Compared to ibuprofen, mild moxibustion can effectively relieve pain in females having primary dysmenorrhea.

This systematic review and network meta-analysis were carried out to compare and rank different object-separated moxibustion methods for determining the most effective choice for the treatment of primary dysmenorrhea, a common gynecological disease.

Databases such as Wanfang Database, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature, PubMed, and China National Knowledge Infrastructure were searched for identifying the randomized controlled trials (RCTs) that investigate the link between moxibustion and dysmenorrhea. Also, the bibliographies of relevant RCTs and reviews were manually checked.

In this study, dysmenorrhea scores and efficacy (response rate) were the major endpoints. Quality of evidence was evaluated via the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Utilizing pairwise and network meta-analyses with random effects, the summary odds ratio (OR) and mean difference (MD) were estimated. Statistical evaluation of data was done.

Overall, 56 RCTs with 5550 participants were incorporated, comparing six moxibustion therapies with oral medicine or acupuncture.  All moxibustions demonstrated higher efficacy compared to ibuprofen. Moxibustion at the navel exhibited the best curative effect (OR 6.75).

Mild moxibustion was found to be more effective in mitigating pain when compared to others (MD= -1.42). Overall, 1.8% (1/56) of trials were rated as having a low risk of bias, 55.4% (31/56) as moderate, and 42.8% (24/56) as having a high risk of bias. The certainty of evidence was moderate.

Even though GRADE evidence depicted low to moderate for most of the comparisons, mild moxibustion appears to be a reasonable choice to improve symptoms of primary dysmenorrhea.