Pre- menstrual syndrome or commonly shorted to (PMS) is a common gynaecological disorder, which seems to affect most women at some point in their lives. The premenstrual phase occurs one to two weeks prior to bleeding with some women experiencing range of physical and emotional symptoms that can impact on quality of life (1).
Common physical and emotional symptoms that you can experience are;
- abdominal bloating
- depression and lowered mood, which may include suicidal thoughts
- difficulties in concentration, memory lapses
- digestive upsets, including constipation and diarrhoea
- drop in self-esteem and confidence leading to social isolation
- drop in sexual desire, or (occasionally) an increase
- feelings of loneliness and paranoia
- fluid retention
- food cravings
- headache and migraine
- hot flushes or sweats
- increased appetite
- increased sensitivity to sounds, light and touch
- irritability, including angry outbursts
- mood swings, weepiness
- sleep changes, including insomnia or excessive sleepiness
- swollen and tender breasts (1).
For some women these symptoms are mild and go quickly once the period has arrived. However in cases of Premenstrual dysphoric disorder (PMDD) which occurs in between an estemated 3-8% per cent of menstruating women suffer from seriously debilitating PMS. The symptoms of PMDD have a serious impact on a woman’s mental health state and can be so severe that an affected woman is unable to carry out her normal activities (1).
Diagnosis & Treatment of PMS
Unfortunately there are no diagnostic tests for PMS or PMDD as often hormone levels are still within the normal ranges on blood tests. Diagnosis in both western medicine and Traditional Chinese Medicine relies on a diary of symptoms. Current medical interventions include;
- SSRIs (selective serotonin reuptake inhibitors) fluoxetine, sertraline, paroxetine and escitalopram – these medications are mood stabilisers and antidepressants, which can improve PMS symptoms significantly by boosting brain chemicals (neurotransmitters). They may be prescribed just in the premenstrual phase or taken continuously
- agents that suppress ovulation – including GnRH analogues and danazol
- oral contraceptive pill containing drospirenone and ethinyloestradiol – sold in Australia as Yaz
- alprazolam – considered a second-line treatment for PMS. Due to its addictive potential, it is used only in the last two weeks of the menstrual cycle.
Treatments that might improve symptoms include:
- other oral contraceptive pills
- spironolactone, which has not been shown to be consistently of any advantage, but may help if there is fluid retention
- oestradiol patches or implants.
Treatments that have not been proven to relieve symptoms include progesterone and progestogens (such as intrauterine devices (IUD), intrauterine devices (Implanon) and Depo-Provera (injection) (1).
Chinese Medicine & PMS
Due to the lack of non-hormonal or medication treatments many women seek alternative treatments such as Chinese Medicine including Acupuncture and herbal medicine. From a traditional Chinese medial view PMS occurs due to various imbalances within the body, these imbalances are too mild to show up in blood tests but still cause real physical symptoms for the women suffering them.
In Chinese medicine terms PMS can be broken up into a range of different pathologies depending on the symptoms. The important thing to note is that these pathologies were identified and named several thousand years ago. In our western society they may seem strange. Just think of them as a way of explaining what is going on. In general premenstrual syndrome is seen as the function of the hormones, and ovaries are not quite operating as they should.
Different Chinese Medicine pathologies may include:
- Qi and Blood Stagnation – Common symptom; pain
- Dampness – Common symptom; Fluid retention
- Deficiency of Blood – Common symptom; Fatigue
- Liver Qi stagnation – Common symptom; Mood swings
What can you do to help with your PMS?
- Acupuncture – The most recent systematic review in 2016 (3, 4) suggests the research to date while showing promise is unclear as to the effectiveness of acupuncture in the treatment of PMS.
- Chinese herbal medicine – A meta-analysis 8 acupuncture and 11 herbal medicine studies (5) revealed a success rate of 50% or greater for the reduction of PMS and premenstrual dysphoric disorder (PMDD). A more recent study suggested herbal medicine had a positive effect on PMS symptoms of fatigue, insomnia, back pain, anxiety, mood swings, irritability and depression (6).
- Diet – Diets high in sugar and processed foods put far more load on our bodies . A diet high in fresh vegetables, animal protein and low carbohydrates keeps inflammation to a minimum can aid in reducing premenstrual and menstrual symptoms (1).
- Exercise – While it may seem like the last thing you want to be doing exercise can help in improve symptoms of PMS in many ways. By keeping our cardiovascular system in good health a positive blood supply to the uterus is more likely reducing the likelihood of clots and stagnation. Exercise also helps to reduce nervous system excitability helping to relieve emotional symptoms. Endorphins are released during exercise and help to reduce pain while also creating a more positive mindset (1). However balance is the key, use high intensity training only several times per week and focus the rest on relaxing gentle exercise such as walking, yoga, pilates, and TaiChi.