Published Paper Details:

Background: Primary dysmenorrhea (PD) is the most prevalent gynaecological condition among reproductive-age women, with prevalence rates up to 90%. Severe pain interferes with daily functioning in 20-50% of cases, causing absenteeism and a significant socioeconomic burden. Conventional pharmacological treatments, including NSAIDs and hormonal contraceptives, provide only partial relief for many patients and are associated with adverse effects, prompting growing interest in complementary approaches such as acupuncture and moxibustion. Objective: To synthesize clinical efficacy, safety, treatment protocols, and mechanistic insights of acupuncture-related therapies for PD from 1980 to mid-2025, thereby informing clinical practice and guiding future research. Methods: A systematic search of PubMed, PMC, Cochrane Library, and ClinicalTrials.gov identified studies published between January 1980 and July 2025. Eligible studies included randomized controlled trials (RCTs), systematic reviews, meta-analyses, and mechanistic investigations involving human participants with PD. Data were extracted on study design, interventions, outcomes, and adverse events. Methodological quality was assessed using the Cochrane Risk-of-Bias 2 tool, and evidence certainty was evaluated with GRADE criteria. Results: A total of 78 studies were included: 55 RCTs (~4,500 participants), 15 systematic reviews/meta-analyses, and 8 mechanistic studies. Early RCTs suggested promising effects but were limited by small sample sizes and inconsistent protocols. More recent multicentred trials demonstrated significant reductions in pain intensity (VAS ? 3.1-4.2 vs <=1.1 in sham; p<0.001), improvements in menstrual symptom scores, and enhanced quality of life. Meta-analyses further confirmed acupuncture's superiority over no treatment and, in some cases, NSAIDs. Mechanistic studies identified multiple pathways, including prostaglandin suppression (COX-2/mPGES-1), upregulation of endogenous opioids, autonomic nervous system modulation, and functional neuroplasticity in pain-related brain regions. Across studies, adverse events were mild (minor bleeding, soreness, dizziness), with no serious complications reported. Conclusions: Acupuncture, electroacupuncture, wrist-ankle acupuncture, and moxibustion are safe, well-tolerated, and effective interventions for PD, Some trials and meta-analyses suggest that acupuncture may achieve pain reductions approaching those seen with NSAIDs, although the certainty of evidence varies. Standardization of treatment protocols is improving, though methodological heterogeneity and limited evidence on long-term outcomes remain challenges. Future large-scale RCTs with extended follow-up, dose-response evaluation, cost-effectiveness analyses, and integration of omics-based mechanistic approaches are warranted to refine guidelines and facilitate the broader integration of acupuncture-based therapies into mainstream PD management.