Menstrual Period Pain (Dysmenorrhoea)
Many new patients will ask if I think I can help with menstrual period pain(Dysmenorrhoea) using acupuncture. Having been involved in Women’s health for a while now, my immediate response is simply ‘yes’. All medicine has its limits, but for acupuncture and Chinese herbs, helping to regulate the menstrual cycle, and so period pain, is certainly an area in which there has been a long history – over 200 years and counting. More than that, we see research that supports what history has suggested ie. that acupuncture and Chinese herbs have a role to play in stopping severe period pains.(1-5).
Research tells us that it’s not just about the acupuncture needles: coming to see an acupuncturist and hearing our view on the menstrual cycle and your period pain, along with lifestyle choices, gives women a better relationship with their cycle (2).
I’ve written a little bit about how we as Traditional Chinese Medicine (TCM) practitioners view the menstrual cycle and blood (have a look under ‘Women’s Health’), so let’s now take a closer look at how we view the concept of pain when felt during the menstrual cycle. Before we can do that, its important to explain the concept of menstruation in TCM terms, and the organs involved in this physiological process.
Menstruation – The Traditional Chinese Medicine View
Ideally, the menses (periods) should come and go without causing too many issues. The period should come regularly 26-32 days, last for about 4-6 days, expel 30-80 ml of menstrual fluid, be free from clots and disappear with you feeling none the worse-for-ware. The menstrual fluid should be lighter in colour at the beginning, deeper in the middle and pinkish at the end. It shouldn’t be dark, ‘clotty’ or overly ‘thick’ (6).
Often Western medicine will suggest different allowances when talking about a ‘normal period’. Often 21-36 days is quoted as ‘normal’ in Western terms. As a TCM practitioner, our aim is to bring the period in towards a 26-32 day cycle. Regularity is all-important in Chinese Medicine – especially when looking at conceiving (6).
So which organs in TCM are responsible for the production and regulation of the menses? The period is essentially under the direction of several organs in TCM – the kidneys, liver, spleen and heart.
Spleen – the Spleen’s role in producing blood is vital. Blood is produced from the food we ingest (as well as in part from our kidneys and bone marrow ). The spleens role in digestion is to extract the pure Qi from food, which in turn goes on to be transformed into blood.
Liver – The liver is the organ which is responsible for the free flow of Qi throughout the body. She ( she is seen as a ‘Yin’, female energy) is also responsible for the storage of blood within the body – the very blood which is then directed to the uterus and the channels responsible for escorting the endometrial lining out of the body during menstruation.
Heart – the heart and the uterus are connected via an internal channel in TCM. Energy is sent from the heart down towards the uterus in order to help commence menstruation. Blockages in the free flow of Qi of the heart can lead to impaired menstrual flow, or in-fact delay or stop menses altogether. This is how we can explain sudden loss of menses due to emotional shock affecting the Qi of the heart.
Kidneys – As mentioned, the kidneys help to provide a substrate if you like for the menstrual blood by offering some of their ‘Essence’. Our Essence is seen as the root of all of our energy and is stored in the kidneys. In women, It helps govern fertility and reproduction, conception and menopause (6). .
Why do so many women experience irregular & painful periods?
So why is it that so many women experience irregular periods – very short or long, large amounts of sharp or cramping pain, big emotional swings, flooding volumes of blood or barely any blood at all?
Each organ in TCM can also be affected by your emotional state. To take this further, each organ is affected by a particular type of emotional state – the Liver is affected by stress, anger and frustration. Rather than being in a relaxed state of ‘free-flow’ these emotions impact on the Livers energy by tying it up, so to speak – the end result being a stagnated Liver Qi (energy).
To bring in an ancient tenet or saying within TCM, “When there is free-flow, there is no pain. When there is no free-flow, there is pain”.
So, this is just one of the mechanisms through which you might be experiencing some pain within your menstrual cycle. Most Qi stagnation pain is usually experienced as dull, dragging or distending type pain – either before, during or after the period. The time at which the pain is felt is also quite important for us as practitioners as it gives us a clearer idea of which other organs, if any, are involved (6).
Women who experience sharp or stabbing pain, such as is often felt in Endometriosis, are experiencing something in addition to just Qi stagnation. Here, in TCM terms, the menstrual blood has stagnated as well (4)..
One more TCM saying for you – ‘Qi leads the blood’. This is a simple but critical aspect of TCM. If the Qi is ‘stuck’ for long enough, then it is very possible that the blood will also become ‘stuck’ – leading to both distending and sharp/stabbing pains at some stage of the menses. These sharp pains are often accompanied by ‘clots’ in the menstrual blood. The clots are a visual give-away that the menstrual blood is not in free flow. Endometriosis is a classic example of blood stagnation ( though Endometriosis is not necessarily caused through emotions).
So what else can cause blood clots in the menses? Poor blood levels in TCM (seen as ‘Liver Blood deficiency’) which can arise from poor diet, excessive menstrual bleeding over a long time, excessive blood loss during labour or an accident or surgery, is another way in which blood can congeal. Essentially, the blood slows simply because there is not enough blood to flow harmoniously (6).
So how can acupuncture & Chinese Medicine help with menstrual period pain (Dysmenorrhoea)?
Acupuncture helps to regulate both Qi and blood within the body by stimulating specific points which influence these two substances. In fact, regulating Qi and blood is probably the most important and useful thing that acupuncture does from the practitioners point of view. By asking the Liver to break free of her holding pattern and to begin gently spreading Qi to all parts of the body, as is her natural state, then the uninterrupted flow of blood is restored. So too, are pain-free menses. Cold hands and feet can be another tell tale sign that the Liver’s energy is a little constrained – energy is not being sent to the extremities of the body (6,7). Keeping your Qi in free-flow is a big part of how we aim to stop period pains.
In cases where there is blood deficiency, we will often ask our patients to take a Chinese herbal formula in combination with acupuncture treatments – either in simple pill form or as a specially designed formula in granule form (taken as a tea). The herbs are an incredible way to help build this substantial substance from a TCM perspective. For additional information on the importance of blood and women’s physiology have a look at our ‘Women’s Health’ page.
Part of the beauty of acupuncture and Chinese medicine for me, is the time you spend with your practitioner and
the conversations you have regarding your main complaint ie. what you can do to help yourself, what foods may be useful or harmful, how can you see your complaint as part of a bigger picture. I like this quote taken from the ‘Background’ of a recent journal research article :
“Women felt that the TCM self-care advice was related to positive outcomes for their dysmenorrhea ( period pain), and increased their feelings of control over their menstrual symptoms”(2).
What can I do to help stop period pain?
Well, the best thing you can do to help keep your liver energy regulated is to exercise. Regular exercise helps ‘stretch’ out the Liver energy and keep her from stagnating. Any exercise is good, but she seems to particularly like Yoga. If you’re not a Yogi , don’t worry – just move your body in a way that works for you. Dance, limbo, run, swim – whatever works for you!
Remember too, to stay away from red meat whilst your period pain is there. The red meat can antagonise the pain response. As soon as the period is gone, then a good dose of red meat is great if you are a meat eater!! If you are a vegetarian or vegan, then some kidney or black beans, spinach and beetroot are all good blood tonics. In TCM, when your period finishes, you are relatively deficient in blood – so now is the time to boost your blood levels with blood building foods – any good lean protein, loads of leafy greens, beans, beetroot.
Research – Using acupuncture menstrual period pain relief
Menstrual Period Pain Relief: “A Cochrane database systematic review by Australian authors has concluded that current evidence supports the use of acupuncture to reduce menstrual pain. Ten trials with data reporting on 944 participants were included in the review. The results showed that there was an improvement in pain relief from acupuncture compared with a placebo control or with Chinese herbs. In two trials acupuncture reduced menstrual symptoms (for example nausea and back pain) compared with medication; in one trial acupuncture reduced menstrual symptoms compared with Chinese herbs; and in one trial acupuncture improved quality of life compared with usual care. There was an improvement in pain relief from acupressure compared with a placebo control, and in one trial acupressure reduced menstrual symptoms compared with a placebo control. The risk of bias was judged to be low in 50% of trials and the authors called for further well-designed trials. “(Acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev. 2011 Jan 19;1:CD007854). ( http://www.jcm.co.uk/research-archive/article/acupuncture-can-reduce-period-pain-dysmenorrhoea-1799/ accessed 11.9.11 )
I’m very happy to talk with you about menstrual period pain relief options at any stage. I’m always happy to answer questions – 3357 3205.
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1 Lim CED et al, Aust J Acupunct Chin Med 2009;4(2):12-17. Australian Journal Acupuncture and Chinese Medicine
2 Armour, M, Dahlen H, Smith C More Than Needles: The Importance of Explanations and Self-Care Advice in Treating Primary Dysmenorrhea with Acupuncture Volume 2016 (2016), Article ID 3467067, 11 pages http://dx.doi.org/10.1155/2016/3467067
3 Smith CA, et al .Acupuncture for dysmenorrhoea. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD007854. DOI: 10.1002/14651858.CD007854.pub3.
4. Zhu X, Proctor M, Bensoussan A, Wu E, Smith CA. Chinese herbal medicine for primary dysmenorrhoea. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD005288. DOI: 10.1002/14651858.CD005288.pub3
5. J Int Med Res. 2019 Jan;47(1):19-30. doi: 10.1177/0300060518800609. Epub 2018 Nov 30.
6. Maciocia G Obstetrics & Gynecology in Chinese Medicine Elselvier China 2005 p7-8
7. Lim CED et al, Aust J Acupunct Chin Med 2009;4(2):12-17. Australian Journal Acupuncture and Chinese Medicine