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Use of Acupressure for Women's Health

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Chapter 29
Use of Acupressure for Women’s Health
lbahtiyar DEMİREL1 and Nurdan KAYA2
1Assoc. Prof. Dr., Sivas Cumhuriyet University, Faculty of Health Sciences, Department of
Midwifery, Sivas, Turkey
2Lecturer, Sivas Cumhuriyet University, Suşehri School of Health, Department of Nursing,
Sivas, Turkey
INTRODUCTION
Today, complementary and alternative therapies are the treatment methods
preferred by patients all over the world (Topcu 2009). One of these therapies is
acupressure (Maxwell, 1997; Cevik and Tasci 2017). Acupressure is a massage
technique applied with finger and palms based on traditional Chinese medicine (Mucuk
and Ceyhan, 2015). Acupressure is a treatment method that provides health, vitality and
first aid, and is an art of healing applied using fingers to key points on the skin to trigger
the body's natural self-healing process (Maxwell 1997). Acupressure is not just a light
touch, but a feeling between touch and mild pressure (Cevik and Tasci 2017). The main
philosophy of acupressure is based on unity, balance and harmony in the flow of energy
that exists in all living and inanimate places in the whole universe. Body’s energy
balance and protection from disaeases are ensured with this harmony (Maxwell 1997;
Cevik and Tasci 2017).
Acupressure is used for medical purposes in the treatment of various diseases and
to alleviate symptoms (Chang et al. 2011; et al. 2011; Stein et al. 2011; Chao et al.
2013; Mucuk and Ceyhan 2015; Ozgoli et al. 2016; Rohmetra et al. 2017). Acupressure
application has a sedative, psychological and analgesic effects (Maxwell 1997; Cevik
and Tasci 2017). Acupressure is quite effective in reducing labor pain, low back pain,
dysmenorrhea, head, neck and shoulder pains (Wong 2010; Bazarganipour et al. 2010;
Hsieh et al. 2010).
Acupressure is widely used in the field of women's health due to the burden of
reproductive ability (Topcu 2009). Women’s life is divided into four periods as infancy
and childhood period, adolescence period, fertility period, climacteric and old age
(Senturk 2016). Each of these periods cause critical problems for women's health
(Taskin 2016; Senturk 2016). Therefore, use of acupressure for women’s health was
discussed in light of the current literature in this study. This book chapter, which
provides evidence-based data, is predicted to guide health professionals in the use of
acupressure for women's health.
ACUPRESSURE PRESSURE POINTS
In traditional Chinese medicine there are different channels called meridians
circulating all over the body, and each of these meridians targets a separate organ. The
pressure applied to the acupuncture points, where the meridians pass, without using a
needle is called acupressure (Lee 2003; Smith et al. 2011). 12 pairs of main meridian,
which correspond to organs in the human body, are described. The meridians are
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present in both halves of the body. The life energy called qi flows regularly through
these 12 meridians. These meridians are: (Acupuncture Products 2007)
1. Lung=LU
2. Large Intestine=Lİ
3. Stomach=ST
4. Spleen=SP
5. Heart=HT
6. Small Intestine= Sİ
7. Urinary Bladder=BL
8. Gall Bladder=GB
9. Kidney=KID
10. Liver=Liv
11. Perikard=P
12. Triple Warmer=SJ
Commonly used pressure points used in women’s health are Spleen=SP 6 and 8,
Liver=Liv 3, Urinary Bladder=BL 32 and 60, Perikard=P 4 and 6, Kidney=KID 21,
Heart=HT 6 and 7, Large Intestine=Lİ 4, Small Intestine= 1 and Gall Bladder=GB
21.
Spleen=SP
6 and 8
Liver=Liv
3
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Urinary
Bladder=BL
32 and 60
Perikard=P
4 and 6
Kidney=KID
21
Heart=HT
6 and 7
Large Intestine=Lİ
4
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Small Intestine=
1
Gall Bladder=GB
21
Source: Acupuncture Products (2007). Atlas of Acupuncture Points,
www.AcupunctureProducts.com (Accessed: 24 April 2019).
ACUPRESSURE’S MECHANISM OF ACTION
The theories about acupressure’s mechanism of action, also known as needleless
acupuncture, came out after the 1960s. According to these theories, acupressure has
analgesic, homeostatic, autoimmune, sedative, psychological effects and healing effects
on motor functions (Kawakita and Okada 2014; Mucuk and Ceyhan 2015). Acupressure
is most commonly used for pain and prevents pain by stimulating endogenous opioid
release from the central nervous system depots and modulating the hypothalamic-limbic
system. The vast majority of studies focus on the analgesic effect of acupressure and the
role of endogenous opioids (Kwan and Li 2014; Mucuk and Ceyhan 2015; Levett et al.
2016; Sharif Nia et al. 2017).
Acupressure stimulation constitutes a very large scale of systemic responses
including the increase in secretion of neurohormones and neurotransmitters (beta
endorphins, enkephalin and serotonin) and the change in central and peripheral
regulation of blood flow. Stimulation increases the secretion of endogenous steroids
(adrenal cortex) and anti-inflammatory cytokines (lymphocytes) such as IL-10 and IFN-
α by activating the Hypothalamo-Pituitary-Adrenal Axis via histamine released from
mast cells, proinflammatory cytokines (IL-1, IL-6, TNF-α) and other vasoactive amines,
as well as the nociceptive system. Acupressure accelerates the effects on the immune
system and nerve regeneration. It also causes an increase in the number of leukocytes.
These all create anti-inflammatory and autoimmune effects of acupressure (Mucuk and
Ceyhan 2015).
USES OF ACUPRESSURE
Acupressure is used for medical purposes in the treatment of various diseases and
to alleviate symptoms (Stein et al. 2011; Chao et al. 2013; Mucuk and Ceyhan 2015;
Ozgoli et al. 2016; Rohmetra et al. 2017). Acupressure is commonly used in
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musculoskeletal diseases (Stein et al. 2011), reproductive system diseases (Ozgoli et al.
2016), nervous system diseases (Lee et al. 2011), digestive system diseases (Chao et al.
2013), urinary system diseases (Chang et al. 2011), oral and dental diseases (Rohmetra
et al. 2017) and in cancer treatment and symptoms (Mucuk and Ceyhan 2015). One of
the areas that acupressure used is reproductive system and its diseases. Women's health
should be handled differently from other individuals in the society, especially because
of the burden of reproductive ability. The use of this therapy in women's health is also
widespread (Topcu 2009).
Use of Acupressure for Women’s Health
Acupressure is among the complementary and alternative therapies that have been
used widely in the field of women's health in recent years (Topcu 2009). Acupressure is
often used to reduce pain symptoms. Acupressure application involves stimulation of
specific points and stimulation of these points triggers the release of cytokines, such as
endorphins, a neurochemical agent that is effective in reducing pain. These released
substances block certain receptors on the sensory nerve endings, thereby prevent
sensing and transportation of senses that disturb the body (Maxwell 1997; Cevik and
Tasci 2017). Acupressure is used for women's health in menstrual period and symptoms
(Wong et al. 2010; Gharloghi et al. 2012; Kannan and Claydon 2014; Chen et al. 2015;
Abaraogu and Tabansi-Ochuogu, 2015), menopausal symptoms (Kung et al. 2011),
complications occurring during the treatment of cancer (Dibble et al. 2007; Eghbali et
al. 2016) complications occurring during pregnancy (Steele et al. 2001; Hollyer et al.
2002; Puangsricharern and Mahasukhon 2008; Naeimi Rad et al. 2012; Festin 2014;
Bastani 2015; Silva et al. 2016; Neri et al. 2016), vaginal birth (Lee et al. 2004;
Hajiamini et al. 2012; Dabiri and Shahi 2014; Mafetoni and Shimo 2015; Ozgoli et al.
2016; Torkzahrani et al. 2017), cesarean section (Chen et al. 2005; Nani et al. 2015;
Ramezani et al. 2016) and lactation period (Esfahani et al. 2015).
Menstrual Period and Symptoms
Menstruation is a physiological event that occurs in female reproductive system
with the effect of ovarian hormones. It starts with menarche and ends with menopause.
This cycle repeats on average every 28 days. Although not the same in every woman,
there are changes in hormone levels and symptoms such as tension, tenderness and
dysmenorrhea. It is important to ensure that women can effectively manage these
symptoms (Cetin 2012; Taskin 2016). Acupressure’s efficacy in terms of relieving
dysmenorrhea was demonstrated by a meta-analysis study (Abaraogu and Tabansi-
Ochuogu 2015). In a study of 40 adolescents with dysmenorrhea by Wong et al. (2010),
the intervention group (n=19) was applied acupressure on SP6 point for the first 3 days
of the menstrual cycle, twice a day for 20 minutes, and no intervention was made to the
control group (n=21). In the study, it was determined that the effect of acupressure on
reduction of dysmenorrhea was immediate and this effect lasted up to 3 months. In
another study performed with women with dysmenorrhea, acupressure was applied to
SP6 and SP8 points and it relieved dysmenorrhea and its symptoms up to 2 hours
compared to the control group (Gharloghi et al. 2012). In a study conducted by Chen et
al (2015) with 129 adolescent girls who suffered from pain due to dysmenorrhea, girls
in the intervention group (n=65) were applied acupressure to SP6, BL32 and Liver 3
points three times a week for 30 minutes. As a result of the study, it was reported that
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acupressure applied in the intervention group would be used effectively in relieving
symptoms in adolescents with dysmenorrhea.
Menopause Period
Menopause means the last menstrual bleeding. In this period, due to the gradual
decrease and slowing of ovarian hormones, there are many physiological events in the
female reproductive system, urinary system, musculoskeletal system, cardio-vascular
system and nervous system. In this period, women suffer from sleep problems and
insomnia (Cetin 2012; Taskin 2016). In a study by Kung et al. (2011), ear acupressure
was applied to women suffering from insomnia in postmenopausal period and sleep
levels were evaluated before and after application. In the study, it was reported that the
quality of sleep improved in women after the application compared to the pre-
application.
Side Effects of Cancer Treatment
Breast cancer is the most common type of lethal cancer among women aged
between 20-59 years and cervical cancer is in the second place (WHO 2013). The
common side effects of chemotherapeutic drugs used in the treatment of cancer include
nausea and vomiting (Can 2005). In a study conducted by Dibble et al (2007) with
women with breast cancer, patients in the intervention group were administered
acupressure to P6 point to reduce the nausea and vomiting which are side effects of
chemotherapy, and the control group was treated with placebo. As a result of the study,
it was found that acupressure reduced the number and severity of nausea and vomiting.
A study by Eghbali et al. (2016) included 48 women with breast cancer who received
chemotherapy. The women in the intervention group received standard medical
treatment with ear acupressure for 5 days from the beginning of chemotherapy and the
control group received standard medical treatment. As a result of the study, it was found
that the number and intensity of nausea and vomiting decreased in women in the
intervention group.
Pregnancy Symptoms
Although pregnancy is a physiological event in women's life, women are
uncomfortable with systemic complaints due to hormonal changes occurring during this
period (Taskin 2016). Nausea and vomiting, nasal congestion, fatigue, frequent
urination, insomnia, tenderness in the breast, waist and back pain are among symptoms
occurring during pregnancy (Cetin 2012; Taskin 2016). In a qualitative study conducted
in Brazil with pregnant women attending antenatal education program, acupressure was
applied to pregnant women for symptoms occurring during pregnancy. The
effectiveness of acupressure in the alleviation of cramps, backache, legache and
headache during pregnancy was reported verbally by pregnant women (Silva et al.
2016).
The lack of sufficient evidence of drug use safety during pregnancy reveals the
priority of complementary and alternative therapies that are non-pharmacological in this
period. As nausea and vomiting are very common in pregnancy and due to their
negative effects on nutrition, their early diagnosis and treatment are very important
(Ebrahimi et al. 2010). Efficacy and safety of acupressure for nausea and vomiting
during pregnancy were reported in studies (Steele et al. 2001; Hollyer et al. 2002;
Naeimi Rad et al. 2012; Festin 2014). Hollyer et al. (2002) found the incidence of
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acupressor use as 21% for nausea and vomiting during pregnancy. In a study by Steele
et al. (2001) with women who had nausea and vomiting during pregnancy, acupressure
band was inserted to both wrists of the women in the intervention group for 4 days and
placebo was applied to the control group. At the end of the study, it was determined that
the severity and frequency of nausea and vomiting decreased significantly in the
intervention group. In a randomized controlled study evaluating the acupressure applied
to KID21 point to reduce nausea and vomiting during pregnancy by Naeimi Rad et al.
(2012), acupressure was applied to the intervention group for four consecutive days for
20 minutes and placebo was applied to the control group. At the end of the study, the
severity and number of nausea and vomiting in both groups decreased and KID21
acupressure was found to be more effective than placebo. In a study by Puangsricharern
and Mahasukhon (2008), it was reported that ear acupressure did not have a reducing
and relaxing effect on nausea and vomiting during pregnancy.
Although non-pharmacological therapies are not effective for every pregnant
woman, it improves sleep quality during pregnancy (Hollenbach et al. 2013; Hung and
Chiang 2017), and reduces anxiety (Bastani 2015). The ratio of pregnant women who
have sleep problems during pregnancy varies between 54% (Coban and Yanikkerem
2009) and 91.3% (Olcer and Bozkurt 2015). In a study conducted by Neri et al. (2016),
it was found that acupressure applied to H7 point for two weeks to the pregnants who
had sleep problems increased the sleep quality significantly. Anxiety levels of pregnant
women with gestational diabetes mellitus (GDM) are quite high. In a randomized
controlled study to reduce anxiety levels of pregnant women with GDM, a significant
decrease in anxiety levels was reported compared to those who were not applied
acupressure (Bastani 2015).
Vaginal Birth
Vaginal birth is defined as vaginal excretion of the fetus (Taskin 2016). Although
it is not known exactly how the labor starts, synthetic prostaglandin and oxytocin
derivatives are applied to start pharmacological labor (Cetin 2012; Taskin 2016). There
are also studies on the efficacy of acupressure, which is one of complementary and
alternative therapies that is non-pharmacological, for the onset of labor, labor pain and
the level of anxiety at birth (Lee et al. 2004; Gonenc and Terzioglu 2012; Mafetoni and
Shimo 2015; Torkzahrani et al. 2017). In a study of 162 nulliparous women by
Torkzahrani et al. (2017), acupressure was administered to SP6, BL60 and BL 32 points
of the intervention group between 9-11 am daily and symptoms indicating the start of
labor were evaluated. It was concluded that the acupressure had no significant effect on
the start of labor. On the other hand, it was reported that acupressure performed on the
SP6 point at birth decreased the pain and duration of labor (Lee et al. 2004; Calik and
Komurcu 2014; Mafetoni and Shimo 2015). There is also a study indicating that
acupressure to the LI4 point has an effect on labor pain but has no effect on the duration
of the first phase (Dabiri and Shahi 2014). In another study, it was reported that
acupressure applied to LI4 and BL32 points reduced the labor pain. Again, when the
effectiveness of these two points in the same study was compared, application to BL32
point was found to be more effective (Ozgoli et al. 2016). Hajiamini et al. (2012)
investigated the effectiveness of ice massage and acupressure to reduce the labor pain,
ice massage and acupressure were found to decrease the pain, and when ice massage
and acupressure were compared, ice massage was found to be more effective in
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reducing pain. In a study conducted in Turkey, it was found that acupressure applied to
SP6 point in the first phase of labor reduced anxiety at birth (Gonenc and Terzioglu
2012).
Cesarean Section
Cesarean section is the birth of the fetus from the abdominal tract when vaginal
delivery is not possible (Cetin 2012). Cesarean section is a surgical operation and the
pain due to this operation develops. Various pharmacological methods are used to
reduce this pain (Cetin 2012; Taskin 2016). Acupressure, a non-pharmacologic
complementary and alternative therapy, is frequently used to reduce pain after cesarean
section (Chen et al. 2005; Nani et al. 2015). In a study of Chen et al. (2005) conducted
with 104 Taiwanese women, acupressure was applied to the intervention group on P6
point the night before cesarean section, 2-4 hours after cesarean section and 8-10 hours
after cesarean section, and the control group received routine nursing care. As a result
of the study, the pain levels of the intervention group were found to be low compared to
the control group. In a randomized controlled study, acupressure applied to the HT6 and
LI4 points was effective in post-cesarean pain (Nani et al. 2015), whereas in another
randomized controlled study, only acupressure performed on LI4 point was not
effective on post-cesarean pain (Ramezani et al. 2016).
Lactation Period
Lactation period is a period in which postpartum milk production and release
increase. Breast milk is very important for both mother and baby (Cetin 2012; Taskin
2016). In a study conducted with mothers having low milk secretion, a significant
difference was found between the intervention group applied acupressure to SI1, LI4,
and GB21 points and the control group in terms of milk volume, and in the intervention
group at the 2nd and 4th week after the application (Esfahani et al. 2015).
ACUPRESSURE AND THE RESPONSIBILITIES OF HEALTH
PROFESSIONALS
Acupressure is one of the methods used to support medical treatment and relieve
symptoms (Arslan and Ozdemir 2015; Mucuk and Ceyhan 2015; Ozgoli et al. 2016;
Rohmetra et al. 2017). The purpose of complementary and alternative health
applications such as acupressure is to improve the quality of life, strengthen the immune
system and to reduce symptoms (Cole and Shanley 1998). To achieve this goal, health
professionals need to be informed about this application (Cole and Shanley 1998;
Arslan and Ozdemir 2015). Evidence-based studies with strong methodology should be
conducted for acupressure health practices, this practice effective in symptom
management should be taught to midwives, nurses and physicians, and health
professionals should direct women to use this therapy effectively and correctly (Cevik
and Tasci 2017).
CONCLUSION
Acupressure is one of the therapies that have proven effective in the protection,
development and promotion of women's health. Therefore, it is of utmost importance
that healthcare professionals, especially midwives and nurses who provide care for
women, take acupressure trainings and apply this method to alleviate and improve the
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symptoms that may occur in women.
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