Electroacupuncture on Menstrual Frequency in Women With Polycystic Ovary Syndrome: Study Protocol

Study Overview
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Brief Summary
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Polycystic ovary syndrome (PCOS) is a dysfunction of endocrine system of women of reproductive age. Approximately 5%-10% women in China have this syndrome. Irregular menstruation (oligomenorrhea or amenorrhea), hirsutism and obesity are the common clinical manifestations of PCOS. The aim of this study is to evaluate the efficacy of acupuncture in improving the menstrual frequency of PCOS patients who do not have fertility requirements.

Detailed Description
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Methods: A total of 172 participants diagnosed with polycystic ovary syndrome would be randomly assigned to either the acupuncture group or sham-acupuncture group, at a ratio of 1:1. Participants in both groups will receive treatment for 12 weeks, three times a week. The primary outcome will be the proportion of participants with at least a 50% increase from baseline in the monthly menstrual frequency from baseline after 12 weeks intervention, while secondary outcomes will be the difference in anthropometrics, serum hormone level, ovarian morphology, anxiety and depression, and quality of life from baseline to after 12 weeks intervention and to 12 weeks post-intervention follow-up between groups. Discussion The aim of this study is to evaluate the efficacy and safety of acupuncture for improving menstrual frequency and other symptoms of patients with PCOS. The limitation of this trial is that it would be difficult to blind the acupuncturists. Additionally, these findings may not be suitable for women with PCOS who are seeking pregnancy.

Official Title
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Efficacy of Acupunture on Menstrual Frequency in Women With Polycystic Ovary Syndrome: Protocol for a Randomized, Controlled Trial

Conditions
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Polycystic Ovary Syndrome

Intervention / Treatment
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* Other: Acupuncture
* Other: Sham-acupuncture group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants fulfilling any one of the following criteria will be excluded. Participants who fulfill the following criteria will be included. Participants meet the Rotterdam diagnostic criteria with oligomenorrhea or amenorrhea. (Oligomenorrhoea is defined as an intermenstrual interval of >35 days or <8 menstrual bleedings in the past year. Amenorrhoea is defined as absent menstrual bleeding or no menstrual bleeding in the previous 90 days.) Participants who have at least two of the following features that meet the Rotterdam diagnostic criteria: Clinical or biochemical hyperandrogenism: Biochemical hyperandrogenaemia is defined as a total serum testosterone concentration above normal threshold, and/or clinical hyperandrogenism is defined as a Ferriman-Gallwey (FG) score of ≥5 or acne defined by the Global Acne Grading System (GAGS) as mild/ moderate/ severe/ very severe. Polycystic ovary morphology is defined as the presence of ≥12 follicles in each ovary measuring 2-9 mm in diameter and/or an ovarian volume >10 mL on transvaginal ultrasound. Participants who are between 18 to 40 years old. Participants who joined the research and provided a signed informed consent voluntarily. Exclusion Criteria: Participants with fertility requirements. Participants with oligomenorrhea or amenorrhea caused by hyperandrogenemia, premature ovarian failure, or hypothalamus or pituitary disorders. Participants with hyperandrogenism caused by congenital adrenal hyperplasia, Cushing's syndrome and androgen-secreting tumors. Participants with endocrine disorders such as thyroid dysfunction, adrenal disorders, hyperprolactinemia and diabetes mellitus. Participants with severe heart disease, hepatic disease, renal system and hematopoietic system disease, or malnutrition of the whole body. Participants who use hormones or other medications that would affect reproductive function, or received the same protocol of this study in the past three months.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: acupuncture group<br>Bilateral ST25, EX-CA1, CV4 and SP6 will be selected for treatment. After routine sterilization of the local skin, bilateral ST25, EX-CA1, CV4 and SP 6 will be inserted by the needles (0.30 mm in diameter, 40 mm in length) to a depth of 25-30 mm to the abdominal muscle layer with the manipulation of lifting, thrusting and rotating until de qi. Each session will last for 30 minutes, and the manipulation of lifting, thrusting and rotating evenly three times will be used for CV 4 and SP 6 every 10 minutes. If the date of treatment is during the menstrual circle, the treatment will be continued as usual. Participants will be treated three times a week for 12 weeks with 36 sessions. | Other: Acupuncture<br>* Hwato Brand, Suzhou Medical Appliance Factory, China<br>|
| Sham Comparator: Sham-acupuncture group<br>The sham ST25, EX-CA1, CV4 and SP 6, which are 1 cun (25 mm) outward to ST25, EX-CA1, CV4 and SP 6, will be inserted to 2-3 mm with needles with a diameter of 0.30 mm and a length of 13 mm. The needles will be inserted without de qi or any manipulation. The treatment sessions will be the same as those in the acupuncture group. | Other: Sham-acupuncture group<br>* Hwato Brand, Suzhou Medical Appliance Factory, China<br>* Other names: Placebo needle;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The proportion of participants who have at least a 50% increase from baseline in monthly menstrual frequency | Baseline monthly menstrual frequency was calculated through the number of menstrual bleeds in three months before intervention divided by three. Monthly menstrual frequency from baseline to three months was calculated through the number of menstrual bleeds during the three month-intervention divided by three. | Months 3 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in menstrual frequency | The proportion of participants who have at least a 50% increase from baseline in monthly menstrual frequency | Months 6 | 
| The change in measurements for body mass index (BMI) from baseline | Change in anthropometry | Months 3 and 6 | 
| The change in measurements for waist-hip ratio (WHR) from baseline | Change in anthropometry | Months 3 and 6 | 
| The change in serum luteinizing hormone (LH) from baseline | Blood samples will be taken at menstrual cycle days 2-4 when ovulation or bleeding occurs. Otherwise, this will be performed on the arbitrary day of the cycle. | Months 3 and 6 | 
| The change in follicle stimulating hormone (FSH) from baseline | Blood samples will be taken at menstrual cycle days 2-4 when ovulation or bleeding occurs. Otherwise, this will be performed on the arbitrary day of the cycle. | Months 3 and 6 | 
| The change in LH/FSH ratio from baseline | Blood samples will be taken at menstrual cycle days 2-4 when ovulation or bleeding occurs. Otherwise, this will be performed on the arbitrary day of the cycle. | Months 3 and 6 | 
| The change in testosterone (T) from baseline | Blood samples will be taken at menstrual cycle days 2-4 when ovulation or bleeding occurs. Otherwise, this will be performed on the arbitrary day of the cycle. | Months 3 and 6 | 
| The change in estrogen (E) from baseline | Blood samples will be taken at menstrual cycle days 2-4 when ovulation or bleeding occurs. Otherwise, this will be performed on the arbitrary day of the cycle. | Months 3 and 6 | 
| The change in prolactin (PRL) from baseline | Blood samples will be taken at menstrual cycle days 2-4 when ovulation or bleeding occurs. Otherwise, this will be performed on the arbitrary day of the cycle. | Months 3 and 6 | 
| The change in progesterone (Prog) from baseline | Blood samples will be taken at menstrual cycle days 2-4 when ovulation or bleeding occurs. Otherwise, this will be performed on the arbitrary day of the cycle. | Months 3 and 6 | 
| The change in dehydroepiandrosterone (DHEA) from baseline | Blood samples will be taken at menstrual cycle days 2-4 when ovulation or bleeding occurs. Otherwise, this will be performed on the arbitrary day of the cycle. | Months 3 and 6 | 
| The change in sex-hormone binding globulin (SHBG) from baseline | Blood samples will be taken at menstrual cycle days 2-4 when ovulation or bleeding occurs. Otherwise, this will be performed on the arbitrary day of the cycle. | Months 3 and 6 | 
| The change in androstenedione (AND) from baseline | Blood samples will be taken at menstrual cycle days 2-4 when ovulation or bleeding occurs. Otherwise, this will be performed on the arbitrary day of the cycle. | Months 3 and 6 | 
| The change in mean difference in ovary volume from baseline | Change in ovarian morphology | Months 3 and 6 | 
| The change in thickness of the endometrium from baseline | Change in ovarian morphology | Months 3 and 6 | 
| The change in the number of follicles <9 mm from baseline | Change in ovarian morphology | Months 3 and 6 | 
| Change in hirsutism | The change in Ferriman-Gallwey (FG) score from baseline | Months 3 and 6 | 
| Change in acne | The change in Global Acne Grading System (GAGS) from baseline | Months 3 and 6 | 
| Change in anxiety and depression | The change in The score of the Hospital Anxiety and Depression Scale (HADS) from baseline | Months 3 and 6 | 
| Change in quality of life | The change in Polycystic Ovary Syndrome Questionnaire (PCOSQ) scores from baseline | Months 3 and 6 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acupuncture