Dr. Maryam Mahanian, DTCM, RAc

Menstrual Period Cramps

I specialize in women’s health issues in my Chinese medicine clinical practice.

When asking about a woman’s menstrual cycle, it’s rare to meet a woman who doesn’t experience cramps during her menstrual period.

The medical term for period cramps is Dysmenorrhea. Dysmenorrhea is the term used for the throbbing or dull pain in the lower abdomen and/or lower back that can happen right before the period, during the period, and to a much lesser extent even after the period.

The pain can range from being just slightly noticeable to being debilitating where the woman can’t go to work and can’t function for several days. I always ask about the severity of the cramps…do they miss work? Do they have to take pain medications like Advil? What makes the pain better?

As many as half of women who get their period have cramps and of these, about 10% have severe dysmenorrhea, which greatly limits activities for one to three days each month.

The pain isn’t just in the lower abdomen. It can occur in the lower back and may even extend down to the legs. In severe cases, there may be nausea and vomiting, dizziness, headache 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.

You may believe that having cramps is just simply part of the many unfortunate things that women go through; however, according to Chinese medicine, it reveals that there is an imbalance occurring in the body which can be resolved. Yes, I said it can be resolved!

Let’s get deeper into why period cramps happen

What causes menstrual pain?

The pains are caused by contractions in the musculature of the uterus.

These contractions are caused by the release of the body’s prostaglandins. Prostaglandins are hormones produced by the lining of the uterus as the lining prepares to be shed. Prostaglandins help the uterus to contract and relax so that the lining can detach and then flow out of the body as the period.

Higher levels of prostaglandins are associated with more severe menstrual cramps.

Menstrual cramps that aren’t involved with any underlying condition tend to lessen with age and after giving birth.

Two Kinds of Dysmenorrhea

There are two kinds of dysmenorrhea – Primary and Secondary.

Primary Dysmenorrhea:
Primary dysmenorrhea starts from puberty and it isn’t associated with a particular condition. This is simply due to contractions of the uterus.

Since there isn’t an actual disorder causing primary dysmenorrhea, then the treatment is simply pain relief. Or if a hormonal imbalance is found because there is also irregular menstrual cycles involved, then the oral contraceptive pill (birth control pill) is given.

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 Chinese medicine perspective that Qi and blood flow is stagnated in most cases of women suffering with dysmenorrhea.

Secondary Dysmenorrhea:
Secondary dysmenorrhea starts later in life and it might be due to conditions like endometriosis, Pelvic Inflammatory Disease (PID) or fibroids.

When these conditions are addressed and treated, the period cramps hopefully will resolve.

Chinese Medical point of view: All About Stagnation

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). Why the liver? The liver is in charge of the smooth flow of Qi throughout the whole body.

If liver Qi (energy) is stagnant/blocked, it causes pain especially before the period. If liver-blood is stagnant/blocked, it causes pain during the period.

Stagnation is the most important thing to treat when dealing with painful menstruation.

Meridian System & Acupuncture

In acupuncture, there are 14 meridian systems in the body. These meridians are pathways of communication and each meridian corresponds with a particular organ.

In painful menstruation, the liver meridian is the primary meridian that I focus on. The liver in Chinese medicine stores the blood and is considered the “woman’s organ”. As said above, the liver also promotes the smooth flow of Qi and blood throughout the body. When the liver isn’t working properly, or is “stagnant” or “congested”, 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.

Causes of menstrual cramps according to Chinese Medicine

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

Chinese Medicine Patterns of Menstrual Cramps:

Chinese medicine always treats the underlying pattern when treating patients with menstrual cramps as there are always different causes. For example, in my clinic, I may see two women with menstrual cramps but their treatment protocols (acupuncture points and herbal formulas) may be completely different from each other. This is because I’m treating the pattern and not the symptom. This is one of the reasons why Chinese medicine is so effective. The treatments are customized to the individual.

I do a thorough consultation with the patient and then I conclude as to the specific Chinese medicine pattern. Very often, the patient will not only exhibit one pattern but rather many patterns complicated into each other.

Here are some of the common patterns I see in my clinical practice:

Qi Stagnation

Dull achy pain in the lower abdomen before the period or during the first or second day of the period.
Most women dislike any pressure to be placed on their lower abdomen.
The menstrual flow can stop and then start again
Often there is PMS symptoms like irritability, moodiness, breast tenderness and bloating
menstrual flow comes and stops with clots; menstrual flow is dark-red; pain is totally relieved after period

Blood Stasis

Sharp stabbing paain
Dark menstrual blood with large or small clots

Cold in the Uterus

Cold pain during or after period;
Pain is relieved with warmth (heating pad or hot water bottle helps)
Menstrual flow is dull light color or dark color
Periods are lighter flow
Clots in the flow

Damp-Heat in Lower Abdomen

Distending or burning pain in lower abdomen before or during period with the burning sensation extending to lower back
Can 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

Dull pain in lower abdomen during or after period
Like to have pressure (massage) on abdomen
Light and thin menstrual flow

Liver and Kidney Deficiency

Dull pain in lower abdomen during or after period
Scanty and thin menstrual flow

Treatments you will receive in my clinic will consist of acupuncture and/or herbal medicine. Nutrition and lifestyle changes will be addressed as well.

You should expect significant improvements in your menstrual cramps within three months of treatment with Chinese medicine (and even sooner for some women).

Here are some lifestyle and dietary tips I give to my patients who struggle with menstrual cramps:

Always keep your abdomen, lower back and soles of your feet warm
Avoid swimming in cold swimming pools during your period
Eat a diet consisting mainly of warm cooked foods and avoid cold raw foods & iced beverages
Drink hot water and herbal teas throughout the day
Moxibustion (or Moxa) can be applied during your period. This involves burning a Chinese herb called mugwort to heat the lower abdomen to increase blood circulation and ease cramping. In my clinic, I often show my patients how to use moxa and send them home with a few moxa sticks to do at home. I also have video tutorials in my online programs all about how to use Moxa.
Place a hot water bottle or heating pad over your lower abdomen every evening (even when you don’t have your period) for about 10 to 15 minutes
Exercise moderately every day – walking, dancing, yoga & light weights are good options
Rest and keep warm during your period and don’t over-exercise during your period
Consider taking Omega 3 Essential fatty acids from Fish Oil 2000 to 3000mg per day
Get weekly or biweekly acupuncture
Take an appropriate Chinese herbal formula prescribed by a qualified Chinese medicine practitioner (like me) 🙂
Self Acupressure is so helpful and can be done from home or from wherever you are. I teach my patients how to do self acupressure in my clinic and in my online programs.
Magnesium can be helpful in relaxing muscles to ease cramps
Reduce your coffee intake
Do things that bring you joy and reduce your stress levels

If you are experiencing severe menstrual cramps that you have never experienced before, please consult with your doctor. Also consult your doctor if your menstrual cramps have become severe and debilitating.

Hear it from others:

J.B.

BC, Canada

"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. Maryam 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."

T.R.

BC, Canada

"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.”

Dr. Maryam Mahanian, DTCM, RAc

Menstrual Period Cramps

I specialize in women’s health issues in my Chinese medicine clinical practice.

When asking about a woman’s menstrual cycle, it’s rare to meet a woman who doesn’t experience cramps during her menstrual period.

The medical term for period cramps is Dysmenorrhea. Dysmenorrhea is the term used for the throbbing or dull pain in the lower abdomen and/or lower back that can happen right before the period, during the period, and to a much lesser extent even after the period.

The pain can range from being just slightly noticeable to being debilitating where the woman can’t go to work and can’t function for several days. I always ask about the severity of the cramps…do they miss work? Do they have to take pain medications like Advil? What makes the pain better?

As many as half of women who get their period have cramps and of these, about 10% have severe dysmenorrhea, which greatly limits activities for one to three days each month.

The pain isn’t just in the lower abdomen. It can occur in the lower back and may even extend down to the legs. In severe cases, there may be nausea and vomiting, dizziness, headache 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.

You may believe that having cramps is just simply part of the many unfortunate things that women go through; however, according to Chinese medicine, it reveals that there is an imbalance occurring in the body which can be resolved. Yes, I said it can be resolved!

Let’s get deeper into why period cramps happen

What causes menstrual pain?

The pains are caused by contractions in the musculature of the uterus.

Higher levels of prostaglandins are associated with more severe menstrual cramps.

Menstrual cramps that aren’t involved with any underlying condition tend to lessen with age and after giving birth.

Two Kinds of Dysmenorrhea

There are two kinds of dysmenorrhea – Primary and Secondary.

Primary Dysmenorrhea:Primary dysmenorrhea starts from puberty and it isn’t associated with a particular condition. This is simply due to contractions of the uterus.

Since there isn’t an actual disorder causing primary dysmenorrhea, then the treatment is simply pain relief. Or if a hormonal imbalance is found because there is also irregular menstrual cycles involved, then the oral contraceptive pill (birth control pill) is given.

Secondary Dysmenorrhea:Secondary dysmenorrhea starts later in life and it might be due to conditions like endometriosis, Pelvic Inflammatory Disease (PID) or fibroids.

When these conditions are addressed and treated, the period cramps hopefully will resolve.

Chinese Medical point of view: All About Stagnation

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). Why the liver? The liver is in charge of the smooth flow of Qi throughout the whole body.

If liver Qi (energy) is stagnant/blocked, it causes pain especially before the period. If liver-blood is stagnant/blocked, it causes pain during the period.

Stagnation is the most important thing to treat when dealing with painful menstruation.

Meridian System & Acupuncture

In acupuncture, there are 14 meridian systems in the body. These meridians are pathways of communication and each meridian corresponds with a particular organ.

The other organs which can be involved in painful menstruation are the spleen and kidneys.

Causes of menstrual cramps according to Chinese Medicine

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

Chinese Medicine Patterns of Menstrual Cramps:

I do a thorough consultation with the patient and then I conclude as to the specific Chinese medicine pattern. Very often, the patient will not only exhibit one pattern but rather many patterns complicated into each other.

Here are some of the common patterns I see in my clinical practice:

Qi Stagnation

Dull achy pain in the lower abdomen before the period or during the first or second day of the period.

Most women dislike any pressure to be placed on their lower abdomen.

The menstrual flow can stop and then start again

Often there is PMS symptoms like irritability, moodiness, breast tenderness and bloating

menstrual flow comes and stops with clots; menstrual flow is dark-red; pain is totally relieved after period

Blood Stasis

Sharp stabbing paain

Dark menstrual blood with large or small clots

Cold in the Uterus

Cold pain during or after period;

Pain is relieved with warmth (heating pad or hot water bottle helps)

Menstrual flow is dull light color or dark color

Periods are lighter flow

Clots in the flow

Damp-Heat in Lower Abdomen

Distending or burning pain in lower abdomen before or during period with the burning sensation extending to lower back

Can 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

Dull pain in lower abdomen during or after period

Like to have pressure (massage) on abdomen

Light and thin menstrual flow

Liver and Kidney Deficiency

Dull pain in lower abdomen during or after period

Scanty and thin menstrual flow

Treatments you will receive in my clinic will consist of acupuncture and/or herbal medicine. Nutrition and lifestyle changes will be addressed as well.

You should expect significant improvements in your menstrual cramps within three months of treatment with Chinese medicine (and even sooner for some women).

Here are some lifestyle and dietary tips I give to my patients who struggle with menstrual cramps:

Always keep your abdomen, lower back and soles of your feet warm

Avoid swimming in cold swimming pools during your period

Eat a diet consisting mainly of warm cooked foods and avoid cold raw foods & iced beverages

Drink hot water and herbal teas throughout the day

Place a hot water bottle or heating pad over your lower abdomen every evening (even when you don’t have your period) for about 10 to 15 minutes

Exercise moderately every day – walking, dancing, yoga & light weights are good options

Rest and keep warm during your period and don’t over-exercise during your period

Consider taking Omega 3 Essential fatty acids from Fish Oil 2000 to 3000mg per day

Get weekly or biweekly acupuncture

Take an appropriate Chinese herbal formula prescribed by a qualified Chinese medicine practitioner (like me) 🙂

Primary Dysmenorrhea:
Primary dysmenorrhea starts from puberty and it isn’t associated with a particular condition. This is simply due to contractions of the uterus.

Secondary Dysmenorrhea:
Secondary dysmenorrhea starts later in life and it might be due to conditions like endometriosis, Pelvic Inflammatory Disease (PID) or fibroids.