Introduction to your Monthly Affair

Did you know that the regularity, blood flow/colour/viscosity of your period can determine if your period is considered normal or abnormal? How much do you really know and understand about your monthly affair? Read on to learn more.

What is a Menstrual Cycle? 

The average woman gets her first period at age 11-14 and continues monthly until the onset of menopause at around age 48-55. Cycles are usually 28-30 days, lasting 3 to 7 days per cycle.

The menstrual cycle is regulated by hormones such as: Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estrogen, and progesterone in a delicate balance. 

When females reach puberty, the hypothalamus signals the pituitary glands to release FSH and LH. These act as triggers for a cascade of hormonal reactions involving estrogen and progesterone for ovulation and endometrium lining in the uterus for the fertilisation process. If fertilisation does not occur, estrogen and progesterone levels decrease, which triggers the shedding of the endometrium lining. Another round of menstrual cycle repeats.  

Western Medicine Perspective vs TCM Perspective

From a western perspective, the hypothalamus plays a crucial role in many important functions such as releasing hormones, and hormones secreted by the pituitary glands influences growth, sexual development and more.

A minor imbalance in hormones may cause significant effects and symptoms such as irregular periods.

From a TCM perspective, there are multiple things to consider based on your organs and their functions.

In TCM context, the congenital kidney essence（天癸） is inert to ourselves, given from parents upon conception. It is further nourished from the essence of kidney（肾精）and from food transformation by the spleen（脾） as we grow older. 

The spleen not only processes food that we eat, but also plays a part in blood production. The liver（肝） harmonises the Qi and blood in the body meridians and it connects at the lower abdomen to the Chong and Ren meridians. 

The Ren meridian regulates the uterus and the Chong meridian is said to act as a blood reservoir for the uterus. The abundance of congenital kidney essence and balance of spleen and liver functions ensure the surplus of Qi and blood flowing along the uterus for a menstrual cycle to occur.

The spleen plays an important role of absorbing nutrients from food and transforming them into blood and Qi necessary for biological activities. The dispersing function of the liver aids in regulating the Qi and blood of the meridian network.

When all the organs and meridians are ample, menstruation occurs regularly.

What physicians usually look out for and why it matters

1. Regularity (周期，经期)
2. Blood flow (经量)
3. Blood colour (血色)
4. Blood viscosity (质地)
5. Accompanying symptoms:
   • Acne
   • Flu
   • Headache
   • Breast changes (swelling/pain/tenderness)
   • Bloating
   • Cramps
   • Lower backache
   • Bowel movement: Loose stools/constipation

These details of your cycle and accompanying symptoms actually reflect your inner health and body constitution. From there, physicians can then narrow down the root of the problem, if any, and advise treatment plans accordingly.

Understanding Normal v Abnormal Menstrual Cycle

1. A Normal Menstrual Cycle (正常周期)
   • A menstrual cycle is usually 28-30 days. Individuals may experience a difference in a few days for the length of each menstrual cycle.
2. Abnormal Menstrual Cycle (异常周期)
   • When a cycle is shortened or delayed for more than 7 days for more than 2 consecutive menstrual cycles, it can be considered an irregular/abnormal cycle.
     • Advanced Menstruation （月经先期)
     • A shortened cycle of 21 days or lesser for at least two consecutive menstrual cycles.
     • Delayed Menstruation （月经后期)
     • An extended cycle of 37 days or more for at least two consecutive menstrual cycles.
     • Irregular Menstruation （月经先后不定期)
     • A disrupted cycle consisting of irregular shortened or delayed cycles for at least three consecutive menstrual cycles.
3. Abnormal Menstruation Period (异常经期)
   • A normal period usually lasts around 3-7days.
   • Abnormally short menstruation period – when a period lasts for 2 days or less.
   • Prolonged menstruation period – a period that lasts beyond 7-14 days.
4. Normal Blood Flow (正常经量) 
   • On average, a normal flow is suggested to be about 50ml to 80ml per menstruation period. Heavier flows can be expected on the first few days and it gets lighter with spotting as the period ends.
5. Abnormal Blood Flow (异常经量)
   • It is considered normal to be spotting just after a menstruation period but prolonged bleeding or spotting for more than 5-7 days is a cause for concern.
   • Irregular period includes abnormal uterine bleeding that are:
     • Abnormal heavy bleeding and/or prolonged period length
     • Abnormal bleeding or spotting between periods
     • Bleeding after sexual intercourse
     • Bleeding after menopause
     • Abnormal light bleeding and/or very short period length
6. What is your blood colour (血色) and viscosity (质地)?
   • Period colour and viscosity are distinctive symptoms in TCM context explained based on your body constitution and the balancing of Yin and Yang in general. Together with their accompanying symptoms, which one do you match with?

What are some of the common causes of irregular menstrual cycles and periods? 

• Stress
• Irregular diet or eating disorders
• Over-exercising 
• Long term use of medications
• Underlying medical conditions

How can TCM help if you find yourself relating to symptoms? 

Based on your body constitution and symptoms, your TCM physician can diagnose and derive a multi-pronged treatment plan ranging from Chinese herbal medication, acupuncture, cupping and moxibustion to alleviate and target the root cause.

Simple lifestyle improvements for a better monthly affair:

• Developing a positive outlook 
• Healthy diet
  • Consume food high in minerals (iron, potassium, calcium) 
  • Consume food high in Vitamins (B, C) 
• Routine lifestyle 
  • Ensure 8 hours of sleep daily
  • Exercise moderately
• Practice personal hygiene 
  • Helps to prevent vaginal infections especially during periods 
• Massage these acupressure points for 1-2 minutes daily 
  • 足三里 (Zu San Li, ST36) 
  • Location: 3 inches (or 4 finger widths) down from the dent of the anterolateral of the knee cap (patella).

• 三阴交 (San Yin Jiao, SP6)
• Location: 3 inches (or 4 finger widths) above the prominence of Medial Malleolus, just behind the Tibia

• 血海 (Xue Hai, SP 10)
• Location:  The point is 2 inches above the medio superior border of the patella, on the bulge of the vastus medialis of the quadriceps femoris. When the knee is bent at 90 degrees, place palm on the patella. Position your thumb on the inner thigh. The tip of your thumb would be the location of the acupoint.

Period experiences can differ from person to person. Therefore, it is recommended to make it a habit of tracking your period cycles and possible symptoms regularly, in order to help you spot the irregularities. 

This will give you a clearer understanding of your body and personal health, for you to decide if you need to seek professional advice for a more holistic diagnosis.

Article by Physician Oh Xu Xuan

Note: Information provided is not a substitute for a physician or any form of medical care. Individual symptoms differ due to different body constitutions and diagnosis. One should consult a licensed TCM practitioner for accurate diagnosis and treatment.