What are menstrual problems?

These may include:

  • Painful periods
  • Heavy periods
  • Irregular periods
  • Absent periods
  • Pre-menstrual tension (PMT)
  • Endometriosis

What causes menstrual problems?

Painful periods

Can be caused by movement of blood, and maybe the womb contracting to push out the blood.  Extreme pain can be caused by cysts or abnormalities within the gynaecological area.

In Chinese medicine the problem is described as Stagnation of Energy and Stagnation of Blood.  They are often worse with higher stress levels.

Heavy periods

In Western Medical terms are a sign of endometriosis, fibroids, polycystic ovarian syndrome, or other health problems.  Alternatively they can happen if you have a coil (IUD) inserted.

In Chinese Medicine it is a sign of either Internal Heat (which can be caused by stress), or a weakness of the Spleen energy.

Irregular periods

A cycle longer or shorter than 28 days can be caused by stress, exercise, extreme weight changes, contraception, polycycstic ovarian syndrome (PCOS) or thyroid problems.

In Chinese Medicine a short cycle is caused by heat (can be stress) or diminished energy.  A long cycle is more likely to be due to Blood deficiency, invasion of Cold or stuck energy.

Absent periods

Are often caused by stress, over exercise or severe weight loss.

In Chinese Medicine, it is due to Blood deficiency (not always anaemic, but sometimes), stagnation of cold = from skimpy tops, or stagnation of energy - and therefore Blood.

Premenstrual syndrome (PMS)

Western medicine suggests the cause is due to hormone level changes prior to menstruation.

Chinese Medicine suggests PMS is due to stagnation of energy - which can be made worse with stress.  It may also be due to depleted energy, in particular that of the Kidneys (the source of Yin), and the Spleen (one of the sources of Blood).

Endometriosis

Western medicine does not give a cause of endometriosis, although there are some theories.

In Chinese Medicine it is due to Blood Stagnation and Qi stagnation, which combines with an underlying deficiency.

Infertility

See infertility.


Conventional treatment for menstrual problems?

Painful periods

Medication:

  • NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen or aspirin is recommended to deal with the pain, or your GP may prescribe codeine as well.
  • The combined oral contraceptive pill: may give pain relief - and contraception as well
  • If pain is caused by infection you may be given antibiotics.

Further tests:

  • If the pain is caused by an underlying condition you may be referred for surgery or further tests, which may include a pelvic ultrasound, a laparoscopy or a hysteroscopy.

Heavy periods

Medication:

  • Levonorgestrel-releasing intrauterine system (LNG-IUS): inserted into the womb to release progestogen which also acts as a contraceptive
  • Tranexamic acid: taken as tablets to help the womb blood clot - they are taken after bleeding has started, during the bleed
  • NSAID: ibuprofen taken just before, or at the beginning of the bleed
  • Combined contraceptive pill: provides contraception, regulates periods and can reduce any pain
  • Oral norethisterone: progestogen taken in tablet form from day 26 of your cycle
  • Injected progestogen: injected once every twelve weeks
  • Less commonly used: gonadotropin releasing hormone analogue (GnRH-a)

Surgery:

  • Generally for fibroids: uterine artery embolisation (UAE) or myomectomy
  • If not caused by figroids: endometrial ablation or hysterectomy

Irregular periods

You will be asked questions about your periods, lifestyle and medical history.

  • A thyroid test will be taken - and medicated if positive
  • You may be sent for an ultrasound scan if polycystic ovary syndrome (PCOS) is suspected
  • Treatment for PCOS: the contraceptive pill may be recommended; or clomifene and metformin if pregnancy is desired
  • If you have a high BMI (over 25) you will be advised to lose weight
  • Surgery: laparoscopic ovarian drilling (LOD) my be used for fertility problems associated with PCOS
  • Stress management advice may be given.

Absent periods

May be due to pregnancy, excessive weight loss, excessive exercise or excessive stress - lifestyle advice will be given.

If none of these apply you may be given blood tests to check prolactin, thyroid, folicle-stimulating hormone or lutenising hormone.  You may also have an ultrasound scan, CT scan or MRI scan to reveal any problems with the reproductive system or pituitary gland.

Subject to these results medication or surgery might be recommended

Pre-menstrual tension (PMT)

You will be given lifestyle advice - to cut out caffeine and alcohol, to take regular exercise and to eat a balanced diet.

Other options include:

  • Combined contraceptive pill
  • Antidepressants such as selective serotorin reuptake inhibitors (SSRI) or serotonin-norepinephrine reuptake inhibitors (SNRI)

Endometriosis

Diagnosis is through a laparoscopy.

Treatment may include medication:

  • Non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen and naproxen taken before you expect the pain
  • Hormone treatment to limit or stop the production of oestrogen so: progestogens, antiprogestogens, combined contraceptive pill or gonadotrophin-releasing hormone (GnRH) analogues

Surgery:

  • Laparoscopy (used for diagnosis AND treatment)
  • Laparotomy
  • Hysterectomy

How do I treat menstrual problems?

Acupuncture

Acupuncture is used to move stuck energy, and stuck blood - commonly the cause of pain.  Where there is a lack of periods, or where there is a long cycle, acupuncture strengthens vital organs to boost the gynaecological process; or where there is excessive menstrual bleeding.

EFT

Period problems are often associated with stress and emotional issues, particularly in the case of bad pain or endometriosis.  I have found a combination of acupuncture and EFT profoundly effective with such problems.

Kinesiology

Tests for toxicity and pathogens which might be leading to symptoms.

Foods are tested, commonly caffeine, alcohol, sugar and sometimes wheat and/or dairy are best avoided with period problems, especially endometriosis.

Supplements are tested including Agnus Castus, floradix, a general multi vitamin, adrenal support, essential fatty acids, etc.

Effectiveness of treatment

Most should notice a change to symptoms from the beginning to the end of treatment.  With regular treatment you will notice a smoother and smoother cycle each month, with abnormalities smoothed out, including just feeling better in yourself.

Evidence

The reviewers concluded that their review found promising evidence in the form of randomised controlled trials for the use of acupuncture in the treatment of primary dysmenorrhoea compared with pharmacological treatment or herbal medicine

Cho SH, Hwang EW. Acupuncture for primary dysmenorrhoea: A systematic review. BJOG 2010a; 117: 509-21.

The researchers concluded that both ear and body electroacupuncture can effectively relieve endometriosis-induced dysmenorrhoea, and that the former seems to be superior to the latter in reducing pain severity, which may be closely related to their effects in reducing plasma PGE2 and raising 6-Keto-PGF1alpha level.

Jin YB et al. [Randomized controlled study on ear-electroacupuncture treatment of endometriosis-induced dysmenorrhea in patients]. Zhen Ci Yan Jiu 2009; 34(3): 188-92.

The researchers concluded that preliminary findings suggest that Japanese-style acupuncture may be an effective, safe and well-tolerated adjunctive therapy for endometriosis-related pelvic pain in adolescents.

Wayne PM et al. Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial. J Pediatr Adolesc Gynecol 2008; 21(5): 247-57

The researchers concluded that the combined use of acupuncture and herbs has a significant effect on endometriosis and the adverse reactions are less than with danazol

Xia T. Effect of Acupuncture and Traditional Chinese Herbal Medicine in Treating Endometriosis.   International Journal of Clinical Acupuncture 2006; 15(3): 145-50.

Each case is slightly different, so to discuss your symptoms further call 020 7370 4693 or email.


A case study from my clinic

Gemma, 29.  I worked with Gemma during my transition from my job in sales to my career in acupuncture and other therapies.  Gemma had been diagnosed with endometriosis, when I started treating her, she had stopped work due to the terrible pain.  She was on very strong pain-killers, and when it was very bad she was on morphine.

I worked with Gemma a lot, weekly for about 2 years, with acupuncture, EFT and kinesiology.  Over this time her symptoms varied, generally getting better, but if she got stressed she would have a relapse.  Ultimately she was pain free, and the doctors advised, in their view she was endo free - although she didn't have a laparoscopy to confirm the status.

I no longer hear from her, although I imagine if she took a stressful full-on job, some of her symptoms would return.  However, I know she chose to pursue a career out of sales that was more aligned to her passions - in so doing it is more likely she would remain symptom free.


Lifestyle advice for menstrual problems

  • Exercise: although you may not want to exercise while you are having a painful period, keeping active can help to reduce pain. Try some gentle swimming, walking or cycling.
  • Heat: applying heat to your tummy can help to ease your pain. You could try using either a heat pad or a hot water bottle.
  • Warm bath or shower: taking a bath or shower can help to relieve your pain, while also helping you to relax.
  • Massage: light circular massage around your lower abdomen may help to reduce pain.
  • Avoid caffeine and alcohol
  • Avoid sugar and processed food
  • Have a balanced diet with lots of fruit and vegetables
  • Reduce stress levels

Stress reducing tips

In my experience stress is a big contributor to headaches, so:

  • Get good rest, at least 8 hours a night, the more before midnight the better
  • Take a walk in nature: the countryside or a park
  • Try yoga, Qi Gong or Tai Chi
  • Engage your creativity: painting, playing an instrument, taking pictures, creative writing (start with a journal)
  • Avoid over obsessing about emails, texts and the internet
  • Anything to provide balance to counteract a busy life

Ask yourself, what do I do to relax?  I hope you have an answer!  If so, make time for it.  If not - play and find out.