Women's Health - Premenstrual Syndrome (PMS)
Premenstrual Syndrome (PMS) and Chinese Medicine
PMS is a cyclic recurrence of physical, emotional, and behavioral symptoms experienced by around 80 percent of women during the last week or two of their menstrual cycle. The symptoms result from imbalanced hormonal fluctuations and typically begin seven to ten days before menstruation, subsiding shortly after the menstrual flow starts. In Western medicine, PMS symptoms are associated with elevated estrogen levels or a relative lack of progesterone compared to estrogen levels. While most women can manage their daily activities with self-medication, coping techniques, and home remedies, about ten to twenty percent may face incapacitating symptoms that greatly distress their personal and professional life.
The symptoms of PMS are diverse and wide-ranging. Digestive symptoms may include indigestion, constipation, increased appetite, or cravings for sweet or salty foods. Emotional and nervous system signs encompass poor concentration, moodiness, weeping, irritability, anxiety, anger, depression, and insomnia. Physical changes and pain may manifest as breast tenderness, bloating, pelvic pain, cramping, headaches, backache, and weight gain. Seemingly random symptoms like a tendency to catch colds easily in the post-ovulation phase, palpitations, clumsiness, or acne contribute to the overall feeling of discomfort and unease. Besides the various symptoms experienced, PMS can impact a woman's fertility due to hormonal imbalances and overall body stress during each menstrual cycle. Elevated stress can hinder conception by blocking blood flow to the reproductive organs and causing imbalances in hormonal production, leading to irregular menstrual cycles, lack of ovulation, high FSH levels, poor ovarian production, and diminished egg quality. For women desiring to conceive, finding relief from PMS symptoms may ultimately improve fertility.
Common symptoms of PMS:
-
Emotional instability with irritability and angry outbursts.
-
Abdominal bloating and occasional weight gain during specific periods.
-
Sensitivity and tenderness in the breasts.
-
Periodic cramps that coincide with the menstrual cycle.
-
Difficulty sleeping and disrupted sleep patterns.
-
Fluctuations in blood sugar levels.
-
Strong desires or cravings for certain foods or substances.
-
Occasional headaches during the menstrual cycle.
-
Decreased sexual desire or libido.
-
Feelings of anxiety and mood swings.
The causes of PMS are:
-
Elevated estrogen-to-progesterone ratio
-
Irregular neurotransmitter response (in the brain)
-
Disturbed sodium metabolism leading to fluid retention and bloating, often triggered by stress
-
Increased cortisol levels due to stress
-
Carbohydrate metabolism issues
-
Nutritional deficiencies
How Chinese Medicine Views PMS
Women seeking Chinese medical treatment for PMS discover that their symptoms are not seen as unrelated or random in Traditional Chinese Medicine. Instead, the symptoms form a coherent grouping, revealing an underlying diagnostic 'pattern' of imbalance triggering the premenstrual symptoms. Acupuncture and Chinese herbal medicine target these imbalances, leading not only to improved premenstrual symptoms but also enhancing overall physical health and emotional balance, thus boosting vitality for life and potentially improving fertility.
Acupuncture and Chinese herbal medicine work based on the concept of life energy or "Qi" flowing through energetic pathways called channels or meridians. When a person faces mental, emotional, or physical stress, the usually free-flowing energy may stagnate. For example, when someone is stressed, neck and back muscles may tense up, demonstrating "Qi Stagnation" that can interfere with nerve stimulation to the arms or legs. Similarly, the monthly buildup of the uterine endometrial lining and hormonal changes during a woman's period are naturally inclined to stagnation, especially during stressful times.
The primary energetic imbalance causing PMS is "Liver Qi Stagnation," indicating stagnation or congestion of energy in the liver organ and meridian system, typically triggered by stress. This can lead to irritability, depression, breast distention, and premenstrual discomfort. Releasing, invigorating, and balancing the flow of Qi in the body is crucial. Other energetic imbalances may involve the quality and flow of blood, a substance highly susceptible to imbalance in women due to its vital role in menses and pregnancy. Weakness of the Spleen Qi with a tendency to a quality known as Dampness may also be present, resulting in poor digestive strength, bloating, and transient weight gain. The heart channel and organ system often contribute to emotional liability accompanying PMS.
How Chinese Medicine and Acupuncture Treat PMS
Chinese medicine has developed treatments for various PMS symptoms over the past two thousand years, and recently, the National Institute of Health endorsed acupuncture for premenstrual pain and discomfort relief. Treatment and prevention involve acupuncture, Chinese herbs, nutritional guidance, and lifestyle counseling. Consistent Chinese medical treatment over three menstrual cycles is traditionally recommended for the highest success rate and long-term relief, with at least weekly sessions.
Acupuncture directly removes energetic blockages, stabilizing hormonal fluctuations and providing deep relaxation, calming the mind and alleviating stress roots. This can result in emotional harmony and mitigate PMS signs like cramps, breast tenderness, backaches, depression, mood swings, constipation, and bloating.
Chinese herbs can improve natural hormonal functioning and alleviate depression due to their phytoestrogenic qualities. Vitex, bupleurum, white peony, and black cohosh are used in Chinese herbal formulas to balance hormones and treat Qi stagnation. Vitex is particularly useful for fibrocystic breasts and menstrual pain due to endometriosis and fibroids.
Nutritional guidance recommends a healthy diet, stress management, and routine exercise to circulate Qi. Thirty to forty-five minutes of cardiovascular exercise, at least three times per week, improve blood circulation and significantly reduce PMS symptoms. Reducing caffeine and alcohol consumption and adopting an organic diet rich in whole grains, vegetables, lean meats, fish, poultry, and fresh fruits helps balance nutritional and mineral deficiencies that can contribute to additional stress on the body.
Negative emotions aggravate PMS, as Chinese medicine views emotional upset and energetic imbalance as interconnected. Strong outbursts or suppressed feelings disrupt Qi flow in channels contributing to PMS, and imbalances like Liver Qi stagnation trigger emotional tension or depression. Stress disturbs hormonal levels and worsens PMS symptoms, so it is essential to find stress-reducing practices like tai chi, yoga, meditation, or quiet time to achieve emotional and physical equilibrium.
PMS Patterns and Treatments in Chinese Medicine
Acupuncture has been widely and successfully used to treat PMS, with three main patterns in traditional Chinese medicine presented below, along with their differentiating symptoms and commonly prescribed herbs and formulas. Angelica (Dang Gui) is a well-known herb for regulating menstrual cycles and relieving premenstrual discomfort and cramps, while more refined combinations of herbs and acupuncture points are tailored to each pattern.
The Liver Qi Stagnation Pattern is linked to emotional stress and includes symptoms like depression, anger outbursts, chest fullness, and wiry pulse. Bupleurum (Chai Hu) and Mood Smooth (Jia Wei Xiao Yao San) are leading herbs and formulas for this pattern.
The Heart Blood Deficiency Pattern is caused by chronic illness or excessive menstrual blood loss, with symptoms of fatigue, heart palpitations, and pale tongue. Biota seed (Bai Zi Ren) and jujubee (Suan Zao Ren) are important Heart tonic herbs, and Heart Yin Tonic (Tian Wan Bu Xin Dan) and Heart Tonic (Yang Xin Tang) are classical formulas for nourishing the Heart and calming the Spirit.
The Phlegm-Heat Harassment Pattern is related to hot, spicy or greasy foods and chronic emotional trauma, leading to anxiety and agitation. Pinellia tuber (Ban Xia) and bamboo shavings (Zhu Ru) are top herbs for resolving phlegm, and Warming Gallbladder Decoction (Wen Dan Tang) is a leading herbal combination for this pattern.
Acupuncture and Chinese herbal formulas have proven effective in treating PMS and other hormone imbalance disorders by analyzing each individual's body qi mechanism imbalance and providing appropriate treatment based on etiology and pathological changes.
Included in the following single herbs and supplements are various naturally herbal treatments for PMS:
Chasteberry (Vitex agnus-castus) has been shown in clinical studies to reduce symptoms such as breast pain, edema, constipation, irritability, depressed mood, anger, and headache.
Dong quai (Angelica sinensis), also known as Chinese Angelica, has been used for thousands of years in traditional Chinese medicine for gynecological disorders, recovery from childbirth, fatigue, and low vitality. It is primarily used in Chinese medicine to nourish and invigorate blood.
Maca (Lepidium meyenii) has been used by native Peruvians to enhance fertility and is beneficial for female hormone imbalance, menstrual problems, and menopause symptoms.
Black cohosh (Cimicifuga racemosa) is known for relieving menopausal symptoms and is effective for treating irritability and sleep disturbances related to PMS.
Lemon balm (Melissa officinalis) has calming effects and helps with PMS-related anxiety and insomnia.
Wild yam (Dioscorea villosa) has been traditionally used for labor pains and menstrual issues and can be helpful for patients with high estrogen levels.
Burdock is anti-inflammatory and can improve the liver's ability to metabolize hormones, making it helpful for PMS.
St. John's wort is successful in treating mild depression and moodiness related to PMS, but caution is advised as it may interfere with birth control pills.
Ginkgo (Ginkgo biloba) is known for its effects on memory and can also be helpful for PMS symptoms, particularly fluid retention and breast tenderness.
Chromium stabilizes insulin and blood sugar, helping with cravings and appetite regulation.
A combination of Calcium, Magnesium, and Vitamin B6 has positive results for pain, mood, and general PMS symptoms, with Magnesium being effective for combating chocolate cravings, indicating a magnesium deficiency.