Case report - Acupuncture treatment for endometrial hyperplasia

The endometrium is the lining of the uterus, the pear-shaped organ that houses a fetus. Endometrial thickness varies during the menstrual process. Abnormalities of the endometrium, also called the endometrial lining, can result in concerns such as endometriosis, hyperplasia, and cancer. According to Chinese Medicine too thin of an endometrial lining can mean that yin or blood are compromised. Yin is stored in the Kidneys and because of the densest of matter, it creates bones, marrow, and blood. Yin and Blood are responsible for building and nurturing the lining of the uterus and supporting pregnancy. In this article is presented a case of 41 years old woman with infertility and a problem with endometrium thickness (endometrial hyperplasia). S he has done 5 in vitro procedures but they were unsuccessful . She came to our acupuncture clinic because she want ed to do an embryo transfer with frozen eggs, which have already been frozen for half a year. She made 15 acupuncture treatments twice weekly. Аt her last gynecological examination on the 11th day of menstruation, the thickness of the endometrium was 10 mm. Acupuncture has a distinctive capacity to improve uterine blood circulation making it a first-line treatment for a thin endometrium.

traditional chinese medicine, acupuncture, endometrium, infertility, treatment

The endometrium is the lining of the uterus, the pear-shaped organ that houses a fetus. Endometrium plays an important role in women's reproductive health and is connected with the menstrual cycle, also in response to the body's reproductive hormones, estrogen, and progesterone. The endometrial lining, sometimes is abnormally thin or thick, which may impact the ability of becoming pregnant and therefore lead to irregular bleeding. The endometrial lining has the main function during women’s reproductive years. This inner lining of the uterus begins to thicken to prepare for an embryo to implant, when pregnancy occurs, the lining helps to keep the pregnancy. If pregnancy OAIJOARU Open Access International Journal of Academic Research UNIVERSES Online ISSN 2955- 2133, Print ISSN 2955-2177 2023 July,1(2): 19-22 19 Zhu et al. Case report - Acupuncture treatment for endometrial hyperplasia does not occur, the lining sheds, and the process starts again for the following menstrual cycle. The thickness of the endometrium is usually measured by ultrasound, or if not suitable, because of the position of a woman’s uterus or other health conditions, then the doctors use MRI. Factors that contribute to a greater thickness of the endometrium include: obesity, hormone therapy, chronic high blood pressure, diabetes, scar tissue, endometrial polyps, and endometrial hyperplasia. The medical term for very thin endometrium is endometrial hyperplasia. This is often related to excessive levels of estrogen and not enough progesterone. Treatments for excessive endometrial thickness include progestinand treatment for thin endometrium includes: estrogen, human chorionic gonadotrophin, and medications and supplements used to improve blood flow. [1,2] Ovulation rates, female hormones, and appropriate thickness of the endometrial lining are part of the standards of Traditional Chinese Medicine (TCM) on fertility factors, which are essential biomarkers for the analysis of TCM on fertility-related diseases. TCM plays a role in curing and protecting fertility-related diseases, and it is well documented. Acupuncture positively regulates numerous molecules related to endometrial receptivity through different pathways and targets. Acupuncture promotes endometrial microcirculation and increases the clinical pregnancy rate of patients undergoing in vitro fertilization and embryo transfer. Acupuncture, as a complementary alternative medicine, functions mainly by the basic theories of TCM and selects correlated acupoints for treatment according to the differentiation of the collaterals and meridians. Relevant reports have proved that acupuncture can improve endometrial thickness and uterine artery blood flow. The researches have found that acupuncture can increase the blood supply of the endometrium, and improve the receptivity of the endometrium, regulate the endocrine system and the microenvironment of the ovary.[3] [4] [5] Case report The treated patient is a 41 years old woman with infertility and a problem with endometrium thickness (endometrial hyperplasia). She has done 5 invitro procedures but they were unsuccessful. She came to our acupuncture clinic because she wants to do an embryo transfer with frozen eggs, which have already been frozen for half a year. She made 15 acupuncture treatments twice weekly. When she had a gynecological examination on the 4th day of menstruation, the thickness of the endometrium was 7 mm, and on her last gynecological examination on the 11th day of menstruation, the thickness of the endometrium was 10 mm, which is a good result. The acupuncture treatments were made in an acupuncture clinic for acupuncture and TCM in Skopje, North Macedonia by a doctor specialist in acupuncture. Acupuncture OAIJOARU Open Access International Journal of Academic Research UNIVERSES Online ISSN 2955- 2133, Print ISSN 2955-2177 2023 July,1(2): 19-22 20 Zhu et al. Case report - Acupuncture treatment for endometrial hyperplasia treatments were with a duration of 30 to 45 minutes. Treatments were done indoors, on a room temperature, with normal (dry) acupuncture with fine sterile disposable needles sized 0.25x25mm. Acupuncture points used in the treatments are: DU21, BL6, LI4,RN10, RN5, ST25, ST29, ST 30, RN 2, ST36, SP6, LV3,DU3, BL26 Traditional Chine Medicine (TCM) is a medicine with a very great history. The theoretical basis of TCM is different from that of Western medicine. TCM is around 2.500 years old medicineand is anatural form of healing. This medicine is about the way of thinking about health and the body and includes a wide range of health interventions. Ancient TCM is based on the concept that the body is a smaller version of the universe and of the harmony between yin and yang, which through the meridians flows the vital power called Qi in the body and maintains health. In TCM all phenomena can be represented by the five elements (wood, fire, earth, water, and metal). For diagnosis in their assessments, TCM practitioners use 5 basic methods: inspection (looking), auscultation (listening), olfaction (smelling),palpation (touching), and inquiry (asking). TCM encompasses a small group of 6 methods designed to help patients achieve and maintain health like acupuncture, moxibustion, tui na massage, cupping, TCM nutrition, and Chinese herbs. Acupuncture is the most often practiced component. Acupuncture is the practice of inserting needles into the surface of the skin, and muscles of the body at particular acupuncture points. There are 2,000 acupuncture points on the human body, which are connected by 12 main meridians. [6] [7] [8]

Acupuncture as a part of Traditional Chinese Medicine is very effective in treating endometrial hyperplasia in women. Treatment with acupuncture brings balance and harmony to the body and restores health to the mind and body. Source of funding This research received no specific grant from any funding agency in the public, commercial, or not-for profit sectors. Conflict of interest The author have declared that no competing interests exist.

None. Statement of Informed Consent Written informed consent was obtained from the patient for their anonymized information to be published in this article. OAIJOARU Open Access International Journal of Academic Research UNIVERSES Online ISSN 2955- 2133, Print ISSN 2955-2177 2023 July,1(2): 19-22 21 Zhu et al. Case report - Acupuncture treatment for endometrial hyperplasia

1. Rebecca Valdez, MS, RDN, Medically reviewed by Anita Sadaty, MD, All About the Endometrial Lining, February 23, 2022 (www.verywellhealth.com) 2. Danielle Dresden, Medically reviewed by Valinda Riggins Nwadike, MD, MPH, What to know about endometrial thickness,November 19, 2019(www.medicalnewstoday.com) 3. Bo Lv, Yuan-de Peng, Wen-hui Fu, Wen-jing Li, Li-jun Chen, Zhi Wang, "A Traditional Chinese Medicine for the Treatment of Endometrial Hyperplasia via Regulating the HPO Axis in Rats", Evidence-Based Complementary and Alternative Medicine, vol. 2022, Article ID 5200608, 13 pages, 2022. https://doi.org/10.1155/2022/5200608 4. Jin Xi et al; "Electroacupuncture Improves Pregnancy Outcomes in Rats with Thin Endometrium by Promoting the Expression of Pinopode-Related Molecules", BioMed Research International, vol. 2021, Article ID 6658321, 12 pages, 2021. https://doi.org/10.1155/2021/6658321 5. Xiaoyan ZHENG et al; Endometrium receptivity and the dose-related effects of Acupuncture therapies in infertile women: a protocol for systematic review and meta-analysis, https://doi.org/10.1101/2021.04.02.21254309 6. Tian, G, Zhao, C, Zhang, X, et al. Evidence-based traditional Chinese medicine research: Two decades of development, its impact, and breakthrough. J Evid Based Med. 2021; 14: 65– 74. https://doi.org/10.1111/jebm.12420 7. Ryding, Sara. (2019, April 29). The Efficacy of Traditional Chinese Medicine. News-Medical.(https://www.news-medical.net) 8. Cosio D, Lin E. Traditional Chinese Medicine & Acupuncture. Pract Pain Manag. 2015;15(7). OAIJOARU Open Access International Journal of Academic Research UNIVERSES Online ISSN 2955- 2133, Print ISSN 2955-2177 2023 July,1(2): 19-22 22