Abnormal uterine bleeding

Abnormal uterine bleeding is menstrual bleeding outside the normal range of volume, duration, regularity or frequency, the definition used by the American College of Obstetricians and Gynecologists in its Practice Bulletin 128. It covers heavy menstrual bleeding and the irregular bleeding that follows when ovulation fails, which older studies call dysfunctional uterine bleeding. Acupuncture and moxibustion are prescribed for it. The studies testing them are one randomised trial of 60 women and a few case reports; there is no Cochrane review, and no published meta-analysis was found for this page. This page reports each source and what it measured.

How the condition is classified

In 2011 the International Federation of Gynecology and Obstetrics (FIGO) published PALM-COEIN, a system for sorting the causes of abnormal bleeding in women who are not pregnant. The letters stand for polyp, adenomyosis, leiomyoma (fibroid), malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified. FIGO revised the system in a 2018 update after work by its Menstrual Disorders Committee between 2012 and 2017. The list has no category called dysfunctional uterine bleeding: bleeding from failed or irregular ovulation is the O category, written AUB-O, the term the one randomised trial below uses. FIGO's 2022 classification of ovulatory disorders calls them common causes of abnormal uterine bleeding and gives polycystic ovary syndrome a category of its own. A bleeding disorder, fibroids or polyps each have their own letter, so a trial that enrols women with "abnormal uterine bleeding" without saying which cause may be mixing several conditions.

Is there a Cochrane review?

No. A PubMed search on 17 October 2026 for Cochrane reviews of acupuncture in uterine bleeding, menorrhagia or heavy menstrual bleeding returned none on the subject; the nearest Cochrane reviews cover uterine fibroids, period pain and polycystic ovary syndrome. No systematic review or meta-analysis dedicated to acupuncture or moxibustion for abnormal uterine bleeding turned up in PubMed or Europe PMC either.

Broader reviews

Two reviews of acupuncture across women's reproductive health searched for trials in heavy bleeding. A 2003 systematic review by Adrian White at the Peninsula Medical School in Exeter looked for controlled trials of acupuncture or acupressure for gynaecological conditions published in a European language. It found no study of menorrhagia, the older term for heavy menstrual bleeding, that met its inclusion criteria; the trials it did include were in period pain, infertility and the menopause.

A 2010 overview by Caroline Smith and Carmady at the University of Western Sydney searched PubMed, CINAHL and the Cochrane Library to September 2009 for English-language trials and systematic reviews, with heavy periods and menorrhagia among its search terms. It included 5 systematic reviews and 6 randomised trials. Its abstract reports no trial in heavy bleeding, describes menstrual complaints other than period pain and the menopause as under-studied, and says the evidence for them often rests on single studies.

A 2006 PhD thesis by Alison Longridge at the University of York is the one work found that addresses the question by name: its title lists a systematic review, an exploratory randomised trial, a qualitative study and a survey of general practitioners on acupuncture for menorrhagia. Its findings are in the full text, which was not read for this page, and no journal paper from it was found in PubMed.

The randomised trial

A 2019 trial by Zhang and colleagues at the First Affiliated Hospital of Hunan University of Chinese Medicine in Changsha randomised 60 women with AUB-O diagnosed with the Chinese medicine pattern of spleen deficiency. One group had acupuncture under what the authors call an artificial menstrual cycle method: the points changed with the phase of the cycle, with sessions of 30 minutes every other day and none during the period. After menstruation the points included SP10 (Xuehai), SP06 (Sanyinjiao), CV04 (Guanyuan) and ST36 (Zusanli). The other group took cyclic hormone therapy, estradiol for 14 days and estradiol with dydrogesterone, a progestogen, for 14 more. Both groups were treated for three cycles, and 55 women were analysed.

At the end of treatment the groups did not differ: 22 of 27 women improved by the trial's overall response measure with acupuncture and 24 of 28 with hormones, and symptom scores and the response rates for cycle length, period length and menstrual volume were similar. At follow-up three months later, the acupuncture group had lower symptom scores, a higher rate of marked improvement in cycle regularity and more women with a two-phase basal body temperature chart, which the authors read as a sign of ovulation; menstrual volume still did not differ. The abstract does not describe blinding, there was no sham group, and the trial was published in Chinese. It gives no GRADE rating, the scale reviews use to say how far a result can be trusted.

Case reports and practice

Three case reports describe single patients. A 2018 report in BMJ Case Reports by Penn, a paediatrician in Houston, treated a 17-year-old whose irregular bleeding and severe period pain had not improved with 16 months of hormonal treatment; she had 27 acupuncture sessions over 17 weeks while still taking oral contraceptives, her cycle became regular after 4 weeks and it stayed regular 6 months after treatment stopped. A 2024 report in Medical Acupuncture by Prabu and colleagues in Chengalpattu, India, gave daily acupuncture for a month to a 16-year-old who had been bleeding for 41 days, using six points chosen by tongue and pulse diagnosis; the bleeding stopped after 6 days. A 2011 report in Fertility and Sterility by Cakmak and colleagues in Istanbul gave electroacupuncture to a 48-year-old with heavy bleeding from a fibroid inside the uterine cavity; Doppler ultrasound showed less blood flow in the uterine artery during stimulation, and she used fewer pads over repeated sessions. A case report has no comparison group and cannot show what would have happened without treatment.

A 2017 study by Lin and colleagues at China Medical University in Taichung shows how widely Chinese medicine is used for this condition in Taiwan. Of 46,337 women newly diagnosed with dysfunctional uterine bleeding between 1997 and 2010 in a national insurance sample of one million people, 90% used Chinese medicine, and more than half of those had both herbal medicine and acupuncture. Most also took Western drugs, tranexamic acid and anti-inflammatory painkillers most often. The study measured use, not effect.

Beng lou and the point Yinbai

Chinese medicine groups abnormal uterine bleeding under beng lou (崩漏), a term the abstract of a 2022 data-mining study renders in English as metrorrhagia and metrostaxis. Li and colleagues at Shandong University of Traditional Chinese Medicine collected the recorded uses of SP01 (Yinbai), on the inner side of the big toe just behind the corner of the nail, from sources before 1949 and from Chinese and English databases from 1949 to January 2021. In the older sources, SP01 used on its own was recorded for 12 conditions, mostly internal complaints such as asthma, abdominal distension and vomiting, with beng lou among them. In the literature since 1949, SP01 on its own appears mainly for two: beng lou and heavy menstrual bleeding. In combinations it was paired most often with SP06, ST36 and CV04. The study records what authors prescribed, not whether it worked, and no trial of SP01 or of moxibustion at it for heavy bleeding was found for this page. Moxibustion describes the technique.

What guidelines say

NICE guideline NG88 on heavy menstrual bleeding, published in March 2018 and last updated in July 2026, recommends considering a levonorgestrel-releasing intrauterine system, a hormonal coil, as the first treatment where no cause is found, fibroids are under 3 cm or adenomyosis is suspected. Where that is declined or unsuitable it lists tranexamic acid, anti-inflammatory painkillers, combined hormonal contraception and cyclical oral progestogens. Its recommendations do not mention acupuncture.

ACOG's Practice Bulletin 128, published in July 2012 and reaffirmed in 2024, covers how to diagnose abnormal bleeding in women of reproductive age and introduced a new classification system for it. Its Committee Opinion 557 on acute bleeding, issued in April 2013 and reaffirmed in 2026, names intravenous oestrogen, combined oral contraceptives, oral progestins and tranexamic acid as the medical options, and surgery where those fail. Only the summaries of the two ACOG documents were read for this page, and neither summary mentions acupuncture. Clinical guidelines compares other bodies' positions on acupuncture.

What the reviews could not settle

There is no review to report a pooled result, so the question of whether acupuncture or moxibustion changes menstrual blood loss has not been tested beyond single studies. The one randomised trial compared acupuncture with hormone therapy in 55 analysed women, found no difference at the end of treatment and no difference in menstrual volume at any point, and had no sham group to separate the effect of needling from the attention that comes with it; Sham acupuncture explains why that comparison is hard to build. The trial's abstract does not say how menstrual volume was assessed, and the case reports relied on symptoms or pad counts. None separated the causes FIGO distinguishes. Where the trials come from discusses the weight of trials published only in Chinese. Polycystic ovary syndrome reports the trials in that cause of ovulatory dysfunction.

AcuiQ's abnormal uterine bleeding, uterine bleeding, excessive menstrual bleeding and dysfunctional uterine bleeding pages list the protocols individual studies prescribed, each with its citation, and uterine and menstrual conditions gathers the wider group.