Primary Dysmenorrhea (PD)
Conditions
Keywords
Thread embedding acupuncture, Traditional Chinese medicine, Primary dysmenorrhea
Brief summary
The goal of this clinical trial is to learn whether thread-embedding acupuncture can help lower menstrual pain in women aged 18 to 29 years with primary dysmenorrhea. Thread-embedding acupuncture is a type of acupuncture in which a small absorbable thread is placed into selected acupuncture points to provide longer-lasting stimulation. The main questions this study aims to answer are: * Does thread-embedding acupuncture combined with standard treatment lower menstrual pain more than standard treatment alone? * Does it improve other menstrual symptoms and lower the need for ibuprofen? What unwanted effects occur during the study? Researchers will compare participants who receive thread-embedding acupuncture plus standard treatment with participants who receive standard treatment alone. Participants will: * Use heat therapy when menstrual pain begins. * Take ibuprofen as rescue medicine when pain is severe, according to the study instructions. * If assigned to the thread-embedding acupuncture group, receive thread-embedding acupuncture before menstruation during two menstrual cycles. * Record menstrual pain, related symptoms, and ibuprofen use during the study. * Be assessed at the start of the study, during two treatment cycles, and during one menstrual cycle after treatment ends.
Detailed description
This randomized, assessor-blinded, controlled clinical trial evaluated thread-embedding acupuncture (TEA) as an adjunct to standard treatment for primary dysmenorrhea in women aged 18 to 29 years. The study was conducted at the University Medical Center Ho Chi Minh City, Branch 3, Vietnam, from September 2024 to April 2025. Participants were randomly assigned in an approximately 1:1 ratio to either the TEA group or the control group. Both groups received the same standard treatment. The TEA group additionally received thread-embedding acupuncture. Standard treatment included heat therapy and rescue ibuprofen. A warm pack at approximately 40 to 45°C was applied to the lower abdomen for 15 to 20 minutes when menstrual pain reached a visual analogue scale (VAS) score of 4 or higher. Heat therapy could be repeated every 2 to 3 hours as needed. Ibuprofen 400 mg was used as rescue medicine when menstrual pain reached a VAS score of 7 or higher and was continued until pain or discomfort improved to a VAS score below 4, for a maximum of 3 days during each menstrual cycle. Thread-embedding acupuncture was performed by a licensed physician trained and certified in the technique. Sterile, single-use, preloaded polydioxanone (PDO) absorbable threads were used. Each device consisted of a 30-gauge needle with a 25-mm shaft and a 30-mm PDO thread. Participants assigned to the TEA group received two courses of thread-embedding acupuncture. Each course was performed 3 to 7 days before the expected onset of menstruation during two consecutive menstrual cycles. The core acupuncture points used for all participants in the TEA group were: Sanyinjiao (SP6), Guanyuan (CV4), Qihai (CV6), Xuehai (SP10), Zigong (EX-CA1) Additional points were selected according to the participant's Traditional Chinese Medicine (TCM) syndrome pattern. For participants classified as having an Excess Cold pattern, the additional points were: Pishu (BL20), Shenshu (BL23), Ganshu (BL18), Neiguan (PC6), Taichong (LR3) For participants classified as having Qi stagnation and Blood stasis, the additional points were: Tianshu (ST25), Zhongdu (LR6) Acupuncture point locations were determined according to World Health Organization standards. Participants were followed over three consecutive menstrual cycles. Assessments were performed at four time points: * T0: baseline, before treatment * T1: first intervention menstrual cycle * T2: second intervention menstrual cycle * T3: first menstrual cycle after completion of the TEA intervention The primary outcome was menstrual pain intensity measured using a 10-cm visual analogue scale. The scale ranged from 0, meaning no pain, to 10, meaning the worst pain imaginable. Participants marked the point that best represented their pain intensity. The highest VAS score during the most recent menstrual cycle before enrollment was recorded as the baseline value. Follow-up VAS scores were recorded during T1, T2, and T3. Secondary outcomes included TCM syndrome scores and rescue ibuprofen use. TCM syndrome scores were assessed using the syndrome-specific scoring instrument described by Le Ngo Minh Nhu and Trinh Thi Dieu Thuong. Participants were evaluated for either the Excess Cold pattern or the Qi stagnation and Blood stasis pattern. Syndrome scores were recorded at T0, T1, T2, and T3. Rescue medication use was measured as the total number of 400-mg ibuprofen tablets taken during each menstrual cycle. Participants contacted the outcome assessor when their pain reached a VAS score of 7 or higher. The assessor then recorded the amount of ibuprofen used during that cycle. Safety was monitored throughout the study. Adverse events occurring in the TEA group were actively recorded after treatment. Events monitored included pain at the insertion site, dizziness, local discomfort, local skin irritation such as itching or redness, local inflammation, bleeding, chondritis, and nausea. The study also monitored for serious adverse events. A serious adverse event was defined as an event resulting in death, a life-threatening condition, initial or prolonged hospitalization, disability or permanent damage, or the need for medical intervention to prevent permanent impairment. Adverse events occurring during ibuprofen use were also monitored and recorded as present or absent. Outcome assessments were performed by trained assessors who were not informed of participants' treatment allocation. Assessments were conducted at baseline, during both intervention cycles, and during the first menstrual cycle after the intervention period.
Interventions
Thread-embedding acupuncture is performed using sterile, single-use, preloaded polydioxanone (PDO) absorbable threads. Each device consists of a 30-gauge needle with a 25-mm shaft and a 30-mm PDO thread. Two treatment sessions are given, with one session performed 3 to 7 days before the expected onset of menstruation during each of two consecutive menstrual cycles. Core acupoints are SP6, CV4, CV6, SP10, and EX-CA1. Additional acupoints are selected according to Traditional Chinese Medicine syndrome pattern. Acupoint locations follow World Health Organization standards. The procedure is performed by a licensed physician trained in thread-embedding acupuncture.
A warm pack maintained at approximately 40 to 45°C is applied to the lower abdomen when menstrual pain reaches a Visual Analogue Scale score of 4 or higher. Each application lasts approximately 15 to 20 minutes and may be repeated every 2 to 3 hours as needed during menstruation. Participants receive a warm pack and standardized instructions for its use at the beginning of the study.
Ibuprofen 400 mg is used as rescue medication when menstrual pain reaches a Visual Analogue Scale score of 7 or higher. Participants may continue taking ibuprofen until pain or discomfort improves to a score below 4, for a maximum of 3 days during each menstrual cycle. The total number of 400-mg tablets used during each menstrual cycle is recorded, and adverse events occurring during ibuprofen use are monitored.
Sponsors
Study design
Masking description
Assessor blinding: Outcome assessors were not informed of group assignment throughout the study and did not participate in intervention delivery. Assessors recorded outcomes at T0 (baseline), T1 and T2 (intervention cycles), and T3 (post-intervention cycle) and documented results on standardized case report forms. The assessor also prescribed rescue ibuprofen (400 mg) when VAS ≥7.
Intervention model description
A randomized, assessor-blind, parallel controlled trial
Eligibility
Inclusion criteria
* Women aged 18 to 29 years with an active menstrual cycle * Diagnosis of primary dysmenorrhea according to the American College of Obstetricians and Gynecologists criteria * Traditional Chinese Medicine diagnosis of either Excess Cold pattern or Qi stagnation and Blood stasis pattern * Able to understand study procedures and cooperate with the treating physician * Menstrual pain with a Visual Analogue Scale score of 4 or higher in at least 3 menstrual cycles during the previous 6 months, including the most recent cycle * Menstrual duration of 3 to 8 days * Menstrual cycle length of 21 to 35 days * Willing and able to provide written informed consent
Exclusion criteria
* Suspected or confirmed secondary dysmenorrhea detected by ultrasonography * History or diagnosis of endometriosis, ovarian cysts, uterine polyps, uterine leiomyomas, adenomyosis, pelvic inflammatory disease, congenital obstructive Mullerian malformations, pelvic adhesions, pelvic masses, or cervical stenosis * History of needle fainting * History of hypersensitivity or allergic reaction to catgut, acupuncture, or thread-embedding acupuncture * Pregnancy or breastfeeding * Current participation in another clinical trial
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The change in VAS scores | Baseline (T0), first intervention cycle (T1), second intervention cycle (T2), and first post-intervention menstrual cycle (T3), over 3 consecutive menstrual cycles. Each menstrual cycle is defined as 21-35 days, with menstrual bleeding lasting 3-8 days. | Menstrual pain intensity will be assessed using a 10-cm Visual Analogue Scale (VAS), ranging from 0 ("no pain") to 10 ("worst pain imaginable"). Participants will mark the point that best represents their pain intensity during menstruation. The highest VAS score during the most recent pre-enrollment menstrual cycle will be recorded as baseline (T0). Follow-up VAS scores will be recorded during menstruation in the first intervention cycle (T1), during menstruation in the second intervention cycle (T2), and during menstruation in the first post-intervention menstrual cycle (T3). Lower scores indicate less pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Traditional Chinese Medicine (TCM) syndrome score | Baseline (T0), T1, T2, and T3 over 3 consecutive menstrual cycles. Each menstrual cycle is defined as 21-35 days, with menstrual bleeding lasting 3-8 days. | Traditional Chinese Medicine syndrome scores will be assessed using a syndrome-specific symptom scoring form for either the Excess Cold pattern or the Qi stagnation and Blood stasis pattern. Scores will be recorded during menstruation at baseline (T0), during menstruation in the first intervention cycle (T1), during menstruation in the second intervention cycle (T2), and during menstruation in the first post-intervention menstrual cycle (T3). Lower scores indicate improvement in syndrome-related symptoms. |
| Adverse events observed during the study | From the first study intervention through completion of the first post-intervention menstrual cycle (T3), covering 3 consecutive menstrual cycles. Each menstrual cycle is defined as 21-35 days, with menstrual bleeding lasting 3-8 days. | Adverse events will be monitored throughout the study. In the thread-embedding acupuncture group, monitored events include pain at the insertion site, dizziness, local discomfort, skin irritation such as itching or redness, local inflammation, bleeding, chondritis, and nausea. Adverse events occurring during ibuprofen use will also be recorded. Serious adverse events will be documented according to standard clinical criteria. |
Countries
Vietnam
Contacts
University of Medicine and Pharmacy at Ho Chi Minh City