Understanding Menstruation & Acupuncture's role
Menstruation in a state of balance (neuroendocrine physiology)
As stated this neuro-endocrine link is highlighted by the hypothalamus which resembles a 'switchboard' that receives input from other regions of the brain and nervous system and subsequently in menstruation it is the hypothalamus that receives the message to secrete gonadotropin releasing hormone (GnRH). GnRH travels via the portal blood to the anterior pituitary lobe causing the pituitary to release Follicle stimulating hormone (FSH) and Luteinising Hormone (LH). These two hormones (LH & FSH) secreted by the anterior pituitary gland act primarily on the ovaries and essentially regulate the three phases of the menstrual cycle. These three phases are categorised as the Follicular phase, Ovulation, and the Luteal Phase.
If we observe the above graph we can see that the 'x axis' denotes a woman’s cycle that lasts for 28 days, of course individual duration of a woman’s menstrual cycle can vary greatly, however for the purpose of this explanation 28 days is the cycle duration. On the 'y axis' we have what is occurring in the ovaries, body temperature, anterior pituitary hormone release, ovarian hormone release, and the uterus (endometrial lining) in relations to the proposed 28 day cycle. You can observe that the graph shows day 0-14 as the follicular phase leading up to ovulation at day 14 and days 14-28 as the luteal phase. It is important to note that Day 1 of a women’s menstrual cycle is considered to be the first day of menstruation.
Keeping the above in mind lets observe what is occurring during the menstrual cycle from day 1. So as stated Day 1 of the menstrual cycle is the first day of the menstrual bleed. Thus the lining (endometrium) of the uterus is shed as fertilisation of the egg (ovum) did not take place. Generally speaking the menstrual bleed can last for two to seven days depending. Now at this point in time the ovaries are receiving via the pituitary gland Follicle Stimulating Hormone (FSH), which has the main function of stimulating the growth of the ovarian follicles which contain the oocyte (immature egg). You can see on the graph above that FSH rises from Day 0 to around Day 8 and this has the desired effect of causing growth and maturation of the ovarian follicle, as well as causing the follicle to secrete Oestrogen (estradiol in the graph). Thus as the ovarian follicle grows under the effect of FSH, it begins to increasingly secrete oestrogen. Oestrogen is the hormone that is responsible for stimulating in females muscle and bone growth, as well as endometrial growth to some extent, and maintains the female secondary characteristics (related to kidney energetic concept in acupuncture). Furthermore at relatively low concentrations as seen in Day 0 to around Day 8 oestrogen inhibits the secretion of Luteinising Hormone (LH), and this is why on the graph you can see low levels of LH from Day 0 to Day 12.
However this all Changes around Day 12 to 14, as the maturing ovarian follicle is getting pretty big by now and thus is secreting much higher amounts of oestrogen which in turn causes the anterior pituitary to release a surge of Luteinising Hormone (LH). Interesting to note that as stated relative low concentrations of oestrogen inhibits Luteinising Hormone, yet higher concentration of oestrogen stimulates LH. This surge of Luteinising Hormone results in the most mature ovarian follicle to rupture and release its oocyte (egg) in a process called ovulation (Day 14). This point of ovulation brings us out of the follicular phase of the menstrual cycle and into the ovulatory phase. The oocyte (egg) is release from the ovary and is ushered into the fallopian (uterine) tube by the finger like projections (fimbriae) where the egg will await fertilisation to occur.
After ovulation we enter the Luteal phase (Day 14-28) where here we observe that the surge of Luteinising Hormone (LH) has come and gone, and we are left with relatively steady levels of FSH and LH. However what you will note on the graph above is that progesterone levels have increased dramatically from around day 15 to 25 and this correlates with the rise in basal body temperature/basal metabolic rate (by-product of increased progesterone levels/ovulation) as well as the transition of the ruptured ovarian follicle that released the oocyte to the corpus luteum. Thus it is the corpus luteum that under the influence of Luteinising Hormone secretes and is responsible for the high progesterone levels. Interesting to note that the corpus luteum also secretes a hormone called inhibin which inhibits the anterior pituitary from further secreting Follicle stimulating hormone. Now the main effects of progesterone as secreted by the corpus luteum, is to increase blood vessel growth (vascularisation) in the endometrium and subsequently thicken the endometrial lining. The reason for this is to prepare for the possibility that our previously released oocyte (egg) meets a sperm in the fallopian tube and form an embryo which will eventually find its way and embed itself into the vascularised (thanks to progesterone) endometrial lining. Now if no fertilisation takes place the corpus luteum further degrades into the corpus albican and ultimately disintegrates resulting in progesterone and inhibin levels to drop, thus initiating a new menstrual cycle to begin marked by the shedding of the endometrial tissue as menstrual blood.
Imbalanced Menstruation & how acupuncture can help ...
Thus the menstrual cycle and its associated state of balance is of paramount importance and is dependent on the individual’s state of ‘constitutional’ health. Fortunately acupuncture is an amazing form of therapy that is 'regulatory' in its very essence, thus it can beautifully align the individual on a systemic scale and subsequently can ameliorate menstrual disorders very effectively.
Whether the pathological presentation be no menstruation (amenorrhea), heavy and prolonged menstrual flow (menorrhagia), frequent yet irregular menstruation (metrorrhagia), or painful menstruation (dysmenorrhea). It is essential in treatment through acupuncture to establish via palpation and medical history what may be preventing the individual from having a natural, pain free & rhythmic menstruation. Taking into account medications, surgeries, diet, other medical issues, and ultimately palpatory findings a treatment plan is formulated and actively tested on the body through the subsequent amelioration of pressure pain on the associated reflective areas and meridians, as well as diligent record taking in regards to improvements and shifts in the menstrual cycle itself & associated symptoms. This acupuncture treatment approach encompassing immediate shifts on the treatment table coupled with record keeping cycle to cycle allows for accurate benchmarking in regards to treatment progress and further aids in the ‘whole’ regulatory process taking place.
Now if we look at the menstrual cycle from a classical acupuncture perspective we see that in the Suwen (basic questions) an acupuncture text that was written more than 2000 years ago contains a chapter titled “The Universal Truth”. In this chapter among other concepts it discusses the reproductive physiology of women following a seven year cycle. The paragraph begins by stating that a woman’s ‘kidney energy’ becomes full at the age of seven and thus the permanent teeth arrive, at the age of fourteen her fertility essence (heavenly waters) mature and menstruation occurs (menarche), the paragraph continues illustrating the following seven year increments up to the age of forty nine where it states the fertility essence ‘dries up’ and she is no longer able to conceive (menopause).
Now if we observe this pivotal chapter of the Suwen we can see that the energetics of the kidneys which the classical Chinese related with growth, development, reproduction & maturation are mentioned as the foundation of the reproductive cycle. This function that the classical Chinese acupuncturists attributed to the kidney energetics strongly reflects the biological role attributed to the hypothalamic pituitary ovarian axis in particularly oestrogen’s role in bone growth and development (female secondary characteristics). Furthermore the pulsation of gonadotropin releasing hormone (GnRH) from the hypothalamus (brain) affecting the pituitary and ovaries can be related to the heavenly waters the classical Chinese acupuncturists associated with menstruation as it is the ‘heavens’ (brain) that descends its virtue to the ‘earth’ (body) that initiates ‘Qi’ (function).
Thus when treating menstrual disorders with acupuncture, key meridians I work on include the Kidney meridian, for the reasons we have presented above and many more. As well as the Spleen meridian, as the classical Chinese acupuncturists stated that the energetics of the spleen control the blood and dominate the first stages of its formation, as well as ‘holding’ the blood and preventing pathological haemorrhaging. Again, we should not get caught up in the label of ‘spleen’ or 'kidney & liver' as it is the attributed function that is important. We know the spleen is composed primarily of lymphatic tissue, however interestingly the spleen does have a haemopoietic function and is involved in the creation of red blood cells as well as lymphocyte production. Furthermore when we relate this concept of the ‘spleen’ energetics to menstruation and menstrual disorders it relates strongly to the proliferation and growth of the endometrial lining (possibly impeded in amenorrhea presentations), subsequent vascularisation (blood vessel growth), as well as the ability to ‘hold’ the blood and prevent pathological haemorrhaging (i.e. menorrhagia). Thus it is no surprise that when dealing with menstrual disorders from amenorrhea to menorrhagia the spleen meridian is always incorporated in my acupuncture practice.
It is interesting to note that the energetic concept of the Liver encompasses among other functions the contractility of muscles. Keeping this in mind I find that treating the liver meridian can be extremely beneficial in ameliorating menstrual and uterine disorders. Reason being is that although it is the spleen's energetics that have been attributed to the endometrial lining (uterus lining) it is the myometrium (muscular wall) of the uterus and its associated contractility that relates to the energetics of the Liver. Thus in cases of cramps & dysmenorrhea (painful cycle) I find regulating the contractility of the myometrium through the classical acupuncture concept of the liver to be extremely beneficial in ameliorating the individual and thus the condition.
Above I have highlighted some basic acupuncture treatment concepts I use when treating individuals with menstrual disorders, however I use a range of treatment strategies that are guided by what presents on palpation and subsequently what the reflective areas and meridians dictate. As I have stated time and time again I believe the state of a woman's menstrual cycle to be of paramount importance and I have provided all the information above to highlight the multi-system processes and dynamics that can be regulated if a woman's menstrual cycle is brought into a state of balance and harmony. Regardless of the diagnosis/label given it is my goal by treating the individual through acupuncture to assist in creating an environment where a woman's menstrual cycle is regular, timely in flow, and without associated pain or emotional upset.
As always, if you have any questions or would like to make a booking feel free to contact me.
Giancarlo Nerini - Licensed Acupuncturist