Is PMS a physical or psychological symptom? Up to 85% of reproductive age experience it and it can severely impact your life as a woman. Here we discuss PMS and Chinese Medicine.
PMS is Before the Period Not During
That’s right, contrary to belief a woman can experience Pre-Menstrual Syndrome (PMS) or Pre-Menstrual Tension (PMT) prior to their period, and is usually relieved within hours of the period starting. This can be as soon as you ovulate or to a few hours or days before your period begins.
What is Pre-Menstrual Syndrome (PMS)?
A series of signs and symptoms unique to each woman occurring 1 to 14 days before the onset of the period and is characterised by;
- nervousness, irritability & emotional instability
- anxiety, nervousness, anger, crying & depression
- lack of control & agitation
- oedema (fluid retention), weight gain & oliguria (reduced urine output)
- mastalgia (breast fullness and pain)
- dysmenorrhoea (period pain)
- lethargy, depression and fatigue
- constipation, nausea, vomiting & diarrhoea
- skin, pimples and acne
Rates of PMS in Reproductive Women
Most women experience one or more physical, psychological or behavioural symptoms before the period. Around 75% of women have mild symptoms and 20-30% have clinically significant PMS symptoms. Some 13-18% of women have Premenstrual Dysphoric Disorder (PMDD) which is a severe form of PMS (Chen et al., 2014).
Causes of PMS
Unfortunately, aren’t really known. However the pathophysiology of PMS originates from fluctuation in the female hormones oestrogen and progesterones levels. Women will find their PMS to worsen when they are more stressed or burnt out. I believe this is due to increasing levels of cortisol consuming progesterone levels.
PMS has also been attributed to fluctuations in levels of neurotransmitters in the central nervous system (CNS). Specific neurotransmitters such as serotonin (5-hydroxytryptamine) and γ-aminobutyric acid (GABA) appear to contribute to the pathogenesis of PMS.
Cyclical hormonal changes are thought to cause PMS. The dynamic fluctuations in oestradiol and progesterone in the late luteal phase may be another possible mechanism underlying PMS symptoms (Rapkin & Winer, 2009). Excessive oestrogens and xenoestrogens can cause imbalances in female hormones. Read this article to learn how to remove and eliminate them from your diet.
PMS is Different for Each Woman
The type and intensity of the symptoms vary from woman to woman and cycle to cycle. Symptoms can last from a few hours to more than 10 days. They usually subside once the period begins. In fact, the best way to diagnose your PMS is to keep a diary and take note of when your symptoms appear in your menstrual cycle.
Chinese Herbs for PMS: Research & Efficacy
A randomised-controlled trial (RCT) found that Chinese Herbs were effective in the treatment of PMS in women (Chou, Morse & Xu, 2008). Results were statistically significant. The Royal Women’s Hospital (RWH) in Melbourne also endorses that Acupuncture is helpful at reducing menstrual pain and cramps. The RWH also mentions that Chinese Herbal Medicine may help with PMS and hormonal disturbances provided it is prescribed by a qualified Chinese Herbalist.
A recent Systemic Review and Meta-Analysis of Acupuncture for PMS revealed interesting conclusions. Acupuncture treatment was found to have a higher effective rate for PMS. There was no significant difference in efficacy for the intervention time of acupuncture being successful in treating PMS. Some studies were found to have methodological limitations (Zhang et al., 2019).
Systematic Review of PMS
The BMC conducted a Systematic Review on Natural therapies and PMS. The review aimed to review the acupuncture and herbal medical treatments for PMS & PMDD. The study found a favourable effect of Acupuncture, Moxibustion, Herbal medicine over various controls. One study on acupuncture and moxibustion, proved to have far better results than the other studies. Furthermore, there were case studies that showed improvements on PMS/PMDD, however, they were excluded. On all acupuncture interventions, the outcome showed improvements better than the control groups. So their findings were consistent with case studies examining herbal interventions and acupuncture (Jung, Kim & Choi, 2014).
On a review of remedies used for PMS, based on a national probability sample, those who have used Acupuncture to relieve PMS pain, found it effective. Also, in the review on the efficacy and safety of specific herbal medications, Chinese Herbs such as Man Jing Zi, Dang Gui and Xiao Yao San have been proven of some efficacy for PMS when used in multiple-herb formulas (Chou, Morse & Xu, 2008). In herbal treatment, there has been no serious adverse events reported which in turn proves its safety with the recommended dosage. The majority of studies lasted 2 to 3 menstrual cycles and resulted in the relief of PMS/PMDD symptoms (Jung, Kim & Choi, 2014).
Ilana discusses Chinese Herbs & PMS with Heiko Lade
Chinese Medicine & PMS
Much research has been conducted with Chinese herbs and acupuncture for PMS. Famous TCM Physician Giovanni Maciocia called it Rebellious Qi of the Chong Man (Vessel of Crossings). In the clinic I see two common cases of PMS;
PMS due to Deficiency: these women tend to have deficient Liver and Spleen energy, are of a weaker constitution and tend to cry and feel weak and exhausted with their PMS. They tend to have dull pain, such as dull ache on the lower back or abdomen.
PMS due to Excess: this pattern is seen in more robust patients and will get more extreme symptoms such as rib and breast pain, very short and angry with their temper, sharper and stronger pain prior to menses, and don’t get down or depressed, they become angry and vexed. For example, the tale of a lady who would break up with her boyfriend every month just before her period!
PMS due to Combined Excess & Deficiency: this is more rare and seen in women who display a combination of signs and symptoms of the patterns above. This is a more serious case of PMS and requires longer treatment of Chinese herbs and acupuncture, along with delving into the deeper emotional aspects.
PMS & Emotions
A woman is a deeply emotional and sensitive being and the better she can deal and express her emotions the less PMS she will experience. When a woman is pent up emotionally, sexually or physically this provides great stagnation of her energy with in and is released when the period comes. The period and PMS is a reflection of her month prior to. When women have issues with anything related to the menstrual cycle and attaining to being a woman (i.e. reproductive or feminine) it can be due to not loving or accepting herself as a woman, not being authentic or present in her feminine energy and any relative problems to this. A woman has both a masculine and feminine energy and can express either as she pleases providing it is authentic to her nature.
What about PMDD?
As mentioned earlier, Pre-Menstrual Dyphoric Disorder (PMDD) is where a woman experiences many PMS signs and symptoms to such an intensity that it severely impacts her daily life ranging form school to daily life, work, social relationships and self-esteem. In extreme cases it has driven a woman mad and even to commit murder.
Chinese Herbs for PMS
In Asia, women have taken Chinese herbs for centuries for PMS, health and beauty. Chinese herbs can be very helpful for PMS providing you are taking the right formula specific to your pattern.
Xiao Yao San is a common formula often modified to suit the patients signs and symptoms. It translates as the Free and Happy Wanderer, suggesting that taking the medicine will relax the body and calm their stress and tension, all very relevant to PMS.
Here are some classical herbs used in the formula Xiao Yao San, the first word e.g. Chai Hu pertains to the Chinese Pinyin name of the herb and the herb in brackets e.g. (Radix Bupleurum) relates to the Latin Pharmaceutical Name.
Individual Chinese Herbs
Chai Hu (Radix Bupleurum) – Moves stagnant liver qi, pacifies the liver energy, affects the Shao Yang and can cool fever. Combine with Bo He (mint) to help depression, a stifling sensation in the chest and irregular menstruation (due to liver blood deficiency with stagnation).
Dang Gui (Radix Angelicae Sinensis) – Tonifies the blood, regulates menstruation and moves stagnant blood (i.e. blood stagnation that causes pain). Commonly used with Bai Shao (white peony root) to strengthen the blood and calm the mind (anxiety) due to liver qi stagnation.
Bai Shao (Radix Paeoiae Albae) – Anchors the liver yang, reduces pain, tonifies the blood and regulates menstruation. When used with Chai Hu (bupleurum) it can treat flank pain due to liver qi stagnation.
Bai Zhu (Radix Atractylodis Macrocephalae) – Is a qi tonic and strengthens the spleen to tonify qi. When combined with Fu Ling (Poria Fungus), strengthens the spleen and resolves dampness.
Fu Ling (Poria) – Strengthens the spleen function to harmonise the middle jiao, drains dampness, reduces swelling, promotes urination and transforms phlegm.
Zhi Gan Cao (Radix Glyrrhizae Preparata) – is honey-fried liquorice root which gives it a more townifying and warming property. It is a qi tonic, tonifies the spleen qi, stops pain and harmonises other herbs. When combined with Bai Shao (white peony root) it can ease spasmodic abdominal pain.
Sheng Jiang (Zingiberis Recens) – Is often added to detoxify the formula from any strong or harmful effects of the herbs, we call this harmonising. It prevents rebellious qi from uprising and normalises the flow of qi at the centre.
Bo He (Herba Menta Halocalycis) – Used here because it benefits the liver qi and has a cooling effect given when the liver qi stagnates it creates heat. It has been added here to enhance the Chai Hu (bupleurum) function of dispersing the liver qi.
Your Personalised Chinese Herbal Prescription
You can buy these herbs individually or patented however the best result is always obtained from an experienced practitioner. Why? Because if you take the wrong formula it could do you harm.
This is because herbs can be omitted, replaced or added to create a specific formula for your needs. For example for someone who had cold in the stomach and a lot of diarrhoea I would personally replace Sheng Jiang (fresh ginger) with Gan Jiang (dried ginger). For someone who got very angry, hot and irritable I would also add Zhi Zi (gardenia) which clears heat and calms the Shen (mind) along with Mu Dan Pi (peony tree twig) which clears liver fire and moves stagnation. I learnt this from renowned Chinese Herbalist Ngaio Richards.
Chinese Herbs and Acupuncture for PMS Melbourne
Ilana Sowter is a renowned practitioner both having treated PMS for over 12 years experience with Acupuncture and Chinese Herbs in Melbourne. Acupuncture is very effective at moving the stuck energy and ease you into feeling good again before your period.
At Femme Vital, expect the best holistic health consultation, coaching, tailored treatment and advice with 12 years experience supporting wellbeing with acupuncture and Chinese herbs.
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