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The aim of this study was to evaluate the effects of auricular acupressure on relieving menstrual symptoms and decreasing nitric oxide (NO) for women with primary dysmenorrhea.This was a randomized clinical trial comparing the effects of auricular acupressure by seed-pressure method and placebo adhesive patch.Settings included colleges in northern and central Taiwan.Serum CA-125 testing was used as a screening test for primary dysmenorrhea (35 mg/dL). The study included 36 college females randomized to acupressure group, 35 to control group.The acupressure group received auricular acupressure by seed-pressure method on liver (CO12), kidney (CO10), and endocrine (CO18) acupoints. The control group had a plain adhesive patch placed on the same acupoints with no seed attached. Acupressure protocol included massaging 15 times on each acupoint, 3 times a day, for a total of 20 days.Primary: Short-form Menstrual Distress Questionnaire (MDQs). Secondary: blood sample of NO. Assessments of MDQs and NO were performed at baseline and within the first 2 days of their next menses (after completion of 20 days of acupressure).In the acupressure group, the overall menstrual symptoms (95% confidence interval [CI] = -49.8 to -6.5, effect size [ES] = 0.43, p = 0.01) and two subscales, menstrual pain (95% CI = -16.4 -to -2.2, ES = 0.45, p = 0.01) and negative affects (95% CI = -11.9-2.0, ES = 0.38, p = 0.04), revealed that menstrual symptoms decreased significantly after auricular acupressure by the seed-pressure method. The ES for the MDQs were in favor of the auricular acupressure by seed-pressure method. NO level increased in the acupressure group, although this difference did not achieve statistical significance (p0.05).This study supports the effects of auricular acupressure by seed-pressure method in improving menstrual symptoms, and offers a noninvasive complementary therapy for women with primary dysmenorrhea.