TCM Treatment of Menstrual Irregularities


Kathleen Albertson, L.Ac.

Our daughters are experiencing menarche at ages 10 and 11 years of age. Why? Is anyone questioning the amount of estrogenic foods, toxins, harmful metals and chemicals that we inhale, ingest or absorb? For decades the meat industry has injected our chicken, turkey, beef and pork with steroids, weight producing chemicals, and antibiotics which are then absorbed and transmuted into our bodies, affecting each generation with a domino effect of degenerating diseases, reproductive / hormonal imbalances and autoimmune pathologies.

Some women, from onset of puberty, experience hormonal headaches, nausea or vomiting, severe PMS symptoms, heavy bleeding, constipation, diarrhea or fatigue on or before every period. Many women feel that it is normal to take six or eight Advil or Motrin at the onset of cramps just to get through the pain of the day. Ask a woman if her cycle is “normal” and her usual response is “Yes…, other than the usual PMS, plus irritability, fatigue, headache, poor sleep and heavy cramping the first day!” That is not normal to us as TCM practitioners.

Other women wait 35, 40 or more days for ovulation, or for their menstruation to commence. Not normal. Allopathic medicine controls problematic menstrual cycles with the use of birth control pills; and while this may control the symptoms of many gynecological disorders, it never treats the root. What is the true long term effect of years of birth control use? Why can’t we “cure” or resolve these problems more effectively? Could it be contributing to rising infertility rates?

Western View

Western treatment’s first line of defense is medications to treat symptoms, to better regulate the menstrual cycle, or medications to induce the cycle. Difficult or painful periods are also treated with drugs and are often not resolved without surgery. Polycystic ovarian syndrome (PCOS), dysmenorrhea, endometriosis and even premenstrual syndrome (PMS) all too often are undiagnosed or not treated with the full attention of the attending physician. Many gynecologists tell patients that PMS is normal.

TCM: A Proven Track Record

Irregular menstruation is caused by stress, overwork, trauma, exposure to cold, heat or damp, lifestyle or poor dietary choices, the seven emotions, sexual abuse or excessive sexual activity.

PMS, heavy painful cycles and other menstrual irregularities can be resolved with TCM treatments. Both acupuncture and Chinese herbal medicine (CHM) are effective – re-balancing the organ systems, removing blockages, or restoring and strengthening deficiencies in the delicate interrelationships so that the body, mind, and spirit fully function.

Healthy Menstruation
All of the major organ systems (Liver, Kidneys, Lungs, Spleen and Heart) affect proper menstruation. If the Uterus is not receiving what it needs from the major organ systems and if the Du, Ren, and Chong channels’ flow of Qi and Blood is compromised, menstrual irregularities occur. Important and delicate relationships between these systems and menstruation must be properly diagnosed with the proper treatment plan. When balanced… a regular cycle ensues.

The Kidney system provides Essence, the basis for reproduction. The Chong channel travels through the Stomach connecting it to the Uterus. Kidney Qi affects the Heart and mind. Kidney energy infuses the warming function in the Uterus activating Essence, transforming fluids and warming digestion.

The Stomach system "receives" (nutrition), "descends," and as the origin of Qi and Blood, helps food and nutrients absorb and transform.

The Lungs assist in making Blood.

The Spleen system “holds” Blood in the vessels and makes Blood.

The Heart system "governs" Blood, travels to the Uterus and supports physical and mental aspects. As the "emperor" of the organ system it controls all of the other organs, much like the hypothalamus and pituitary are considered the masters of all glands in allopathic medicine.

The Du, Ren, and Chong extraordinary channels are generally involved in resolving gynecology, fertility and pregnancy related issues.

The Liver is responsible for the even flow of Blood and provides Blood to the Uterus. Liver Qi moves Blood and must be balanced for regular menstruation to occur.

TCM treats root cause, not just symptoms. Proper movement, amount and delivery of Qi and Blood maintain regular menstruation and help achieve successful pregnancy, and delivery.

What is a "normal" menstrual cycle?
A normal cycle can be anywhere from 25 to 35 days.

The pattern of disease is determined by what occurs with Blood, Yin, Yang and Qi, over the 28 day cycle. The menstrual calendar is based on Yin (first half of the cycle) and Yang (second half). TCM theory did not chart basal body temperature (BBT) or review blood tests of follicle-stimulating hormone (FSH) or luteinizing hormone (LH) levels (not their science, nor did practitioners have the capability thousands of years ago). TCM diagnosis has a semblance of order and is similar in some respects to what western treatment examines in terms of the follicular or luteal phase, but TCM looks closer at more variables that make a difference, and that can (in many cases) naturally normalize the menses.

Questions relating to the length of your patient’s cycle:

  • How many days she has of normal bleeding?
  • Any clotting? (large or small)
  • What is the color of the blood? The quantity, the thickness (watery or thick), any odor?
  • How does she feel before, during and after her cycle? If there is pain, what is the nature of the pain and when does it occur? What relieves it? What makes it worse?
  • Any PMS symptoms?
  • Does she feel cold, any heat signs?
  • Any difficulty sleeping?
  • Any headaches? Digestive changes?
  • Any changes in energy levels?
  • Any emotions or irritability concerns?
  • Ask about the quantity, color and thickness of the cervical mucus at points during her cycle.

All of these questions determine your pattern and help create your unique treatment plan. Today, TCM practitioners who specialize in gynecology, fertility and pregnancy are versed in Western terms, protocols, pharmaceutical regiments to help the patient understand how these two sciences are successfully integrated.

Menstrual pain decreased by 33%
A German study of 201 women found that acupuncture relieved menstrual pain, severe cramps and discomfort. The majority of patients receiving acupuncture reported at least a 33% decrease in pain following 10 acupuncture treatments. Women have typically used non-steroidal anti-inflammatory drugs to treat menstrual cramps. Side effects of their use affect the liver and kidneys. There are no known side effects from acupuncture. Acupuncture is extremely effective at treating menstrual disorders including painful periods, irregular periods, amenorrhea, and PMS. (American Journal of Obstetrics & Gynecology, Feb. 2008).

Phases of the Menstrual Cycle
Various TCM authors including Maciocia, Flaws, Lyttleton and Lewis have written, and discussed the calendar phases of the menstrual cycle (Table 1). TCM uniquely treats the phases of the menstrual cycle. Most TCM practitioners recognize 4 phases, some treat according to 5 phases. The key is determining the proper pattern diagnosis and using the correct treatment principles which result in success treatment plans. This chart summarizes the 4 phases.

Table 1. Calendar Phasing of the Menstrual Cycle

Phase Description TCM View Cycle Days Western View
Phase 1 – Menstruation
Blood Phase: The first day of bleeding is considered Day 1. This phase normally lasts from one to five days. Many women would consider their normal period three to five days or four to six days, but one to seven days is still normal. TCM addresses the flow of Blood in this phase. Blood should move allowing the menstrual blood to exit. Acupuncture moves the stagnant Blood (i.e. cramps) via the Liver channel. Cramping pain is caused from the blood’s inability to flow, causing swelling. Painful, late menstruation or a small volume of menstrual flow is a sign of the Blood’s inability to move easily. Acupuncture reduces excessive menstrual blood flow. CHM is used to move the blood, alleviate pain and normalize blood flow.

Possible herbal formulas include: Gui Zhi Fu Ling Wan, Tao Hong Si Wu Tang, Xiao Yao San, Liu Wei Di Huang Wan, Gui Pi Tang, Bu Zhong Yi Qi Tang, or Er Chen Tang depending on the pattern of disease.

Days 1 – 7
(Week 1)
  • Follicular phase
  • Endometrial tissue sheds
  • FSH and LH stimulate new follicles
Phase 2 – Post Period: Pre-ovulation
Yin Phase: Menses has stopped and pre-ovulation begins with estrogen rising. Liver Blood and Kidney Yin are empty, and lost blood needs to be restored. A transformation occurs as the first half of the cycle, Yin in nature (the follicular phase), becomes Yang in the second half (luteal phase). CHM is used to restore Blood and nourish Essence.

Possible herbal formulas include: Zhi Bai Di Huang Wan, Gui Shao Di Huang Wan, Ba Zhen Tang, Wen Jing Tang, Ren Shen Yang Ying Tang, or Xiang Sha Liu Jun Zi Tang.

Days 7 – 14
(Week 2)
  • Follicular phase
  • FSH rising
  • Estrogen rising
  • Uterine lining thickening
Phase 3 – Ovulation: Ovulation/Mid-cycle
Yang Phase: Basal body temperature (BBT) rises in response to progesterone as ovulation occurs. Yin is at it highest point now and must transform to Yang (this transformation happens when the negative change in BBT occurs just before ovulation). The luteal phase is negatively affected if Qi cannot be moved, or if Yin cannot transform into warmer Yang energy. Kidney Essence is nourished with the help of the Chong and Ren channels. CHM is used to strengthen and warm Yang energy and to move Blood.

Possible herbal formulas include: Xiao Yao San, Jia Wei Xiao Yao San, Liu Wei Di Huang Wan, Wen Jing Tang, or Cu Pai Luan.

Days 14 – 21
(Week 3)
  • Ovulation occurs with LH surge
  • BBT rises following ovulation
  • Fertilization / implantation possible
Phase 4 – Post ovulation: Pre-menstruation
Qi Phase: Yang transforms to Yin preparing for menstruation. If pregnancy occurs, Yang energy remains strong. If pregnancy does not occur, the body prepares for menstruation. If Yang or Qi is insufficient or weakened it must be strengthened. PMS indicates the Liver Qi may be inadequate or stagnant, unable to create the movement and flow of Blood. Heart Qi may not be able to move Blood to the Uterus, affecting emotions and moods in the pre-menstrual phase. Spleen Qi may be weak, causing early or excessive menstruation. CHM is used to regulate, adjust, strengthen or move Qi.

Possible herbal formulas include: Xiao Yao San, Jia Wei Xiao Yao San, Gui Pi Tang, Shao Fu Zhu Yu Tang, Tao Ren Si Wu Tang, Ren Shen Yang Ying Tang, Jia Wei Er Chen Tang, Wu Yao San Jia Wei, Xiao Chai Hu Tang, Ba Zhen Tang, You Gui Wan, Jian Gu Tang, Liu Jun Zi Tang, or Tao Hong Si Wu Tang.

Days 21 – 28
(Week 4)
  • Luteal phase
  • Estrogen drops
  • Lining breaks down or pregnancy results

Adjust your treatment plans and CHM to address each phase’s pattern, signs and symptoms. Write down your treatment principles and follow your plan. Basal Body Temperature (BBT) charts help you identify patterns. TCM is undervalued and underutilized as primary treatment for women suffering with menstrual issues. TCM success rates are generally high, and stand the test of time, restoring your patient’s quality of health and life.

About the Author
Kathleen Albertson, L.Ac., graduated from SAMRA University of Oriental Medicine in 1995. She has been in private practice for over 15 years and currently practices out of Irvine, California. She also holds a Ph.D in Holistic Nutrition and specializes in women’s heath issues and fertility. In 2009, she authored a book titled Acupuncture and Chinese Herbal Medicine for Women’s Health: Bridging the Gap between Western and Eastern Medicine.

To learn more about TCM Treatment of Menstrual Irregularities, click here to view a complete list of courses by Kathleen Albertson.