Are you feeling dread around “that time of the month”? Is your period a gate-crasher that makes it difficult to embrace your body? You’re not alone. Many women experience uncomfortable symptoms related to their periods, such as abdominal and back pain, breast tenderness, irritability, migraines or headaches, restless sleep, changes in appetite, bloating, and skin issues.
These symptoms can be so common that many women may not even mention them as a problem. However, PMS and dysmenorrhea (painful periods) are two of the most common complaints among female patients, even if they were not the primary reason for their visit to the doctor.
TCM practitioner Su Hyun Park, RTCMP, RAc, has experience in helping women return their periods to a healthy state. There are many forms of PMS, and the symptoms can vary in intensity and duration from one person to another, ranging from one day to two weeks before a period. While there are various theories trying to explain the cause of PMS, none of them have conclusive clinical evidence.
If you have this menstrual-related symptoms, you may have experienced following symptoms:
- Lower abdominal pain or lower back pain couple days before or during the period
- Breast tenderness or distension
- Feeling irritated and short on fuse
- Migraine or headache prior to or during the period
- Restless sleep prior to/during/after the period
- Dampened or voracious appetite and inability to control snacking
- Feeling bloated and swollen overall
- Skin trouble before period, such as acne breakouts
“First, my body starts to feel tired, and I hate myself and others as I approach my period. Then, I need to take at least 2 painkillers on my first day due to cramps.”
Traditional Chinese medicine (TCM) is one approach that has been shown to be effective in improving menstrual health.
WHAT IS THE CAUSE OF THE PMS or PAIN?
There are many forms of PMS with varying symptoms from one person to another. These symptoms vary in intensity as well as duration, ranging from 1 day to 2 weeks before period.
PMS may be related to various endocrine factors. There are many theories trying to explain the cause of PMS but none of them have conclusive clinical evidence.
One theory suggests that progesterone deficiency can cause PMS. As progesterone levels drop in the late luteal phase, there is an unbalanced and relatively excess estrogen level that could cause water retention, breast enlargement, and distension. Vitamin B6 deficiency could also be related to premenstrual symptoms, and magnesium deficiency may be associated with menstrual cramps.
Vitamin B6 deficiency could be related to pre-menstrual emotional symptoms. This deficiency may be caused by estrogen excess. Vitamin B6 is involved in synthesis of neurotransmitters dopamine and serotonin which are important in regulating mood.
Elevated prolactin and/or aldosterone levels may have significance in pre-menstrual fluid retention due to their activity on fluid balance.
Prostaglandins that acts on the uterus during the period have been suggested to cause some symptoms of PMS such as diarrhea, which results from them acting on the bowels.
What is the Traditional Chinese Medicine approach?
TCM views the menstrual cycle as a reflection of the body’s overall health. It is believed that the balance of yin and yang energies can affect the flow of qi (energy) and blood, which can impact the menstrual cycle. Here are some TCM treatments for menstrual issues:
- Acupuncture: Involves the insertion of thin needles into specific points on the body to stimulate the flow of qi and blood.
- Herbal medicine: Includes a variety of natural remedies, such as teas, decoctions, powders, or capsules, that can help balance hormones, improve circulation, reduce inflammation, and alleviate pain.
- Dietary therapy: Involves the inclusion of certain foods and the avoidance of others that may aggravate symptoms.
- Lifestyle modifications: Can include exercise, stress reduction, and self-care practices such as meditation, yoga, or massage.
In Chinese Medicine, most PMS symptoms may be related to the ‘unsmooth’ flow of Liver Qi. Qi is the vital energy within the body that is responsible for serving physiological functions. Liver in Chinese Medicine regulates the smooth flow of Qi within our body. Our body goes through various qualitative and quantitative changes throughout the menstrual cycle which can be divided into menstrual phase (day 1-4 for a 28 day cycle), follicular phase (day 4-12), ovulatory phase (day 12-16), luteal phase (day 16-28).
What is notable is that at points of major transition during the cycle such as ovulation and menstruation, our Qi needs to flow smoothly within the body in order for these processes to occur on time and without pain or discomfort. As a result, Liver Qi Stagnation can also cause irregular menstrual cycle.
But what causes this “Liver Qi Stagnation”?
The most common cause of it is stress or negative emotions such as anger, frustration, resentment, and hatred. This is the reason why you may notice more pain or discomfort before or during your period on months with more stress (e.g. month with exams). However, in many cases Liver Qi Stagnation in females are related to Liver Blood or Yin Deficiency. Blood and Yin are responsible for lubricating and softening the Liver so that its Qi can course smoothly. Therefore, when Liver Blood Deficiency persists for a while, Liver Qi Stagnation will ensue.
However, Liver Qi Stagnation is not the only pattern responsible for PMS and there could be other Chinese Medicine patterns behind PMS, including Blood Deficiency, Spleen & Kidney Yang Deficiency, Phlegm, Heart Heat, or combination of any of the patterns that have been mentioned thus far. These other patterns may be caused by irregular diet, overwork, or constitution.
Painful menses (dysmenorrhea) also shares similar causes as PMS. Excessive release of prostaglandin during the period can cause cramping pain as it induces strong uterine muscle contractions as well as ischemia due to circulation cutoff.
Dysmenorrhea can be divided into primary and secondary type. Primary dysmenorrhea starts in adolescence without an explainable structural abnormality. Secondary dysmenorrhea usually occurs in adulthood and there are underlying pelvic abnormalities. These structural disorders include endometriosis, uterine polyps, uterine fibroids, uterine tumours, and pelvic inflammatory disease.
Pain is caused any time there is an obstruction to Qi and Blood flow. Liver Qi Stagnation can lead to unsmooth flow of blood, leading to pain and blood clots. Cold in the uterus is another cause of painful menses. Cold can either come from internal Kidney Yang Deficiency or invade our body from the exterior. Cold congeals and stagnates the Blood causing symptoms such as painful period and delayed cycle. As with PMS, these are not the only patterns that can cause painful menstruation, and there are other patterns such as Qi and Blood Deficiency, Liver and Kidney Yin Deficiency which may originate from overwork, chronic illness, or multiple childbirths.
What can I do about Liver Qi Stagnation and Pain?
Below are some general suggestions for alleviating PMS or painful menstruation:
- Exercise: Movement of the body promotes the flow of Qi, therefore allowing smooth transition to menstrual phase as well as smooth flow of menstrual blood. Excessive exercise should be avoided during the period as body is weaker and more vulnerable at that time. Light movements and stretching involving the pelvic region is recommended.
- Diet changes: Diet changes to less junk food such as sugary and greasy food, as well as less dairy products can help the Spleen which tends to be overwhelmed by the stagnant Liver. Spleen is an important organ in Chinese Medicine for digestion and transformation of food and drinks into energy/Qi. Above kinds of food are difficult to digest and overworks the Spleen, which can then result in PMS symptoms such as fatigue, bloating, abdominal distension, diarrhea, water retention, and dampened appetite.
- Vitamin B6 supplementation: Vitamin B6 can be recommended if you are experiencing mood changes for PMS. Vitamin B6 is involved in synthesis of neurotransmitters like dopamine and serotonin. People who experience PMS tend to have low serotonin levels and this is associated with symptoms of irritability, forgetfulness, insomnia, anxiety, and moodiness. Foods that are rich in Vitamin B6, such as leafy greens are also recommended from a Chinese Medicine perspective, because they help to regulate Liver Qi.
- Heat pad: Use of heat pad on lower abdomen can promote circulation of Qi and Blood which means that it can alleviate pain from stagnation. It is especially effective when Cold stagnation is the cause of painful menstruation.
- Sufficient sleep: Sleeping sufficiently and soundly may be difficult for some whose PMS symptom is insomnia, but practicing it at other times of the month can help regulate hormone production and alleviate stress.
- Get Acupuncture and Herbal Treatment: One study published in the Journal of Acupuncture and Meridian Studies found that acupuncture can be effective in reducing menstrual pain and cramps. Another study published in the journal Obstetrics & Gynecology found that a combination of acupuncture and Chinese herbal medicine was effective in improving menstrual pain and quality of life in women with primary dysmenorrhea.
If you’re experiencing menstrual issues, consider consulting with a TCM practitioner or other healthcare professional to explore treatment options that can help bring balance to your body and alleviate your symptoms.
Ask personal questions in your free 15 minute consult session with a TCM practitioner or an Acupuncturist at this link here.
Your period is a result of natural function of your body, just like going to the bathroom after you process your food and drinks. However, this process may be disturbed by various factors, causing PMS and pain. We believe that they are important symptoms to consider and by offering patients acupuncture and/or Chinese herbal medicine treatments, we can help to return the period and menstrual cycle to its functional state.
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