Most of what we publish is about the weeks after birth. This guide is about the other rhythm in a woman's life, the one that runs for roughly forty years on either side of those weeks: the menstrual cycle.
We came to it the way our customers did. The Chinese tradition behind confinement does not stop at the postpartum month. The same framework of warmth, nourishment and timing has, for centuries, been applied to the cycle, and the same ingredients turn up in both: ginger, red dates, angelica root, cinnamon. When mothers who had used our soups asked what the tradition had to say about their periods, we did not have a good answer written down. This is that answer.
It is written to be checked. Where there is good evidence, we say what it shows. Where the evidence is thin, we say that too. Where a practice is traditional rather than proven, we call it traditional and leave it there.
Understanding Your Cycle
A menstrual cycle is counted from the first day of one period to the first day of the next. The textbook cycle is 28 days, but the textbook is a convenience: a 2019 analysis of more than 600,000 cycles logged in a tracking app found an average of about 29 days, with wide and normal variation from one woman to another and from one cycle to the next. US guidance (the Office on Women's Health, the Mayo Clinic) treats 24 to 38 days as regular; the NHS gives 21 to 35.
The Four Phases
The cycle is driven by a conversation between the brain and the ovaries, carried by four hormones. In the menstrual phase (roughly days 1 to 5) the uterine lining is shed and estrogen and progesterone are at their lowest. In the follicular phase (from the first day of bleeding to ovulation) follicle-stimulating hormone matures an egg and rising estrogen rebuilds the lining; many women notice energy and mood lifting. Ovulation, triggered by a surge of luteinizing hormone around the middle of the cycle, releases the egg. In the luteal phase (ovulation to the next period, typically 12 to 14 days) progesterone rises, then falls if there is no pregnancy, and the cycle restarts.
"Cycle syncing," the idea that diet and exercise should be rearranged around these phases, is popular and largely untested; the article explains what the few studies actually measured.
Read more: The Four Phases of the Menstrual Cycle: What Happens and When →
The Luteal Phase
The second half of the cycle is where most of the complaints live: bloating, cravings, broken sleep, a shorter fuse. Progesterone raises core body temperature by a fraction of a degree, changes fluid balance and appetite, and interacts with the brain's serotonin system. In the final days before a period, as both progesterone and estrogen fall away, these effects peak. Understanding that timeline is half the battle. It is also the window the Chinese tradition singles out for warming teas, which the Traditional Approaches section below describes.
Read more: The Luteal Phase Explained: Bloating, Cravings, Sleep and Mood →
Symptoms and Comfort
What Is PMS?
Premenstrual syndrome is a cluster of physical and emotional symptoms that arrive in the week or so before a period and ease once it starts. The American College of Obstetricians and Gynecologists defines it by that pattern: symptoms present in the five days before a period in each of three consecutive cycles, ending within four days of the period starting. Most women have some premenstrual symptoms; a 2014 meta-analysis of 17 studies put the pooled prevalence of PMS proper at just under half of women of reproductive age, with enormous variation between countries. A small minority, around 2 to 5 percent, have premenstrual dysphoric disorder, a severe form that needs a clinician. The article walks through what the evidence says about calcium, vitamin B6, exercise, talking therapies and antidepressants.
Read more: What Is PMS? Symptoms, Causes and What the Research Says →
Why Period Cramps Happen
Period cramps are the most common gynecological complaint there is: a 2019 survey of more than 21,000 young women found that 71 percent experienced them. Primary dysmenorrhea is pain with no underlying disease, driven by prostaglandins released from the uterine lining; secondary dysmenorrhea is pain caused by a condition such as endometriosis, which is why pain that is new, worsening or does not respond to the usual measures deserves a proper look. On the evidence: anti-inflammatory painkillers are the best-studied option, with a Cochrane review of 80 trials behind them; heat and regular exercise both have supportive trials; and ginger has a run of small randomized trials and meta-analyses that are encouraging but low in certainty.
Read more: Why Period Cramps Happen and What the Evidence Says Helps →
Traditional Approaches
How Traditional Chinese Medicine Views the Cycle
Traditional Chinese Medicine reads the month as a rhythm of blood and qi that can be nourished, moved or warmed at different points: the classical idea of tiao jing, regulating the cycle. In that framework, cramps and a late, scanty period are often read as cold or stagnation, and warming, moving ingredients are prescribed in the days before bleeding. Several classical recipes come from this thinking, including Si Wu Tang and Wen Jing Tang. Systematic reviews of Chinese herbal medicine and of acupuncture for painful periods have found some promising results and a great deal of low-quality evidence; the article reports both honestly, and explains the difference between a practitioner's prescription, adjusted to the person in front of her, and the fixed household recipes families have always made at home.
Read more: How Traditional Chinese Medicine Views the Menstrual Cycle →
Foods and Teas Traditionally Taken Around Your Period
If you grew up in a Chinese household you already know the brown-sugar ginger tea (红糖姜茶) that appears when a period does. Red dates, goji berries, longan, rose and cinnamon are the other regulars, with a strong tradition of keeping food and drink warm and avoiding anything iced in the days around bleeding. Of all of these, ginger is the one with repeated trials behind it. The article separates what is traditional from what is tested, and ends with a simple week-before menu.
Read more: Foods and Teas Traditionally Taken Around Your Period →
After Birth
Your First Period After Birth
This is the article that joins our two guides. When your period returns after a baby depends mostly on how you feed: exclusive breastfeeding suppresses ovulation for months in many women, while formula-feeding mothers often see a first period within about five to nine weeks. The first cycles back are often heavier, longer or irregular, and ovulation can happen before that first period, which matters for contraception. Readers arriving from the Confinement Guide will find the postpartum context there.
Read more: Your First Period After Birth: When It Returns and What Changes →
How This Guide Relates to What We Make
The Fourth Trimester makes soups and teas from dried culinary and herbal ingredients, drawn from recipes traditionally prepared in China. Our Premenstrual Tea applies that tradition to the five days before a period. We describe what is in it and how it has traditionally been used; we make no medical claims for it, and nothing in this guide should be read as medical advice. If you have symptoms that worry you, a clinician is the right first stop, and the articles above say when that is.
The Fourth Trimester makes teas from dried culinary and herbal ingredients, drawn from recipes traditionally prepared in China around the menstrual cycle. That is the tradition behind our Premenstrual Tea.
Explore the Menstrual Cycle rangeReferences
- American College of Obstetricians and Gynecologists. Premenstrual Syndrome (PMS). ACOG
- American College of Obstetricians and Gynecologists. Dysmenorrhea: Painful Periods. ACOG
- Office on Women's Health, U.S. Department of Health and Human Services. Menstrual cycle. womenshealth.gov
- Bull, J.R. et al. (2019). Real-world menstrual cycle characteristics of more than 600,000 menstrual cycles. npj Digital Medicine, 2, 83. npj Digital Medicine
- Direkvand-Moghadam, A. et al. (2014). Epidemiology of premenstrual syndrome: a systematic review and meta-analysis study. Journal of Clinical and Diagnostic Research, 8(2), 106-109. PubMed
- Armour, M. et al. (2019). The prevalence and academic impact of dysmenorrhea in 21,573 young women: a systematic review and meta-analysis. Journal of Women's Health, 28(8), 1161-1171. PubMed
- Marjoribanks, J. et al. (2015). Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database of Systematic Reviews, CD001751. PubMed
- Chen, C.X., Barrett, B. & Kwekkeboom, K.L. (2016). Efficacy of oral ginger (Zingiber officinale) for dysmenorrhea: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2016, 6295737. PMC