The Menstrual Cycle & Fertility According To Traditional Chinese Medicine

Illustration by Harriet Lee-Merrion

The way Chinese Medicine looks at and treats the menstrual cycle is super interesting. It is a view that is guided by nature, Daoist principles, and yin/yang theory. Understanding a little bit about yin/yang theory could help to understand how we see the ebb and flow of the menstrual cycle. 

Here's a chart with some examples of yin and yang characteristics:

From this chart, you can see that yin and yang are opposites. They can not exist without each other, and are constantly morphing and transforming from one to the other. For example, early morning represents the gradual transition from Yin to Yang, as does when a person goes from a heavy sleep to being fully awake. There are aspects of the menstrual cycle which are distinctly Yin and Yang, however the constant movement and flux of your hormones leads to change.

Without further ado, here are the basics of how we look at the 4 phases of the menstrual cycle and how we might treat them.

Phase 1: Menstruation

The day you start your period is the first day of your cycle. Menstruation is the shedding of the uterine lining (endometrium) and typically consists of 4-7 days of bleeding. This marks when the previous cycle has ended and a pregnancy hasn't taken place. 

Chinese View: In this phase, it is important to ensure the proper shedding of the uterine lining to provide an optimal surrounding for implantation later in the cycle. Acupuncture points are used and qi and blood moving herbs are prescribed which help to accomplish this. Qi and blood stagnation, in what we call the "lower jiao," are what cause pain and other symptoms during the period. The less severe the symptoms during your period, the less stagnation there is.

Phase 2: Follicular Phase

The follicular phase occurs after menstruation and before ovulation. At this time the follicle-stimulating hormone (FSH) increases slightly, stimulating the development of several follicles in the ovaries. Each follicle contains an egg. Later in this stage, the FSH level begins to decrease and one follicle continues to develop. This follicle produces estrogen.

Chinese View: During menstruation, our bodies lose blood, yin, and Jing, all substances needed to ensure healthy conception, according to Chinese Medicine. The treatment goal at this time is to replenish these substances before ovulation. This is considered a Yin time during the cycle. There is, however, a Yang aspect to this phase which is the growth of a dominant follicle.

Phase 3: Ovulatory Phase

This phase begins with a surge of luteinizing hormone (LH) and FSH levels. LH stimulates egg release (ovulation) which usually occurs 16 to 32 hours after the surge begins. The estrogen level peaks during the surge and progesterone levels begin to increase.

Chinese View: In Chinese Medicine, this is when yin energy is at its peak and yang energy begins to rise. This is when your body goes from yin dominance (just before ovulation) to yang dominance (just after ovulation).

The primary treatment plan during the ovulatory phase is to help the eggs mature and to promote ovulation. Yang herbal tonics have the effect to enhance the surge of LH, which stimulates ovulation. Other acupuncture points and herbs have a moving effect which help the egg on its way through the fallopian tube towards the uterus. 

Phase 4: Luteal Phase

During the luteal phase, LH and FSH levels decrease. The ruptured follicle that the egg came from forms a corpus luteum, which produces progesteron. Estrogen and progesterone cause the lining of the uterus to thicken, in preparation for implantation of a fertilized egg. If the egg is not fertilized or doesn't implant, the corpus luteum degenerates after 14 days, estrogen and progesterone levels drop, and a new cycle begins. If an embryo is implanted, a hormone called human chorionic gonadotropin (hCG) is produced which maintains the corpus luteum. This is the hormone that is being tested for in a pregnancy test.

Chinese View: In Chinese Medicine, this is when yang energy is at its peak. The major sign of yang energy warmth, is evidenced by a higher basal body temperature. During the luteal phase, we want to support Yang energy and also regulate qi and and blood. This can also help with any PMS signs that might be occurring.