Can TCM help with irregular menstruation?

Link copied! Menstruation refers to the shedding of the lining of the uterus (endometrium) accompanied by bleeding. This usually occurs monthly throughout a woman’s reproductive life, except during pregnancy. Menstruation starts when a woman experiences puberty and stops permanently after menopause. The menstrual cycle is defined as the first day of bleeding of one cycle to the first day of menstrual bleeding of the next cycle, and the length of the menstrual cycle varies among different women. Normally, regular menstrual cycles range from about 21-35 days and the average is 28 days. [1][2] The menstrual period usually lasts around 2-7 days and on average women will lose about 20-90 ml of blood in a period. [3] The menstrual cycle is regulated by hormones such as Follicle-stimulating hormones (FSH), Luteinizing hormone (LH), estrogen and progesterone. When females reach puberty, the hypothalamus will send signals to pituitary glands to release FSH and LH. These will trigger the secretion of estrogen and progesterone that are required for ovulation and the formation of endometrium lining for fertilization. When there is no fertilization, estrogen and progesterone levels decrease and the endometrium lining starts shedding, resulting in the start of the next menstrual cycle. What is the TCM’s perspective on menstrual periods? 女子二七而天癸至, 任脉通，太冲脉盛, 月事以事下   According to the Inner Canon of the Yellow Emperor (黄帝内经) ，menstrual cycles usually occurs at the age of 14 in which the congenital Kidney essence (天癸) arrives, the flow in Ren meridian (任脉) opens up and the energy in Chong meridian is sufficient. The congenital Kidney essence (天癸) is given from our parents upon conception which is further nourished by the Kidney essence (肾精) and the essence from food transformation by the Spleen (脾) as we age (先天天癸始父母，后天精血水榖生). Besides being in the food transformation, the Spleen also plays an important role in blood production. The Liver (肝) harmonizes the blood and Qi in the body meridians and connects them to Chong (冲脉) and Ren (任脉）meridians at the lower abdomen. The Chong meridian acts as a blood reservoir for the uterus while Ren meridian regulates the uterus. A menstrual cycle occurs when there is an abundance of congenital Kidney essence and a balance of Kidney, Spleen and Liver functions to ensure a surplus of blood and Qi flowing to the uterus. In TCM perspective, a menstrual cycle can be viewed in four phases: Menstrual flow: the descending flow of energy and blood to expel old blood for the regeneration of new blood. Post-period: new blood and essence is needed to renourish the body and this can be achieved by strengthening the Kidney and digestive functions. The new blood plays an important role as it prepares the uterus for implantation and pregnancy. Ovulation: an increase in Kidney function which stimulates the ovaries for ovulation Pre-period: the Kidney’s Yang energy facilitates the implantation of the fertilized egg. When there is no implantation, the Yang energy will peak and decline as the menstruation begins again. Regularity of menstrual cycles is considered an indicator for women’s reproductive health, and there are various reasons that can lead to changes in the menstrual cycle. A study has shown that 9% to 14% of women experienced irregular menstrual cycles. [4] So what is defined as an irregular menstruation? Irregular menstrual cycles can be defined by either shorter or longer menstrual cycles than usual; either heavier or lighter flow than normal; or are experienced with other problems like lower abdominal cramps. The most common types of irregular menstruation are: Abnormal menstrual cycle When a cycle is shortened or delayed for more than 7 days and lasts for 2 consecutive menstrual cycles. Short menstrual cycles (月经先期) A menstrual cycle that is shorter than 21 days for at least 2 consecutive cycles. Delayed menstrual cycles(月经后期） Delayed menstrual cycle that is longer than 35 days for 2 consecutives menstrual cycles. Irregular menstrual cycles(月经先后不定期) Irregular and inconsistent menstrual cycle in which shortened or delayed cycles for at least 3 consecutive menstrual cycles. Bleeding between periodsaka spotting(经间期出血) Bleeding that occurs between periods. Abnormal menstrual cycle When a menstruation period is shorter than 2 days or prolonged more than 7-14 days. Short menstruation period(月经先期) A period that lasts for 2 days or less. Prolonged menstruation period（经期延长) A period that lasts beyond 7-14 days. Abnormal menstrual cycle Spotting or prolonged bleeding for more than 5-7 days after a menstruation period. Prolong menstrual bleeding/ heavy bleeding Menstrual bleeding that lasts more than 7 days. How do you know if you are experiencing heavy bleeding? If you have to change your sanitary pad (regular day-used size, 20-22cm) or tampon after less than 2 hours, it is considered as heavy bleeding. [7] Light menstrual bleeding Menstrual bleeding lasts for a short duration of 2 days and the flow is less than 50 ml of blood [8] ,approximately 1-2 regular day-used size pads daily. Painful periods Most women would experience menstrual pain for 1 to 2 days monthly. Usually, the pain is mild, however for some women, the pain is so severe that it affects their daily routines for several days. Common causes of irregular periods (excluding pregnancy): [5-7] Stress Irregular diet or eating disorder that can lead to extreme weight loss or weight gain Underlying medication conditions such as thyroid dysfunction, uncontrolled diabetes, polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids and pelvic inflammatory disease Usage of certain medications such as hormonal birth control pills, medications used to treat mental health problems or epilepsy and steroids From TCM perspective, irregular periods are often caused by reduced blood production due to an exhaustion in blood and essence that weakens the body. It may be due to Blood stasis or Dampness that result in stagnation of blood flow which obstructs the channels in the body. It also views irregular periods as an imbalance between the Yin and Yang, especially the Spleen, Kidney, and Liver. Studies have shown that irregular and long menstrual cycles have been associated with an increased risk for certain conditions and diseases. Here’s are some health complications [9]: