Painful Menstruation

By Jiang Liu, Diplomate of Oriental Medicine
AR Licensed Acupuncturist and Herbalist
Acupuncture & Chinese Medicine Clinic
2024 Arkansas Valley Dr., Suite 402
Little Rock, AR 72212


What is painful menstruation?
Painful menstruation is also called dysmenorrhea or dysmenorrhoea and is a medical condition characterized by severe uterine pain during menstruation. While most women experience minor pain during menstruation, dysmenorrhea is diagnosed when the pain is so severe as to limit normal activities, or require medication.

Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull, burning, or shooting pain. Dysmenorrhea may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Dysmenorrhea may coexist with excessively heavy blood loss, known as menorrhagia.

Primary dysmenorrhea frequently affects women in their teens and early 20s and secondary dysmenorrhea is diagnosed when symptoms are attributable to an underlying disease, disorder, or structural abnormality either within or outside the uterus such as endometriosis, fibroids or pelvic inflammatory disease.

Common symptoms

  • Bloating
  • Dull or sharp pain in lower abdomen or lower back
  • Headache or migraine
  • Heavy menstrual flow
  • Constipation or diarrhea
  • Nausea, vomiting, or not feeling hungry
  • Frequent urination
  • Fatigue
  • Anxiety, irritability or depression

Risk factors

  • Age <20 years
  • Being under stress
  • Depression or anxiety
  • Drinking alcohol
  • Smoking, or being around tobacco smoke
  • Trying to lose weight
  • Nulliparity
  • Overweight

Conventional treatment
For primary dysmenorrhea, painkillers such as ibuprofen, ketoprofen or naproxen are often recommended by your doctors. These medicines work well for mild or moderate pain. Your doctor might want you to try using birth control medicine.

In cases of secondary dysmenorrhea, once the reason for your secondary dysmenorrhea has been found, your doctor will be able to discuss an appropriate treatment with you. For temporarily symptom relief, you are also advised to painkillers and birth-control pills.

Dysmenorrhea and Chinese medicine
Chinese medicine has been treating dysmenorrhea for centuries and offers very real solutions for many women and has become popular in western countries in recent years. Acupuncture is well tolerated and free of relevant side effects and has been approved by FDA. Its use for the treatment of dysmenorrhea has been recommended by the National Institute of Health and World Health Origination.

Basic and clinic studies
Numerous Studies show that acupuncture:

  • Increases plasma 6-Keto-PGF1alpha
  • Reduces prostaglandin E2
  • Regulates neuroendocrine activities and the related receptor expression of hypothalamus-pituitary-ovary axis
  • Regulates the plasma beta-endorphin content
  • Improves blood circulation
  • Enhances nitric oxide production
  • Decreases plasma endothelin-1

Benefits from acupuncture, herbal medicine or other Chinese medicine modalities

  • Reduces menstrual discomfort
  • Relieves abdominal pain
  • Improves headache and menstrual migraine
  • Reduces anxiety
  • Attenuates gastrointestinal symptoms
  • Improves overall quality of life

Mechanisms and manifestations
Chinese medicine considers the body is a balance of qi, blood and yin-yang within whole body, as well as within each organ and among the organs. Chinese medicine regulates this balance and promotes the smooth flow of qi and blood throughout the body. Dysmenorrhea is an imbalance or disharmony of qi, blood or yin-yang. Dysmenorrhea is categorized into:

Stagnation of blood and qi

  • Pain and tenderness in the lower abdomen before or during menstruation
  • Hypochondrium and breast tenderness
  • Deep-purple blood with clots
  • Ecchymoses on the tongue edges
  • Wiry-choppy-strong pulse

Blood deficiency

  • Scanty menstruation with reddish and thin blood
  • Weakness and lack of strength
  • Pale tongue with white and thin fur
  • Weak pulse


  • A feeling of heaviness
  • Swelling or water retention
  • Abdomen cramps and pain
  • Phlegm discharge
  • Loose bowels

Damp heat

  • Lower abdomen pain
  • Joint pain
  • Menstrual discharge with dark red with clots
  • Slippery rapid pulse
  • Red tongue
  • Dark urine

Damp wind

  • Abdominal cramps and wind, a few days before or during menstruation
  • Menstrual flow acanty in acmount
  • Period with darK color and clots
  • Pale tongue with white and greasy fur
  • Deep and tense pulse

Deficiency of qi and blood

  • Abdominal pain after menstruation
  • Period is thin and volume is small
  • Tiredness
  • Loose stools
  • Pale complexion

Imbalance of kidney yang deficiency

  • Cold and pain in the lower abdomen during or after menstruation
  • Small amount of dark menstrual discharge
  • Weak and aching lower back and legs’
  • Deep and weak pulse
  • Pale tongue

Imbalance of liver

  • Pain in the lower abdomen during menstruation
  • Difficult menstruation
  • Scanty menstrual discharge
  • Period with dark purple color containing blood clots
  • Breast tenderness

Deficiency of liver and kidney

  • Lower abdominal pain either proceeding and /or following menstruation
  • Thin and light color menstruation
  • Fatigue and dizziness
  • Fever
  • Scanty urination
  • Lower back pain

Treatment Principle:

  • Stagnation of qi and blood: move qi and blood, and eliminate stasis
  • Deficiency of qi and blood: tonify qi, nourish blood and move blood
  • Stagnation of cold: expel cold, warm the uterus and move blood
  • Damp: resolve dampness and eliminate stasis
  • Damp heat: clear heat, resolve dampness and eliminate stasis
  • Damp wind: expel wind, resolve dampness and eliminate stasis
  • Deficiency of Kidney and Liver: tonify Liver and Kidney and move blood

In treating dysmenorrheal, acupuncture or herbal medicine, as well as other Chinese medicine modalities such as moxibustion or TuiNa can be used alone, or combined according to individual patient’s situation.