Comparative effectiveness and safety of Huangdi internal needling versus ibuprofen for primary dysmenorrhea

Primary dysmenorrhea (PDM) is highly prevalent among reproductive-aged women and is commonly managed with nonsteroidal anti-inflammatory drugs (NSAIDs), although medication-related adverse events and incomplete symptom control remain clinically relevant. Huangdi internal needling (HIN) is a traditional acupuncture-based technique that has been applied in pain conditions, but real-world comparative data in PDM are limited. This retrospective cohort study reviewed consecutive PDM patients treated at a single center between July 2021 and September 2023. Patients receiving HIN were compared with those managed using ibuprofen sustained-release capsules. Pain intensity and menstrual symptom burden were assessed using the Visual Analog Scale (VAS) and the Cox Menstrual Symptom Scale (CMSS) at baseline, after each of 3 menstrual cycles, and at a 6-month follow-up. Safety was evaluated by documented adverse events graded using CTCAE criteria. A total of 132 patients were included (66 per group). Baseline characteristics were comparable. Across treatment cycles and at 6 months, the HIN group demonstrated lower mean VAS scores than the ibuprofen group (baseline: 7.63 vs 7.78; cycle 3: 1.58 vs 3.24; 6 months: 2.36 vs 4.22; all between-group P < .05). CMSS scores also favored HIN at each posttreatment assessment. No adverse events were recorded in the HIN group, whereas 9 patients in the ibuprofen group reported grade 1 gastrointestinal symptoms that resolved after drug discontinuation. In routine clinical practice, HIN was associated with greater symptom improvement and fewer adverse events than ibuprofen for PDM, supporting further validation in multicenter studies.