Many girls of fifteen or sixteen are already used to spending the first day of their period curled up in bed, hugging a bottle of warm water to their belly and missing a day of school. Ten years later, the same women keep a strip of painkillers in their handbag and try not to schedule anything important on the first day of their period. Ask the older women in the family, and you often hear the same line: all girls go through it, and it goes away once you marry and have a baby.
That advice leaves quite a few people putting up with pain for many more years. Pain bad enough to make you miss school or work deserves an examination, because sometimes it is a sign of a treatable condition, such as endometriosis.
Why you shouldn’t put up with period pain every month
A review by Iacovides and colleagues (2015) found that primary dysmenorrhea (period pain with no underlying disease) affects 45–95% of women who menstruate. Patients, and health workers too, tend to see it as normal, and the pain is often not treated adequately.
Pain that comes back every month does not make the body get used to it, either. The same authors found that:
- People who often have period pain are more sensitive to pain, even on days when they don’t have their period;
- Period pain is a risk factor for chronic pain conditions later in life, such as fibromyalgia;
- During the days of the period, mood, sleep and quality of life all go down.
Two kinds of period pain: primary and secondary
During a period, the lining of the uterus releases prostaglandins, substances that make the uterus contract. When there is a lot of them, the uterus contracts too strongly, blood flow to the uterine muscle drops, and you feel cramping pain in the lower belly.
Period pain is called primary when an examination finds no disease in the pelvis. This kind of pain usually starts within the first few years after periods begin, is strongest during the first one to three days of the period, and then gradually eases.
Secondary period pain has a condition behind it: endometriosis, adenomyosis (endometrial tissue growing into the muscle of the uterus), uterine fibroids, pelvic inflammatory disease or hormonal disorders. To know which kind you have, you need to look at how the pain has changed over the years and have a pelvic examination.
Endometriosis and the signs that mean you should get checked
Endometriosis is a chronic inflammatory disease. Tissue similar to the lining of the uterus grows outside the uterus, mostly on organs in the pelvis. Zondervan and colleagues (2018) report that it affects about 5–10% of women of reproductive age, causing pelvic pain and making it harder to have a baby.
A definite diagnosis requires laparoscopy (keyhole surgery) and a tissue test. Ultrasound and magnetic resonance imaging (MRI) can only show a few forms, such as endometriosis cysts on the ovaries or deep nodules. So a normal ultrasound does not fully rule out the disease.
You should get checked if your period pain has any of the following features:
- The pain gets worse year by year, each period worse than the last;
- The pain is new, or started after age 25 when you previously had no pain;
- Pain during sex;
- Pain when you open your bowels or pass urine during your period;
- You are trying to conceive but have not yet become pregnant;
- Ordinary painkillers don’t help, or you need more and more of them;
- Heavy periods, irregular cycles, or many blood clots.
If your periods are also heavy, the article Why are my periods so heavy? (Vietnamese) explains the signs and the iron deficiency that often comes with them.
When to go to the emergency department
Go to the emergency department right away, without waiting for your period to end, if you have:
- Severe, sudden abdominal pain that is clearly different from your usual pain;
- Abdominal pain with a fever;
- Dizziness, fainting or a cold sweat;
- Abdominal pain or bleeding when there is a chance you could be pregnant.
Period pain through the lens of traditional medicine
Traditional medicine has a saying, “where there is free flow there is no pain; where there is pain there is no free flow” (通则不痛，痛则不通 / 通則不痛，痛則不通, tōng zé bù tòng, tòng zé bù tōng): when qi and blood circulate freely there is no pain, and pain means something is blocked. The practitioner looks for what is causing the blockage, and whether the body is in excess or deficiency.
Many families still tell their daughters not to drink iced water, bathe late at night or wade through water during their period. That advice fits the cold pattern; for other patterns it may not. Three common patterns are:
- Cold congealing with blood stasis (寒凝血瘀, hán níng xuè yū): the lower belly feels cold, with cramping pain that feels better with a warm compress, and dark menstrual blood with clots; common in people who eat or drink cold things, or get caught in the rain, during their period;
- Qi and blood deficiency (气血虚 / 氣血虛, qì xuè xū): a dull ache toward the end of the period or after it finishes, a liking for gentle pressure on the belly, pale and thin menstrual blood, tiredness, and pale skin;
- Yin deficiency with blood heat (阴虚血热 / 陰虛血熱, yīn xū xuè rè): a dull ache with heat in the lower belly, periods that often come early and are deep red, a tendency to feel hot inside, hot palms and soles, and a dry mouth.
Quite a few people show features of two patterns at the same time.
The Conception Vessel (Ren mai) and the Penetrating Vessel (Chong mai) both start in the lower belly, together with the Governing Vessel (Du mai), which runs up along the back. The old texts call the Penetrating Vessel the sea of blood, and say the Conception Vessel governs pregnancy. The Liver, Spleen and Kidney meridians also pass through the lower belly, so the points chosen may be on the belly, the back or the legs.
What Dr. Tam checks when you come to Tam Duc
The first visit takes about 30–45 minutes. The questions start with your cycle: how many days it lasts, whether it is regular, how heavy the flow is, its color, and any clots. The pain is asked about day by day: before the period, on the first or last days, cramping or dull, whether a warm compress helps, and how bad it is on a scale of 0 to 10. You will also be asked about trying to conceive, past pregnancies, surgeries and the medicines you are taking.
These details help the doctor work out where the problem lies. Dr. Pham Tran Dan Tam (MD, Specialist Level I in Traditional Medicine) once recorded the case of a 28-year-old woman with cramping pain for one or two days before her period that eased with a warm compress. On the second day she passed a large clot; on the third day the flow dropped suddenly and then stopped. At the examination, she had stress factors, a problem in the Governing Vessel, and functional disturbances involving the Heart, Liver and Triple Burner. The doctor treated the stress with Applied Kinesiology and prescribed an herbal decoction. In the period right after the first treatment session, the premenstrual pain dropped by more than half and the clots were smaller. That is only one cycle, and she is still being followed up.
Alongside a clinical examination by modern medicine come the four examinations of traditional medicine: looking, listening, asking, taking the pulse and looking at the tongue. A pelvic ultrasound or lab tests, if needed, are done before treatment. Muscle testing according to Applied Kinesiology helps Dr. Tam check for stress in the frontal lobe, limbic system and cingulate gyrus, and test ions (minerals, electrolytes) and medicinal substances; the results only add to the ultrasound and lab tests. See how to prepare for an Applied Kinesiology examination.
Treatment at the clinic
Acupuncture and moxibustion
Li and colleagues (2024) pooled 33 studies on eight non-drug approaches for primary dysmenorrhea; exercise, acupuncture and heat showed a clear ability to reduce pain. A meta-analysis by Wang and colleagues (2025) of 22 randomized trials with 1,955 people also found that acupoint stimulation reduced pain. Compared with groups taking anti-inflammatory painkillers (NSAIDs), acupoint stimulation relieved pain about as well, and the women in this group used fewer painkillers; the effect was immediate and held over three cycles, most clearly with needle acupuncture. Side effects did not differ from the control groups; the certainty of the evidence was low to moderate.
For pain caused by endometriosis, Chen and colleagues (2024) pooled 14 studies with 793 people and found that acupuncture lowered pain levels compared with control groups, although the quality of the original studies was still limited.
At Tam Duc, acupuncture and moxibustion (warming points with burning mugwort) are done by the doctor personally. Moxibustion suits people with the cold pattern best. See also our article on acupuncture.
Herbal decoctions by pattern and by phase of the cycle
The prescription is modified to your pattern and changes with each phase of the menstrual cycle. So a prescription used over and over, or someone else’s prescription, usually doesn’t suit you. If cooking the herbs at home is inconvenient, you can ask the clinic to prepare the decoction for you. More about herbal decoctions.
Nutrition, exercise and working with obstetrics and gynecology
Your meals are adjusted, micronutrients are added when the examination finds a shortfall, and you get exercises suited to your fitness. For endometriosis, fibroids or other conditions that need laparoscopy, surgery or hormonal treatment, the doctor works together with obstetrics and gynecology specialists.
What you can do at home
If warmth eases your pain, keep your belly and lower back warm and cut down on cold drinks during your period. Use a heat pack at about 40°C (104°F), always with a towel in between. A few slices of fresh ginger in hot water also suit people who catch cold easily. Walking and yoga are best done regularly throughout the month; on days with a lot of pain, go lighter. Take painkillers as your doctor directs.
For at least three cycles, write down the day the pain starts, how bad it is from 0 to 10, how long it lasts and what medicines you took.
Frequently asked questions
Does period pain go away after having a baby?
For some people it gets better after birth; for others it doesn’t. If the cause is endometriosis, waiting until you have a baby can delay the diagnosis, while the disease itself can make it harder to get pregnant.
I’m trying to conceive and have bad period pain. What should I do?
Get checked early, because endometriosis makes it harder to have a baby. Let the doctor know you are trying to conceive, so the herbs, points and timing of treatment can fit each phase of your cycle.
Should I worry about bad period pain in a teenager?
Primary dysmenorrhea often starts at this age. If your teenager often has to miss school, the pain keeps getting worse or the periods are very heavy, the family should take her for an examination. For someone who has not yet had sex, the doctor chooses a suitable way to examine and do the ultrasound.
Worth keeping
- Keep a pain diary for at least three cycles: the start day, pain from 0 to 10, how long it lasts, medicines taken;
- Also note any pain during sex, or when you open your bowels or pass urine;
- Put a warm compress of about 40°C (104°F) on your lower belly, always with a towel in between;
- Walk or do light exercise every day, regularly all month long, not only on the days with pain;
- Don’t use someone else’s prescription, and don’t raise your painkiller dose on your own;
- Bring your pain diary and old ultrasound results to your visit;
- Remember the signs that mean going to the emergency department: severe sudden pain, fever, fainting, a chance you could be pregnant.
If your pain has any of the signs above, you can bring your pain diary to Dr. Pham Tran Dan Tam (MD, Specialist Level I in Traditional Medicine) for an examination to find the cause.
References
- Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015;21(6):762-778. https://doi.org/10.1093/humupd/dmv039
- Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. Endometriosis. Nat Rev Dis Primers. 2018;4(1):9. https://doi.org/10.1038/s41572-018-0008-5
- Li X, Hao X, Liu JH, Huang JP. Efficacy of non-pharmacological interventions for primary dysmenorrhoea: a systematic review and Bayesian network meta-analysis. BMJ Evid Based Med. 2024;29(3):162-170. https://doi.org/10.1136/bmjebm-2023-112434
- Wang Y, Liu L, Wu X, et al. Clinical evidence of acupoint stimulation for primary dysmenorrhea: a systematic review and updated meta-analysis. J Pain Res. 2025;18:4307-4336. https://doi.org/10.2147/JPR.S533585
- Chen C, Li X, Lu S, Yang J, Liu Y. Acupuncture for clinical improvement of endometriosis-related pain: a systematic review and meta-analysis. Arch Gynecol Obstet. 2024;310(4):2101-2114. https://doi.org/10.1007/s00404-024-07675-z
