Menstrual health: A traditional Chinese Medicine perspective

Main disruptors of menstrual health in TCM are:

Qi stagnation

A very common and readily treatable clinical presentation, qi stagnation (in particular of liver and heart qi) impedes the natural flow of qi and blood in women’s cycles, particularly at ovulation and in the lead up to menstruation. It manifests with premenstrual tension with marked breast and abdominal distension, moodiness, depression and irritability. Where stagnant qi has become errant and invaded the digestion, there may also be diarrhea before the period. Menstrual blood will be darker than the fresh red colour we would expect in a healthy cycle.

Ovulatory issues are common here as it relies on the smooth flow of heart and liver qi and cycles will be irregular, delayed or even absent. There will often be pain (worse just before and during the period) that is aggravated by pressure (a sign that the pain is due to a condition of excess rather than deficiency). The flow itself might stop and start, reflecting the lack of smooth qi flow in the body. This constraint is also displayed in a wiry radial pulse; taught under the fingers, like a guitar string. This pattern is typically brought on by emotional strain but can also result from a history oral contraceptive use.

Blood stagnation

If left untreated, qi stagnation can lead to Blood stasis. Here, pain will be more significant, fixed and stabbing in nature and relieved with the passing of clots (a hallmark feature of blood stasis). As with qi stagnation, it will be worse for pressure and blood will be very, usually with clots. Periods can be both light (the blood is simply not flowing) or long and heavy as the body attempts to flush out stagnant blood and clots.

The cycle will be irregular or even absent and there may be spotting in between. The tongue will be purple with distended veins underneath and, again, the pulse will be wiry. We see blood stagnation in conditions such as amenorrhea, endometriosis, fibroids, tumors and PMT, where mental restlessness is pronounced. Aside from qi stagnation, blood stagnation can also stem from cold in the uterus, obstruction from phlegm-damp and qi deficiency, where there is simply not enough energy to guide the blood out. It is a common presentation after childbirth and surgery.

Heat

Heat may arise if qi and, or, blood stagnation continues or from a deficiency of yin and manifests with short cycles as heat can trigger early ovulation. Heat also results in the reckless movement of blood, so we will typically see heavy periods with fresh, bright red blood. However, where heat has injured the fluids, menstrual blood may be thick and dry and where it stems from yin deficiency, it will be scanty. Depending on the source of the heat, we might also see accompanying symptoms such as intense irritability, headaches with red eyes, nosebleeds (liver qi stagnation with liver fire or yang rising), insomnia, anxiety, palpitations, mouth ulcers, red tongue tip (heart qi stagnation with heart fire) or reflux, acne and mucus in the blood (phlegm-damp).

Yin deficiency is a common cause of heat, especially in women over 35 years, and the primary cause of amenorrhea. Yin deficiency signs in the absence of heat might include long cycles (weak yin, reflected in oestrogen levels, is slow to nourish developing follicles and, therefore, ovulation is delayed), vaginal dryness, dry skin and hair, insomnia, hot palms and soles, a red, cracked, dry tongue and a weak, ‘floating’ (at the surface) pulse. Where yin deficiency has generated deficient heat, we may also see scanty yellow urine, red lips, nightsweats and a strong libido. As with yin deficiency, the tongue is red and cracked but here it will also have a thin yellow coat. The pulse is still weak and at the surface but the heat has made it rapid.   

Heat may come from a variety of sources, both internal and external, excess and deficient. Common sources include overwork, lack of rest, excessive heating food and drink and prolonged emotional turmoil.

Cold

In TCM, a warm womb is of great importance and necessary for healthy menstruation and fertility. However, cold is a very common clinical pattern with menstrual disorders and can emerge from either excess or deficient sources. Cycles are generally late, often with pain that is relieved with warmth. Blood will be red with small, dark clots in excess cases or pale in deficient ones. The tongue will be pale and the pulse slow.

Cold food and drink as well as exposure to cold (cold environments, swimming or wearing tops that expose the midriff) can lead to cold in the uterus and these are to be avoided during menstruation. Cold can also enter the uterus via the leg channels if we walk barefoot on cold surfaces or expose our legs to cold. It is also vitally important to keep warm after childbirth to prevent cold invading the uterus and we often suggest treatment with warming, blood invigorating herbs and moxibustion over the lower abdomen and lower back in the post-partum to chase out lingering cold, a technique  known as ‘mother warming’.   

In the case of yang deficiency, we will see issues in the luteal phase, notably low progesterone, which can result in spotting before the period. This will be accompanied by symptoms such as diarrhea and low back pain at the onset of menses, late or no ovulation, oedema, low libido, cold hands feet and abdomen, a pale, wet tongue and a slow pulse. Hypothyroidism is a classic example of a yang deficient condition that can impact menstruation and endometriosis often has its roots in weak yang. Yang deficiency can come about from constitutional weakness, overwork, inadequate rest, chronic illness, yin deficiency (yin and yang are mutually-engendering) or external cold invasion that is left untreated.   

Phlegm-Damp

A diet of excessive damp foods (e.g. greasy, sweetened, dairy) and/ or improper metabolism and circulation of fluids can lead to phlegm-damp. This has a tendency to sink and settle in the lower part of the body, disrupting menstrual function, resulting in absent, irregular and long cycles. Here we will have symptoms such as mucus in the menstrual blood, thick, copious discharge, oedema, a feeling of heaviness, weight gain, acne, sinus issues, a phlegmy cough and might see conditions such as polycystic ovarian syndrome (PCOS) and thrush. The tongue will be swollen with a thick coat, the pulse full and ‘slippery’ under the fingers.   

Qi deficiency

Spleen qi is said to hold the blood. Where qi is weak, there will be early periods, long flows, bleeding in between and heavy periods. Blood will be brown, pale and watery. It will often be accompanied by symptoms such as easy bruising, tiredness, poor appetite, loose bowels, a pale tongue and weak pulse. As qi engenders blood, it often goes hand in hand with blood deficiency. It can arise from excessive worry or mental taxation, poor diet and inadequate rest.   

Blood deficiency

In addition to qi deficiency, blood may be deficient as a result of short cycles (and, therefore, frequent menstruation), heavy periods, blood loss from trauma or childbirth or a poor diet. The period may be late or even absent and light. The blood will be pale and dilute, the tongue pale and the pulse thin. Accompanying signs and symptoms may include anaemia, pallor, dizziness, dry skin and nails and insomnia (especially getting to sleep).  

Jing deficiency

At the extreme end of jing deficiency, we might see delayed puberty, primary amenorrhea (periods have not started by age 15) and even underdeveloped uterus and ovaries. Milder forms of jing weakness will manifest with conditions such as irregular periods, early menopause and fertility issues. This type of deficiency may be inherited (especially in the youngest of many children or offspring from older parents) or due to lifestyle factors – living large, using recreational drugs or overworking without adequate rest. It can also result from many pregnancies close together and simply aging as our stores of essence deplete naturally over time and with each menstrual cycle (1-4).