{"paper_id":"d80d2ca4-a738-4e99-8426-d097b27c2a96","body_text":"INTRODUCTION \nReview question / Objective: Can patients \nw i t h a d e n o m y o s i s b e n efit f r o m \nacupuncture treatments? Evaluation of \ncurrent evidence with respect to the \nefficacy and safety of acupuncture for \nadenomyosis by conducting a systematic \nreview and meta-analysis of the available \nrandomized controlled trial. \nRationale: Adenomyosis is a common \ngynecological disorder. As present \nhormonal or surgical methods are often \nassociated with unwanted side e ffects, \ninsufficiency, and recurrency, some women \nINPLASY 1\nInternational Platform of Registered Systematic Review and Meta-analysis Protocols\nINPLASY\nPROTOCOL Acupuncture for adenomyosis: a \nsystematic review and meta-analysis\nLin, S1; Tan, B2; Sooranna, SR3; Getaneh, TK4; Li, M5; Zhao, C6; \nXiong, X7; Wang, X8; Zhang, T9; Wang, CC10.\nTo cite: Lin et al. Acupuncture \nfor adenomyosis: a systematic \nreview and meta-analysis. \nInplasy protocol 2021120001. \ndoi: \n10.37766/inplasy2021.12.0001\nReceived: 01 December 2021\nPublished: 01 December 2021\nReview question / Objective: Can patients with adenomyosis \nbenefit from acupuncture treatments? Evaluation of current \nevidence with respect to the e fficacy and safety of \nacupuncture for adenomyosis by conducting a systematic \nreview and meta-analysis of the available randomized \ncontrolled trial. \nCondition being studied: Adenomyosis is a gynecological \ndisorder defined as the presence of the endometrial gland and \nstroma cells within the myometrium. This condition mainly \noccurs in women who are multiparous and over the age of 30. \nAmong women undergoing hysterectomy, the frequency of \nadenomyosis is reported to range from 8.8% to 61.5%. \nAdenomyosis is also observed in 20. 9% to 34% of women \nwho have been referred for pelvic imaging. The incidence of \nadenomyosis in the general population remains uncertain. \nAdenomyosis can significantly decrease the patient’s quality \nof life, with the clinical presentations of menorrhagia, \ndysmenorrhea, metrorrhagia, chronic pelvic pain and \ndyspareunia. \nINPLASY registration number: This protocol was registered with \nthe International Platform of Registered Systematic Review and \nMeta-Analysis Protocols (INPLASY) on 01 December 2021 and \nwas last updated on 01 December 2021 (registration number \nINPLASY2021120001). \nCorresponding author: \nChi Chiu Wang \nccwang@cuhk.edu.hk \nAuthor Affiliation:                  \nThe Chinese University of \nHong Kong. \nSupport: NA. \nReview Stage at time of this \nsubmission: Preliminary \nsearches. \nConflicts of interest:          \nNone declared.\nLin et al. Inplasy protocol 2021120001. doi:10.37766/inplasy2021.12.0001\nLin et al. Inplasy protocol 2021120001. doi:10.37766/inplasy2021.12.0001 Downloaded from https://inplasy.com/inplasy-2021-12-0001/\n\nwith adenomyosis receive acupuncture as \nadjunctive therapy for improvement of \nsymptoms and health, despite sparse \nevidence. \nCondition being studied: Adenomyosis is a \ngynecological disorder de fined as the \npresence of the endometrial gland and \nstroma cells within the myometrium. This \ncondition mainly occurs in women who are \nmultiparous and over the age of 30. Among \nwomen undergoing hysterectomy, the \nfrequency of adenomyosis is reported to \nrange from 8.8% to 61.5%. Adenomyosis is \nalso observed in 20. 9% to 34% of women \nwho have been referred for pelvic imaging. \nThe incidence of adenomyosis in the \ngeneral population remains uncertain. \nAdenomyosis can significantly decrease \nthe patient’s quality of life, with the clinical \np r e s e n t a t i o n s o f m e n o r r h a g i a , \ndysmenorrhea, metrorrhagia, chronic \npelvic pain and dyspareunia. \nMETHODS \nSearch strategy: Eligible studies will be \nsearched from electronic databases \nincluding the Cochrane Central Register of \nControlled Trials, the Chinese Clinical Trial \nRegistry, MEDLINE (PubMed), Embase \n(Ovid), AMED Allied and Complementary \nMedicine Database (Ovid) and China \nAcademic Journals Full- biomedical \nliterature service system (SinoMed). We will \nsearch with different combinations of the \nterms ‘acupuncture’, ‘adenomyosis’, \n‘adenomyoma’ and ‘randomized controlled \ntrials’. Other resources will also be \nsearched, including the references of the \nretrieved studies, reviews and meta-\nanalyses for identi fication of further \nrelevant articles. \nParticipant or population: Patients who had \nbeen diagnosed with adenomyosis and \nshow featured clinical presentations, \nincluding dysmenorrhea, heavy menstrual \nbleeding, chronic pelvic pain, dyspareunia \nand infertility. Diagnosis of adenomyosis is \nbasically through sonographic or magnetic \nresonance imaging (MRI) examinations, in \ncomply with a clinical guideline. \nIntervention: Any forms of acupuncture \ntreatment include but not limited to manual \nacupuncture, electroacupuncture, auricular \na c u p u n c t u r e , c a t g u t - e m b e d d i n g \nacupuncture, acupoint herbal plaster and \nacupoint-based TENS. \nComparator: No treatment, placebo or \nsham acupuncture, western medicine or \ntraditional Chinese herbal medicines. \nStudy designs to be included: randomized \ncontrolled study. \nE l i g i b i l i t y c r i t e r i a : R C Ts i n v o l v e d \na d e n o m y o s i s p a t i e n t s r e c e i v i n g \nacupucnture treatments comparing with no \ntreatment, placebo or sham acupuncture, \nwestern medicine or traditional Chinese \nherbal medicines. \nInformation sources: Electronic databases. \nMain outcome(s): Menstrual symptoms, \npain relief, quality of life, and anxiety and \ndepression, measured by using Menstrual \nSymptom Scale (MSS), Visual Analogue \nScale (VAS) or Numeric Rating Scale (NRS), \nSF-36 Health Survey and The World Health \nOrganization Quality of Life (WHOQOL), the \nHospital Anxiety and Depression Scale \n(HADS), Depression Anxiety Stress Scales \n(DASS), and Hamilton Depression Rating \nScale (HDRS), or other valid tools \nrespectively. \nAdditional outcome(s): Menstrual bleeding \nvolume, serum cancer antigen 125 \n(CA-125), uterine size, success rate, and \nadverse events. \nData management: Data extraction will be \nc o n d u c t e d b y t w o i n d e p e n d e n t \nresearchers. \nQuality assessment / Risk of bias analysis: \nThe quality of the trials of included studies \nwill be assessed by two other researchers \nin accordance with the Cochrane \nHandbook for Systematic Reviews of \nInterventions (Version 6.2) \nStrategy of data synthesis: We will use the \nRevman 5.4 software program provided by \nINPLASY 2\nLin et al. Inplasy protocol 2021120001. doi:10.37766/inplasy2021.12.0001 Downloaded from https://inplasy.com/inplasy-2021-12-0001/\nLin et al. Inplasy protocol 2021120001. doi:10.37766/inplasy2021.12.0001\n\nthe Cochrane Library for data synthesis. \nFor continuous data, mean difference (MD) \nwith 95% confidence interval (CI) will be \nused for comparison of the e ffects \nobserved. For binary outcomes, the risk \nratio (RR) with 95% IC will be used. If \np>0.10 and I2 < 50%, the fixed-effect model \nwill be used in pooled data analysis; if \np<0.10 and 50% < I2 < 75%, the random-\neffect model will be used. Where there is \nconstantly considerable heterogeneity (P \n75%), meta-analysis will be given up and a \ndescriptive analysis will be conducted. \nSubgroup analysis: When more than 10 \nstudies are included in one outcome, \nsubgroup analysis will be conducted based \non the different acupuncture techniques in \nt h e n a t u r e o f i n v a s i v e n e s s o r \nnoninvasiveness. \nSensitivity analysis: If the chi-squared test \n(χ2) introduces p 50% which indicates \nheterogeneity, we will perform sensitivity \nanalysis to detect the source of bias. \nLanguage: No restriction. \nCountry(ies) involved: China, Hong \nKong(China), UK. \nK e y w o r d s : a d e n o m y o s i s ; p a i n ; \na c u p u n c t u r e ; c l i n i c a l effic a c y ; \ncomplementary medicine; systematic \nreview.  \nContributions of each author: \nAuthor 1 - Shike Lin - Develop and conduct \nof the study, and draft the manuscript. \nEmail: scott_linsk@live.cuhk.edu.hk \nAuthor 2 - Bing Tan - Literature search and \ndata extraction, assessment, and \nmanuscript drafting. \nEmail: icetan.gx@qq.com \nAuthor 3 - Suren Rao Sooranna - Provided \nsuggestions and draft the manuscript. \nEmail: s.sooranna@imperial.co.uk \nAuthor 4 - Tlaye Kenean Getaneh - Provide \nsuggestions and be involved in drafting the \nmanuscript. \nEmail: keneanget@link.cuhk.edu.hk \nAuthor 5 - Meiyan Li - Provide suggestions \nand be involved in drafting the manuscript. \nEmail: limeiyan9696@msn.com \nAuthor 6 - Chaoting Zhao - Provide \nsuggestions and be involved in drafting the \nmanuscript. \nEmail: 48356360@qq.com \nAuthor 7 - Xi Xiong - Provide suggestions \nand be involved in drafting the manuscript. \nEmail: cici0226@163.com \nAuthor 8 - Xiong Wang - Provide \nsuggestions and be involved in drafting the \nmanuscript. \nEmail: wangxiong918@msn.com \nAuthor 9 - Tao Zhang - Provide suggestions \nand be involved in drafting the manuscript. \nEmail: taozhang@cuhk.edu.hk \nAuthor 10 - Chi Chiu Wang. \nEmail: ccwang@cuhk.edu.hk \nINPLASY 3\nLin et al. Inplasy protocol 2021120001. doi:10.37766/inplasy2021.12.0001 Downloaded from https://inplasy.com/inplasy-2021-12-0001/\nLin et al. Inplasy protocol 2021120001. doi:10.37766/inplasy2021.12.0001","source_license":"CC0","license_restricted":false}