Effectiveness and Safety of Acupuncture and Moxibustion for Primary Dysmenorrhea: An Overview of Systematic Reviews and Meta-Analyses

BACKGROUND: Acupuncture and moxibustion have been accepted as treatment options for primary dysmenorrhea (PD). So far, several systematic reviews (SRs) and meta-analyses (MAs) have reported on the efficacy and safety of acupuncture and moxibustion in treating PD. OBJECTIVES: The aim of this study was to critically summarize the evidence from relevant SRs and MAs reporting on the efficacy and safety of acupuncture and moxibustion in treatment of PD. MATERIALS AND METHODS: Seven electronic databases, including Cochrane Database of Systematic Reviews, EMBASE, PubMed, SinoMed, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang database, were systematically searched. SRs or MAs about acupuncture for PD published up to May 2019 were included in the analysis. More than two authors independently assessed the quality of the evidence by AMSTAR2, PRISMA, PRISMA-A, and GRADE approach. RESULTS: A total of 28 SRs and MAs, 281 original studies, reporting on 26,459 female patients were analyzed. The majority of the SRs were of moderate reporting quality and poor methodological quality. Moderate-quality evidence suggested that acupuncture and moxibustion were more effective compared to indomethacin or Fenbid in treating PD. Low-quality evidence suggested that, compared to NSAIDs, acupuncture and moxibustion could relieve pain with less adverse effects. CONCLUSION: Acupuncture and moxibustion seem to be effective and safe approaches in treatment of PD; yet, the methodological quality of most of the studies and the quality of evidence were low. Thus, additional studies are required to further confirm these results.