Dr. Maryam Mahanian Acupuncture & Chinese Medicine Clinic
The term painful menstruation (dysmenorrhea) refers to pain that occurs before, during, or after the menstruation. As many as half of menstruating women are affected by dysmenorrhea, and of these, about 10% have severe dysmenorrhea, which greatly limits activities for one to three days each month.
The pain may occur in the lower abdomen, lower back, and may extend down to the legs. In severe cases, there may be nausea and vomiting or even fainting. Some women describe cramps as being sharp throbbing pains that come and go while others describe them to be dull and constant. Some people may think that having cramps is just simply part of the unfortunate things that women go through; however, according to traditional Chinese medicine, it reveals that there is an imbalance occurring in the body which can be resolved.
What causes menstrual pain?
The pains are caused by contractions in the musculature of the uterus. The contractions are caused by the release of the body's prostaglandins, which are hormones produced by the lining of the uterus.
Western Medical Treatments
If there isn't an actual disorder detected which is causing primary dysmenorrhea, then the treatment is simply pain relief. If a hormonal imbalance is detected where irregular cycles are also involved, the oral contraceptive pills are taken.
- Primary Dysmenorrhea
-starts from adolescence and is not associated with a particular disorder; is due to uterine contractions; usually in younger women
- Secondary Dysmenorrhea
-starts later in life and may be associated with organic disorders such as endometriosis, pelvic inflammatory disease, or myomas.
Studies show that primary dysmenorrhea is associated with uterine hyper contractibility: during contractions endometrial blood flow is reduced, and there is a correlation between minimal blood flow and maximal colicky pain - thus confirming that ischemia (lack of blood supply) due to hyper contractibility causes primary dysmenorrhea. This ties in with the TCM perspective that Qi and blood flow is stagnated in most cases of women suffering with dysmenorrhea.
Chinese Medical point of view:
For a normal period to occur, blood must be abundant and move adequately. Proper movement of blood relies on the free flow of liver Qi (energy). If liver Qi is stagnant, it causes pain especially before the period. If liver-blood is stagnant, it causes pain during the period. Stagnation is the most important thing to treat when dealing with painful menstruation.
In acupuncture, there are 14 meridian systems in the body. These meridians are pathways of communication. Each meridian corresponds with a particular organ. In painful menstruation, the liver meridian is the primary meridian that is focused on. The liver in TCM stores the blood and is considered the "woman's organ". The liver also promotes the smooth flow of Qi and blood throughout the body. When the liver is not working properly, or is "stagnant", the Qi and blood will not flow through the body properly and pain will result. The liver meridian also runs to the pelvic region. The other organs which can be involved in painful menstruation are the spleen and kidneys.
Etiology according to TCM:
- Excess exposure to cold and dampness especially during puberty
- heat or damp-heat invades the body during period or after childbirth
- prolonged severe illness
- excessive sexual activity
- too many childbirths or insufficient rest after giving birth
- constitutional spleen, stomach, liver, and/or kidney deficiency
Patterns in TCM:
Qi Stagnation & Blood Stasis
Symptoms include distending pain in lower abdomen before period or during first or second day of period; dislike pressure on abdomen; menstrual flow comes and stops with clots; menstrual flow is dark-red; pain is totally relieved after period
Cold in the Uterus due to Yang Deficiency
Symptoms include cold pain appearing during or after period; pain is relieved with warmth; menstrual flow is dull light color; periods are quite scanty
Cold-Dampness in Uterus
Symptoms include cold pain before or during period; pain is relieved with warmth but not with pressure; small amount of menstrual blood; dark-red color of blood; pain in lower back
Damp-Heat in Lower Abdomen
Symptoms include distending or burning pain in lower abdomen before or during period; burning sensation extends to sacrum; may always have lower abdominal pain but worse during period; bright-red colored blood; blood is thick with clots; profuse yellow smelly vaginal discharge This pattern is usually in patients with chronic pelvic inflammation
Qi and Blood Deficiency
Symptoms include dull pain in lower abdomen during or after period; like pressure on abdomen; scanty, light, and thin menstrual flow
Liver and Kidney-Yin Deficiency
Symptoms include dull pain in lower abdomen during or after period; scanty and thin menstrual flow
The TCM Doctor does a thorough consultation with the patient and then concludes as to the specific TCM pattern. Very often, the patient will not only exhibit one pattern but rather many patterns complicated into each other. Treatments will consist of acupuncture and/or herbal medicine. Nutrition and lifestyle changes will be addressed as well. With treatments for painful menstruation, the patient should expect significant improvements within three months of treatment.
The results of a study published in Gynakol Geburtshilfliche Rundsch. 2003;43(4):250-3 by Habek et al entitled "Efficacy of Acupuncture for the Treatment of Primary Dysmenorrhea" concluded that the success rate of acupuncture for the treatment of primary dysmenorrhea symptoms within 1 year after the acupuncture treatment is 93.3% compared with 3.7% in the placebo group.
The results of a study published in Obstet Gynecol. 1987 Jan;69(1):51-6 by Helms entitled "Acupuncture for the management of primary dysmenorrhea" found that in the Real Acupuncture group 90.9% of the women showed improvement; in the Placebo Acupuncture group, 36.4% and in the Standard Control group 18.2%. There was a 41% reduction of analgesic medication used by the women in the Real Acupuncture group after their treatment series, and no change or increased use of medication seen in the other groups.
The results of a study published in Croatian in Jugosl Ginekol Opstet. 1984 Sept-Dec; 24(5-6):104-6 by Maric entitled "Use of acupuncture in the treatment of primary dysmenorrhea" concluded that a relief of dysmenorrheal pain was already evidenced after the first menstruation. One year after the completed therapy there was a full disappearance of dysmenorrheal pain in 93% of the cases and a partial one in 7% of the cases.
The results of a study published in Bulgarian in Akush Ginekol (Sofia). 1996; 35(3):24-5 by Tsenov entitled "The effect of acupuncture in dysmenorrhea" found that the effect of acupuncture treatment on dysmenorrhea depends on its kind --primary dysmenorrhea is influenced very well, while secondary dysmenorrhea is influenced satisfactorily.
I suffered from period cramps most of my life and when I hit my mid-20's, they felt like they were getting worse each month. Sometimes even advil wouldn't help. It was along with heavy bleeding with large clots and lots of PMS symptoms like breast swelling and irritability. My periods would always come late as well. I saw Dr. Mahanian and the pain definitely improved after a couple of months of weekly acupuncture treatments and the herbal medicines. My periods are also not as heavy anymore and the PMS has decreased.
JB 29 yrs old
Acupuncture has helped me tremendously with my ability to get through my days comfortably as I get it done to reduce the pain I have associated with my menstrual cycle. In the past, I got severe cramps and wouldn't be able to function normally unless I took pharmaceutical drugs such as Naproxen (an anti-inflammatory), or large amounts of Ibuprofen. I also had a problem with my lower back & some days wouldn't be able to stand up properly because of the pain in one of my lower vertebrae. After getting a few treatments of acupuncture along with some acupressure massage, the pain has completely disappeared. Sometimes from standing all day at my job, I get pain in my upper back between my shoulder blades. Every once in awhile, I'll go in and get a treatment with needles in that area with some massage & I'll feel great for weeks after with no complications. I have found that the treatments along with the herbs have helped me feel more alert & my energy has increased to a healthy level. I no longer feel as tired as I used to. I also found that if I'm feeling stressed during the week, acupuncture is a really great way to alleviate the stress associated with everyday life."
NF 24 yrs old