Acupressure for Period Pain and PMS

Painful periods (dysmenorrhea) cause crampy pain in the lower belly that can be sharp or aching and may come and go. Some people also feel it in the lower back or legs. MedlinePlus says some pain is normal, but a large amount of pain that gets in the way of daily life is not. It separates two kinds:

• Primary dysmenorrhea starts around the time periods begin, in people who are otherwise healthy, and is not usually linked to a problem in the pelvis. Higher activity of prostaglandins, hormone-like substances in the uterus, is thought to play a part.
• Secondary dysmenorrhea starts later, after years of normal periods, and is more often caused by a condition such as endometriosis, fibroids, an IUD, pelvic inflammatory disease or a sexually transmitted infection.

Acupressure is self-care for the first kind. Pain of the second kind needs its cause found, so see a provider first (below).

Premenstrual syndrome (PMS) is a separate thing that often comes with it: symptoms that start in the second half of the cycle and usually ease 1 to 2 days after the period starts. They include bloating, breast tenderness, food cravings, headache, tiredness, sleep changes, irritability and mood swings. The PMS-Period Pain page covers both.

A 2016 Cochrane review pooled 42 randomised trials with 4,640 women who had primary dysmenorrhea, and looked at both acupuncture and acupressure. Its conclusion: there is not enough evidence to show whether either works for period pain.

For acupressure specifically:

• against sham (fake) acupressure, two trials found pain lower by 1 to 3 points on a 0 to 10 scale, and four more reported lower pain in a form that could not be combined;
• against no treatment, two trials with 140 women showed no clear difference;
• against an anti-inflammatory painkiller, one trial found more pain with acupressure.

The reviewers rated the evidence as low or very low quality for every comparison, because of risk of bias, poor reporting, inconsistent results and possible publication bias. None of the acupressure trials reported side effects, and the reviewers note that data on side effects were mostly missing.

So the points below are tradition, labelled as such. Heat, rest and gentle movement are what MedlinePlus lists for self-care, and the routine is built around them.

Traditional use: in TCM, these points are traditionally used for period pain and premenstrual symptoms. Each point's page shows where to find it.

• Main points: SP-8 Earth Pivot (Dì jī) on the lower leg, CV-4 Gate of Origin (Guān yuán) on the lower belly, and LR-3 Great Rushing (Tài chōng) on the foot.
• On the belly, optional: CV-6 Sea of Qi (Qì hǎi) and ST-29 Return (Guī lái).
• When the pain reaches the lower back: BL-32 Second Crevice (Cì liáo).
• On the thigh: SP-10 Sea of Blood (Xuè hǎi).
• For mood swings: spend longer on LR-3 and add HT-7 Spirit Gate (Shén mén) on the wrist.

The concern page's routine has the order and timings. The idea behind it is to press while you are already warm and lying still:

1. Put a heating pad on low on your lower belly, or start after a warm bath or shower.
2. Lie down with your knees bent and a pillow under them, or lie on your side with your knees bent. Breathe slowly into your belly for a minute.
3. Press with your thumb or fingertip, straight into the skin. The pressure should be firm, steady and noticeable, but never painful. Start lighter until you know how much feels right.
4. Hold each point for 15 to 30 seconds to begin with, and work up to 1 to 2 minutes. Do both sides for points that come in pairs.
5. Go gently on the belly points: no deep, unrelenting pressure.

You can repeat this a few times a day in the days before your period and during it.

Don't press on broken, irritated or blistered skin, bruises or new scars, or on an area that has not healed after surgery. If you have a bleeding or clotting disorder or low platelets, press more lightly and for less time, or ask your doctor first.

If you might be pregnant, for example because your period is late, leave out CV-4, CV-6, ST-29 and BL-32: the guide marks them as traditionally avoided in pregnancy (see their pages). A late period with sudden or severe pain needs a provider right away.

MedlinePlus lists these for period pain and PMS:

• Walk or exercise regularly, including pelvic rocking. For PMS, regular aerobic exercise, with more of it in the weeks you have symptoms.
• Eat small, frequent meals, with more whole grains, vegetables and fruit and less salt and sugar.
• Drink water or juice rather than drinks with caffeine, and avoid alcohol.
• Relaxation such as meditation or yoga.

For PMS, it also suggests a symptom diary for at least 3 months: the type of symptom, how bad it is and how long it lasts. It shows whether your symptoms follow your cycle, and it is worth taking to your provider. Ask your provider about medicines or supplements.

Contact your provider right away if you have:

• sudden or severe pain, especially if your period is more than 1 week late and you have been sexually active
• fever with pelvic pain
• increased or foul-smelling discharge

Also contact a provider if:

• treatment has not helped after 3 months
• you have pain and an IUD was placed more than 3 months ago
• you pass blood clots or have other symptoms with the pain
• the pain comes at other times than your period, starts more than 5 days before it, or goes on after it has ended
• PMS does not get better with self-care, or your symptoms limit your ability to function

If you feel like you want to hurt yourself or others, call your local emergency number. In the United States, you can also call or text 988.

See also when not to self-treat.