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Your Menstrual Health Matters

March 05, 2024

A close up of a woman's abdominal and pelvic regions. The woman is wearing an oversize beige knitted top. A white flower extends upwards from the bottom of the frame to where her uterus would be.

 

By Jeannie Kim

International Women’s Day (IWD) is a day to celebrate the achievements, resilience, and voices of women around the world. It's also a day to acknowledge the challenges we still face, and one crucial area that demands attention is our health. As a fertility acupuncturist with 12 years of experience working with women, I have witnessed firsthand the struggles many face navigating their gynecological and reproductive health.

 

It’s alarming to see how often women are given inaccurate and insufficient information about what a healthy menstrual cycle should be like. This can lead to accepting pain and discomfort as typical, which isn't the case. Endometriosis, dysmenorrhea (painful periods), and other period disorders are not something to suffer through silently.

 

Unfortunately, the medical industry often overlooks women's health concerns. For example, in a survey of 758 women, an astounding 50% of participants were misdiagnosed with endometriosis by gynecologists (1). Other evidence shows that many women feel unheard and dismissed when seeking help for their symptoms, affecting health-seeking behavior and their health outcomes (2). Even a world-renowned expert in endometriosis has raised a call to action for doctors to listen to their female patients (3). This is why it is crucial to advocate for yourself. Don't be afraid to ask for further investigations, such as blood tests or ultrasounds, and second opinions if you feel your concerns aren't being addressed adequately.

 

The basic concepts of TCM

 

Qi

Qi is the energy which flows through our bodies along highways known as meridians. 

 

Yin and Yang

Yin and Yang is one of the most well-known dualistic principles outside of Traditional Chinese Medicine (TCM). Yin and Yang cannot exist without each other. Yin is typically associated with cold, internal, and resting states, while Yang is commonly known to be associated with warm, external, and active states. Every person has Yin and Yang within them, but the amount of Yin and Yang can change depending on lifestyle habits, such as diet, and major life changes, such as surgery or giving birth.

Diagnosis and Treatment of Disease in TCM

TCM diagnosis traditionally incorporates a combination of three theories and approaches to allow practitioners to offer a holistic approach to diagnose and treat patients:  

 

Eight Principles

The Eight Principles are used to diagnose disease, which are diagnosed as states of Excess or Deficiency. They are:
 

  • Yin and Yang
  • Internal (within the body) and External (outside or superficial regions of the body)
  • Hot and Cold
  • Qi and Blood

 

Five Organ Elements

The Five Organ Elements explain how the body works and correspond to specific organs within the body. They are:

 

  • Fire (Heart, Small Intestine, Triple Energizer, and Pericardium)
  • Earth (Spleen and Stomach)
  • Metal (Lung and Large Intestine)
  • Water (Kidney Yin, Kidney Yang, and Bladder)
  • Wood (Liver and Gall Bladder)


The TCM organs refer to the meridians in the body through which Qi, Blood, Yin and Yang flow. The Five Elements require a smooth flow of Qi through each Element, known as the “Mother and Son cycle”. In a healthy Five Element cycle, energy is smoothly passed on from the Mother element to the Son element. Occasionally, this flow gets disrupted if there is an imbalance of power between the Mother and Son, for example, an overpowering Mother and a weak Son leads to the Mother controlling the Son.
 

A disrupted flow between Mother and Son elements presents as either physical or emotional symptoms. A commonly seen example of a controlling Mother on a weak Son is the Liver controlling the Spleen. This typically occurs when a person has a diet high in sugar and/or fat (which causes Spleen deficiency) while also experiencing extreme stress (which causes Liver excess). Eventually, the Liver controlling the Spleen can present as irritability, stomach pain, loose stools, fatigue, and insomnia in a person.  

 

Root and Branch Diagnosis and Treatment  

The Root and Branch approach to diagnosis and treatment generally explains that TCM treatments can treat either the “root” of the problem (for example, treating the Liver TCM organ to treat mood swings, period pain, headaches, bloating, and shoulder pain) or the “branch”, or symptoms (for example, using Stomach meridian points to treat digestive problems).

 

 

The menstrual cycle from a TCM perspective 

Traditional Chinese Medicine (TCM) takes a holistic view of the menstrual cycle. This alternative perspective offers insight into what a healthy cycle looks like. 

 

In TCM, the menstrual cycle is viewed as a rise and fall between Kidney Yin and Kidney Yang that generally lasts four weeks and involves four phases (4). When referring to the menstrual cycle, Kidney Yin is associated with cold and blood, while Kidney Yang is associated with heat and dynamic Qi. 

 

The first phase is menstruation, which traditional texts state should last about five days, and in most women, Kidney Yang is at its highest, while Kidney Yin is at its lowest. During this phase, the Liver, Spleen, and Heart organs in TCM are responsible for the uninterrupted flow of menstrual blood. Abnormal menstrual flow includes menstrual clots, dark menstrual color, temporary ceasing of menstrual blood for one day (for example, bleeding on days one to three, no bleeding on day four, then bleeding again on days five and six), or light menstrual flow. 

 

In the second phase (post-menstrual), which typically lasts for seven days, the reproductive system prepares for ovulation. 

 

Phase three is the post-ovulation stage, which typically lasts one week. During this time, Kidney Yang starts to increase while Kidney Yin decreases and is akin to the thickening of the endometrial lining, which allows for a fertilized egg to implant and, therefore, pregnancy. 

 

Phase four is the premenstrual phase, where Kidney Yang rises to keep the uterus warm if a woman is pregnant, while Kidney Yin slowly decreases. 

 

Abnormality can occur in either one phase or a combination of two to four phases, leading to reproductive health problems, such as period pain, miscarriages, extremely long (over 35 days) or extremely short cycles (less than 24 days). 

 

Two cups of tea sitting on a wooden table behind a sofly glowing candle. Two women dressed in robes sit in armchairs behind the table.

 

What does a healthy period look like?

TCM defines a "healthy" period as (5):
 

  • Fresh red blood for two to three days. Day one of a menstrual cycle is considered a full flow of fresh red blood. (Note: some menstrual bleeds can deviate from fresh red blood. When this occurs, TCM considers this as a pathological abnormality of Qi / Blood / Yin / Yang due to either the Kidney, Liver, Spleen, or Heart, or a combination of two to four of these organs.) 
  • No premenstrual spotting or prolonged bleeding (for more than seven consecutive days).
  • No premenstrual or accompanying symptoms (e.g., bloating, cramps). TCM considers the presence of any premenstrual symptoms to be a sign of deficiency or stagnation within the body. For example, irritability or headaches before a period can be due to Liver Qi stagnation and/or Liver Blood stagnation. Another example is a pattern of loose stools or constipation five to seven days before a menstrual bleed that can be due to spleen qi deficiency, liver blood stagnation, or dampness (excess fluid in the body).
  • No menstrual pain requiring painkillers.

 

This does not mean every cycle will be identical, but if you experience significant deviations from this baseline, it is best to consult a gynecologist and advocate for further investigations. Remember, you are your own best advocate for your health.

 

Five top tips for a healthy menstrual cycle

A few TCM principles can be used as guidance to experience a healthy menstrual cycle. 

(Note: the following tips focus on general practices and should not be misconstrued as medical advice. Please also remember that individual needs may vary.)

1. Embrace warmth

Choose warm, nourishing foods like cooked vegetables, soups, and stews leading up to and during your menstrual cycle. Warm foods are thought to promote Blood circulation in the body according to TCM principles (5). 

Avoid cold or raw foods that can aggravate painful periods, as these types of foods tend to be culprits of Qi and Blood stagnation (6). Pain, according to TCM, is associated with any form of stagnation.

2. Manage stress

Stress can exacerbate menstrual symptoms (7). Incorporate gentle mind–body practices like yoga, meditation, or deep breathing exercises to manage stress and promote overall well-being (8).

3. Sleep well

Poor sleep quality is a risk factor for PMS and dysmenorrhoea (9). Healthy habits for good sleep quality include regular bedtime, aiming for seven to nine hours of sleep per night (10), and limiting the use of electronic devices before bedtime (11).

4. Explore holistic medicine options for pain and discomfort

Consider exploring the world of natural therapy treatments. Research suggests that therapies like acupuncture, heat therapy, counseling, massage, transcutaneous electrical nerve stimulation (TENS), and physiotherapy can be as effective as pain medications (12). These holistic approaches not only address the physical discomfort but also have minimal short-term side effects.

5. Seek professional guidance

A qualified TCM practitioner experienced in treating menstrual issues can conduct a comprehensive assessment and develop a personalized treatment plan based on your individual needs and medical history.

 

The assessment for menstrual health typically involves questions about your cycle (including the age of your first period, length of menstrual cycle and bleeding, the color of menstrual blood, presence of clots / stringy blood, spotting, pain, mood swings, bowel or sleep changes before or during your menstrual bleed); fertility history (such as several pregnancies, miscarriages, IVF cycles); what you generally eat daily (including caffeinated and alcoholic beverages); bowel motion habits (number of stools per day / week and quality of stools), sleep quality (including trouble falling or staying asleep); quality of energy levels; migraines (location of migraine, description of pain); and more. 

 

Physical assessment for menstrual health typically includes observation of your tongue and feeling the pulse on your wrists. (Fun fact: the pulse strength and tone are different on both right and left!) The tongue and pulse give TCM practitioners crucial insight into the quality and quantity of your Yin, Yang, Qi, and Blood for various organs.

 

If you experience significant menstrual irregularities, persistent pain, or any other concerning symptoms, you should consult a gynecologist for diagnosis and appropriate medical treatment.

 

By empowering ourselves with knowledge and advocating for our health, we can break the silence on women's health issues. This IWD, let's prioritize our well-being, listen to our bodies, and embrace a holistic approach to managing our menstrual cycles. Remember, you are not alone. Together, we can create a world where women's health is understood, respected, and supported.

 

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for personalized guidance.

 

Photos from Canva.

 

References

  1. Bontempo, A. C., & Mikesell, L. (2020). Patient perceptions of misdiagnosis of endometriosis: Results from an online national survey. Diagnosis, 7(2), 97–106. doi.org/10.1515/dx-2019-0020
  2. Govender, V., & Penn-Kekana, L. (2008). Gender biases and discrimination: A review of health care interpersonal interactions. Global Public Health, 3(1), 90-103. doi.org/10.1080/17441690801892208
  3. Abbott, J. (2016). Endometriosis and getting the information right. alanahealthcare.com.au/2016/02/29/endometriosis-and-getting-the-information-right/ 
  4. Maciocia, G. (2011). Obstetrics and Gynecology in Chinese Medicine (2nd ed.). Churchill Livingstone. 
  5. Lyttleton, J. (2013). Treatment of Infertility with Chinese Medicine (2nd ed.). Churchill Livingstone. doi.org/10.1016/C2009-0-54723-X
  6. Wang, L., Yan, Y., Qiu, H., Xu, D., Zhu, L. Liu, J., Li, H. (2022). Prevalence and Risk Factors of Primary Dysmenorrhea in Students: A Meta-Analysis. Value in Health,25(10), 1678-1684. doi.org/10.1016/j.jval.2022.03.023 
  7. Ju, H., Jones, M., Mishra, G. (2014). The Prevalence and Risk Factors of Dysmenorrhea, Epidemiologic Reviews, 36(1), 104–113. doi.org/10.1093/epirev/mxt009
  8. McGovern, C.E., & Cheung, C. (2018). Yoga and quality of life in women with primary dysmenorrhea: A systematic review. Journal of Midwifery & Women's Health, 63, 470-482. doi.org/10.1111/jmwh.12729
  9. Jeon, B., Baek, J. (2023). Menstrual disturbances and its association with sleep disturbances: a systematic review. BMC Women's Health, 23, 470. doi.org/10.1186/s12905-023-02629-0
  10. Khubchandani, J., Price, J.H. (2020). Short sleep duration in working American adults, 2010-2018. J Community Health, 45(2), 219–27. doi.org/10.1007/s10900-019-00731-9
  11. AlShareef, S.M. (2022). The impact of bedtime technology use on sleep quality and excessive daytime sleepiness in adults. Sleep science, 15(2), 318–327. doi.org/10.5935/1984-0063.20200128
  12. Aboualsoltani, F., Bastani, P., Khodaie, L., Fazljou, S. M. B. (2020). Non-pharmacological treatments of primary dysmenorrhea: A systematic review. Arch Pharma Pract, 11(S1), 136-42.

 

Further Reading

The following links explain further about menstrual health from a TCM perspective. (Note: I have no affiliations or conflicts of interest with any of the websites/companies mentioned.)

 

About the Author

Jeannie is currently pursuing an honors degree in psychology with a focus on clinical applications. Prior to this, she was an acupuncturist specializing in fertility, stress management, and pain relief in Sydney for 12 years. With her unique blend of Eastern and Western therapeutic approaches and maternal perspective, as feature writer, Jeannie promises a valuable contribution to BAMBI magazine.