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Uterine fibroids (UFs) are the most common type of gynaecological tumour, found in up to 70% of postmenopausal women.1 Although mostly asymptomatic (80%), UFs can be highly deleterious to women's health.1
Medical and surgical treatment options have been studied widely, but these are often invasive and can compromise fertility. Although hysterectomy is the only definitive treatment, it is the one that renders future childbearing impossible.2 Hysterectomies are commonly performed via laparotomy, are associated with considerable morbidity and may require a hospital admission of up to 6 days;2 they are often complicated by pyrexia and wound infections.2
The most studied therapeutic agents are gonadotropin-releasing hormone (GnRH) analogues and there is evidence that they can control bleeding and reduce UF volume by up to 50%.1 However, GnRH analogues are associated with significant side effects such as hot flushes and a decrease in bone density, secondary to low oestrogen concentrations.1 Furthermore, tumour growth increases rapidly upon cessation of treatment and thus the beneficial effects of GnRH analogues are short-lived.1
It is therefore unsurprising that patients should seek safer, effective treatments with fewer side effects. A recent study highlights that nearly 50% of women in the USA rely on complementary and alternative medicine (CAM) to treat symptoms of UFs.3 Common CAM treatments include exercise (45%), diet (34%), herbs (37%), and acupuncture (16%).3 Interestingly, patients using these interventions report significant symptomatic improvement and fewer side effects than those using pharmacological and surgical treatments.3
Acupuncture for the treatment of gynaecological conditions has been widely studied.4 A recent systematic review concluded that acupuncture is as effective as pharmacological treatment at reducing symptom burden in patients with primary dysmenorrhoea.4 However, the paper concluded that the use of acupuncture to treat UFs was relatively understudied and that the available evidence was of low quality.4
The Cochrane Collaboration has published a report on the use of acupuncture as a treatment for UFs.5 Although 106 citations were identified, the review concluded that there is “currently no high quality adequate evidence available to allow assessment of the efficacy of acupuncture in the treatment of UFs”.5
While there is a diverse range of management options, patients are frequently dissatisfied with the side effects and complications of current treatments for UFs. While hysterectomy represents a definitive management option, there is nevertheless a need for less invasive but equally effective treatment options. CAM treatments have a high uptake among patients, but there is still no medical consensus regarding their effectiveness. A recent systematic review concluded that acupuncture may be beneficial in some gynaecological conditions; however, evidence to support its use in treatment of UFs was insufficient.4
In conclusion, there is a need for high-quality studies to robustly evaluate the effectiveness of acupuncture for treatment of UFs. Considering the high prevalence of UFs and the limitations of the currently available treatment options, acupuncture as a potential treatment for UFs deserves further study.
Contributors Both authors have provided substantial contribution to the design of the work. A significant proportion of the time was spent on review of existing literature. Both authors are happy to be kept accountable for all aspects of the work.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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