Acupuncture for Painful Periods, Endometriosis and Chronic Pelvic Pain

June 20, 2024 Kathryn Puffett

Chronic, or persistent pelvic pain in women and menstruating people is SUPER common and has been vastly underestimated.

If you ask any complementary integrative health care provider, like an Acupuncturist, we would tell you from clinical experience what 2023 research from Jean Hailes Women’s Health found; that almost half (47%) of Australian women* over 18 experienced pelvic pain in the last five years.

*This research uses the terms women, and woman - the remainder of this article will use gender-inclusive languaging.

This same research found that half of those with pain did not discuss their symptoms with a doctor; 35% felt that nothing could be done and 69% felt their symptoms weren’t “bad enough” to justify a discussion with a doctor (1).

Again, I think most complimentary & integrative healthcare providers could retell countless harrowing stories of people’s symptoms being dismissed by healthcare providers - often the catalyst that leads them to seek our support.

Thankfully, I am seeing a new trend of better-informed GPs, offering integrative solutions for patients.

Despite this, according to the Pelvic Pain Foundation of Australia, guidelines for management are not readily available to general practitioners, and few practitioners feel adequately skilled to manage the complex range of symptoms that present (2).

SO WHAT IS PELVIC PAIN?

Pelvic pain is felt in the lower abdomen and lower back. It can include dull aching, debilitating cramping or sharp, shooting pain. It might present after sitting for a long time, with penetration (like sex, or using a tampon).

Pelvic pain can also be symptomatic of chronic conditions like endometriosis, uterine fibroids, adenomyosis, irritable bowel syndrome (IBS), pelvic floor dysfunction, painful bladder syndrome, urinary tract infections (UTI) and vulvodynia.

It’s also not uncommon for more than one of these conditions to be present.

ENDOMETRIOSIS

All pelvic pain is not endometriosis, but endometriosis very often presents with pelvic pain.

Endometriosis is a chronic condition that is estrogen-dependent and causes nerve-related inflammation. In endometriosis, endometrial cells (similar to the cells that line the uterus) grow onto other tissues where they don’t belong.

These growths, called lesions, behave like the cells in the uterus, they respond to hormonal changes and bleed monthly, leading to pain, inflammation, and scarring.

Endometriosis most often affects the reproductive organs and the bladder and bowels but It has been found all through the body.

Symptoms are different for everyone but can include:

Fatigue, bloating
Pain during or around your period and or ovulation
Pain during or after penetrative sex
Pain with bowel movements or urination
Pain in your pelvic region, lower back or legs
Frequent urination, or difficulty holding a full bladder
Heavy menstrual bleeding or irregular bleeding

Diagnosis of endometriosis is made via laparoscopy and biopsy of tissue, but it is not always essential to receive a diagnosis, sometimes a doctor will suggest endometriosis based on clinical presentation.

A diagnosis is not required for acupuncture treatment, we treat people, not conditions.

Best-in-class treatment is tailored to the individual and would include a combination of health professionals working together, such as a pelvic physiotherapist or exercise physiologist, psychologist, nutritionist or naturopath and Acupuncturist - working alongside your GP and or gynecologist. Surgery and medications are commonly used to manage symptoms, but they are rarely the full picture.

Chinese Medicine has a long and rich history of treating gynecological conditions and menstrual disharmony - and although the medical profession has been stumped by this complex presentation of symptoms for the last few decades - each unique presentation of endometriosis forms a clear pattern when you apply the Chinese Medicine framework for diagnosis and treatment. More on that a little further down…

WHAT ABOUT CHRONIC PAIN?

Our understanding of chronic pain is evolving. Pain is not simply about tissue injury or diseases (like endometriosis) causing problems. Many factors are involved, including the nerves, muscles, brain, immune system, and hormonal system. Stress levels, sleep, and psychological and social aspects of life also influence these systems.

Experiences of trauma can also impact how pain is felt and processed.

When pain persists beyond a few months, the body's sensitivity to pain changes and tissues become hypersensitive. At this point, the pain experienced is less about the original tissue damage (or disease) and more about the body's protective mechanisms.

The brain perceives a threat, whether real or not, and this perception drives the pain experience. Fear steps in to protect you from potential pain.

Persistent pain leads to changes in the nervous system, creating hypersensitive communication between the brain and the affected area, like the pelvis. Things that previously didn't cause pain, like a tight waistband or a full bladder, now hurt. Similarly, things that used to cause minor discomfort, like period pain or exposure to hot and cold, are now experienced as significant pain.

We can learn tools to reduce the impact of persistent pain and decrease nerve sensitivity. Pain education, combined with techniques to manage stress and promote relaxation, can help shift the body from a state of high stress (sympathetic nervous system dominance) to a more relaxed state (parasympathetic nervous system responsiveness).

This shift can mitigate the intensity of chronic pain and enhance overall well-being.

And - you guessed it, Acupuncture is great at promoting a parasympathetic state, and directly engages with the body’s internal pain-relieving chemicals.

If you are looking for something that has been shown to engage with all of the systems involved in chronic pain - immune, nervous, endocrine, musculoskeletal - Acupuncture is it.

Again, more on that, and the science a little further down…

CHINESE MEDICINE PERSPECTIVE

If you have ever seen an Acupuncturist, you will know that we ask you directly about your cycles (even if you are not currently experiencing them, due to contraception, menopause etc), and we ask directly about pain.

That 69% of people with persistent pain who didn’t feel it was worth a discussion with a GP will never go unnoticed by an Acupuncturist.

Pain generally, and the menstrual cycle ALWAYS form part of our conversation. Even if you are seeing us for something seemingly unrelated. In holistic medicine practices - everything is related. Everything you experience matters.

In Chinese Medicine theory, pain is attributed to Qi or Blood being unable to move in the channels freely as it does when there is no pain.

Qi or Blood might be stagnant because there is not enough (deficiency), or too much (excess), emotions might be causing disharmony, or there could be something blocking the channels (like dampness or phlegm), or constricting the channels (like cold).

There will be different underlying mechanisms for each person, as Acupuncturists, it is our job to determine what is involved, and then use the many tools we have access to to bring balance, flow, and harmony back into your system.

It might sound esoteric, but there is good science showing how it works.

HOW ACUPUNCTURE WORKS FOR PERIOD PAIN (DYSMENORRHEA), ENDOMETRIOSIS AND PELVIC PAIN

Acupuncture relieves pain through many mechanisms involving the nervous system and biochemical pathways. It activates nerve fibres and pathways that trigger the release of biochemicals, including opioid and non-opioid neuropeptides like endorphins and serotonin, which help reduce pain.

Acupuncture initiates purinergic signalling, a process that regulates bodily functions and responds to tissue damage. Additionally, acupuncture influences the central nervous system by stimulating muscle relaxation, altering brain activity to reduce stress, and enhancing the regulation of hormones and the body's stress response.

In essence, acupuncture improves local blood circulation, regulates inflammation, regulates the immune system, and promotes relaxation and healing through the harmonious and responsive activities of the nervous system.

Whilst there are certain acupuncture points most commonly used to treat pelvic pain and symptoms of endometriosis, a true Acupuncturist will develop a point prescription unique to you, based on your presentation.

EVIDENCE FOR ACUPUNCTURE & ENDOMETRIOSIS

A recent (2023) systematic review and meta-analysis assessed six studies and concluded that acupuncture treatment for endometriosis demonstrated clinically relevant improvements in pelvic pain and should be considered a potential treatment intervention (3). The study found that Acupuncture treatment for endometriosis showed benefit in reducing the severity of menstrual pain and overall pelvic pain.

A recent (2023) small randomised controlled trial (RCT) found that acupuncture administered over 12 weeks was an effective and safe method of relieving dysmenorrhea (period pain), shortening the pain duration, and improving well-being and quality of life in women with endometriosis-associated pain (4).

CHINESE HERBAL MEDICINE FOR ENDOMETRIOSIS, PAINFUL PERIODS, HEAVY PERIODS, IRREGULAR PERIODS

Chinese Herbal Medicine has a long history of effectively addressing gynecological issues such as period pain, pelvic pain, and irregular bleeding. Unlike Western medicine, Chinese Herbal Medicine tailors prescriptions to an individual's unique symptoms and presentation. This personalised approach means there's no one-size-fits-all formula for conditions like painful periods or pelvic pain; instead, treatments focus on correcting specific imbalances such as Qi and Blood stagnation or Dampness and Cold accumulation. This targeted use of different herbs aims to restore harmony and alleviate symptoms by addressing the root causes of discomfort and dysfunction.

INTEGRATIVE & FUNCTIONAL MEDICINE AND VAGINAL MICROBIOME MAPPING FOR PERIOD PAIN, ENDOMETRIOSIS AND PELVIC PAIN

As an Acupuncturist with an interest in Integrative and Functional Medicine, I will review your blood tests to help direct our investigations with greater specificity & arrange vaginal microbiome testing if your signs and symptoms indicate that it is worthwhile doing so.

The vaginal microbiome consists of specific strains of beneficial bacteria that can become imbalanced, leading to inflammation and infections that contribute to pelvic pain and period pain. This imbalance can also exacerbate conditions like endometriosis by increasing inflammation and disrupting the normal functioning of pelvic organs.

ARE ENDOCRINE-DISRUPTING CHEMICALS INVOLVED IN ENDOMETRIOSIS?

You bet they are, and I will be helping you do your best to navigate lifestyle changes to mitigate their impact on your health.

Xenoestrogens and endocrine-disrupting chemicals (EDCs) are substances that can interfere with the body's hormonal balance and might contribute to the development and progression of endometriosis.

Research continues to explore the exact mechanisms by which xenoestrogens and EDCs influence endometriosis, but evidence suggests that reducing exposure to these chemicals may help manage the risk and progression of the condition (5).

NUTRITIONAL SUPPLEMENTS TO HELP RELIEVE PERIOD PAIN AND PELVIC PAIN

Along with supporting you in seeking further testing with your primary care provider, I might prescribe practitioner-quality nutritional supplements, providing they are indicated in your presentation, and blood tests, and enjoy good quality evidence for efficacy. I prefer to encourage diet and lifestyle changes to support you as a first step. Part of what I do often is help you audit the supplements you are already taking, particularly those you have self-prescribed and ensure you are not wasting your money (and taxing your system unnecessarily).

HAVE YOU TRIED ACUPUNCTURE FOR YOUR PAIN?

So, if you are one of the 47% of menstruating people in Australia who suffers from chronic or persistent pelvic pain related to your cycle - have you given acupuncture a try?

Book online, or reach out to chat about how I can support you.

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