---
title: "Abnormal uterine bleeding"
url: "https://acuiq.com/wiki/evidence/abnormal-uterine-bleeding"
updated: 2026-10-17
last_verified: 2026-10-17
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-17"
reading_minutes: 9
sources: 15
---

# Abnormal uterine bleeding

_What the reviews, the one randomised trial, case reports and current guidelines report on acupuncture and moxibustion for 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](https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2012/07/diagnosis-of-abnormal-uterine-bleeding-in-reproductive-aged-women). 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](https://doi.org/10.1016/j.ijgo.2010.11.011), 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](https://doi.org/10.1002/ijgo.12666) 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](https://doi.org/10.1002/ijgo.14331) 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](/wiki/evidence/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](https://doi.org/10.1783/147118903101197863) 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](https://doi.org/10.1016/j.autneu.2010.03.013) 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](https://etheses.whiterose.ac.uk/11007/) 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](https://doi.org/10.13703/j.0255-2930.2019.05.008) 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`](/points/sp10) (Xuehai), [`SP06`](/points/sp06) (Sanyinjiao), [`CV04`](/points/cv04) (Guanyuan) and [`ST36`](/points/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](https://doi.org/10.1136/bcr-2018-224725) 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](https://doi.org/10.1089/acu.2024.0053) 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](https://doi.org/10.1016/j.fertnstert.2011.03.110) 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](https://doi.org/10.1186/s12906-017-1939-1) 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](https://doi.org/10.13702/j.1000-0607.20210096) renders in English as metrorrhagia and metrostaxis. Li and colleagues at Shandong University of Traditional Chinese Medicine collected the recorded uses of [`SP01`](/points/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](/wiki/techniques/moxibustion) describes the technique.

## What guidelines say

[NICE guideline NG88](https://www.nice.org.uk/guidance/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](https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/04/management-of-acute-abnormal-uterine-bleeding-in-nonpregnant-reproductive-aged-women) 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](/wiki/evidence/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](/wiki/research/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](/wiki/research/where-the-trials-come-from) discusses the weight of trials published only in Chinese. [Polycystic ovary syndrome](/wiki/evidence/polycystic-ovary-syndrome) reports the trials in that cause of ovulatory dysfunction.

AcuiQ's [abnormal uterine bleeding](/symptoms/abnormal-uterine-bleeding), [uterine bleeding](/symptoms/bleeding-uterine), [excessive menstrual bleeding](/symptoms/bleeding-menstrual-excessive) and [dysfunctional uterine bleeding](/symptoms/uterine-bleeding-dysfunctional) pages list the protocols individual studies prescribed, each with its citation, and [uterine and menstrual conditions](/symptoms/uterine-and-menstrual-conditions) gathers the wider group.

### Sources

1. Munro MG, Critchley HO, Broder MS, Fraser IS, FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age, International Journal of Gynecology and Obstetrics 2011 — https://doi.org/10.1016/j.ijgo.2010.11.011
2. Munro MG, Critchley HOD, Fraser IS, The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions, International Journal of Gynecology and Obstetrics 2018 — https://doi.org/10.1002/ijgo.12666
3. Munro MG, Balen AH, Cho S, et al., The FIGO ovulatory disorders classification system, International Journal of Gynecology and Obstetrics 2022 — https://doi.org/10.1002/ijgo.14331
4. White AR, A review of controlled trials of acupuncture for women's reproductive health care, Journal of Family Planning and Reproductive Health Care 2003 — https://doi.org/10.1783/147118903101197863
5. Smith CA, Carmady B, Acupuncture to treat common reproductive health complaints: an overview of the evidence, Autonomic Neuroscience 2010 — https://doi.org/10.1016/j.autneu.2010.03.013
6. Longridge AE, Is acupuncture an effective treatment for menorrhagia? Systematic review, exploratory randomised trial, qualitative investigation and GP survey, PhD thesis, University of York 2006 — https://etheses.whiterose.ac.uk/11007/
7. Zhang L, Li J, Pan S, et al., Acupuncture artificial menstrual cycle method for abnormal uterine bleeding-ovulatory dysfunction (spleen deficiency syndrome), Zhongguo Zhen Jiu 2019 (in Chinese) — https://doi.org/10.13703/j.0255-2930.2019.05.008
8. Penn YY, Acupuncture treatment for dysfunctional uterine bleeding in an adolescent, BMJ Case Reports 2018 — https://doi.org/10.1136/bcr-2018-224725
9. Prabu N, M R M, K K, K MK, Exploring acupuncture as an adjunctive therapy for puberty menorrhagia: a case report, Medical Acupuncture 2024 — https://doi.org/10.1089/acu.2024.0053
10. Cakmak YÖ, Akpınar IN, Yoldemir T, Cavdar S, Decreasing bleeding due to uterine fibroid with electroacupuncture, Fertility and Sterility 2011 — https://doi.org/10.1016/j.fertnstert.2011.03.110
11. Lin YR, Wu MY, Chiang JH, Yen HR, Yang ST, The utilization of traditional Chinese medicine in patients with dysfunctional uterine bleeding in Taiwan: a nationwide population-based study, BMC Complementary and Alternative Medicine 2017 — https://doi.org/10.1186/s12906-017-1939-1
12. Li ML, Zhang ZL, Jia HL, Zhang YC, Analysis of clinical indications of acupoint Yinbai (SP1) and its compatible regularities based on data mining technology, Zhen Ci Yan Jiu 2022 (in Chinese) — https://doi.org/10.13702/j.1000-0607.20210096
13. National Institute for Health and Care Excellence, Heavy menstrual bleeding: assessment and management (NG88), 2018, last updated 2026 — https://www.nice.org.uk/guidance/ng88
14. American College of Obstetricians and Gynecologists, Diagnosis of abnormal uterine bleeding in reproductive-aged women, Practice Bulletin No. 128, 2012, reaffirmed 2024 — https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2012/07/diagnosis-of-abnormal-uterine-bleeding-in-reproductive-aged-women
15. American College of Obstetricians and Gynecologists, Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women, Committee Opinion No. 557, 2013, reaffirmed 2026 — https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/04/management-of-acute-abnormal-uterine-bleeding-in-nonpregnant-reproductive-aged-women