TOPICS: Menstrual Cycle | Menopause | Infertility | Pregnancy & Postpartum | Research

Chinese Medicine and Menstrual Disorders
There are volumes of classic Chinese medicine texts devoted to TCM gynecology, all of which emphasize regulation of the menstrual cycle as a means of improving internal balance and treating common, and often complex, women’s health complaints. In Chinese medicine, this is first accomplished with a detailed diagnosis of the patient’s individual TCM pattern. Once the pattern is determined, the patient is then treated according to her individual diagnosis as well as the phase of the menstrual cycle.

The menstrual cycle has 4 phases in Chinese medicine. Each of these phases requires different treatment methods (i.e. varying acupuncture points and herbs) according to what is happening in the body during the respective phase.

Phase 1: Menstruation
This phase begins with the onset of the menstrual period and represents the beginning of the yin half of the cycle. During this time, the endometrial layer (a yin substance) is shed, estrogen levels increase, and the framework is set for a new layer of endometrium to develop. There is not only moving of yin and blood (the endometrium), but also the building of yin and blood (a new endometrium). Complaints of menstruation can be successfully treated during this time period (i.e. dysmenorrhea, heavy or scant bleeding, clots, etc.), as well as the pain and bleeding associated with endometriosis and fibroids. Similarly, this phase is very important for the development of a thick endometrial layer, a necessary component of successful conception.

Phase 2: Pre-ovulation
This phase begins with the cessation of menses and continues until immediately pre-ovulation. During this time, estrogen continues to increase, signaling FSH to recruit follicles in preparation for ovulation. In response to rising estrogen levels, the endometrium continues to thicken and the cervix becomes rich with fertile mucus (again, a yin substance) necessary to escort sperm through the cervix for fertilization of the released oocyte. This phase is very important in cases of infertility when there is a delayed ovulation, thin endometrium, decreased cervical mucus, and/or poor quality/number of eggs.

Phase 3: Ovulation
This phase is very short, and typically involves the 3-4 days surrounding actual ovulation. Prior to ovulation, estrogen experiences a dramatic surge followed by a rapid decline, signaling the release of LH, which then allows for luteinization of the selected follicle in preparation for ovulation. It is a dynamic time, one in which the menstrual energy transitions from the yin half of the cycle to the yang half. A strong movement of qi and blood allows for the transition to occur with subsequent expulsion of the egg from the follicle. During this phase, we support the transition from yin to yang (follicular to luteal) by choosing acupuncture points and herbs that move qi and blood to promote ovulation in a timely manner. This phase is important to treat in all cases of infertility or menstrual complaints, as well as polycystic ovarian syndrome (PCOS).

Phase 4: Post-ovulation
This phase makes up the rest of the cycle and ends with the onset of the next menses. During this time, progesterone is released from the corpus luteum (the byproduct of ovulation), which helps to maintain the thick endometrial lining that was developed during the follicular phase. The typical lifespan of the corpus luteum is 14 days; therefore, this phase of the cycle is usually as long. However, when the time between ovulation and menstruation is <12 days, it is often due to a progesterone insufficiency and/or luteal phase defect (LPD). Utilizing TCM during this phase can help raise and/or maintain progesterone levels. Treatment during this phase is indicated in cases of recurrent miscarriage, suspected or confirmed progesterone insufficiency leading to infertility, or to mitigate pre-menstrual symptoms.

Basal Body Temperatures
In an effort to correctly identify a woman’s pattern and diagnosis, TCM women’s health specialists routinely request that the patient record their basal body temperatures (BBT). The information contained in the BBT is invaluable to those versed in interpreting their findings. Not only does the overall pattern of the chart indicate a likely TCM diagnosis, but variances within the phases can help pinpoint specific imbalances within the cycle itself, often suggesting concurrent medical diagnoses. For example, the chart of an infertility patient might show a dip in temperature during the luteal phase. This could indicate a potential progesterone insufficiency and we would then encourage the patient to have her progesterone level evaluated. If positive, she would have a greater chance of maintaining a pregnancy if appropriately treated.

The basal temperature is best taken first thing in the morning, at approximately the same time each day, before stirring or rising. The basal thermometer is placed in the same position under the tongue, before having any food or fluids. This value is then charted in the BBT chart and taken to each acupuncture appointment for review by the practitioner. Other details, including presence of cervical mucus, are recorded as well to help inform the case. You can download BBT charts and directions for use here.