Acupuncture-Related Therapies for Primary Dysmenorrhea: A Systematic Review and Network Meta-Analysis

Background: Primary dysmenorrhea (PD) is characterized by a cramping pain in the lower abdomen during menstruation. Acupuncture-related therapy is frequently used to treat patients with PD. We conducted a network meta-analysis to compare the efficacy and safety of acupuncture-related therapies based on Korean and Chinese clinical practice guidelines. Methods: We searched 10 databases from their inception to November 1, 2024, including the Cochrane Central Register of Controlled Trials, Embase, PubMed, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, SinoMed, KoreaMed, Korean Studies Information Service System, and Oriental Medicine Advanced Search Integrated System. The Cochrane Handbook was used to assess the risk of bias, and analyses were performed using the RevMan and Netmeta packages in R (4.4.2). Results: A total of 120 studies (9,571 participants with PD) were included, reporting 29 types of acupuncture-related therapies aligned with the Korean and Chinese guidelines. Overall, risk of bias was low. Based on a network meta-analysis, the most effective treatments were acupoint catgut embedding (ACE) + moxibustion, warm acupuncture + acupressure, and warm acupuncture + Western medicine. At 3-month follow-up, the highest visual analog scale (VAS) improvements were observed with ACE + moxibustion, ACE + cupping, and acupressure + manual acupuncture (MA). For prostaglandin E2 (PGE2), the most effective therapies were ACE, MA + western medicine, and MA + moxibustion. For prostaglandin F2α (PGF2α), ACE + Western medicine, MA + moxibustion, and transcutaneous electrical nerve stimulation ranked highest. Conclusions: Acupuncture-related therapies appear more effective than Western medicine for improving VAS scores during treatment, at 3 months, and for regulating PGE2 and PGF2α levels. Among these, ACE + moxibustion may be the optimal approach for reducing pain intensity, whereas ACE and ACE + Western medicine exhibit the greatest benefits in modulating prostaglandin levels in PD.