Your Period Shouldn’t be Painful

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I talk about menstrual cycles all the time—every day, multiple times a day. I talk about menstrual cycles so often and in such detail that I forget it’s not “normal” to do so. When we do talk about menstruation in our culture, it’s typically to lament the PMS, the pain, or the messy inconvenience of it all. What we don’t talk about is what is actually happening in our body every month, or the way our cycles can provide a striking window into the status of our overall health.

As a practitioner of Chinese medicine, the details of a woman’s menstrual cycle will of course inform my treatment plan for any issue related to her cycle, but it surprises people that it will also inform my approach in treating almost any other complaint. Every aspect of your menstrual cycle tells me something important about the state of your general health: the length of your cycle, the volume of blood, the color of blood, the timing of ovulation, your basal body temperature, any pre-menstrual symptoms, and the presence or absence of cramping are all quite revealing. Positive changes in your cycle as we move through treatment also serve as a useful barometer to track your body’s journey back toward balance; this is true even if your primary complaint had seemingly “nothing” to do with your menstruation.

Bottom line? Menstrual cycles matter. This article is the second in a year-long series for ELM chronicling different aspects of women’s menstrual health. My hope is that by the end, you’re as comfortable and curious as I am about the monthly event common to half of our population.

Periods Should NOT Be Painful
This month we tackle dysmenorrhea, otherwise knows as CRAMPS!!! Ladies—they’re the worst, am I right?

What’s unfortunate is that at least HALF of you out there are nodding in agreement, suffering through painful periods yourselves, every month. Some studies suggest that between 5 and 20% of women experience periods so painful that they interfere with daily life—missing school, calling out from work, or skipping social activities. Painful periods, like the PMS we discussed in our previous article, may be common but they are not normal! Like PMS, cramps—even severe ones—are both preventable and treatable in the vast majority of cases. Periods should not be painful. Period (pardon the pun)!

So, when you’re cramping, what exactly is happening in that cranky uterus of yours? Your uterine lining builds up every month in anticipation of the fertilized egg that may come down the pike looking for a soft, cozy spot to snuggle up and implant. Once your body determines you are *not* pregnant this time around, it gets to work expelling that lining—out with the old, in with the new. Cramps are caused by contractions of your uterus—a muscle—in its effort to clean house. After your period, the cycle starts all over again with your body building up a fresh lining to welcome next month’s potential embryo.

Now, I’ve said that cramping isn’t normal and I stand by that statement, but the fact of the matter is that your uterus *is* a muscle and it *is* contracting. This is normal. You may experience a sensation associated with those contractions during the first few days of your cycle, but it should not be painful, per se, and it certainly shouldn’t interfere with your life.

If a woman comes to see me and reports mild cramping for a day or so that responds well to conservative measures like a heating pad or a few ibuprofen, do I worry? No. Could she be totally symptom-free? Most likely. Must she be totally symptom-free to consider herself healthy, balanced, and fully vital? Not necessarily. A practitioner of Chinese medicine will take mild cramping under consideration as we assess the rest of the woman’s physical, mental, and emotional make-up.

On the other hand, if a woman comes to me and reports her cramps are bad enough to regularly miss school or work, this is a problem that needs to be addressed. Even if you’ve had bad cramps since you first started menstruating, even if this is “normal” for you, even if you’ve been evaluated and your Western doc says there is nothing medically wrong and/or there’s nothing they can do about it, cramps like this are not normal and always call for further scrutiny. If your moderate to severe period pain is new, or is worsening, or is changing over time, this definitely merits investigation. Painful menstrual cramps are a sign of a system in distress. While the particular distress signal of dysmenorrhea only has the opportunity to show itself strongly once a month through the rhythm of your cycle, the underlying issue is in fact present all of the time—and it may be responsible for other symptoms that you’ve been ignoring, or thinking are no big deal or completely unrelated.

Types of Dysmenorrhea
Dysmenorrhea is often split in to two types: primary and secondary.

Primary dysmenorrhea is a painful period that’s not linked to any particular gynecological “disorder”—no endometriosis, no fibroids, no discernable masses, no signs pointing to any other cause identifiable by Western diagnostic tests, etc. And yet, the period is painful. In these instances, most women are told to take Advil and endure—they are told this is normal and they need to accept that they will likely have painful periods throughout their lives. Chinese medicine thinks this approach is bonkers.

Secondary dysmenorrhea is painful menstruation that we can link to a more tangible “cause.” In other words, the pain is considered “secondary” to an underlying, identifiable gynecological issue. These include:

• Endometriosis: When the endometrium—the lining of the uterus—implants in areas outside of the uterus. As your hormones fluctuate this tissue responds accordingly, building up, shedding, and “bleeding” just like the lining inside of your uterus—but it has no way to exit the body in the way the endometrium is supposed to do. This causes pain, and over time can contribute to ovarian cysts and scar tissue, which can also cause pain.
• Adenomyosis: When the lining of the uterus starts to invade into the muscle of the uterus, itself. Your uterus contracts and cramps more intensely in an effort to shed the buildup that’s embedded more deeply than it should be.
• Fibroids: Benign tumors that grow in the walls of the uterus. They’re common—over 70% of women will experience them at some point in their lives. They’re not necessarily a problem and can be completely asymptomatic. The trouble is when they become the root of heavy periods, prolonged bleeding, or severe cramping.
• Sexually Transmitted Infection (STI) or Pelvic Inflammatory Disease (PID): These are active infections in your reproductive organs. Neither is a cause of painful menstrual cramps, per se, but infection may be behind generalized lower abdominal pain or pelvic pain, be it during your period or at other times of the month. Pelvic pain accompanied by increased vaginal discharge with a strong odor, bleeding after intercourse or at times other than your regular cycle, issues with urination or pain on moving your bowels, or chills and fever warrant a trip to your doctor’s office to rule out infection and/or treat it as soon as possible.
• Adhesions: Scar tissue that has built up in the uterine cavity. Adhesions may be due to trauma such as a D&C procedure or past infection (another reason to seek treatment for suspected infection as soon as possible). Less commonly, adhesions can develop as a result of an IUD (intra-uterine device), endometriosis, or other surgical procedures (such as surgery to remove fibroids).
• Ovarian cysts: Many women have ovarian cysts at some time or other, and most present little or no discomfort and are harmless. Larger cysts or a ruptured cyst may cause pelvic pain—a dull or sharp ache in the lower abdomen on the side of the cyst. (Rarely a ruptured cyst can cause severe symptoms requiring medical attention.)
• IUD birth control devices: These can cause or increase dysmenorrhea in some women, particularly in the months immediately following insertion.
• Miscarriages can present as anomalous painful period. Miscarriage is more common than we think, with many women miscarrying without realizing they were pregnant to begin with. Of course, this sort of dysmenorrhea would happen only as an outlying cycle, not regularly, every month.

What To Do About It?
Always play it safe: check with your primary care provider so you know, from a Western perspective, what may (and may not) be going on with your painful periods. Once you have that information, take the time to consider your options. Drugs or surgery are often the primary—or *only*—avenues presented by allopathic providers. There are times when these are the best avenues to pursue. That said, if you can safely postpone drugs or surgery and are interested in an approach that may resolve your dysmenorrhea on a deeper level, Chinese medicine has extraordinary tools to balance your cycle, your hormones, and your body, regardless of the “cause” of your dysmenorrhea.

Chinese medicine teaches that there are many possible imbalances that can lead to painful cycles; they all have in common some sort of stagnation. In Chinese medicine, wherever there is stagnation there is pain. We may identify a stagnation of qi, heat, cold, damp, or deficiency as the root of your dysmenorrhea. It’s okay if that makes no sense to you—the important thing is that it makes sense to your Chinese medical provider! After a thorough intake they should be able to match your symptoms to a particular pattern of disharmony, and then treat that disharmony with the appropriate acupuncture and herbs.

After such an explanation from me, women often counter, “Well, I’m sure it’s hormonal.” Of course it is! You have hormones, and hormones govern your menstrual cycle. It is also true that Chinese medicine developed a sophisticated understanding of your female physiology before the concept of “hormones.” If it’s determined that your dysmenorrhea is caused by cold accumulation and blood stagnation in your uterus, that doesn’t deny the fact that your “hormones” are likely out of balance. What it does do is give a practitioner of Chinese medicine a useful framework to actually treat you. Chinese herbs can then be prescribed that will address your particular menstrual pain—in this case, herbs that warm the uterus and quicken the blood. As the herbs do their work, your symptoms resolve. Your “hormones” are more balanced by default—but they were balanced using the lens and the tools of Chinese medicine.

Self Care for Dysmenorrhea
Moderate to severe dysmenorrhea will likely require the applied acupuncture and herbal skills of a trained practitioner to fully resolve—this is particularly so if your symptoms stem from something on the “secondary dysmenorrhea” list. However, mild to moderate symptoms may be well served by diet and lifestyle interventions, alone. You may recognize some of the suggestions below from our article on PMS—PMS and mild dysmenorrhea share common roots. For many women, getting back to the basics of sleep, nutrition, exercise, mindfulness, hydration, and play goes a long way.

• Be boundaried about your sleep. Sleep is when your body can finally take care of itself, unencumbered by the daily demands you place upon it during your waking hours. Honor your body by honoring that time. Treat your bedtime like an appointment you wouldn’t dare miss. Keep consistent sleep and wake times whenever possible to support hormone regulation and regulation of all the other systems in your body.
• Optimize your digestion. Your food can only nourish you if your body is properly absorbing it. If digestive distress is a chronic struggle, seek out professional help. Acupuncture and Chinese medicine can be enormously beneficial; other modalities have their own, sometimes more appropriate interventions. Interview providers and find a good fit.
• Eat real food. Every day we’re bombarded with some new health craze around food. Bottom line, in the words of the brilliant food journalist Michael Pollan: Eat. Real. Food. Sounds simple, right? But it’s far less common than you think—and not always easy. Eat quality food. Eat a wide range of seasonal and organic foods. Limit processed foods, snack foods, refined sugar, alcohol and coffee, and increase your fiber intake. We can *all* benefit from this advice, but it’s particularly important if you suffer from hormone imbalance. If you’d like to go deeper, a skilled practitioner of Chinese medicine will have dietary suggestions specific to you and the support your individual system needs.

More specifics on what to curb:

• Quit the caffeine: I know! I also love a good cup of coffee in the morning, but caffeine constricts blood vessels—including those supplying blood to the uterus. This makes it a no-go if you’re trying to resolve your cramps. At least consider reducing your caffeine intake during the second half of your cycle.
• Avoid the alcohol: Coffee AND alcohol?! I know!! We know alcohol inhibits hormone regulation—the opposite of what we’re aiming for. If you’re serious about managing your cramps on your own, skip it, at least during the second half of your cycle.
• Red meat and dairy: To be clear, red meat and dairy are not inherently bad. Assuming the meat and milk is from pastured, organic cows, there are some folks for whom one or both can be absolute positive game-changers in terms of their health—not so much if you’re prone to cramps. Red meat and milk contain a substance known as arachidonic acid that stimulates prostaglandins and intensifies cramps. If you’re craving iron pre-menstrually (or menstrually), and prone to cramping, better to reach for plant-based sources like chickpeas, beans, and lentils.
• Move your body in a joyful way: Remember how we said that where there is stagnation there is pain? The endorphin release and increased oxygenation to the uterus that comes with exercise will help relieve your cramps. Walk, run, stretch, breathe, lift, dance, laugh, love. Your body was meant to be fully inhabited. Find a way to move it that lights you up and makes you smile. Repeat often.
• Reduce stress: Stress creates constriction in the body, which interferes with the free flow of qi, which creates stagnation and contributes to menstrual pain. Stress-management and stress-relief should be a lifelong pursuit. It will help with your dysmenorrhea—and with your everything else.
• Practice mindfulness: We hear this all the time, but what does it mean? Incorporating mindfulness into your daily life doesn’t have to be a huge (stressful) undertaking. Do you brush your teeth every day? Drive your car every day? Wash your dishes every day? Turn on your computer every day? Make a habit of punctuating the start of any recurring event with a moment of attention. All you need is a pause and a slow deep breath. Be still. Notice that you are doing what you’re doing. We throw our attention mindlessly out into the world all day, every day. Start to pepper your day with brief moments of drawing that attention back into your body, back in to the right now. If you’re unsure of where to start, start there.

In Conclusion
The good news is in alleviating your dysmenorrhea we are also course-correcting your body, more generally. Why should you care? The more optimally your body is functioning in any given moment, the more likely it is that we’ve staved off larger health issues that might have otherwise accumulated over time. Try some of these recommendations, find a team of practitioners to help support you in health journey, free up the energy currently bound up in managing your menstrual pain, and get out there and live your most extraordinary life!

Alexandra Gilmore, LAc, MAcOM is a practitioner of acupuncture and Chinese medicine in South Portland. She knows you have extraordinary things to bring forth in the world, and her mission is to amplify your vitality in the service of that greatness. She brings to the table a unique understanding of your physiology and symptoms, a comprehensive treatment plan, and the opportunity to cultivate a different outcome for your health and your future. She has a special affinity for all things women’s health and dermatology, and loves the challenge of a complex case. She lives in Portland with Oscar, her 90-pound “puppy” and office mascot. www.atxacu.com or www.atxskin.com.

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