Period pain is common — that does not make it normal

Many of the women we see have organized their lives around their cycle without quite noticing they were doing it. The heating pad lives next to the bed. Plans get quietly moved when the timing looks wrong. There is a stretch before the period when they feel irritable, bloated, and tender, and a first stretch of bleeding when they are curled up and taking pain relievers on a schedule. Somewhere along the way they were told this is just how periods are.

Period pain and PMS are common. Common is not the same as normal, and it is certainly not the same as untreatable. Acupuncture and Chinese herbal medicine have a long track record with menstrual complaints — but the first step is making sure we know what kind of pain we are dealing with.

Primary and secondary: the distinction that matters first

Primary dysmenorrhea is period pain without an underlying structural cause. It usually begins in the teens, soon after periods start, and is centered in the lower abdomen, sometimes spreading to the lower back and thighs. Secondary dysmenorrhea is pain caused by something identifiable in the pelvis, and it needs proper evaluation, not just symptom management.

• Endometriosis. Tissue similar to the uterine lining growing outside the uterus. It can cause severe cramps, pain with sex or bowel movements, and pain outside of the period itself.
• Adenomyosis. Lining tissue growing into the muscular wall of the uterus, often with heavy, painful periods and an enlarged, tender uterus.
• Fibroids. Benign muscular growths that can cause heavy bleeding, pressure, and cramping.
• Other causes. Pelvic infection, ovarian cysts, and some IUDs can also be behind a change in period pain.

Signs that point toward a secondary cause include pain that started or worsened later in life, pain that is getting progressively worse, pain between periods or with sex, very heavy bleeding, bleeding between periods, and difficulty conceiving. If any of these fit, we want you evaluated by a gynecologist, often with a pelvic ultrasound. Acupuncture can still be part of the plan. It should not be the reason a diagnosis gets missed.

Why cramps happen: prostaglandins

As the uterine lining prepares to shed, it produces prostaglandins — hormone-like signaling molecules that make the uterine muscle contract. Some contraction is how the lining leaves. When prostaglandin levels are high, the contractions are stronger and more frequent, they briefly reduce blood flow to the uterine muscle, and the result is the cramping, aching pain that most people know. Prostaglandins do not stay in the uterus, either, which is why heavy periods so often come with loose stools, nausea, headache, and a general unwell feeling.

This is also why common over-the-counter pain relievers help: they block prostaglandin production. The questions we add are why prostaglandin output is running high, and why the nervous system is registering it so loudly. Inflammation, nutrient status, hormonal balance, and pain sensitization all feed into that answer.

How Chinese medicine reads period pain and PMS

In Traditional Chinese Medicine, the timing, quality, and response to heat or pressure tell us which pattern is behind the pain. The classical principle is that pain comes from lack of free flow — something is stuck, cold, or not sufficiently nourished.

• Qi and Blood stagnation. Sharp or stabbing cramps, worse before or at the start of bleeding, often with dark blood and clots. Pain eases once the flow gets going or a clot passes. The priority is to move.
• Cold in the uterus. Cramping that feels much better with a heating pad, cold hands and feet, and dark blood with clots. Cold, in this framing, constricts — much like cold tightens muscle and slows circulation. The priority is to warm, which is where moxa often comes in.
• Qi and Blood deficiency. A dull, dragging ache that comes toward the end of the period or after it, better with pressure, with fatigue, pale skin, and sometimes dizziness. The priority is to nourish rather than move.
• Liver Qi stagnation. The classic PMS picture: irritability, tearfulness, breast tenderness, bloating, sighing, and a short fuse in the run-up to the period, often with a wiry pulse. The Liver in Chinese medicine governs the smooth flow of Qi, and emotional tension is both a cause and a symptom of that flow getting stuck.

Most people have a mix, and the mix changes. That is why the tongue, the pulse, and a careful menstrual history matter as much as the pain itself.

What treatment looks like across the cycle

Because the cycle has phases, treatment follows them. After the period, when the body is rebuilding the lining, the emphasis is usually on nourishing Blood and supporting digestion. Around and after ovulation, the focus shifts to keeping Liver Qi moving, which is where PMS symptoms are headed off. In the premenstrual phase and at the start of bleeding, treatment turns to moving Qi and Blood, warming if there is cold, and easing pain directly.

Acupuncture acts on pelvic blood flow, on the autonomic nervous system, and on the brain’s processing of pain, and it tends to reduce the tension-and-bracing state that amplifies cramps. Chinese herbal formulas are chosen for the pattern — classical formulas like Xiao Yao San for Liver Qi stagnation or Shao Fu Zhu Yu Tang for cold with stagnation are examples, adapted to the individual. Herbs are prescribed after a full review of your medications, including hormonal contraception, and any prescription change stays with your prescribing doctor. If your questions are about conception rather than comfort, that is a different plan, covered in acupuncture for fertility and IVF.

The pain is information. The question is not only how to quiet it, but what it is telling us about the rest of the cycle.

What we look at alongside

Period problems rarely exist in isolation, and several measurable things make them worse. Collecting all the pieces of the puzzle usually means looking at:

• Iron and ferritin. Heavy periods drain iron stores, and low ferritin brings fatigue, hair shedding, and worse PMS — often while hemoglobin still looks fine. See ferritin, iron, fatigue, and hair loss.
• Thyroid. An underactive or autoimmune thyroid can make periods heavier, longer, or irregular. We look beyond TSH to free T4, free T3, and antibodies, as described in why thyroid labs can look normal while you still feel tired.
• Hormones. Progesterone relative to estrogen in the luteal phase, and how estrogen is being processed, can shape both PMS and heavy, painful bleeding.
• Nutrient status and inflammation. Magnesium, zinc, omega-3 balance, and markers of inflammation all bear on prostaglandin production and muscle tone.

Results are read with functional ranges alongside the standard reference ranges, because the gray area between “normal” and “optimal” is exactly where many cycle symptoms live.

How we approach it

A first visit covers your menstrual history in detail — when pain starts and ends, what the bleeding is like, what helps, what the premenstrual phase feels like — along with any gynecologic workup you have already had. We check tongue and pulse, identify the pattern, and decide whether testing belongs in the first step. If something points toward a secondary cause, we will say so and help you get it evaluated. Our women’s health page explains how acupuncture, herbs, and functional testing fit together at the clinic. When you are ready, call to book — and bring your cycle notes if you have them.

The journal is written by Dr. Nazzar from the practice. Articles reflect clinical observation and current research, not personalized medical advice. To explore your own case, schedule a consultation.