Thread-Embedding versus Manual Acupuncture for Overactive Bladder in Postmenopausal Women: Randomized Controlled Trial

Overactive bladder is a very common condition in postmenopausal women, characterized by urinary urgency, increased frequency, and the need to urinate at night. This condition significantly affects quality of life, with prevalence reaching 43% in women over 40 years old. Although effective medications exist, many patients discontinue treatment due to side effects such as dry mouth, constipation, and cognitive problems. This study investigated a promising alternative: thread-embedding acupuncture (TEA), which could offer continuous stimulation of acupuncture points, potentially reducing the need for frequent sessions.

The double-blind randomized clinical trial involved 68 postmenopausal women with overactive bladder, equally divided between TEA and manual acupuncture (control). Treatment consisted of weekly sessions for 8 weeks, followed by 8 weeks of follow-up. Specific points were used: CV-3 (lower abdominal region) and BL-33 and BL-35 bilaterally (sacral region), selected for their relationship with bladder innervation. TEA involved insertion of absorbable polydioxanone threads that remained in the tissue, while the control group received manual acupuncture at the same points but without the threads.

Blinding was maintained through the use of masks during treatment. Results showed that both groups experienced clinically significant improvements. Daily urinary frequency decreased by approximately 2 episodes in both groups, a reduction considered clinically relevant. The OABSS score improved by about 4 points, exceeding the 3-point threshold considered minimal clinical improvement.

Importantly, these improvements were maintained during the 2 months of follow-up. For nocturnal urination, the TEA group maintained a significant reduction at follow-up, while the control group did not reach statistical significance, although the between-group difference was not statistically significant. No serious adverse events were observed in either group. Reported adverse events were mild and similar between groups, including mainly musculoskeletal and gastrointestinal symptoms and minor respiratory infections, most considered unrelated to treatment.

The main conclusion is that there was no significant difference between TEA and manual acupuncture, suggesting that the benefit comes primarily from acupuncture itself, not necessarily from the threads. This has important practical implications, as manual acupuncture, being simpler and less invasive, may be equally effective. For clinical practice, these results are encouraging, showing that acupuncture represents a safe and effective option for postmenopausal women with overactive bladder, especially those who do not tolerate or prefer to avoid medications. The protocol of 8 weekly sessions proved adequate to obtain lasting benefits.

Limitations include the relatively small sample, follow-up of only 2 months after treatment, and absence of urodynamic assessments. Future studies should include larger samples, longer follow-up (ideally 3-6 months), and possibly longer intervals between sessions to better evaluate the specific benefit of absorbable threads.