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 gy- necological “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 underly- ing, identifiable gynecological issue. These include:

• Endometriosis: When the endometri- um—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 con- tracts and cramps more intensely in an effort to shed the buildup that’s embed- ded more deeply than it should be.

• Fibroids: Benign tumors that grow in the walls of the uterus. They’re com- mon—over 70% of women will experi- ence 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 accom- panied by increased vaginal discharge with a strong odor, bleeding after

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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 proce- dure 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), endometrio- sis, 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 requir- ing medical attention.)

• IUD birth control devices: These can cause or increase dysmenorrhea in some women, particularly in the months im- mediately 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 com- mon 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 medi- cal 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 under- standing of your female physiology before the concept of “hormones.” If it’s deter- mined 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 particu- lar menstrual pain—in this case, herbs that warm the uterus and quicken the blood. As the herbs do their work, your symptoms re- solve. 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 symp- toms stem from something on the “second- ary dysmenorrhea” list. However, mild to moderate symptoms may be well served by diet and lifestyle interventions, alone. You may recognize some of the suggestions be- low from my previous article on PMS—PMS and mild dysmenorrhea share common roots. For many women, getting back to the basics of sleep, nutrition, exercise, mindful- ness, 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.

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