Painful Periods, PMS, and Irregular or Absent Periods

The context

A menstrual cycle does not have to be completely symptom-free. But severe pain, very heavy bleeding, markedly irregular cycles, or a week or more of significant physical and emotional symptoms before every period should not simply be accepted as an inevitable part of being a woman.

In Chinese medicine, the menstrual cycle gives us information. When bleeding begins, how long it lasts, whether there is pain or spotting, the amount and character of the blood, when ovulation occurs, and how you feel during the weeks between periods all contribute to the diagnostic picture.

This is one of the foundations of Chinese medical gynecology and has been a core part of our practice since it opened. Adele completed postgraduate clinical training in the gynecology ward at Xi Yuan Hospital in Beijing, studying with physicians specializing in infertility, menopausal disorders, and general gynecology, and has treated and taught Chinese medical gynecology for more than twenty-five years.

What we treat

We regularly treat:

• Painful periods, including cramping, low back or thigh pain, and pain that begins before bleeding
• PMS, including irritability, low mood, anxiety, breast tenderness, bloating, headaches, food cravings, and changes in sleep
• Irregular cycles that are consistently long, short, or unpredictable
• Heavy or prolonged periods, including flooding and clotting
• Light or absent periods (amenorrhea)
• Spotting before or between periods
• Ovulation pain and other symptoms that reliably track the menstrual cycle
• Cyclical headaches, migraines, digestive symptoms, and acne

We also treat patients with diagnosed gynecological conditions such as endometriosis, adenomyosis, and PCOS. When menstrual symptoms suggest an underlying condition that has not been investigated, we will recommend appropriate medical evaluation rather than assuming everything is simply part of a difficult period.

Reading the cycle

Two people can both describe their problem as “bad periods” and have very different menstrual patterns.

When does the pain begin — before bleeding, with the onset of the period, or afterward? Is it cramping, sharp, dull, or heavy? Does heat help? What is the bleeding like — bright or dark, heavy or light, thin or clotted? Does spotting precede the period? When do breast tenderness, irritability, headaches, food cravings, or changes in digestion begin?

We also want to know what happens during the rest of the month: the length of the cycle, signs of ovulation, cervical fluid, sleep, digestion, energy, temperature, mood, and anything else that changes predictably as the cycle progresses.

From this, we build a Chinese medical diagnosis and treatment plan. Two patients with similar symptoms may need very different treatment, which is why we don’t use a fixed protocol for period pain, PMS, or irregular cycles.

The treatment itself can also change through the month. The follicular phase, ovulation, luteal phase, and menstruation are physiologically different parts of the cycle, and acupuncture points and herbal formulas may change accordingly.

Three cycles — a season of treatment

We generally think about menstrual treatment in cycles rather than individual visits. Three cycles — roughly three months, or a season of treatment — gives us enough time to work through the different phases of the menstrual cycle repeatedly and see how the pattern is changing.

During that period, treatment is usually weekly, with Chinese herbal medicine when appropriate. Diet, exercise, sleep, and other aspects of daily life may also be part of the conversation, depending on what is contributing to the individual pattern.

When a patient is able to participate fully in that process, we often see significant changes over those three cycles — whether that means substantially less pain, a more regular cycle, lighter or more manageable bleeding, or a premenstrual week that is considerably easier.

What treatment involves

Acupuncture is the foundation of treatment. Chinese herbal medicine is frequently used for menstrual disorders and can be especially useful when we are treating a pattern that changes through different phases of the month. Formulas are individualized and adjusted as needed rather than prescribed simply because someone has PMS or painful periods.

Moxibustion is also used frequently, particularly for the kind of menstrual cramping that feels better with warmth. When home moxa is appropriate, we can teach you how and when to use it safely.

Dietary and lifestyle recommendations are specific to the individual. We are not interested in handing everyone the same restrictive diet. Sometimes a few changes are important; sometimes diet is not the central issue. The treatment plan should reflect the person in front of us.

PMS and PMDD

Premenstrual symptoms can begin well before the period itself. Irritability, anxiety, sadness or weepiness, breast tenderness, bloating, headaches, sleep changes, fatigue, and food cravings can occupy a substantial part of every month.

We treat the pattern across the entire cycle rather than waiting for symptoms to appear in the days before menstruation.

PMDD is different from ordinary PMS. Symptoms can be severe and can significantly affect mood, relationships, and daily functioning. We can use Chinese medicine as part of care for patients with PMDD, but significant depression, anxiety, or other severe mood symptoms also deserve appropriate medical or mental-health evaluation and treatment.

Hormonal contraception and changes in the cycle

You can receive acupuncture while taking hormonal contraception or using a hormonal IUD. Some patients come because they have symptoms despite contraception; others come while transitioning off it.

If periods do not return after stopping hormonal contraception, or a previously regular cycle becomes markedly irregular or disappears, we look at the circumstances and also recommend medical evaluation when appropriate. Pregnancy, PCOS, thyroid disorders, changes in weight or nutrition, intensive athletic training, perimenopause, and other factors can all affect menstruation and need to be considered.

Tell us what medications, hormones, and supplements you are taking. If Chinese herbs are part of your treatment, we need the complete picture in order to prescribe them appropriately.

When menstrual symptoms need medical investigation

Chinese medicine should complement appropriate gynecological care, not replace it.

New or severe pelvic pain, a significant change in a previously stable cycle, bleeding between periods or after sex, unexplained absence of menstruation, or unusually heavy bleeding should be medically evaluated.

Severe or progressively worsening menstrual pain can also be a sign of an underlying condition such as endometriosis or adenomyosis. If that is part of your picture, we will encourage appropriate evaluation while continuing to address your symptoms. These conditions are discussed in more detail on our Endometriosis & Adenomyosis page.

What we’re looking for

Progress is not measured by whether you suddenly have a textbook-perfect 28-day cycle.

We look for meaningful changes: pain that no longer takes you out of work or keeps you in bed; less reliance on pain medication; bleeding that is more manageable; cycles that become more predictable; fewer days of spotting; or PMS that no longer consumes a significant part of every month.

Sometimes pain changes first. Sometimes the timing of the cycle changes before anything else. What matters is that over successive cycles, we can see meaningful and sustained change.

Common questions

How many treatments before I know if this is working?

We generally recommend giving treatment three complete cycles. That allows us to treat through each phase of the menstrual cycle several times and evaluate what is actually changing.

When in my cycle should I come in?

You can start at any point. Once we understand your pattern, we may recommend particular timing for some visits. For menstrual pain, for example, treatment in the days leading up to the period can be particularly useful.

Can I be treated while taking birth control or using an IUD?

Yes. Tell us what you are using and why it was prescribed, and we will take that into account.

Do I need to take Chinese herbs?

Not necessarily. We use them frequently for menstrual disorders, but whether they belong in your treatment depends on your particular pattern and circumstances.

My periods are very painful, but my scans are normal. Can you still treat me?

Yes. Normal imaging does not mean the pain is unimportant or that there is nothing to treat. At the same time, if the history suggests that further investigation is warranted, we will tell you.

Could my painful periods be endometriosis?

They could be. Severe or worsening menstrual pain — particularly when accompanied by pain with sex, bowel movements, or other pelvic symptoms — deserves appropriate assessment. See our Endometriosis & Adenomyosis page for more about how we approach these conditions.

Is treatment safe if I am trying to conceive?

Yes. Tell us that you are trying to conceive, because it changes how we approach different phases of the cycle and which herbs, if any, we use.