Dysmenorrhoea (painful periods) — Wokingham, Berkshire

1. Overview

Dysmenorrhoea — painful menstruation — is one of the most common gynaecological complaints, affecting an estimated 45–95% of women of reproductive age. It is divided into primary dysmenorrhoea, where no underlying structural cause is identified, and secondary dysmenorrhoea, which arises from conditions such as endometriosis, uterine fibroids, adenomyosis or pelvic inflammatory disease. Severe menstrual pain is a leading cause of absenteeism from school and work in younger women, with studies reporting absence rates of up to 14%.

Conventional treatment centres on non-steroidal anti-inflammatory drugs (NSAIDs) and the combined oral contraceptive pill, which suppress prostaglandin production and reduce uterine contractions. While effective for many women, these approaches are unsuitable for those wishing to conceive, those with contraindications to hormonal treatment, or those who prefer a drug-free approach. Acupuncture and Chinese herbal medicine offer evidence-based, drug-free alternatives that address both the immediate pain and its underlying causes, reducing pain intensity, duration and associated symptoms including nausea, back pain and mood disturbance.

2. Symptoms

Cramping lower abdominal pain — the hallmark symptom; spasmodic, colicky pain in the lower abdomen and pelvis ranging from mild discomfort to severe pain that prevents normal activity; pain may radiate to the lower back, inner thighs and buttocks; in secondary dysmenorrhoea from endometriosis, pain is often more persistent and may not be confined to menstruation
Lower back pain — dull or aching pain in the lower back and sacrum; in TCM terms, this reflects the close relationship between the Kidney channel and the Chong and Ren vessels which govern the uterus
Nausea and vomiting — prostaglandin-mediated stimulation of smooth muscle extends to the gastrointestinal tract, producing nausea, vomiting and sometimes diarrhoea alongside the uterine cramping
Headaches — headaches and migraines triggered at menstruation are common, particularly in women with Liver Qi stagnation or Blood deficiency patterns
Fatigue and malaise — profound fatigue accompanies the pain in many women; it reflects the significant Qi and Blood movement involved in menstruation and is often worsened by underlying Blood deficiency
Emotional symptoms — irritability, low mood, anxiety and emotional sensitivity in the days before and during menstruation; in TCM these reflect Liver Qi stagnation affecting the Mind

3. Causes

Prostaglandin excess (primary dysmenorrhoea) — the central mechanism; during menstruation the endometrium releases prostaglandins (PGF2α and PGE2) as it breaks down, causing sustained painful uterine contractions, reduced uterine blood flow and sensitisation of pain receptors; women with primary dysmenorrhoea have significantly higher endometrial prostaglandin concentrations than those without pain
Endometriosis (secondary dysmenorrhoea) — the most common cause of secondary dysmenorrhoea; endometrial tissue implanted outside the uterus undergoes cyclical bleeding, producing inflammation, adhesions and pain; endometriosis-related pain typically begins earlier in the cycle and is often more severe and persistent
Uterine fibroids and adenomyosis — uterine fibroids distort the uterine cavity and increase menstrual flow and cramping; adenomyosis causes heavy painful periods from uterine enlargement and increased prostaglandin production
Pelvic inflammatory disease — chronic pelvic infection produces adhesions and inflammation that worsen menstrual pain
Constitutional and lifestyle factors — early menarche, heavy periods, high stress, low physical activity, poor diet high in inflammatory foods and deficiency of omega-3 fatty acids all increase severity; in TCM terms, overwork, cold exposure, emotional tension and irregular diet create the patterns of Blood stasis, Cold obstruction and Liver Qi stagnation that drive menstrual pain

4. Dysmenorrhoea in Chinese medicine

In traditional Chinese medicine, painful menstruation arises from obstruction of Qi and Blood flow in the Chong and Ren channels — the extraordinary vessels governing the uterus and menstruation. The guiding principle is: “where there is free flow, there is no pain; where there is no free flow, there is pain.” Treatment restores free flow through the uterine channels. The most common TCM patterns are:

Qi stagnation and Blood stasis — the most frequent pattern; emotional stress causes Liver Qi to stagnate, impairing Blood flow through the uterine channels; Blood accumulates and stagnates, producing cramping, stabbing pain with dark clotted menstrual blood; pain precedes or accompanies menstruation and is relieved by passing of clots; treatment spreads Liver Qi and invigorates Blood
Cold obstructing the uterus — Cold invades the uterus (from cold exposure, excessive raw food or constitutional Cold tendency), constricting the channels and producing severe cramping relieved by warmth and worsened by cold; menstrual blood is scanty, dark and clotted; treatment warms the channels and disperses Cold, with moxibustion as a core modality
Damp-Heat accumulation — Heat and Dampness accumulate in the uterus, producing burning lower abdominal pain during menstruation; this pattern underlies many cases of endometriosis with inflammatory activity; treatment clears Heat, resolves Dampness and invigorates Blood
Blood deficiency with channel malnourishment — insufficient Blood fails to nourish the uterine channels, producing a dull, empty cramp-like pain during or after menstruation, relieved by pressure and warmth; menstrual blood is pale and scanty; common in young women with poor diet or heavy periods; treatment nourishes Blood and the Liver
Liver and Kidney deficiency — chronic deficiency of Liver and Kidney Yin fails to nourish the Chong and Ren vessels, producing an intermittent aching lower abdominal and back pain; lower back weakness, tinnitus and a delayed cycle are accompanying features; treatment nourishes Liver and Kidney and replenishes Essence

5. Acupuncture for dysmenorrhoea

Acupuncture relieves menstrual pain through several well-established mechanisms:

Inhibiting prostaglandin synthesis — acupuncture downregulates the production of PGF2α and PGE2 in the endometrium, directly reducing uterine cramping intensity and duration and restoring normal uterine blood flow
Improving uterine blood flow — acupuncture at points on the Spleen, Liver, Kidney and Ren channels improves pelvic and uterine blood flow, reducing the ischaemia that contributes substantially to menstrual pain and resolving the Blood stasis underlying most TCM dysmenorrhoea patterns
Endorphin and enkephalin release — acupuncture stimulates the release of beta-endorphins and enkephalins at peripheral and central levels, providing direct analgesia and raising the pain threshold in the uterus and lower abdomen
Autonomic nervous system modulation — acupuncture reduces sympathetic hyperactivity in the pelvis, which contributes to uterine vasospasm and cramping; normalising autonomic tone also relieves associated symptoms including nausea, headache and diarrhoea
Reducing endometriosis inflammation — in secondary dysmenorrhoea from endometriosis, acupuncture reduces local and systemic inflammatory markers, alleviates pelvic pain and has been shown to reduce serum CA-125 levels and nodule size

Research evidence

A network meta-analysis by Chen et al. (2024), published in Heliyon, included 70 RCTs with 5,772 participants across 8 databases comparing 25 acupuncture-related therapies for primary dysmenorrhoea, confirming acupuncture’s significant superiority for pain relief with warm acupuncture and acupoint electrical stimulation among the most effective modalities. A systematic review and meta-analysis by Liu et al. (2022), published in the Journal of Pain Research, pooled 13 RCTs with 675 participants and found acupuncture and moxibustion significantly reduced pain (VAS reduction MD −1.93, 95% CI: −2.80 to −1.06) compared to control; moxibustion also showed significant benefit (MD −2.67). A Bayesian network meta-analysis published in BMJ Open (2024) analysed 33 RCTs and confirmed acupuncture and herbal medicine among the most effective non-pharmacological approaches. A meta-analysis by Chen et al. (2024) in the Archives of Gynaecology and Obstetrics examining 14 RCTs with 793 endometriosis patients found acupuncture significantly reduced dysmenorrhoea and pelvic pain and lowered serum CA-125 levels.

Key acupoints include SP6 (Sanyinjiao), SP8 (Diji), CV4 (Guanyuan), CV3 (Zhongji), ST29 (Guilai), LV3 (Taichong), KD3 (Taixi), BL32 (Ciliao) and BL23 (Shenshu). Moxibustion over the lower abdomen and sacrum is particularly effective for Cold obstruction patterns. Electroacupuncture at BL32 and BL33 is especially effective for endometriosis-related pain.

6. Chinese herbal medicine for dysmenorrhoea

Chinese herbal medicine treats dysmenorrhoea at its root, taken daily throughout the menstrual cycle rather than only at the time of pain. This means herbal treatment gradually addresses the underlying pattern — whether Blood stasis, Cold obstruction, Damp-Heat or Blood deficiency — reducing pain progressively over two to three cycles. Formulae are individually tailored to the specific TCM pattern:

Tao Hong Si Wu Tang (Four Substance Decoction with Safflower and Peach Pit) — the foundational formula for Blood stasis dysmenorrhoea; nourishes Blood while powerfully invigorating circulation to resolve stasis; reduces clotting, alleviates cramping and regulates the menstrual cycle
Wen Jing Tang (Warm the Menses Decoction) — the classical formula for Cold obstructing the Chong and Ren channels with Blood deficiency; warms the channels, dispels Cold, nourishes Blood and resolves stasis; particularly effective for cold-sensitive dysmenorrhoea with pale, clotted blood
Ge Xia Zhu Yu Tang (Drive Out Blood Stasis Below the Diaphragm) — a stronger formula for severe Blood stasis in the lower abdomen; used for dysmenorrhoea from endometriosis with fixed, stabbing pain and dark clotted blood
Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill) — the primary classical formula for uterine Blood stasis; widely used for dysmenorrhoea secondary to fibroids or endometriosis; multiple clinical trials confirm its ability to reduce lesion size, alleviate pain and regulate menstruation
Long Dan Xie Gan Tang modifications — for Damp-Heat patterns underlying inflammatory secondary dysmenorrhoea; clears Damp-Heat from the lower burner, invigorates Blood and alleviates pain

Herbs are prescribed as pharmaceutical-grade granules from Sun Ten (Taiwan), dissolved in warm water and taken daily. An online Chinese herbal consultation is available for patients who cannot attend in person.

7. Self-care tips

Apply heat to the lower abdomen — a warm wheat bag or heat pad over the lower abdomen or lower back during menstruation reduces uterine cramping by promoting blood flow and relaxing uterine muscle; studies confirm continuous low-level heat is as effective as ibuprofen for primary dysmenorrhoea and directly addresses the Cold obstruction pattern in TCM
Warm diet and avoid cold foods — in TCM, consuming cold and raw foods around and during menstruation worsens Cold obstruction in the uterus and intensifies cramping; avoid cold drinks, ice cream and raw salads during period days; favour warming foods including ginger tea, cinnamon, rice congee and cooked root vegetables; ginger has documented anti-prostaglandin properties
Gentle regular exercise — regular moderate aerobic exercise throughout the cycle reduces prostaglandin levels, improves pelvic blood flow and reduces pain severity; yoga, walking and swimming are well tolerated; specific yoga postures targeting the lower abdomen and lower back provide additional relief during menstruation
Omega-3 fatty acids — dietary omega-3s (from oily fish, flaxseed and walnuts) competitively reduce the production of pro-inflammatory prostaglandins; supplementation has RCT evidence for reducing dysmenorrhoea severity; this aligns with the TCM goal of improving Blood quality to reduce stasis
Reduce stress — psychological stress worsens Liver Qi stagnation in TCM terms and increases prostaglandin production, intensifying menstrual pain; acupuncture has a direct calming effect; mindfulness, adequate sleep and regular gentle movement reduce pre-menstrual tension and pain
Track your cycle — keeping a menstrual symptom diary (pain severity, blood characteristics, clotting, mood) helps both your GP and your TCM practitioner identify the underlying pattern and monitor treatment progress over cycles

8. Treatment at my clinic

I treat dysmenorrhoea at my clinic in Wokingham, Berkshire, using a combination of acupuncture, moxibustion and Chinese herbal medicine tailored to the specific TCM pattern. Treatment works throughout the cycle — not only during menstruation — addressing the underlying Blood stasis, Cold obstruction, Damp-Heat or Blood deficiency. Most patients notice meaningful improvement after two to three cycles; Chinese herbal medicine is particularly effective for dysmenorrhoea secondary to endometriosis or fibroids where daily systemic treatment is needed. Related conditions commonly co-treated include endometriosis, uterine fibroids, irregular menstrual cycle, PCOS and infertility.

Visit the prices page for treatment costs or book an online Chinese herbal consultation if you cannot attend in person.

9. Frequently asked questions

Can acupuncture help painful periods?

Yes. A 2024 network meta-analysis of 70 RCTs with 5,772 participants confirmed acupuncture’s significant effectiveness for primary dysmenorrhoea. A 2022 systematic review of 13 RCTs found acupuncture and moxibustion significantly reduced pain (VAS reduction −1.93 compared to control). Acupuncture works by inhibiting prostaglandin production, improving uterine blood flow and releasing endogenous pain-relieving compounds.

How long does treatment take to work?

Most women notice meaningful improvement after two to three treated cycles. Acupuncture is typically recommended for two to three cycles, with sessions timed around menstruation and mid-cycle. Chinese herbal medicine taken daily tends to produce more consistent improvement. For dysmenorrhoea secondary to endometriosis or fibroids, a course of three to six months is typical.

Is Chinese herbal medicine better than acupuncture for period pain?

Both are effective and work well together. Chinese herbal medicine provides daily systemic treatment throughout the entire cycle, gradually resolving Blood stasis or other underlying patterns; this is particularly valuable for secondary dysmenorrhoea linked to endometriosis or fibroids. Acupuncture provides strong immediate pain relief and regulates prostaglandin production. Combining both modalities typically gives the best results.

What is secondary dysmenorrhoea?

Secondary dysmenorrhoea is menstrual pain caused by an identifiable underlying condition, most commonly endometriosis, uterine fibroids, adenomyosis or pelvic inflammatory disease. It typically begins before menstruation, is often more severe and persistent, and may be associated with pain during intercourse or with fertility difficulties. New or worsening menstrual pain should be assessed by a gynaecologist.