Stress & Anxiety

By Xiaomei Cai, L.Ac., Ph.D. & Qineng Tan, L.Ac., Ph.D.

Monthly mood swings, bloated stomach, headaches, and weight gain. Why is PMS so bad? Premenstrual syndrome (PMS) is a set of symptoms that occur in the days before a woman gets her period. PMS symptoms affect every woman differently, and can be serious enough to disrupt your life every month. TCM is an effective way to deal with PMS, because acupuncture treatment can help relieve both physical and emotional symptoms of PMS and severe PMS, also known as PMDD (premenstrual dysphoric disorder).

To say that PMS is common among women is an understatement. The vast majority of women experience some changes in both their mental health and their bodies the week before their period starts. Whether or not a woman feels that it has a negative impact on her daily life may change over time. For some women, PMS isn’t a big deal; for others, it’s a major problem that can affect their relationships, impact their work, and make life hell every month.

Most women find their own particular pattern of PMS is somewhat predictable–until it isn’t. One of the most frustrating aspects of menstrual problems is the sense that things change without warning, and symptoms can come on suddenly with ferocious intensity. It can be difficult to describe how you feel before your period, because the symptoms seem to come and go. Some women find that their PMS symptoms are different from month to month. In some cases, they might find that every other month is bad, while the alternating months aren’t so bad. Why is PMS worse some months?

Other than the basic understanding that PMS is caused by fluctuations in hormones and brain chemistry, conventional medical science does not offer much in the way of clear answers about what causes PMS.

TCM provides a different framework for looking at menstrual problems and has been used to treat women’s health issues of all kinds for many centuries. TCM treatments including acupuncture, acupressure, moxibustion, and Chinese herbs can not only help relieve PMS symptoms, they can also be beneficial for other menstrual problems like irregular periods, PCOS, painful periods, endometriosis, heavy periods, fibroids, and symptoms of perimenopause.

Top 10 Symptoms of PMS

As a syndrome, PMS is considered a collection of symptoms that often appear together, in various combinations in different individuals. In the case of PMS, a woman may feel that her own symptoms change as often as every month, or gradually over the course of years. Girls in their teenage years may experience PMS in one way. Then, a woman in her early adult years may develop a different set of symptoms. After having a baby, a woman may find that her PMS symptoms have changed again. Then, many women in middle age experience changes in PMS symptoms as they go through perimenopause, approaching menopause. The most common signs of premenstrual syndrome include:

1. Mood swings, low mood, feelings of sadness or anger
2. Anxiety, feeling tense and irritable, cry easily or lose temper, want to be left alone
3. Trouble sleeping, insomnia, disturbed sleep
4. Breast tenderness, sore breasts, swollen breasts
5. Food cravings, changes in appetite
6. Weight gain, stomach bloating, water retention, pelvic pressure
7. Gassiness, changes in digestion and elimination
8. Acne, skin problems
9. Changes in libido
10. Headaches, migraines, difficulty concentrating, foggy head

Less obvious or well-known symptoms of PMS include: vision problems, tingling in the arms or legs, lack of coordination (clumsiness, dropping things), bruising easily, heart palpitations, dizziness, itchy skin, cold sores, toothaches, back pain, joint pain, and increased TMJ jaw pain.

Other health problems can be amplified during the premenstrual period, such as: chronic fatigue syndrome, fibromyalgia, interstitial cystitis, migraines, IBS, Meniere’s disease (dizziness, vertigo), clinical depression and anxiety disorders.

The physical and emotional aspects of PMS can affect each other, causing the typical mood swings. Feelings of sadness and frustration, or lack of sleep, may lead to comfort eating, but then the sight and sensation of your bloated stomach can cause you to feel depressed about your body. Minor problems with your spouse or co-workers can suddenly seem overwhelming and make you feel angry or helpless. 

For some women, PMS symptoms are so bad that they feel unable to function the week before their period. Severe PMS is now diagnosed as PMDD.

What Is PMDD?

PMDD (premenstrual dysphoric disorder) is a severe form of PMS marked by intense emotional symptoms that dramatically impact a woman’s life, in addition to physical symptoms. “Dysphoria” is the opposite of “euphoria;” in other words, it is a mental state characterized by profound unhappiness and negative feelings. It is estimated that about 5% of all women experience this extreme type of PMS. Signs of PMDD include:

1. Severe anxiety, panic attacks, paranoia
2. Severe depression, in some cases even suicidal thoughts, lack of self-worth
3. Anger and irritability that provokes rage and causes conflicts with other people
4. Fatigue, low energy, inability to concentrate, feelings of confusion
5. Intense food cravings, possibly leading to binge eating

Again, there is currently no scientific answer for what causes PMDD, although it is generally believed to be related to the way estrogen levels and progesterone levels change between ovulation and the onset of the menstrual period. Mood is considered to be related to serotonin levels in the brain, and this is why PMDD is usually treated with birth control pills, which suppress ovulation, and/or antidepressants (SSRIs), which affect serotonin uptake.

Medical Treatment for PMS

Naturally, when a woman asks for advice about PMS or PMDD, she is going to hear suggestions like: “try meditating, exercise more, eat a healthy diet, and get more sleep.” And it is true that making good lifestyle choices is an important part of helping to reduce PMS symptoms. But women who are suffering with serious PMS need solutions beyond these kinds of lifestyle guidelines. 

When women complain of PMS symptoms, doctors will most often recommend OTC pain medications like ibuprofen or acetaminophen (NSAIDs) to relieve pain. Diuretics may be used to relieve bloating or premenstrual weight gain. Of course, most commonly, women are prescribed oral birth control pills, which suppress ovulation, and therefore may reduce the severity of PMS symptoms. More and more frequently, women may be prescribed antidepressants to try to deal with emotional symptoms and mood swings, or anxiety medications to take as needed during PMS. In effect, doctors often treat PMS the same way they would depression or anxiety. 

Clearly, birth control pills are not helpful for women who may want to get pregnant, and some women may be concerned about how taking the pill or antidepressants may affect their fertility in the future. None of these pharmacological solutions for PMS address the root cause of the symptoms, and all of these medications carry side effects that may impact a woman’s overall health. Health care for women with TCM seeks to address the deeper internal causes of hormonal imbalances and other problems with the organ systems that are impacting the health of the ovaries and the regularity of the menstrual cycle.

Can Acupuncture Help PMS?

While it is only in recent years that conventional medicine has begun to acknowledge connections between physical health and emotional health, TCM has understood for many hundreds of years that health conditions of all kinds, especially those related to the menstrual cycle, are rooted in the balance of energies. Menstruation represents an ongoing process of transformation that occurs not only within the reproductive organs, but which affects every part of a woman, and even the people around her.

The concept of Yin and Yang in Chinese philosophy describes two opposing yet complementary forces that are constantly acting upon each other in order to achieve balance. The menstrual cycle is very much based on Yin and Yang energies; during the follicular phase of the cycle (before ovulation), Yin is increasing while Yang is decreasing, and in the luteal phase (after ovulation, before the period), Yang is increasing while Yin is decreasing. The system is designed, naturally, to create the right conditions for conception; this process of Yin and Yang exchange is what determines a woman’s fertility.

While the health of the uterus and ovaries is definitely central to the process, within the TCM philosophy, they are not the only organs involved with menstruation. The Kidneys, Liver, and Heart all have important roles to play, as well. In TCM, we also view the elements of Fire–to provide warmth, controlled by the Heart–and Water, controlled by the Kidneys–to provide moisture, as being vital to all processes within the body, especially to menstruation. Blood is cleansed, stored, and then distributed to the other organs by the Liver. Blood being central to the process of menstruation, the Liver’s role is really key in how the whole thing plays out. 

According to TCM theory, most PMS and PMDD symptoms are caused by problems with Liver Qi. When the Liver Qi is out of balance, it can lead to feelings of anger, frustration, depression, and irritability. The Liver system is particularly susceptible to negative effects of stress.

There are a few different variations of Liver Qi imbalance and other patterns that can contribute to PMS symptoms:

• Liver Qi invasion – This is a condition of excess, in which there is too much rising Liver Qi, characterized by overall negative emotions that are disruptive, including anger and anxiety, breast tenderness, headaches, dizziness, and constipation.
• Liver Qi depression – In this case, there is not enough Liver Qi, causing feelings of sadness, heaviness in chest, painful swelling of breasts, sighing, bloated stomach, lack of appetite, cramping during period, scanty blood during period.
• Spleen Kidney deficiency – In this case, stagnant energy in the Kidney system is preventing water from moving appropriately, causing water retention or edema.

From the scientific medical standpoint, acupuncture treatment has been shown to have a positive effect on neurotransmitters like serotonin, and to impact levels of estrogen and progesterone. This happens naturally because we are using TCM methods to restore optimal function of all the organs. With Chinese herbs we are able to get specific nutrients into the body that we cannot get from the foods we normally eat.

Acupuncture treatment accompanied with specific herbs for PMS patterns can help balance the liver Qi, and bring all of the organs into synergistic harmony.

In order to make lasting change, it is best to have acupuncture treatment at least once or twice a week. We need to deal with each phase of the menstrual cycle as it occurs by tailoring the acupuncture treatment and herbs to your PMS and period symptoms. 

A systematic review of ten controlled trials using acupuncture to treat PMS concluded that TCM treatment of PMS significantly improved symptoms.

Top 3 Tips for PMS Relief From TCM Perspective

There are still a lot of taboos surrounding women’s health, and many girls and women have never learned how to take care of their reproductive health. Working with an experienced TCM doctor will enable you to get personalized care and advice about how to eat the best diet for PMS symptoms, what activities to avoid before your period, and other female hygiene tips that you may not have heard before. 

1. Nutrition – conventional Western thinking about healthy eating currently focuses on eating fresh, whole foods, which is good, except that people tend to think this means eating a lot of foods raw or cold, as in salads and smoothies. According to the TCM philosophy of nutrition, though, eating cold foods is actually one of the worst things you can do when it comes to relieving PMS and painful periods. Putting a lot of cold food into the stomach cools down the temperature of the other internal organs, which can contribute to more cramping and worse cramps. During the week before your period, concentrate on eating plenty of nourishing, cooked foods like soups and stews, proteins and vegetables, and whole grains like brown rice and quinoa. Avoid too much dairy, sugar, caffeine, hot, spicy or fried foods (that includes chips and crackers), and definitely avoid icy cold beverages and frozen treats.
2. Keep track of your period – there are many apps available now to help with this, but it can also be a simple chart with room for notes about your symptoms. Keeping track of your PMS symptoms every month can help you recognize patterns in your own behaviors and experiences. A record of PMS symptoms will also help you communicate what you’re feeling to your health care providers when you are seeking treatment for PMS or PMDD.
3. Exercise – gentle movement modalities that move Qi through the body are great to help PMS: Tai Qi, yoga, or dancing are all good. Avoid deep twists that could squeeze or put pressure on the ovaries and other organs. Again, keep track of your exercise routines and how they affect your physical and emotional wellbeing from month to month so that you can see which type of workout is best for you, or if some types of exercise make PMS worse.

Acupuncture Near Me for PMS in Los Angeles, CA

Many women come to us at Art of Wellness seeking help with menstrual problems or fertility issues. We have over 30 years of experience in helping to relieve symptoms of PMS and all types of period pain and dysfunction. It is possible for the menstrual cycle to flow without extreme feelings or strong physical discomfort. If you feel like PMS or PMDD is negatively impacting your life every month, please do not hesitate to give us a call. 

*This article is for education from the perspective of Traditional Chinese Medicine only. The education provided by this article is not approved by FDA to diagnose, prevent, treat and cure human diseases. It should not stop you from consulting with your physician for your medical conditions. Traditional Chinese Medicine is based on Qi, which is an invisible force that usually cannot be observed by modern science. Because science focuses on testing ideas about the natural world with evidence obtained through observation, these aspects of acupuncture can’t be studied by science. Therefore acupuncture and Chinese herbs are often not supported by double-blind, randomized trials, and they are considered alternative medicine therapies in the United States.