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Pelvic Pain guidelines from the EAU


The European Association of Urology highlights the role of Acupuncture in the treatment of Chronic Pelvic Pain Syndrome, as well as other non-invasive approaches:

“Supportive therapies, such as biofeedback, relaxation exercises, lifestyle changes (i.e. diet, discontinuing bike riding), acupuncture, massage therapy, chiropractic therapy or meditation”

Stefan Chmelik has a special interest in the treatment of Endometriosis and Fibroids using integrated medicine and a natural healthcare approach.


Only women bleed…

Stefan Chmelik on fibroids and endometriosis

The concepts of Blood Stasis and Phlegm Accumulations in Chinese Medicine sound strange enough as it is, and even more so when we learn that they are often applied to problems in the abdomen, and especially in women.

First we need to appreciate that Chinese Traditional Medicine is almost entirely empirical (based on observation) and that for various reasons it appears the ancient Chinese did not perform autopsy. Also, although they can be credited with a great many things (including the seismograph, magnetic compass, mortar and pestle, the plough, gunpowder, printing, unmanned flight, the decimal zero, the spinning wheel and paper, to name a very few), the Chinese didn’t use microscopes 3,000 years ago. Without the science of microscopy, phenomenon which were observed in the body had to be attributed to something, so the Chinese said that the ‘Blood’ was responsible for what we now call hormones and many aspects of endocrine and brain chemistry function. As it turns out, as with so many things from China, they were pretty much spot on.

It is not hard to make the link between Blood and women’s health however. In Chinese Medicine we say ‘women’s health is dominated by Blood’, and this can be observed in many ways, but perhaps most conspicuously (to the woman at least), in the menstrual cycle and when going for a baby.

Blood accumulates in a woman’s abdomen every month, leading up to the menstrual cycle. This is a normal physiological process that requires both function (Yang) and form (Yin) to work together. The two halves of the menstrual cycle, the follicular and ovulatory phases, are neatly expressed by the concept of Yin-Yang, which represents a transformation and change over time. The flipping of oestrogen to progesterone and the dip and rise in basal body temperature is reflected in the curve and ellipse of Yin and Yang.


Stasis is the cause of all lumps and pain

We say that lumps in the abdomen are due to one or a combination of three causes: Qi Stagnation, Blood Stasis and Phlegm Accumulation. Qi Stagnation is poor energy circulation, and the flow of body fluids and blood follow from that, so reduced circulation can lead to localised pooling of blood or lymph, and over a period of time these can coalesce into lumps (Fibroids or myoma). It takes time for solid and immobile lumps to form. A history of clotted menstrual blood, painful periods or soft and mobile abdominal lumps that change throughout the cycle may be present before fibroids are found.

Endometriosis is not seen or felt as lumps in the abdomen. Endometriosis is where a part of the uterine lining, the endometrium, has travelled outside the uterus, but continues to bleed with the monthly cycle. Obviously if this bleeding occurs in a small space it can cause a lot of pain. This process is still considered as one of Blood Stasis in Chinese Medicine.

The incidence of fibroids and endometriosis is almost certainly rising significantly. One reason for this is likely to be the massive increase in lifetime hormone exposure that is most women’s experience. I am routinely visited by women who have been on oral hormone supplements, for contraceptive, pain relief or skin reasons, for often as long as 15 years without anyone questioning whether this is a good idea. In addition, everybody is exposed to hormone levels in the environment that are hundreds of times higher that a generation ago, and then many women will be offered HRT towards the end of their fertile years. In addition, there are hormone precursors in plastics and common household objects around you. For those that eat meat or dairy, animal protein is directly linked to lump formation, and non-organic meat is laden with growth hormones.

Periods are starting earlier, now not uncommonly at age 9, and stopping earlier as a result. Most women will have a fraction of the menstrual cycles of their grandmothers, due to relative lack of pregnancy and breastfeeding. All of this is part of the picture.


How is your cycle?

If you do not have a regular, proper menstrual cycle, get advice on how to make it so. A proper cycle should be 26-30 days, should last 5-7 days, be not too heavy or not too light, there should be nothing mote than mild pain and the blood should not be clotted or dark. Any significant variation from that picture is potentially problematic in one of several ways, and may indicate a concern for the future. Obviously all of this only applies if you are not on oral contraceptives.


What works?

I have no doubt in saying that Chinese Medicine (Herbs, acupuncture, diet, massage) is the treatment of choice for women’s health. Also effective when given by a properly qualified and experienced practitioner are homeopathy and nutritional medicine, and reflexology can also be helpful.



Science in Traditional China, Joseph Needham

The Genius of China, Robert Temple

The China Study, T. Colin Cambell