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Effect of acupuncture on primary hypothyroidism and irregular menstruation
in infertile women: a randomised controlled study
DOI: https://doi.org/10.5114/pq/173581
Eman Sedky Abdullah1 , Abeer Mohamed ElDeeb2 , Eman Ahmed Sultan1 , Hassan Omar Ghareib3 ,
Salwa Mostafa EL-Badry2
1 National Nutrition Institute, General Organization for Teaching Hospitals and Institutes, Ministry of Health, Giza, Egypt
2 Women’s Health Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
3 Faculty of Medicine, Cairo University, Giza, Egypt
Abstract
Introduction. This study aimed to examine the impact of acupuncture and a low-caloric diet on primary hypothyroidism and
irregular menstruation in infertile women.
Methods. Sixty infertile women participated in the trial. All women were diagnosed with hypothyroidism, polycystic ovarian
syndrome (PCOS), and oligomenorrhea. They were between the ages of 20 and 35, with a BMI between 30 and 34.9 kg/m2.
They were divided at random into two equal groups. For four months, a control group was given thyroxine tablets once daily
with a low-calorie diet (1200 kcal/day). The study group was given the same treatment and acupuncture sessions, twice a week
for four months. BMI, waist, waist-to-stature ratio (WSR), free thyroxine (FT4), thyroid-stimulating hormone (TSH), luteinising
hormone (LH), follicle-stimulating hormone (FSH), LH/FSH ratio, menstrual cycle period, and a health-related quality-of-life
questionnaire (PCOSQ) were evaluated for all patients.
Results. There was a significant reduction in waist circumference, WSR, BMI, LH, LH/FSH ratio, TSH, and menstrual cycle period
in both groups ( p < 0.05) and a significant increase ( p < 0.05) in FT4 and PCOSQ scores. Also, there was a significant increase
in FSH in the study group. Compared to the control group, the study group revealed a significant reduction ( p < 0.05) in waist
circumference, WSR, LH, TSH, LH/FSH ratio, menstrual cycle period, and a significant increase in PCOSQ scores and FSH.
Conclusions. Adding acupuncture to a low-caloric diet and medical treatment has an effective role in decreasing abdominal
adiposity and improving the hormonal profile and menstrual cycle, which in turn improves reproductive health in infertile women
with hypothyroidism.
Key words: hypothyroidism, infertile women, acupuncture, low-caloric diet
Physiotherapy Quarterly (ISSN 2544-4395)
2024, 32(4), 60–67
Correspondence address: Eman Sedky Abdullah, National Nutrition Institute, General Organization for Teaching Hospitals and Institutes,
Ministry of Health, Giza, Egypt, e-mail: emansedky164@gmail.com; https://orcid.org/0009-0008-0294-5688
Received: 12.07.2023
Accepted: 10.10.2023
Citation: Abdullah ES, ElDeeb AM, Sultan EA, Ghareib HO, EL-Badry SM. Effect of acupuncture on primary hypothyroidism and irregular men-
struation in infertile women: a randomised controlled study. Physiother Quart. 2024;32(4):60–67; doi: https://doi.org/10.5114/pq/173581.
original paper
© Wroclaw University of Health and Sport Sciences
Introduction
Primary hypothyroidism is a common endocrine condition
characterised by inadequate thyroid hormone production [1].
Hypothyroidism impacts 2–4% of reproductive-age women,
which has been linked to infertility and frequent miscarriages
[2]. Lack of thyroid secretion makes the basal metabolic rate
decrease to 40% below normal [3]. It also affects the menstrual
cycle, reproductive system, metabolism, body weight, appe-
tite, body temperature, respiration, activity, and sleep [4].
Hypothyroidism has serious consequences for a wom-
an’s reproductive health, including her menstrual cycle, fer-
tility, andestrogen, as well as androgen metabolism. It may
result in infertility, anovulatory cycles, miscarriages, delayed
anovulatory cycles, and a delayed onset of puberty [5]. Met-
abolic dysfunction is the root cause of many health issues,
including difficulties during pregnancy, metabolic disorders,
and elevated risk factors forcardiovascular diseases [6]. Men-
strual irregularities are more common in hypothyroid women
than euthyroid women, with incidence rates between 25%
to 60%. Women with hypothyroidism typically suffer from oli-
gomenorrhea [7]. One of the most prevalent diverse endo-
crine illnesses is polycystic ovarian syndrome (PCOS), in which
hirsutism, oligo-amenorrhea (rare or little menstruation), as
well as infertility, are the defining clinical characteristics [8].
PCOS women are 5–10% more likely to have hypothy-
roidism [9]. In primary hypothyroidism, an increase in thyro-
tropin-releasing hormone (TRH) causes an increase in pro-
lactin as well as thyroid-stimulating hormone (TSH). Prolactin
inhibits ovulation because of a change in the levels of FSH
and LH, in addition to an increase in dehydroepiandroster-
one from the adrenal gland, which contributes to polycystic
ovarian morphology. FSH receptors are affected by elevated
TSH. It has also been proposed that hypothyroidism causes
an increase in the deposition of collagen in the ovaries, which
results in the polycystic morphology of the ovaries depend-
ing on the severity and duration of hypothyroidism [10].
Common causes of infertility include thyroid dysfunction,
which is easily treated by restoring healthy hormone levels in
the thyroid gland. It has been suggested that if elevated pro-
lactin levels are accompanied by elevated TSH, hypothyroid-
ism should be treated first before any other potential causes
of hyperprolactinemia are considered [11].
Established hypothyroidism is treated with hormone ther-
apy using thyroxine. In addition to improving fertility, it also
regulates the menstrual cycle and prolactin levels. Therefore,
following 6 weeks to 1 year of medication, 76.6% of infertile
women having hypothyroidism conceived with simple oral
treatment [11]. More modalities need to be investigated to
determine their effectiveness in improving outcomes in re-
productive women with hypothyroidism and irregular men-
struation.
Numerous research studies have looked at how losing
weight affects the thyroid. Serum T3 concentrations have
been shown to drop in lean and normal-weight people who
follow a calorie-restricted diet [12]. Furthermore, both TSHand
E.S. Abdullah, A.M. ElDeeb, E.A. Sultan, H.O. Ghareib, S.M. EL-Badry
Effect of acupuncture on primary hypothyroidism and irregular menstruation in infertile women
61
Physiother Quart 2024, 32(4)
T3 levels in obese people were found to be lower after weight
loss [13–15].
The World Health Organization (WHO) recommends acu-
puncture as a successful modality to treat more than forty
medical conditions and to enhance endocrine function and
general health [16]. It has been reported that acupuncture can
be used to treat hypothyroidism by regulating energy levels
and restoring hormonal balance [17]. The TSH levels of women
with subclinical hypothyroidism have balanced after receiv-
ing acupuncture, and their overall quality of life (QoL)has im-
proved [18]. Acupuncture’s effectiveness on PCOS patients
has been the subject of numerous studies; however, a recent
systematic review has reported that there is not enough data
to recommend acupuncture for PCOS-related ovulation prob-
lems [19]. To the authors’ knowledge, there is little knowledge
of the influence of acupuncture on the anthropometric meas-
urements as well as hormonal profile in infertile women with
hypothyroidism.
Therefore, this research was carried out to examine the
impact of acupuncture on thyroid hormones, reproductive
hormones, period of menstruation, as well as health-related
QoL (HRQoL) among infertile women having PCOS. It was
hypothesised that acupuncture would improve the hormone
profiles, menstruation, and HRQoL in infertile women with
primary hypothyroidism.
Subjects and methods
Participants
A randomised controlled pre-post design was performed.
Sixty hypothyroid infertile women took part in the research.
Participants were chosen from the Out Clinic at the National
Nutritional Institute. Female participants ranged in age from 20
to 35 years with a BMI between 30 to 34.9 kg/m2. All women
were diagnosed with primary hypothyroidism; their TSH was
> 4.0 mu/L and free tetraiodothyronine (FT4) was < 0.8 ng/dL.
Also, they experienced oligomenorrhea (menstrual periods
more than 35 days) and PCOS, which was confirmed by the
presence of antral follicular excess on ultrasonography with
> 12 follicles between 2–9 mm for each ovary and/or an ovar-
ian volume greater than 10 ml according to the Rotterdam
consensus (2003) and an androgen excess as determined by
the PCOS society (2006) [20]. Also, their luteinising/follicular
stimulating hormone (LH/FSH) ratio was above 1 and after at
least one year of regular, unprotected sexual intercourse, no
females became pregnant.
Women were excluded if they had a history of previous
neurological disorders, previous thyroidectomy, surgical re-
moval of the uterus, and presence of haemorrhage, carci-
noma, metal implants, endometriosis, uterine fibroids, primary
ovary insufficiency, fallopian tube damage or blockage, pelvic
adhesion, autoimmune disorders, implantation failure, and
infections, or currently using immune suppressant drugs.
Randomisation
Sample size calculation was performed using an epi cal-
culator (12) with a two-sided significance level (1-alpha) = 95,
power (1-beta, % chance of detecting) = 80, a ratio of sample
size, unexposed/exposed = 1, percent of unexposed with out-
come = 5, odds ratio = 9, risk/prevalence ratio = 6.4, and
a risk/prevalence difference = 27. This gave a total sample
size of 60. A total of 79 patients were enrolled, taking into ac-
count a 20% drop rate. Nineteen patients were excluded from
this study; two did not meet inclusion criteria, two refused to
participate, and 15 did not complete the treatment because
of personal reasons resulting in 60 patients completing the
study (Figure 1).
Randomisation was carried out for a single-blinded ran-
domised clinical trial (1:1). A random project was done via
computer-generated chance numbers. The randomised por-
tion succession, enrolling participants, and allocating them to
interventions was conducted by a researcher. Sixty infertile
women were assigned randomly to the control or acupunc-
ture groups. The control group were given thyroxine tablets
once daily and a low-caloric diet (1200 kcal) throughout
a period of four months. However, the acupuncture group
Figure 1. Flowchart for participant
recruitment and allocation
E.S. Abdullah, A.M. ElDeeb, E.A. Sultan, H.O. Ghareib, S.M. EL-Badry
Effect of acupuncture on primary hypothyroidism and irregular menstruation in infertile women
62
Physiother Quart 2024, 32(4)
was given a similar diet regime as well as acupuncture ses-
sions twice a week throughout a period of four months. At
the beginning of this trial, each participant provided written
consent. Each patient was instructed about the assessment
and treatment procedures to gain their cooperation during
the treatment. All evaluations were conducted at the begin-
ning and end of the treatment. The study lasted from August
2020 to February 2023.
Assessment
Anthropometric measurements
Height and weight were measured for each patient. The
BMI was computed by dividing weight by the square of their
height: BMI = weight/height square (kg/m2).
At the level of the waistline, the waist circumference has
been measured using a measuring tape.
Also, the waist-to-stature ratio (WSR) was determined by
dividing the patient’s waist circumference by their height; both
were measured in the same units (cm). WSR was used as an
indicator of obesity-associated cardiovascular disease. It is
a measurement of body fat distribution and thus is associ-
ated with abdominal obesity [21].
Assessment of thyroid and reproductive hormone
At 9 a.m., 3 cm3 of venous blood was withdrawn from
each female. Samples were kept in an icebox until analysis
[22]. The testing procedures for TSH, FT4, FSH, and LH were
conducted using enzyme-linked immunosorbent analysis
(ELISA). A minimum of one antibody with a particular antigen-
specificity was used in ELISA. A matching antibody ELISA
kit (LH, FSH, T4, or TSH ELISA) was linked with the sample’s
antigen. An enzyme and the antibody were connected. The
final step was adding a material that contained the enzyme’s
substrate. The ensuing reaction created a discernible signal
that was used to measure the hormone content within the
serum [23].
Assessment of HRQoL
The polycystic ovarian syndrome questionnaire (PCOSQ)
was used to assess HRQoL. The PCOSQ is a valid instrument
for measuring the HRQoL of females with PCOS [24]. Twenty-
six questions on health and health-related topics were in-
cluded in the survey, including ones about emotions, body
hair, weight, infertility troubles, as well as menstrual irregulari-
ties. There were seven grading statements to rate each ques-
tion. The maximum impairment was represented by choice 1,
while the minimum impairment was represented by option 7.
A thorough explanation of the questionnaire and an appro-
priate window of time to record the answers were given to
each patient. Each question required the patient to tick the box
next to the rating that best described how they felt [25].
Intervention
Medical treatment
Each woman received thyroxine tablets (levothyroxine
dosed based on body weight) once per day, which was pre-
scribed by their physician. Levothyroxine was usually taken
30–60 min before breakfast because calcium and food can
inhibit the absorption of levothyroxine [26].
Low-caloric diet
Each patient in both groups followed a low-caloric diet
regime consisting of 1200 kcal/day throughout a period of four
months. Every participant in the trial was given a detailed de-
scription of the low-calorie diet regime, including a list of foods
to be avoided and those to be eaten at a higher frequency.
Each patient was given a weekly menu designed to facilitate
the regimen suggested for them.
According to the recommendations of medical profession-
als, who advised getting 55% of daily calories from carbohy-
drates, 15% from protein, and 30% from fats, the low-calorie
diet plan was developed [27].
Application of acupuncture
Each woman in the study group was given acupuncture
sessions. Sixteen needles were inserted in the following
points: DU20, ST9, LI4, RN6, RN4, SP9, ST36, SP6, KI3, LR2,
GB20, DU14, BL15, BL20, BL23, and DU4. The anatomical
locations of these points are represented in Table 1 [17].
Table 1. Anatomical location of acupuncture points
Point Location
DU20 (BaiHui) Lies on the head’s central line, up from the tops of the ears, where they meet in the midline.
GB20 (FengChi) Lies in a hollow between the upper trapezius and sternocleidomastoid muscles.
DU14 (DaZhui) Is centred just below the spinous process of the seventh cervical vertebra, indicating a midline position.
ST9 (RenYing) Lies on the anterior edge of the sternocleidomastoidmuscle in the neck, laterally to the Adam’s apple.
LI4 (HeGu) Lies in the middle of the 2nd metacarpal bone along the radial side.
BL15 (XinShu) Lies on the bladder meridian, at the level of the T5 vertebra’s inferior border of the spinous process.
BL20 (PiShu) Lies 1.5 cun laterally of the lower margin of the spinous process of the T11 vertebra.
BL23 (ShenShu) Lies lateral from the spinous process of the L2 vertebra on the meridian of the kidneys.
DU4 (MingMen) Lies beneath the L2 vertebra’s spinous process.
RN6 (QiHai) Lies 1.5 cun underneath the umbilicus in the lower abdomen.
RN4 (QuanYuan) Lies 3 cun inferior to the umbilical on the median line of the belly.
SP9 (YinLingQuan) Lies on the tibia’s lower medial condyle.
ST36 (ZuSanLi) Lies 3 cun underneath the patella’s inferior border.
SP6 (SanYinJiao) Lies just above the ankle on the inside of the leg.
KI3 (TaiXi) Lies behind the medial malleolus.
LR2 (TaiChong) Lies between the 1st and 2nd metatarsophalangeal joints on the top of each foot.
E.S. Abdullah, A.M. ElDeeb, E.A. Sultan, H.O. Ghareib, S.M. EL-Badry
Effect of acupuncture on primary hypothyroidism and irregular menstruation in infertile women
63
Physiother Quart 2024, 32(4)
Table 2. Baseline characteristics for the infertile women
Variable
Diet group
(n = 30)
mean ± SD
Acupuncture group
(n = 30)
mean ± SD
t-value p-value
Age (years) 26.9 ± 4.7 27.7 ± 5.14 0.654 0.51NS
Weight (kg) 90.86 ± 14.09 94.65 ± 12.65 –1.10 0.28NS
Height (cm) 164.60 ± 4.16 164.93 ± 5.41 –0.27 0.79NS
BMI (kg/m2) 33.37 ± 4.62 34.35 ± 3.76 –0.90 0.37NS
BMI – body mass index, NS non-significant
A size 0.25 × 25 mm fine, sterile needles were used only
once. After local skin cleaning with 70% alcohol, they were
inserted at different depths (0.2–5 cm) depending on the lo-
cation and fat buildup. Each woman in the study group as-
sumed a supine position for the acupoints DU20, ST9, LI4,
RN6, RN4, SP9, ST36, SP6, KI3, and LR2 and prone posi-
tion for the acupoints GB20, DU14, BL15, BL20, BL23, and
DU4. Needles were left in place for 20 min with 1 min of very
light stimulation applied to each spot. Thirty-two acupuncture
sessions overall, each lasting 40–45 min, were administered
to all patients over the course of four months, two sessions
each week.
Data analysis
Version 20.0 (Armonk, NY: IBM Corp) of the SPSS sta-
tistical tool was used to examine the data. We checked for
distributional normality using the Kolmogorov–Smirnov test.
For normally distributed data, comparisons between and within
groups were performed using the paired and unpaired t-tests,
respectively. For data that was not regularly distributed, the
Wilcoxon test and the Mann–Whitney test were used to make
comparisons within and between groups, respectively. The
level of significance was set at < 0.05.
Table. 3 Comparison of the anthropometric measurements in the diet and acupuncture groups
Variable Diet group
(n = 30)
Acupuncture group
(n = 30) MD p-value
BMI
before (mean ± SD) 33.37 ± 4.62 34.35 ± 3.76 –0.90 0.3NS
after (mean ± SD) 31.08 ± 3.98 29.65 ± 3.59 1.47 0.15NS
MD 2.29 4.70
percent of change 6.86 13.68
p-value 0.00* 0.00*
Waist circumference
before (mean ± SD) 101.78 ± 10.07 99.67 ± 10.16 2.12 0.42NS
after (mean ± SD) 97.85 ± 3.98 91.18 ± 9.86 6.7 0.01*
MD 3.93 8.49
percent of change 3.86 8.51
p-value 0.00* 0.00*
WSR
before (mean ± SD) 0.62 ± 0.06 0.60 ± 0.05 0.0146 0.30NS
after (mean ± SD) 0.59 ± 0.06 0.55 ± 0.05 0.0410 0.00*
MD 0.03 0.05
percent of change 4.8 8.3
p-value 0.00* 0.00*
BMI – body mass index, WSR – waist-stature ratio, NS non-significant, * significant at p < 0.05
Results
Table 2 represents the mean ± SD of the infertile women’s
baseline characteristics in diet and acupuncture groups, as
well as a comparison between groups before treatment. The
ages of both groups did not differ substantially using an un-
paired t-test (p = 0.51), weights (p = 0.28), heights (p = 0.79),
and BMI (p = 0.37).
According to a paired t-test, both the diet and acupunc-
ture groups experienced a substantial decline (p = 0.00) in
BMI accompanied by a percentage change equal to 6.86%
and 13.68%, respectively, and in waist circumference with
a percentage of change equal to 3.86% and 8.51% respec-
tively, as well as in WSR accompanied by a percentage
change equal to 4.8% and 8.3%, respectively.
Using an unpaired t-test, we found no statistically sub-
stantial differences in BMI (p = 0.15), while it revealed a sub-
stantial decline in the waist circumference (p = 0.01) and
WSR (p = 0.00) between groups after treatment in favour of
the acupuncture group (Table 3).
Wilcoxon test revealed a substantial decline (p = 0.00)
in TSH in the diet and acupuncture groups accompanied by
a percentage change equal to 33.5% and 51.4%, respec-
tively. Also, it revealed a highly substantial improvement
E.S. Abdullah, A.M. ElDeeb, E.A. Sultan, H.O. Ghareib, S.M. EL-Badry
Effect of acupuncture on primary hypothyroidism and irregular menstruation in infertile women
64
Physiother Quart 2024, 32(4)
Table 4. Comparison of thyroid hormone levels in the diet and acupuncture groups
Variable Diet group
(n = 30)
Acupuncture group
(n = 30) MD p-value
TSH
before (mean ± SD) 4.41 ± (2.7–7.7) 5.08 ± (3.8–9.7) –1.39 0.13NS
after (mean ± SD) 2.93 ± (1.9–5.7) 1.94 ± (0.87–3.32) 0.99 0.03*
MD 1.48 3.86
percent of change 33.5 51.4
p-value 0.00*0.00*
FT4
before (mean ± SD) 0.91 ± (0.7–1.11) 0.81 ± (0.66–1.13) 0.101 0.35NS
after (mean ± SD) 1.1 ± (1.1–1.5) 1.36 ± (0.97–1.5) –0.26 0.082NS
MD –0.04 –0.13
percent of change 5.1 13.4
p-value 0.00*0.00*
TSH – thyroid-stimulating hormone, FT4 – free thyroxine, NS non-significant, * significant at p < 0.05
Table 5. Comparison of reproductive hormones, PCOSQ, and menstrual cycle period in the diet and acupuncture groups
Variable Diet group
(n = 30)
Acupuncture group
(n = 30) MD p-value
LH
before (mean ± SD) 11.82 ± 4.11 11.81 ± 3.84 0.01 1.00NS
after (mean ± SD) 10.06 ± 3.27 5.37 ± 1.77 4.69 0.00*
MD 1.76 6.44
percent of change 14.89 54.5
p-value 0.00*0.00*
FSH
before (mean ± SD) 5.52 ± 1.64 5.29 ± 1.38 0.227 0.56NS
after (mean ± SD) 5.47 ± 1.40 6.51 ± 2.07 –1.04 0.03*
MD 0.05 1.22
percent of change 0.9 23
p-value 0.84NS 0.00*
LH/FSH
before (mean ± SD) 2.23 ± 0.85 2.24 ± 0.50 –0.0108 0.95NS
after (mean ± SD) 1.89 ± 0.63 0.86 ± 0.21 –1.037 0.00*
MD 0.34 1.38
percent of change 15.24 61.6
p-value 0.02*0.00*
PCOSQ
before (mean ± SD) 57.50 ± 13.06 54.70 ± 16.78 2.8 0.47NS
after (mean ± SD) 88.60 ± 15.03 142.93 ± 11.86 –54.33 0.00*
MD –31.10 –88.16
percent of change 96.5 161
p-value 0.00*0.00*
Menstrual cycle
period
before (mean ± SD) 46.2 ± 11.50 48.4 ± 11.60 –2.2 0.46NS
after (mean ± SD) 40.2 ± 9.90 30.4 ± 6.22 9.8 0.00*
MD 6.00 18.00
percent of change 12.98 37.19
p-value 0.00*0.00*
LH – luteinising hormone, FSH – follicle-stimulating hormone, PCOSQ – polycystic ovarian syndrome questionnaire, NS non-significant
* significant at p < 0.05
E.S. Abdullah, A.M. ElDeeb, E.A. Sultan, H.O. Ghareib, S.M. EL-Badry
Effect of acupuncture on primary hypothyroidism and irregular menstruation in infertile women
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Physiother Quart 2024, 32(4)
(p = 0.00) in the FT4 hormone with a percentage of change
equal to 5.1% and 13.4% in the diet and acupuncture groups,
respectively. Mann–Whitney test revealed a substantial de-
cline in TSH (p = 0.03) among the groups after treatment, fa-
vouring those who were given acupuncture; however, it showed
no substantial difference in FT4 (p = 0.082) after treatment, as
shown in Table 4.
The percentage of patients with a normal TSH after treat-
ment was 43.3% for the diet group and 70% for the acupunc-
ture group, while the percentage of patients with a normal
FT4 was 53% and 80% for the diet and acupuncture groups,
respectively.
Table 5 represents the mean values of reproductive hor-
mones, PCOSQ, and menstrual cycle period for diet and acu-
puncture groups pre- and post-treatment. The diet group
revealed a substantial decline (p = 0.00) in LH, the LH/FSH
ratio, and the period of the menstrual cycle with a percentage
of change equal to 14.89%, 15.24%, and 12.98%, respec-
tively. It also revealed a substantial improvement (p = 0.00)
in PCOSQ scores with a percentage of change of 96.50%
with no substantial change (p = 0.84) in FSH. The acupunc-
ture group revealed a substantial decline (p = 0.00) in LH, the
LH/FSH ratio, and the period of the menstrual cycle with a per-
centage of change equal to 54.50%, 61.60%, and 37.19%,
respectively. It also revealed a substantial improvement (p =
0.00) in FSH and PCOSQ scores with a percentage of change
of 23% and 161%, respectively.
Unpaired t-tests revealed a substantial decline (p = 0.00)
in LH, the LH/FSH ratio, and the period of the menstrual cycle,
as well as a substantial improvement in FSH (p = 0.03) and
PCOSQ questionnaire scores (p = 0.00) between groups
post-treatment favouring those who underwent acupuncture.
The percentage of females with a LH/FSH ratio of less
than 1 after treatment was 36.6% and 90% for the diet and
acupuncture groups, respectively. The percentage of women
with a menstrual cycle of less than 35 days was 36.6% and
86% for the diet and acupuncture groups, respectively.
Discussion
Androgen metabolism, menstrual function, and fertility are
all severely impacted by hypothyroidism. Puberty may be de-
layed, irregular menstruation may occur, cycles may be anovu-
latory, pregnancies may end in miscarriage, and infertility may
result [5]. Pregnancy difficulties, metabolic disorders, and
elevated risks of cardiovascular disease are all associated
with metabolic dysfunction [6].
The results revealed that the diet and acupuncture groups
revealed a substantial decline in BMI, waist circumference,
WSR, TSH, LH, LH/FSH ratio, and menstrual cycle period
and a substantial improvement in FT4 and PCOSQ scores.
Also, results revealed a substantial improvement in FSH for
the acupuncture group only. Contrasted to the diet group, the
acupuncture group revealed a substantial decline in waist,
WSR, TSH, LH, LH/FSH ratio, and menstrual cycle frequency
and a substantial improvement in FSH and PCOSQ scores,
without a substantial difference in BMI and FT4.
Weight loss with a low-calorie diet improved health and
anthropometric measurements such as BMI, weight, waist,
and hip circumference, correlating with a prior study’s find-
ings [28]. Also, a diet program for 4 weeks has shown a de-
crease in the levels of FT4, TSH, and FT3 in obese patients
[27–29]. In addition, a low-calorie diet was linked to improved
levels of FSH, LH, BMI, weight, waist circumference, and in-
flammatory cytokines among obese PCOS women [30].
In addition, menstruation regularity and ovarian function
have both been shown to improve with calorie restriction as
well as weight loss. After 24 weeks on an energy-restricted
diet, 80% of women who had previously experienced irregu-
lar periods reported having regular periods. This outcome in-
dicated that a greater decrease in BMI was associated with
better menstrual regularities [31].
According to previous studies, acupuncture has shown
improvement in FSH and LH levels, anxiety, mental tension,
and menopausal symptoms in patients with premature ovarian
failure [32]. Moreover, acupuncture has improved the QoL
and balanced TSH levels in female participants with subclini-
cal hypothyroidism [18].
In addition, previous studies have examined the effect of
acupuncture as well as fire cupping when treating hypothy-
roidism. They have reported improvement in TSH, decreased
drug dosages, andBMI [33].
The impacts of acupuncture in euthyroid PCOS women
have been the subject of numerous research efforts. They
have reported improvement in the LH/FSH ratio, ovulation
rate, clinical pregnancy rate (CPR), and BMI in response to
combining acupuncture with other medications [34]. Also, true
acupuncture has shown a decrease in intermenstrual days
in PCOS patients compared with sham acupuncture [35].
Additionally, acupuncture has improved the HRQoL, depres-
sion, and anxiety of PCOS patients [36]. The impact of acu-
puncture may be brought about by enhancing chemical and
muscular signals, which then trigger key brain components
to be released, regulating the female reproductive axis [37].
Hypothyroidism was described as a kidney Yin and Yang
deficiency. Effects of acupuncture may include warming the
meridians, clearing obstructions, replenishing Yang Qi, toni-
fying the kidney and spleen, clearing phlegm, lifting the clear
Yang, warming the kidney Yang, and balancing the Yin and
Yang [17]. It has been reported that acupuncture could treat
hypothyroidism by regulating energy levels, restoring hormo-
nal balance, calming emotions, and managing sleep, mood,
and menstruation issues [17]. Acupuncture is a safe and af-
fordable integrative therapy or alternative medicine that is ap-
propriate for treating thyroid disease [38].
These results prove the effectiveness of combining acu-
puncture with a low-calorie diet regimen and thyroxine medi-
cation for infertile women having hypothyroidism. As a result,
acupuncture is highly effective in treating primary hypothy-
roidism in women who are unable to conceive.
Limitations
There are some limitations to consider in this study. For
example, the mechanism underlying the improvement of thy-
roid and reproductive hormones in infertile hypothyroid wom-
en is still unknown. Also, pregnancy outcomes and size of
follicles in PCOS patients have not been monitored, which
needs further studies. Furthermore, more research is required
to determine the long-term impact of acupuncture on hor-
mone profiles in hypothyroid patients with infertility. Moreover,
a comparative study of the impact of laser acupuncture and
needle acupuncture on infertile hypothyroid patients is war-
ranted.
Conclusions
Acupuncture sessions, in addition to a low-caloric diet
program and medical treatment, produce more improvement
in decreasing abdominal adiposity and hormonal variables
E.S. Abdullah, A.M. ElDeeb, E.A. Sultan, H.O. Ghareib, S.M. EL-Badry
Effect of acupuncture on primary hypothyroidism and irregular menstruation in infertile women
66
Physiother Quart 2024, 32(4)
and are more effective in improving menstrual cycle and
HRQoL variables than low-caloric diet and medical treatment
alone in hypothyroid infertile women.
Acknowledgements
Neither financial nor technical assistance was provided
for this study.
Ethical approval
The research related to human use has complied with all
the relevant national regulations and institutional policies,
has followed the tenets of the Declaration of Helsinki, and has
been approved by the Faculty of Physical Therapy, Cairo Uni-
versity (approval No.: P.T.REC/012/002825). Study identifier:
NCT05804149 on ClinicalTrials.gov.
Informed consent
Informed consent has been obtained from all individuals
included in this study.
Disclosure statement
No author has any financial interest or received any finan-
cial benefit from this research.
Conflict of interest
The authors state no conflict of interest.
Funding
This research received no external funding.
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