Painful periods: understanding dysmenorrhoea

Having pain during your period is very common, but it should not be seen as inevitable. When the pain is intense, it can cause missed school or work and weigh on daily life. This is called dysmenorrhoea.

Two situations to distinguish

Primary dysmenorrhoea appears from the first cycles, with no abnormality of the uterus: it is linked to contractions caused by substances called prostaglandins. It often eases with age or after a pregnancy.

Secondary dysmenorrhoea is due to an identified cause (endometriosis, adenomyosis, fibroids, an IUD, infection…). It often appears later, or worsens over time.

How does Chinese medicine explain it?

For TCM, menstruation requires the free circulation of Blood in the uterus. Pain reflects a blockage. Several profiles are distinguished:

• Qi stagnation — pain that precedes or accompanies the period, tender breasts, irritability, bloating.
• Blood stasis — fixed, very sharp pain, with dark clots.
• Cold in the uterus — cramping pain, relieved by heat, worsened by cold.
• Qi and Blood deficiency — dull pain, at the end of or after the period, with fatigue and pallor.

What can acupuncture offer?

The level of evidence remains limited. Some analyses suggest acupuncture may reduce period pain, but the latest Cochrane review (2016) judges the quality of the evidence low to very low and concludes that the evidence is insufficient. I place needles on the lower abdomen, lower back, legs and hands, sometimes with heat (moxibustion or a Wei lamp).

The work is preferably done over several cycles, then reassessed. Here again, acupuncture is a very worthwhile complementary option, added to prescribed treatments, not replacing them.

What can you do day to day?

• Heat: a hot-water bottle on the lower abdomen or lower back.
• Gentle movement: walking, yoga, qi gong; regular physical activity often reduces the pain.
• According to TCM, avoid iced foods and excess raw vegetables during your period, and favour warm, cooked dishes and a fresh ginger infusion.
• Listen to your body: don’t dismiss pain that disrupts your life.

Does it hurt?

I use very small, single-use needles, much finer than a blood-test needle. Most of the time you feel a slight prick, then nothing more. Sometimes you feel nothing at all; some areas are more sensitive than others. This sensation lasts a few seconds, then settles.

You may also feel, around the needle, a dull impression of heaviness, warmth or tingling: this is an expected, harmless sensation. If something bothers you, tell me: I can adjust or remove the needle right away. The lower abdomen and lower back can be more sensitive, especially when the area is already painful: I adapt to your sensitivity, and can start with a small number of needles.

This article is intended for information and education. It does not replace a medical consultation and does not constitute personalised advice.

References

• Smith CA, Armour M, Zhu X, Li X, Lu ZY, Song J. Acupuncture for dysmenorrhoea. Cochrane Database Syst Rev 2016;(4):CD007854.

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