period pain suggest that in can help. There is some evidence to support acupressure too. But there is not enough good evidence showing that it can help PMS.

Safety
Acupuncture is generally considered to be safe if practised by a trained acupuncturist. The most common problems are slight discomfort (common) and bruising (occasionally).

Cost
A session may cost £35-£50. Frequency of treatment will depend on you and your practitioner.

 

Further information
The following professional organisations can help you find a qualified practitioner:
Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society

View the evidence

The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis.
Woo HL, Ji HR, Pak YK, Lee H, Heo SJ, Lee JM, Park KS. Medicine (Baltimore). 2018 Jun;97(23):e11007.
The results of this study suggest that acupuncture might reduce menstrual pain and associated symptoms more effectively compared to no treatment or NSAIDs, and the efficacy could be maintained during a short-term follow-up period. Despite limitations due to the low quality and methodological restrictions of the included studies, acupuncture might be used as an effective and safe treatment for females with primary dysmenorrheas.
Link to Abstract

Acupressure for primary dysmenorrhoea: a systematic review.
Cho SH, Hwang EW. Complement Ther Med. 2010 Feb;18(1):49-56. Epub 2009 Nov 27.
SR of 4 RCTs. Conclusions: The available data from RCTs suggest that acupressure alleviates menstrual pain. These results were limited by the small number of trials.
Link to Abstract

Acupuncture for dysmenorrhoea.
Smith CA, Armour M, Zhu X, Li X, Lu ZY, Song J.  Cochrane Database Syst Rev. 2016 Apr 18;4:CD007854.
SR. Results: There is insufficient evidence to demonstrate whether or not acupuncture or acupressure are effective in treating primary dysmenorrhoea, and for most comparisons no data were available on adverse events.
Link to Abstract

Psychological therapies for PMS

Summary
Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says “CBT can help you to change how you think (‘cognitive’) and what you do (‘behavioural’)”. For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.

Evidence
Some studies suggest that psychological therapies may be helpful in PMS. Better, larger studies are needed.

Safety
These techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist.

Cost
In most areas in the UK your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions.

Further information
It is important to find a qualified counsellor or psychologist. Contact The British Psychological Society

View the evidence

Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.
Lustyk MK, Gerrish WG, Shaver S, Keys SL. Arch Womens Ment Health. 2009 Apr;12(2):85-96. Epub 2009 Feb 27.
SR. Conclusions: Our review revealed a dearth of evidence providing statistically significant CBT intervention effects.
Link to Abstract

Psychological intervention for premenstrual syndrome: a meta-analysis of randomized controlled trials.
Buysse JW, Montori VM, Krasnik C, Patelis-Siotis I, Guyatt GH. Psychother Psychosom. 2009;78(1):6-15. Epub 2008 Oct 14.
SR. Conclusions: Low quality evidence from randomized trials suggests that cognitive behavioural therapy may have important beneficial effects in managing symptoms associated with premenstrual syndrome.
Link to Abstract

Yoga for PMS

Summary
Yoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation.

Evidence
There is some evidence from research that yoga can help ease PMS symptoms.

Safety
Yoga is generally safe when practised appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.

Cost
Once you have learned the techniques you can do this at home, at no cost.

Further information
Classes are run in most areas by both private tutors and by adult education services.

To find a qualified teacher near you see also the The British Council for Yoga Therapy
and the The British Wheel of Yoga

View the evidence

Psychological effects of yoga nidra in women with menstrual disorders: A systematic review of randomized controlled trials.
Kim SD. Complement Ther Clin Pract. 2017 Aug;28:4-8.
There is evidence from two RCTs that yoga nidra may have favorable effects in terms of reducing psychological problems in women with menstrual disorders.
Link to Abstract

Systematic review of the efficacy of meditation techniques as treatments for medical illness.
Arias AJ, Steinberg K, Banga A, Trestman RL. J Altern Complement Med. 2006 Oct;12(8):817-32.
SR of 20 trials. Results: The strongest evidence for efficacy was found for epilepsy, symptoms of the premenstrual syndrome and menopausal symptoms.
Link to Abstract