The Menstrual Cycle

Menstrual Disorders and Chinese Medicine

Volumes of Chinese Medical texts spanning the centuries have been devoted to Chinese Medical gynecology, all of which emphasize regulating the menstrual cycle as a means of improving internal-physiologic balance and treating common, and often complex, women’s gynecologic health complaints. In Chinese medicine, this is first accomplished by forming a detailed Chinese Medical diagnosis based off of the patient’s Chinese Medical “pattern differentiation”.  This “pattern differentiation” is based off of sign’s and symptoms the patient is presenting with and experiencing. Once the pattern is determined, the patient is then treated according to her individual diagnosis, as well as, according to each phase of the menstrual cycle.

Chinese medicine views the menstrual cycle as having 4 different phases. Each of these 4 phases of the menstrual cycle requires different treatment methodologies (i.e. varying acupuncture points and Chinese herbal therapy used during different phases of each cycle) according to what is happening in the body during the respective phase.  The 4 phases of the menstrual cycle are broken down according to Chinese Medicine in the folloiwng way:

  1. Menstrual Phase (Yin phase)
  2. Follicular Phase (Yin Phase)
  3. Ovulation Phase (Combination of Yin and Yang)
  4. Luteal Phase (Yang Phase)

Phase 1: Menstruation – aka – “Menstrual Phase”

  • The “Menstrual Phase” begins with the onset of the menstrual period when both progesterone and estrogen/estradiol levels decrease or drop at the end of the luteal phase (phase following ovulation) of the preceding cycle. 
  • According to Chinese Gynecologic Medical theory, the menstrual phase represents the beginning of the “Yin” half of the cycle. During this time, the endometrial layer or uterine lining  (a “yin” substance) is shed, estrogen levels begin to increase, and the stage is set for a new layer of endometrium/uterine lining to begin developing.
  • Menstruation usually lasts from 1-7 days, and over this period roughly 35-50ml of blood can be lost.  
  • Growth and development of a new endometrial/uterine lining is dependent upon appropriate and thorough sloughing of the old endometrial lining.  This thorough sloughing makes way for the engendering of a new, thick and healthy endomentrium.  Growth, quality and thickness of this new endometrium/uterine lining is dependent upon appropriate estrogen levels, as well as, a necessary component of successful conception.
  • Treatment during this phase consists of enhancing and encouraging adequate circulation both systemically and specifically in the uterus via a combination of acupuncture and Chinese  Herbal Therapy.
  • Complaints of menstruation can be successfully treated during this time (i.e. dysmenorrhea, heavy or scant bleeding, clots, etc.), as well as, the pain and bleeding associated with endometriosis and fibroids. 

Phase 2: Follicular Phase

  • The follicular phase begins with the cessation of menses and continues until time of ovulation. During this time, FSH (Follicle Stimulating hormone), released by Anterior pituitary in the brain, signals the ovaries to recruit and mature ovarian follicles which contain the eggs or oocytes.  The recruitment and maturation of ovarian follicles results in rising levels of estrogen as the ovarian follicles themselves are the manufacturing and release site of estrogen.
  • Ovulation will ultimately be triggered in response to rising and sufficient estrogen levels.  If inadequate amounts of estrogen are being produced, then ovulation will not happen.  Also, if the ovaries for whatever reason are not responding to the FSH being released by the pituitary or there is not enough FSH being released by the pituitary, then ovulation will not happen.  These different situations preventing ovulation can be due to various causes (i.e.: stress, declining ovarian reserve, HPO Axis not communicating…)
  • Also 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 carry 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 Phase

  • This phase is very short, and typically involves the 3-4 days surrounding the actual time of ovulation. In a “Normal Menstrual Cycle” ovulation can occur between days 13-15, give or take. 
  • Prior to ovulation, estrogen experiences a dramatic surge followed by a rapid decline, signaling the release of LH (Luteinizing hormone) from the Anterior Pituitary in the brain, which acts on the ovaries and its selected follicle, encouraging the release of the oocyte/egg from the selected ovarian follicle.  The release of the oocyte or egg from the ovarian follicle is “Ovulation”.
  • Following the surge of estrogen and trigger of LH, the woman’s basal body temperature should also rise, resulting in a spike in temperature of .7-1 degree F over a 24 hour time frame as demonstrated on a Basal Body Temperature Chart taken by the woman (see below).
  • Ovualation is a dynamic time, one in which the menstrual energy transitions from the the follicular phase – the “Yin half” of the cycle to the Luteal phase – the “Yang half” of the cycle. Strong encouragement of blood circulation at this time with both acupuncture and Herbal Therapy allows for this transition to occur with subsequent expulsion of the egg from the follicle. During this phase, we support the transition from follicular phase to luteal phase (yin to yang) by choosing acupuncture points and herbs that promote sufficient blood circulation and movement 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: Luteal Phase – Post-ovulation

  • The Luteal phase makes up the rest of the menstrual cycle following ovulation and ends with the onset of the next menses. During this time, progesterone is released from the Corpus Luteum (the remnants of the left over ovarian follicle that released the oocyte/egg – aka, the byproduct of ovulation), which helps to maintain the thick endometrial lining that was developed during the follicular phase.
  • Adequate progesterone levels are a necessity should the woman conceive, as progesterone released from the corpus luteum is what both maintains the uterine lining, as well as, potential pregnancies.
  • The typical lifespan of the corpus luteum is 14 days, therefore, the luteal phase usually lasts around 14 days.  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).
  • If Fertilization does not occur by the end of the Luteal phase, the corpus luteum disintegrates, progesterone and estrogen/estradiol levels drop and the endometrial lining begins to slough indicating the onset of the menses and therefore, a new cycle.
  • Utilizing Chinese Medicine 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 Temperature Charting

  • In an effort to correctly identify a woman’s pattern and therefore Chinese Medical diagnosis, Chinese Medical women’s health specialists routinely request that their patients 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 BBT chart indicate a likely Chinese Medical diagnosis, but variances within the individual phases of the chart can help pinpoint specific imbalances within the cycle itself, often suggesting or indicating hormonal imbalances and or concurrent medical diagnoses.
    • For example, the chart of an infertility patient might show a dip in temperature during the luteal phase (phase following ovulation). This could  be indicative of a potential progesterone insufficiency and we would then encourage the patient to have her “day 21” progesterone level evaluated. If evaluation confirms a progesterone deficiency, appropriate treatment will then be aimed at encouraging sufficient progesterone levels which would thus, improve the patient’s chance of maintaining a pregnancy should she conceive. 
    • Another example would be a chart showing a longer Follicular phase (i.e.: > 15 days) and therefore a later ovulation or a very weak ovulation (lacking a significant rise in temperature).  This could potentially be indicative of low estrogen levels coupled with diminished “Hypothalamus-Pituitary-Ovarian communication”, aka, ovaries that are struggling to respond to the signals from the brain to begin developing and maturing ovarian follicles and therefore eggs.  We would therefore encourage this patient to have both her Estradiol and FSH levels evaluated.  From the Chinese Medical Paradigm, we would work towards encouraging and promoting healthy follicular development during the week following menstruation.  Healthy follicular development sets the stage for healthy ovulations to take place.
  • How to Take your BBT Correctly:
    • 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 appointment for review by the practitioner. Other details, such as presence of cervical mucus, abdominal cramping, and timing of intercourse are recorded as well to help inform the case.
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  • Liang, L. Contemporary Gynecology, An Integrated Chinese-Western Approach, 2010
  • Lyttleton, J, Treatment of Infertilty with Chinese Medicne, 2004
  • Maciocia G. Obstetrics and Gynecology in Chinese Medicine.  Edinburg: Churchill Livingston, 2011
  • Marchment R. Gynecology Revisted – Obstetrics and Gynecology for practitioners of Chinese Medicine.  Elsevier Australia: Churhill Livingston, 2007.
  • Martini, Timmons, McKinley, Human Anatomy, Third Edition. Upper Saddle River, New Jersey: Prentice-Hall, 2000
  • Vander, Sherman, Luciano, Human Physiology – The Mechanisms of Body Function, 8th edition.  New York, NY: McGraw Hill, 2001