Chiropractic for menstrual pains? No evidence. Period.

I'll hopefully convince you by the end of this blogpost, that there are bogus chiropractors in the UK.

Menstrual pain (or to give it its posh name, dysmenorrhoea) is estimated to affect between 45 - 95% of women at some point. (Bit of a rubbish estimation, if you ask me, but it gives an idea of its occurrence).

Here we have a condition which is widespread, can be debilitating, can be chronic, and the main respite from which is through painkillers. A perfect combination for a theatrical placebo. (And a cynic would add it was a regular monthly income).

It takes a leap and jump in the logic to imagineer how chiropractic could assist in the alleviation of dysmenorrhoeaic pain, but it goes something like this, courtesy of Pringle Chiropractic, Belfast:

[Pringle Chiropractic] are aware that many women who suffer from menstrual cramps also experience frequent back pain. Is there a connection? Both may be related to subluxation in the lower spine that affects the nerves that serve the female anatomy.

More hand waving than the Queen on a walkabout. Subluxations are interesting little chaps - it seems they are impossible to x-ray, and the definition of what they are has changed over time - they used to be a considered a disruption in innate intelligence but that has been dropped for obvious reasons and replaced with something along the woolly lines of

a loss of function in the spine and nervous system due to a reduction in its normal motion or alignment.

- from Pringle Chiropractic, Belfast again. And what, amongst other things do Pringle recommend for menstrual pain?

Good, old fashioned chiropractic adjustments.

Glasgow Chiropractic also are keen to espouse the amazing ability of chiropractic to deal with menstrual pain, by starting off by talking about chiropractic for menopausal symptoms, using this paper from Obstetrics and Gynaecology. Which is interesting because dysmenorrhoea and menopause are completely different beasties. I guess Glasgow Chiro just lumped them together in a sort of hand-wavy "women's problems"-type way. In fact, according to Latthe et al., the predisposition factors for dysmenorrhoea are as follows:

Age < 30 years, low body mass index, smoking, earlier menarche (< 12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms.

Glasgow Chiro claim:

Chiropractic provides the mechanisms through which dysmenorrheic women can be relieved of their pain in a drug-free environment and even go on to live a life free of period pain.

which is pretty much a statement of cure.

It's a fairly widespread chiropractic claim to be able to assist in menstrual pain - a quick squizz on Google shows that alongside Pringle Chiropractic, Belfast and Glasgow Chiropractic, Tooting Chiropractic, Townhill Total Health, Bank Chambers Clinic in Chipping Sodbury and Newcastle Chiropractic to name a few, also insist that chiropractic can assist in some way with menstrual pain.

So, given that there is a widespread belief within chiropractic circles that it can cure or relieve dysmenorrhoea, what decent evidence exists to back this up?

It should come as no surprise to anyone who knows anything about chiropractic that the answer is "not a jot".

A Cochrane Review in 2006 titled Spinal manipulation for primary and secondary dysmenorrhoea concluded that:

Overall there is no evidence to suggest that spinal manipulation is effective in the treatment of primary and secondary dysmenorrhoea. There is no greater risk of adverse effects with spinal manipulation than there is with sham manipulation.

The Clinical Evidence section of the BMJ places Chiropractic in the "Unlikely to be beneficial" category for dysmenorrhoea.

BUPA's page on chiropractic categorically states

Currently, there is no evidence that spinal manipulation helps to relieve period pain.

The NHS page quotes the Cochrane review above and follows its conclusion.

What about the General Chiropractic Council? Does it recommend chiropractic for menstrual pain?

It used to. In this letter (.doc) written in 2004 to the GCC on behalf of Actions for Victims of Chiropractic, Frances Denoon happens to quote from the GCC's document "What Can I Expect When I See A Chiropractor?" which states:

benefit may also be seen for some types of asthma, digestive disorders, migraine, infant colic and menstrual pains.

The current version of this document can be found on the GCC website here (.pdf), dated Sept 2007, and the same passage now reads:

You may also see an improvement in some types of asthma headaches (including migraine) and infant colic.

It seems clear that following the publishing of the Cochrane Review, in 2006 showing that chiropractic had no demonstrable effect on menstrual pain, the GCC (in an attempt to show it was evidence-based) removed menstrual pain from its list of treatable disorders.

That means the GCC, the UK regulator of chiropractics, is fully aware that dysmenorrhoea cannot be treated successfully with chiropractic. No doubt it will have made every effort to communicate this to its members and ensure that no-one was claiming otherwise. I'll be arranging for complaints to be made to the GCC regarding the above chiropractor's claims.

I now suggest to you that, given the evidence above, any chiropractor that suggests that chiropractic is a worthwhile therapy for menstrual pain is bogus. Period.

BPSDB