Moxibustion for pain relief in patients with primary dysmenorrhea: A randomized controlled trial

Primary dysmenorrhea (menstrual pain) affects between 45% and 72% of women of reproductive age and may reach up to 93% among adolescents. This condition is characterized by severe lower abdominal pain during menstruation, frequently accompanied by nausea, vomiting, diarrhea, fatigue, headache, and back pain. In Brazil and worldwide, primary dysmenorrhea is the leading cause of recurrent school absenteeism among adolescents and significantly impacts women's quality of life. From a medical standpoint, excessive prostaglandin production in the endometrium during menstruation is believed to cause intense uterine contractions, reduced uterine blood flow, and increased sensitivity of pain nerve fibers.

Conventionally, treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives; however, approximately 20% of women do not respond adequately to these medications, which can also cause gastrointestinal, renal, and hepatic adverse effects.

This study investigated the efficacy of moxibustion, a longstanding technique of traditional Chinese medicine, in relieving menstrual pain compared with conventional drug treatment. Moxibustion involves applying heat by burning mugwort (moxa) over specific body points, combining thermal stimulation with chemical effects from the plant's pharmaceutical components. Although widely used in China to treat dysmenorrhea, scientific evidence regarding its efficacy was still limited.

Investigators conducted a randomized controlled clinical trial enrolling 152 university students from Chengdu, China, aged 18 to 35, all with moderate to severe primary dysmenorrhea. Participants were randomly assigned to two groups: one received moxibustion treatment and the other received ibuprofen (an anti-inflammatory drug). The moxibustion group received daily heat applications at Guanyuan, Shenque, and Sanyinjiao for approximately 25 to 30 minutes, starting seven days before menstruation, for three consecutive menstrual cycles. The control group took ibuprofen capsules twice daily for three days during each menstrual cycle, also for three cycles.

Pain intensity was measured using the visual analog scale (VAS), in which patients rated their pain perception on a 0 to 10 scale.

Results showed that both treatments were equally effective in reducing menstrual pain after three months of therapy. Pain intensity decreased from approximately 6.4 points to 2.5 points on the pain scale in both groups, representing a clinically meaningful improvement. During the first two months of treatment, the medication was slightly superior to moxibustion in pain control; however, by the end of the third month, there was no significant difference between groups. Notably, three months after treatment ended, moxibustion demonstrated more durable effects than the medication, with the moxibustion group showing lower pain intensity.

Laboratory testing confirmed that both treatments significantly modulated blood pain mediators, including prostaglandins, oxytocin, and other markers related to uterine contraction and inflammation.

For patients and clinicians, these findings suggest that moxibustion represents a valid and effective therapeutic alternative for primary dysmenorrhea. The technique appeared particularly advantageous for long-term control of menstrual symptoms, offering benefits that persist after treatment discontinuation. In addition, no adverse effects were reported during the study, contrasting with the potential side effects of NSAIDs. Moxibustion may be especially useful for women who do not respond well to conventional medications, have contraindications to NSAIDs, or prefer nonpharmacological treatments.

Economically, moxibustion may also represent a more accessible long-term option, given its sustained effects.

It is important to acknowledge the study's limitations. First, blinding was not feasible because the treatments were very different, which may have influenced participants' perceptions of efficacy. Additionally, most participants were young university students, which may limit generalizability to more diverse populations. The study also relied solely on subjective pain measures, and future research with more objective assessment methods is needed.

Finally, because this was a pragmatic trial comparing the effectiveness of two active treatments, psychological factors that may have contributed to the observed results cannot be entirely ruled out.

In conclusion, this study provides robust scientific evidence that moxibustion is as effective as conventional medications for menstrual pain relief, with the added advantage of more durable benefits. These findings suggest that moxibustion should be considered a legitimate therapeutic option for women with primary dysmenorrhea, especially for those seeking longer-lasting effects. The choice between moxibustion and pharmacologic therapy should be individualized, considering patient preferences, availability of qualified clinicians, and case-specific characteristics, always in consultation with experienced healthcare professionals.