By Mary Vincent, L.Ac.

We see a variety of complaints related to menstrual problems here at BCA, but by far the most common (and one that almost every woman has experienced at some time in her life) is due to pain occurring before or during the period (otherwise known as dysmenorrhea). Pain severity ranges from mild to debilitating, and while it most often manifests as cramps affecting the lower abdomen, it can also present as pain or pressure in the lower back or hips, groin, and inner thighs. This pain can be dull, aching, sharp, and/or radiating, sometimes accompanied by nausea, vomiting, or diarrhea. In a study published in 2008 in the American Journal of Obstetrics and Gynecology, a randomized controlled trial that included 201 women with dysmenorrhea showed that the women who received acupuncture had lower pain intensity and concluded that “Additional acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life as compared to treatment with usual care alone and was cost-effective within usual thresholds.”

What Causes Dysmenorrhea?

During the menstrual cycle, the lining of the uterus (the endometrium) thickens to prepare for a possible pregnancy. If a fertilized egg does not implant into this lining, it will begin to break down in order to be passed out of the body in preparation for a new cycle. As the endometrium deteriorates, the cells release prostaglandins, a specific type of lipid (fat) molecule that can have a strong physical effect on smooth muscle tissues of the body. Specifically in the uterus, this can cause painful contractions as the lining is preparing to or being shed during menstruation.

Types of Dysmenorrhea

Primary Dysmenorrhea

Primary dysmenorrhea is pain occurring before or during the period with no other underlying diseases or dysfunction. If pain is mild to moderate, and no other issues are present, we want to see you once a week including the first day the pain starts (if you can time it to get in just before the onset of pain, even better). Depending on the severity of pain, we may want to see you again for a second treatment the following day. If your menstrual cycle is irregular, you will typically need to be treated 2 times a week for 2-3 cycles, not only to reduce pain, but in order to effectively regulate the menstrual cycle in general.

Secondary dysmenorrhea typically involves more severe symptoms and is directly related to an underlying issue such as endometriosis or uterine fibroids.

Secondary Dysmenorrhea

Secondary dysmenorrhea typically involves more severe symptoms and is directly related to an underlying issue such as endometriosis or uterine fibroids. Treatment should start with 2 times a week with a cluster of 2-3 treatments in a row during times of pain. Often an herbal formula will be indicated in order to more effectively control the patient’s specific condition and presenting symptoms. Once pain in reduced and under control, treatment reduces to weekly until issues are resolved. Depending on severity of the underlying condition, some patients may need to continue on herbs and/or receive regular acupuncture on an ongoing basis as part of their overall pain management therapy.

References:
Witt CM, Reinhold T, Brinkhaus B, et al. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol 2008;198:166.e1-166.e8.
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