Treating Dysmenorrhea (Painful Periods) with Acupuncture
by Cindi Ignatovsky, LAc.
Menstrual cramps due to primary dysmenorrhea are one of the most common gynecological health complaints reported by women of reproductive age. Current medications to treat this condition are sometimes ineffective and can carry serious health risks with extended use. Acupuncture has been shown to address many of the mechanisms causing menstrual pain, such as inflammation and constricted blood flow. This article will provide evidence and research showing that acupuncture is an effective treatment for primary dysmenorrhea.
Acupuncture as an Effective Treatment for Primary Dysmenorrhea
The word dysmenorrhea, the medical term for painful menstrual cramps, derives from an ancient Greek expression that means difficult monthly flow. It is a very common health complaint that can have a significant impact on a woman’s quality of life. This article will explain why and how acupuncture can successfully treat dysmenorrhea.
Dysmenorrhea is one of the most reported gynecological complaints in women of reproductive age. Painful periods are so prevalent that:
- up to 90% of menstruating women report having dysmenorrhea at some point of their lives
- up to 29% of menstruating women report their pain as severe
- up to 41% of women under age 26 report that it impacts daily activities
- up to 14% of teenagers with menstrual cramps report missing school due to pain
- up to 50% of teenagers report that their cramps are generally severe (Sturpe, 2013).
So many women experience painful periods that it is generally thought of as a normal part of menstruation, and therefore many women don’t seek treatment, even when the pain impacts daily activities or productivity.
Primary and Secondary Dysmenorrhea
There are two types of menstrual cramps, primary and secondary dysmenorrhea.
- Primary dysmenorrhea is defined as menstrual cramps that are recurrent and independent of other diseases. Pain generally starts one to two days before menstruation or when bleeding starts, and can be felt in the lower abdomen, back, thighs, or even as shooting pain down the legs. Pain ranges from mild to severe, can last for several days, and can be accompanied by secondary symptoms such as nausea and vomiting, headaches, fatigue, and diarrhea.
- Secondary dysmenorrhea is pain caused by a disorder in the reproductive organs. Common causes of secondary dysmenorrhea are endometriosis, adenomyosis, fibroids, and infections such as pelvic inflammatory disease. Pain from secondary dysmenorrhea can occur throughout the cycle and normally lasts longer than pain from primary dysmenorrhea (Cleveland Clinic, 2014).
Because secondary dysmenorrhea can stem from a variety of complex gynecological conditions, each with a unique treatment protocol, the focus of this article will be primary dysmenorrhea.
Cause of Pain
The pain in primary dysmenorrhea is caused by naturally-occurring chemicals called prostaglandins, which are found in almost every tissue in the body, including in the lining of the uterus. Prostaglandins cause inflammation and are involved in muscle contractions, blood vessel constriction, blood clotting, and pain. The endometrial cells that form the uterine lining begin to make larger amounts of prostaglandins in the luteal phase of the menstrual cycle, shortly before the period begins. As the endometrial cells break down during menstruation, prostaglandins are released, constricting the uterine blood vessels and causing the muscle layers to contract, which results in painful cramps. Prostaglandins can also enter the blood stream, causing the secondary symptoms of nausea, vomiting, headaches, and diarrhea that can accompany dysmenorrhea (Physician's Committee for Responsible Medicine, 2019). It is theorized that women with dysmenorrhea have higher levels of prostaglandins before menses than women without menstrual pain.
Factors that can increase the risk of primary dysmenorrhea are an early start to menses (before age 12), longer periods, smoking, alcohol, stress, and obesity (ironically, attempting to lose weight significantly increases the incidence of primary dysmenorrhea). Exercise, or lack of, does not seem to be a factor. There is a widely held belief that primary dysmenorrhea diminishes after having children, but data on this is inconsistent. Some studies show evidence of decreased pain after childbirth, but other studies show no change in pain levels (Coco, 1999).
In Western medicine, nonsteroidal anti-inflammatory drugs (NSAIDS) and combined oral contraceptives are the main therapies used. Many women report improvement in symptoms with these treatments, but for many these therapies are ineffective and not without risks. Chronic NSAID use is not advised, as prolonged use can cause a wide variety of negative health effects, from increasing risk of stroke and heart attack to decreased kidney function. Oral contraceptives can also increase risk of heart attack and stroke and may also cause less serious side effects such as nausea, bloating, weight gain, headaches, and mood issues. Oral contraceptives are obviously not an option for women with dysmenorrhea who are trying to conceive.
Complementary Therapies: Traditional Chinese Medicine and Acupuncture
More and more women with dysmenorrhea are seeking complimentary therapies for their menstrual pain, and many are looking to Traditional Chinese Medicine and acupuncture for help. What exactly are the mechanisms behind acupuncture’s ability to effectively treat primary dysmenorrhea?
Inflammation. As previously mentioned, one of the key causes of primary dysmenorrhea is inflammation due to Prostaglandins. Studies show that acupuncture decreases inflammation by successfully down-regulating a pro-inflammatory biochemical, tumor necrosis factor alpha, resulting in an anti-inflammatory response. Acupuncture also seems to signal the neural pathways to release dopamine, which triggers anti-inflammatory effects, as well as decreasing inflammation by stimulating the pituitary gland to regulate cortisol, a hormone that affects inflammation (Piech, 2017; NAAS, 2019). In this way, acupuncture can be a safe and very effective alternative to NSAIDs for inflammation reduction. A 2018 meta-analysis of 17 randomized control trials found that acupuncture is actually more effective than NSAIDs in reducing pain due to primary dysmenorrhea (Luo, Huang, Liu, Wang, & Xu, 2019). One study of 122 women compared those who received daily acupuncture for five days, starting the day prior to the start of menstruation, with women who took NSAIDs 2-3 times daily in the same time period. The results showed that the women who received acupuncture had a significantly higher effective treatment rate (96.2%) compared to the NSAIDs group (80%) (Liu, 2017).
Natural painkillers. Acupuncture has also been shown to release natural painkillers in the body. When acupuncture needles are inserted, the nervous system sends a signal to the brain, which releases endorphins, norepinephrine, serotonin, and other chemicals into the bloodstream, which work as the body’s own opioids, lowering pain thresholds. In addition, acupuncture also releases a natural pain killer in our cells, called Adenosine, which is thought to work like a local anesthetic. The insertion of acupuncture needles starts a process which injures local cells. This injury releases Adenosine, which inhibits nerve signals to the brain, blocking pain messages and reducing the sensation of pain (Lapidus, 2010).
Increased blood flow. Another way that acupuncture reduces the pain of dysmenorrhea is to increase blood flow to the uterus. As mentioned before, prostaglandins released from the uterine lining constrict the uterine blood vessels, causing the muscle layers to contract, which causes pain. When acupuncture needles are inserted locally in the lower abdomen, nerves in the tissue are stimulated. This causes the release of neuropeptides, resulting in vasodilation and increased blood circulation. The increased blood circulation has several affects – it dilutes intravascular prostaglandins, bradykinins and histamines (all pain-inducing molecules) and also increases nitric oxide levels, which relaxes the smooth muscles of the uterus and helps inhibit uterine contractions (Shetty, Shetty, & Mooventhan, 2018). Therefore, by increasing blood flow to the uterus, the muscles relax and pain is alleviated. Needling distal points can be just as effective. A 2010 Chinese study on the acupuncture point Spleen 6 showed immediate improvement to uterine arterial blood flow in patients with primary dysmenorrhea. Other distal points in the study, such as GB 39, did not have the same effect (Yu, et al., 2010).
Stress reduction. Acupuncture can also help reduce stress, which is one of the main external factors that can impact dysmenorrhea. Many women report that psychological stress increases their menstrual pain. In one Chinese study, the incidence of primary dysmenorrhea was double in women who reported high levels of stress, 44% versus 22% of women who reported low stress. Stress in the first half of the menstrual cycle, before ovulation, was more strongly associated with painful menstruation than stress in the second half of the cycle, post-ovulation (Stoppler, 2018). Acupuncture reduces stress in the same way it reduces pain, by releasing natural “feel-good” chemicals, such as serotonin and endorphins, into the bloodstream. In 2013, a study done at Georgetown University on rats showed that the rats who endured stressful conditions and then received acupuncture had lowered blood hormone levels secreted by the hypothalamus pituitary adrenal axis, which controls reactions to stress. They also measured the levels of NPY, a peptide secreted during a “fight or flight” response, and found it to be lower than before acupuncture treatment (Goetz, 2015).
Research Shows Results
Research on acupuncture and primary dysmenorrhea shows very positive results. For example, a 2016 randomized control trial looked at 60 women with primary dysmenorrhea. The study group received daily acupuncture (lasting 20 minutes per day) for 15 days of the month, over a period of 90 days. After 90 days, there was a “significant reduction” in the study group with pain scores related to menstrual cramps, headaches, dizziness, diarrhea, mood changes, fatigue, and nausea and vomiting, compared to the control group (Shetty, Shetty, & Mooventhan, 2018).
A 2017 Australian study also showed excellent results. The study looked at women with chronic primary dysmenorrhea to see if regular acupuncture treatments could reduce both the intensity levels and duration of their pain. The researchers also explored whether acupuncture would reduce the common secondary symptoms of back pain, headache, and nausea. The women received acupuncture for a total of only twelve treatments (once per week), each lasting 20-30 minutes. Some participants received electro-acupuncture while other received manual acupuncture. The conclusion was that once-weekly acupuncture over three menstrual cycles significantly reduced menstrual pain, with manual acupuncture showing slightly better results than electro-acupuncture. The most impressive result of this study, however, was that the benefits were sustained for up to a year after the last acupuncture treatment (Liu, 2017).
A 2018 meta-analysis (a review of many studies) evaluating 49 randomized controlled trials (having removed 11 poor-quality studies from consideration), found that acupuncture could be more effective than no treatment or NSAIDs, and be an effective and safe treatment for primary dysmenorrhea. (Woo, 2018).
Primary dysmenorrhea, although common, is not a condition that women need to suffer from. The evidence shows that acupuncture can be just as effective, and sometimes more so, than the standard treatment of NAIDs and oral contraceptives, without the negative side effects that come with those medications. Hopefully this research and evidence will encourage women who suffer from primary dysmenorrhea to seek acupuncture treatment for relief of their symptoms, and for other health care professions to refer their patients to acupuncture for treatment.
About the Author
Dr. Cynthia Ignatovsky, DACM, LAc. has been involved with Chinese Medicine since 1997. She graduated from Five Branches Institute in Santa Cruz, CA, in 2002, where she earned her Masters of Science in Traditional Chinese Medicine. Currently a licensed acupuncturist and herbalist in California, she is pursuing her Doctorate in Acupuncture and Chinese Medicine at Pacific College of Oriental Medicine. Her post-graduate work includes on-going advanced training in the areas of gynecology, obstetrics, and reproductive medicine, which is the focus of her private practice in Campbell, CA.
Cleveland Clinic: Health Library. (2014, July 13). What Is Dysmenorrhea/Menstrual Cramps. Retrieved October 5, 2019, from https://my.clevelandclinic.org/health/diseases/4148-dysmenorrhea.
Coco, A. S. (1999, August 1). Primary Dysmenorrhea. Retrieved October 5, 2019, from https://www.aafp.org/afp/1999/0801/p489.html.
Goetz, T. (2015, September 28). Acupuncture for Stress and Depression? Yes, Please! Retrieved October 5, 2019, from https://www.psychologytoday.com/us/blog/renaissance-woman/201509/acupuncture-stress-and-depression-yes-please.
Lapidus, F. (2010, June 6). Acupuncture Triggers Natural Painkillers. Retrieved October 5, 2019, from https://www.voanews.com/science-health/acupuncture-triggers-natural-painkillers.
Liu, W. (2017, August 21). Acupuncture Alleviates Menstrual Pain in Australia. Retrieved October 5, 2019, from https://www.healthcmi.com/Acupuncture-Continuing-Education-News/1780-acupuncture-alleviates-menstrual-pain-in-australia.
Luo, F., Huang, X., Liu, X., Wang, L., & Xu, N. (2019, January). Comparative efficacy and safety of NSAIDs-controlled acupuncture in the treatment of patients with primary dysmenorrhoea: a Bayesian network meta-analysis. Retrieved October 5, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/30497312.
NAAS. (2019). Treatments. Retrieved October 5, 2019, from https://www.spine.org/KnowYourBack/Treatments/Alternative-Medicine/Acupuncture.
Physician's Committee for Responsible Medicine. (2019). Using Foods Against Menstrual Pain. Retrieved October 5, 2019, from https://www.pcrm.org/good-nutrition/nutrition-information/using-foods-against-menstrual-pain.
Piech, E. (2017, February 3). Acupuncture Anti-inflammatory Marker Found. Retrieved October 5, 2019, from https://www.healthcmi.com/Acupuncture-Continuing-Education-News/1714-acupuncture-anti-inflammatory-marker-found.
Shetty, G., Shetty, B., & Mooventhan, A. (2018, April 12). Efficacy of Acupuncture in the Management of Primary Dysmenorrhea: A Randomized Controlled Trial. Retrieved October 5, 2019, from https://www.sciencedirect.com/science/article/pii/S2005290117302066?via=ihub.
Stoppler, M. (2018, June 13). Painful Periods Related to Stress. Retrieved October 5, 2019, from https://www.medicinenet.com/painful_periods_related_to_stress/views.htm.
Sturpe, D. A. (2013, September 18). The Management of Primary Dysmenorrhea. Retrieved October 5, 2019, from https://www.uspharmacist.com/article/the-management-of-primary-dysmenorrhea-43009.
Woo, H.L., Ji, H.R., Pak, Y.K., Lee, H., Heo S.J., et al. (2018, June). The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis. Medicine (Baltimore). Jun;97(23):e11007.
Yu, Y.-P., Ma, L.-X., Ma, Y.-X., Ma, Y.-X., Liu, Y.-Q., Liu, C.-Z., … Zhu, J. (2010, October). Immediate effect of acupuncture at Sanyinjiao (SP6) and Xuanzhong (GB39) on uterine arterial blood flow in primary dysmenorrhea. Retrieved October 5, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/20932189.