Menstrual pain
Menstrual pain (dysmenorrhoea) is common. Mild cramps during menstruation are normal, but in some women the pain is so severe that working, exercising, sleeping or other daily activities become difficult. The pain is usually low in the abdomen and can radiate to the lower back, hips or legs. Sometimes nausea, diarrhoea, headache, dizziness or fatigue occur.
The pain can start just before menstrual periods, especially during the first few days or occur at the end of or after menstrual periods. These differences may give clues as to the cause of the symptoms.
Acupuncture and Chinese herbal medicine can be added to menstrual pain. It looks at the nature and timing of the pain as well as other complaints that are part of the overall picture.
Possible Western disorders
During menstrual periods, the uterus pulls together to repel the uterine mucosa. Protaglandins play an important role in this. High prostaglandin levels can cause more powerful contractions and temporarily reduce the blood flow of the uterine muscle, causing pain.
When no underlying condition is found, primary dysmenorrhoea is mentioned. However, menstrual pain may also be associated with an underlying condition. This is called secondary dysmenorrhoea.
Possible conditions include:
- Endometriosis;
- adenomyosis;
- meat trees (myomas);
- a pelvic inflammation (PID);
- small pelvic adhesions;
- Ovarian cysts.
In particular, menstrual pain that develops at a later age, increases in severity, is present outside menstrual periods or coincides with other notable complaints deserve medical assessment.
Possible causes
In primary dysmenorrhoea, powerful contractions of the uterus and prostaglandins play an important role. There is then no other condition that explains the pain.
In secondary dysmenorrhoea, pain is caused by an underlying condition, such as endemic or adenomyosis. Therefore, the appropriate treatment depends partly on the cause of menstrual pain.
Factors such as stress can also affect how severe pain is experienced, but this does not mean that menstrual pain is caused solely by tension.
How can acupuncture help with menstrual pain?
Acupuncture can be added to menstrual pain. The treatment is tailored to the moment the pain occurs, the nature of the pain, the menstrual period itself and other physical and emotional symptoms.
Within TCM, for example, sharp pain and dark clots can fit a different pattern than dull pain after menstruation. It also looks at whether heat relieves, whether pressure is pleasant or unpleasant and whether there are fatigue, PMS, cold or heat complaints.
Depending on the picture of complaints, treatment may be directed at:
- support Qi and Blood circulation;
- Decrease blood stasis when this pattern is recognised;
- Reduce Qi-stagnation at clear voltage and distension;
- warm the lower abdomen when characteristics of Cold are present;
- Dampness and Heat reduce when these characteristics are present;
- Support Qi and Blood, Yang or Yin in deficiency patterns;
- Chong Mai and Ren Mai support in the regulation of menstruation.
Treatment may change during the menstrual cycle. Around menstruation, more emphasis is often placed on treating the pain and circulation of Qi and Blood. Between menstrual periods, more attention can be paid to the underlying pattern.
What can Chinese herbal medicine do?
Chinese herbal medicine can also be tailored to the pattern behind menstrual pain. Therefore, there is no single herbal formula suitable for any woman with dysmenorrhoea.
The nature of the pain gives important information. For example, in case of severe stabbing pain with dark clots, a different treatment principle can be chosen than in case of spasming pain that greatly improves due to heat or dull pain that occurs especially after menstrual periods.
Depending on the pattern, herbal treatment may focus on:
- Free circulation of Qi and Blood;
- Decrease blood stasis;
- Removing cold and heating the lower abdomen;
- Reduce Dampness-Heat
- Feeding Qi and Blood;
- Support Yang;
- Feeding Liver and Kidney-Yin.
Treatment can also be adapted to the menstrual cycle. For example, in case of a deficiency patterns between menstrual periods, more emphasis may be placed on feeding and strengthening, while around the menstrual period more attention is paid to pain and circulation.
Chinese herbs can be used daily between acupuncture treatments.
How does Chinese medicine view menstrual pain?
Within Western medicine, a distinction is made between primary and secondary dysmenorrhoea. Chinese medicine also looks at the overall pattern of symptoms and physical characteristics present in individual women.
For menstrual pain, Qi and Blood in the lower abdomen are given a lot of attention within TCM. For normal menstrual periods, Qi and Blood should be sufficiently present and able to move freely according to this model. Therefore, stagnation of Qi and/or Blood is an important pattern for menstrual pain. Even when empty patterns occur, menstrual periods can be painful, but then the pain is usually less severe and other characteristics, such as fatigue or low menstrual blood, are more prominent.
The nature and timing of the pain helps to recognise the pattern. For example, a strong bloated or tense feeling before menstruation fits more often with Qi-stagnation. Sharp, fixed pain with dark blood and clots fits more with Blood stasis. Cramping pain that clearly improves by heat can fit Cold, while dull pain at the end of or after menstruation is more frequently seen with deficiency patterns. These characteristics are always assessed together with the rest of the complaint image.
Especially the Liver plays an important role in the free movement of Qi and Blood. The Spleen is involved within TCM in the formation of Qi and Blood, while the Kidneys are closely linked to the menstrual cycle and reproduction.
In addition, the Chong Mai is important. This particular meridian is also called the Sea of Blood within TCM and is closely linked to the womb and menstrual period. In menstrual pain, the Chong Mai plays an important role, especially when the free movement of Qi and Blood in the abdomen is disturbed.
What is a TCM organ system?
A TCM organ system describes a group of related body functions and is wider than just the anatomical organ with the same name. Read more at TCM basics .
What is a TCM pattern?
A TCM pattern is a recognizable combination of complaints and physical characteristics that indicates which imbalance is likely to be present. The pattern is not a Western diagnosis and is determined on the basis of the overall complaint image. Read more at TCM basics .
Below are only the most common patterns discussed. Other patterns are possible and multiple patterns can occur at the same time. This allows you to recognize yourself in different descriptions. Also, someone with a certain pattern does not have to have all the symptoms mentioned. The pattern is determined on the basis of the overall picture of complaints.
Most common TCM patterns in menstrual pain
Liver-Qi-stagnation
This pattern clearly shows a feeling of tension or distension. The pain often starts before menstrual periods and may be associated with other premenstrual complaints. Emotional stress and prolonged stress can contribute to Liver-Qi-stagnation within TCM.
Common symptoms
- menstrual pain already present before or at the beginning of menstrual periods;
- feeling tense or bloated in the abdomen;
- tense or sensitive breasts;
- irritability or mood changes;
- PMS;
- sometimes a hesitant onset of menstruation.
Examples of Western disorders
Primary dysmenorrhoea, PMS and other menstrual symptoms in which stress and distension are clearly prominent.
Blood stasis
Blood stasis is recognized especially when the menstrual pain is severe, sharp or stabbing. Dark menstrual blood and clots are important characteristics. The pain can be reduced after clots have been removed.
Common symptoms
- severe menstrual pain;
- sharp or stabbing pain;
- pain in a fixed place;
- dark menstrual blood;
- large or dark blood clots;
- pain reduced after removal of clots;
- sometimes a period that starts hesitantly or temporarily stops.
Examples of Western disorders
Primary dysmenorrhoea, endometriosis, adenomyosis and menstrual symptoms in which dark clots and pronounced pain occur.
Cold in the Uterus
In this pattern, the menstrual pain is associated with clear features of Cold. Especially severe, spasming pain that greatly improves by heat is characteristic. Both full and empty forms of Cold can occur; for a client-oriented page they do not need to be worked out as separate patterns.
Common symptoms
- severe, spasmsing menstrual pain;
- pain that is clearly enhanced by heat;
- feeling cold during menstrual periods;
- cold hands and feet;
- low back pain;
- relatively low menstrual blood;
- often small, dark clots.
Examples of Western disorders
Primary dysmenorrhoea and other menstrual symptoms in which cramps and obvious relief from heat are at the forefront.
Damp-Heat
In a smaller part of the women, a pattern of Dampness-Heat is recognized. The pain then more often has a burning character and goes along with characteristics of both Heat and Dampness.
Common symptoms
- pain before menstrual periods or sometimes ovulation;
- burning abdominal pain;
- feeling heavy or compressive in the pelvis;
- feeling warm and thirsty;
- red menstrual period with small clots;
- vaginal discharge;
- dark or relatively little urine.
Examples of Western disorders
Menstruation pain in addition to which discharge and other characteristics of Dampness-Heat are present. In case of complaints that may indicate an infection, conventional medical assessment is important.
Qi- and Blood deficiency
With this pattern, menstrual pain is usually less sharp and rather dull or nagging. The pain occurs more often towards the end of or after menstrual periods and can improve due to mild pressure or massage. Fatigue and low menstrual blood are important additional characteristics.
Common symptoms
- dull or nasty pain at the end of or after menstruation;
- pain improved by pressure or massage;
- low menstrual blood;
- fatigue;
- dizziness;
- pale facial colour;
- loose stools sometimes.
Examples of Western disorders
Primary dysmenorrhoea and menstrual symptoms in which fatigue and mild menstruation are at the forefront.
Yang- and Blood deficiency
This pattern combines characteristics of Blood deficiency with clear signs of insufficient heat and activity. The pain usually occurs after menstruation and is more dull than sharp. Heat and pressure are often experienced as pleasant.
Common symptoms
- dull menstrual pain, especially after menstruation;
- low and relatively pale menstrual blood;
- pain improved by heat and pressure;
- feeling cold;
- fatigue;
- dizziness;
- blurred vision;
- sadness.
Examples of Western disorders
Menstruation pain in which mild menstruation, fatigue and cold symptoms are at the forefront.
Liver- and Kidney-Yin-deficiency
This pattern is especially recognized when dull pain at the end of or after menstruation coincides with characteristics of Yin deficiency of Liver and Kidneys. Mensing is usually relatively light.
Common symptoms
- dull pain at the end of or after menstruation;
- pain improved by pressure;
- low menstrual blood;
- low back pain;
- fatigue;
- dizziness;
- ringing in the ears;
- blurred vision;
- sometimes feeling warmth or night sweats.
Examples of Western disorders
Menstruation pain where there are also clear characteristics of Liver and Kidney-Yin deficiency.
Outlook
The course of treatment in menstrual pain depends, among other things, on the severity and duration of the symptoms, the underlying TCM pattern and the presence of a condition such as endemic or adenomyosis.
In primary dysmenorrhoea without an underlying condition, symptoms may sometimes change relatively quickly. Because menstrual pain can only be properly assessed once per cycle, it is usually useful to monitor results over several menstrual cycles. In Chinese medicine, at least a few cycles are often used to assess changes in menstruation and the effect of treatment. Endometriosis and other long-standing gynaecological conditions usually require a longer course of treatment.
In the initial phase, one acupuncture treatment per week is a common guideline. In case of severe menstrual pain, it can be temporarily treated twice or three times a week around the period. If the symptoms decrease and become more stable, the frequency can be reduced gradually.
Chinese herbs may, if appropriate, be used daily between treatments and adjusted to the underlying pattern throughout the cycle.
Contact
Do you regularly suffer from menstrual pain and want to know if acupuncture and/or Chinese herbal medicine can match your symptoms?
During a first consultation we discuss menstrual pain, your cycle, medical history and other relevant symptoms. Among other things, we look at the moment and character of the pain, menstrual blood and factors that improve or worsen the symptoms. On the basis of the overall complaint picture, it is considered which TCM-pattern is probably at the forefront and which treatment fits.
You can make an appointment directly online or contact us for more information.