Painful Periods

Menstrual cramps, or dysmenorrhea, is considered by most allopathic doctors as a normal aspect of a woman’s menstrual cycle. They do agree, however, that when the cramps are so severe that they interrupt with normal chores (school, work, etc.), the patient should seek treatment.

Background

During the bleeding phase (menstruation) of the menstrual cycle, the lining of the uterus (endometrium) is shed. During the follicular and luteal phases of the menstrual cycle the endometrium has been preparing itself for implantation - the arrival of a blastocyst (a roughly 5-day old fertilized egg). If there is no implantation, then the lining - the functional zone of the endometrium, is shed.

With the absence of  implantation, progesterone declines. This causes the spiral arteries of the endometrial tissue to constrict, reducing the oxygen supply to the lining. The lack of oxygen leads to the breakdown and, subsequently, the shedding of the endometrial lining - resulting in menstruation.

Introduction

According to a review published by American Family Physicians in 2021, dysmenorrhea occurs in 50 to 90% of women of reproductive age. The pain has been reported to vary from mild discomfort to severe, debilitating pain. While some experts argue that the temporary lack of oxygen in the endometrial lining is the main reason for the pain and cramping experienced during menstruation, many healthy women don’t experience any type of pain during their bleeding phase. When it comes to treatment, the first-line medical options are nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives. Unfortunately, neither one of these are options for someone that is trying to conceive. NSAIDs are not recommended while trying to conceive since they can inhibit the production of prostaglandins, which are important for ovulation. A study published by Reproductive Biology and Endocrinology in 2018 concluded that “We suggest that in clinical practice, the administration of non-steroidal anti-inflammatory drugs, which are PGE2 synthesis inhibitors, should be reasonable and limited in infertile women”.

TCM and Dysmenorrhea

From a TCM point of view, dysmenorrhea is considered abnormal – regardless of the intensity of the pain. Pain always indicates blockage – either a blockage of Blood, Qi (energy), or both. There are many factors that can contribute to the blockage of Qi, Blood or both. For example, the emotions of stress and frustration can block the Qi of the Liver (Liver Qi Stagnation). Liver Qi Stagnation causes Blood to stagnate in the Uterus leading to painful periods. Cold in the Uterus can also contribute to a blockage of Qi and/or Blood. This typically is seen when patients are in the habit of drinking/eating cold drinks/food. The coldness constricts the vessels in the Uterus resulting in an inadequate amount of Blood and Qi, leading to dysmenorrhea.

A systematic review published in 2024 by Frontiers in Medicine looked at 57 randomized controlled trials involving 3,903 participants. The aim of the review was to compare the effect of TCM interventions with waitlist, placebo, western medicine, and conventional therapies for primary dysmenorrhea. The review concluded that:

“ For primary dysmenorrhea pain, the effects of acupressure, acupuncture, warm needling, and moxibustion were superior to those of NSAIDs and waitlist”.

Acupuncture and Dysmenorrhea

A randomized controlled trial published in 2018 by the Journal of Acupuncture and Meridian Studies, looked at the efficacy of acupuncture in the management of primary dysmenorrhea. Participants were randomly allocated to either the study group or control group. The participants in the study group received acupuncture, whereas the control group participants did not. Each participant received a total of 45 sessions of acupuncture - 15 sessions/30 days, for a total of 90 days. The study showed a significant reduction in pain severity, muscle cramps, and systemic symptoms in the study group compared with the control group. The study concluded by saying that:

“ Results of this study suggest that acupuncture could be considered an effective treatment modality for the management of primary dysmenorrhea”.

Chinese Herbs and Dysmenorrhea

Several Chinese herbal formulas have been shown to be very effective in the treatment of primary dysmenorrhea. A systematic review published by Explore in 2020 looked at a total of 10 databases (four English databases, three Chinese databases, two Korean databases, and one Japanese database) with the aim of finding randomized controlled trials where the efficacy of the Chinese herbal formula Tao Hong Si Wu Tang – and modifications of it, was evaluated. The review concluded that:

“ This systematic review and meta-analysis provides moderate quality evidence for the superiority of Tao Hong Si Wu Tang (modified) over NSAIDs as well as that of Tao Hong Si Wu Tang plus oral contraceptives over oral contraceptives in the treatment of primary dysmenorrhea”.

Another well-known Chinese herbal formula, Gui Zhi Fu Ling Wan, was the subject of a study done by the Journal of Ethnopharmacology and published in 2023. Participants in this randomized, double-blinded, placebo-controlled trial were randomly assigned to one of two groups; to receive the Chinese herbal formula Gui Zhi Fu Ling Wan or a placebo. Participants were asked to take the herbal formula or the placebo for 3 months. The outcome, change in pain intensity measured by a Visual Analog Scale, was determined 3 months after the last herbal or placebo pill was taken – 6 months from baseline. The study concluded by saying:

“ Our findings revealed that Gui Zhi Fu Ling Wan significantly alleviated the severity of menstrual pain in primary dysmenorrhea patients with the heat-burning blood-stasis syndrome without significant adverse effects”.

Moxibustion and Dysmenorrhea

A systematic review published by Frontiers in 2025 examined seven research databases looking for studies that evaluated the efficacy of moxibustion as the treatment for primary dysmenorrhea. The findings demonstrated that the moxibustion group exhibited a statistically significant response in comparison to the control group and concluded by saying that:

“ Moxibustion therapy shows significantly better efficacy in treating primary dysmenorrhea”

Conclusion

From a TCM point of view menstrual cramps are not normal and they indicate that there is a problem with how Blood and/or Qi are flowing. Under the TCM umbrella there are several therapies such as: acupuncture, Chinese herbal medicine, moxibustion, etc. that have been proven to have a positive effect in dealing with dysmenorrhea.