Premenstrual Syndrome - It Is Not Necessary

Overview

• Premenstrual Syndrome (PMS) is common but not a necessary part of having a period.
• PMS in Western terms is due primarily to a hormone imbalance between estrogen and progesterone.
• In Chinese Medicine, the Liver plays a significant role, though the other organ systems are part of the picture too.
• PMS can be treated with diet, herbal formulas, acupuncture, homeopathy, stress reduction, and exercise.

Premenstrual syndrome (PMS) is so ubiquitous that many of us consider it to be normal. Symptoms are wide-ranging and can be both physical and mental-emotional. According to medscape.com, symptoms are divided into five categories:

It may be common to experience PMS, but that doesn’t mean it’s a necessary part of having a period. These symptoms are messages to the body that something is out of balance. You are not required to have PMS as part of having a menstrual cycle. It is a testament to our stressful lives that so many people experience PMS. I would like to provide some context from a Chinese Medicine perspective to this very common problem. But first, what does Western medicine say about PMS?

The Western Perspective

Conventional Medicine

According to the Medscape monograph on PMS the true cause of PMS is unknown, though the article postulates several possible causes, including decreased serotonin, magnesium and calcium deficiencies, sensitivity to fluctuations in hormone levels, and history of abuse. They specifically state that estrogen excess, estrogen withdrawal, progesterone deficiency, pyridoxine (vitamin B6) deficiency, alteration of glucose metabolism, and fluid-electrolyte imbalances are all older and incorrect theories. You will see below that I don’t agree with several of these conclusions.

Functional Medicine

Functional Medicine, though coming from a Western perspective, goes beyond the limitations of the conventional approach. According to Dr. Hyman, a prominent Functional Medicine doctor, PMS is due to elevated estrogen and decreased progesterone, either in their overall amounts, or their levels relative to each other. A number of different issues can lead to this kind of hormonal imbalance.

The liver is responsible for taking extra hormones out of the blood and changing them chemically so they can be eliminated in the bile. Things that interfere with liver metabolism or bile production can cause problems. A poor diet, exposure to toxic chemicals, stress, or alcohol can impact the liver and cause estrogen to build up in the system. The gallbladder takes the bile produced in the liver and secretes into the intestines. If the bile isn’t flowing well due to gallbladder problems it’s the same situation as with poor liver metabolism. If there is constipation, the bile isn’t eliminated and the estrogen the body is trying to eliminate gets reabsorbed by the intestines.

There’s also a stress and adrenals connection. When we are under stress the adrenals make cortisol, our major stress hormone. If the stress is ongoing and doesn’t go away all the cortisol can interfere with the hypothalamus and the pituitary. These two endocrine glands in the head control a lot of hormone production, including estrogen and progesterone. Since all these hormones are made from cholesterol, making a lot of cortisol can decrease the amount of estrogen or progesterone that is made. This is one of the effects of adrenal fatigue.

Chinese Medicine Perspective

Liver Qi and Blood

The Liver (referring to the complete organ system and not just the physical organ) in Chinese Medicine is an incredibly important organ system. It has several roles relating to Qi and Blood in the body. It is responsible for the smooth movement of Qi, and it contains and stores the Blood. Qi is required to move the Blood, and so the Liver is also partly in charge of moving the Blood. Even though the circulation is ruled by the Heart, it is assisted by the Qi of the Liver in delivering Blood to all the various parts of the body.

The Liver is responsible for containing everyday stress and emotion so that frustrations do not continually erupt and disturb the ability of a person to live in society. When the Liver is healthy we are able to hold emotional outbursts in check until a time when letting them out is appropriate. In terms of female menstruation, the Liver is in charge of moving Blood to the uterus during the second half of the cycle, in preparation for a possible pregnancy. If Blood is sufficient, the Liver’s capacity to store Blood is healthy, and the Liver Qi is strong, there will be no symptoms of PMS.

Qi Stagnation and Deficiency

If there is pain then there is no free flow, if there is free flow then there is no pain. Since the Liver is in charge of the smooth flow of Qi if there is stagnation or deficiency (often both) it will lead to pain, depending on where the Qi gets stuck. This can account for a lot of the pain that may occur, like muscle pain, joint pain, back pain, breast tenderness, headache, as well as feeling tight or stiff in any of these areas. A good sign of pain is caused by Liver Qi issues is that stretching and exercise feel good and reduce discomfort.

The stagnation of Qi in the digestive organs can create a host of problems. Because the Liver Qi helps the smooth movement of food if there is a deficiency food can get ‘stuck’, slowing down the digestion and leading to bloating, nausea, and a feeling of food sitting in the stomach. There can be constipation, interspersed with bouts of diarrhea as the Qi builds up and tries to move the stagnation.

If the Liver is deficient it won’t be able to contain the emotions as well. Since the Liver Qi is involved in moving Blood to the uterus it has less Qi available for containment. This can lead to moodiness and fluctuating emotions, such as anxiety or depression.

Blood Deficiency

If there isn’t enough Blood when the second half of the menstrual cycle arrives, other areas of the body will suffer a lack of this vital substance as Blood is moved to the uterus. Pain can also be caused by a lack of Blood and tends to be dull and achy. This describes a common type of headache in PMS. Issues with eyesight can occur as the eyes get less Blood than they need. Insomnia during this time is often due to an issue with Blood. If the person wakes up after sleeping 4 to 5 hours this indicates Heart Blood deficiency which can originate from the Liver.

Blood is created from a combination of Spleen and Kidney energetics. The Spleen contributes nourishment from food, and the Kidney contributes Essence from the Marrow. If either of these organ systems is deficient there can be difficulty creating Blood. Without enough Blood being created even if the Liver is doing well it won’t have enough Blood to distribute, and there will be signs of Blood deficiency.

The Heart is also intimately connected with the Blood. The Blood houses the shen (our spirit, or consciousness) and the emotions, both of which are linked to the Heart. If the Heart is agitated (with anxiety, worries, excessive thinking, etc.) it will require more Blood to keep it calm. Over time this agitation depletes the Blood; Blood (and subsequently yin) deficiency tends to create more agitation, a downward spiral. The Heart could be the source of this agitation, or it could be suffering from a lack of Blood due to a Liver deficiency. Agitation also leads to Heart Qi deficiency, and since the Heart rules over the circulation without enough Qi the distribution of Blood will be compromised.

Treatments

At present conventional medicine has few effective therapies to offer. A common first-line approach is to prescribe SSRIs (antidepressants). The monograph on Medscape also lists a number of alternative approaches, including meditation or biofeedback techniques, light therapy, massage, homeopathy, and herbal medicine.

Dr. Hyman, in his article on PMS, lists five things to do in order to take care of PMS. The first is to eat well. Second, he lists a number of supplements, including certain herbs, seeds, and probiotics. The third and fourth is to exercise and reduce stress. The fifth is alternative therapies such as acupuncture and homeopathy. Let’s explore some of these options more fully.

Food cravings during PMS are often due to a Spleen Qi deficiency. In this circumstance, it is easier on the Spleen to eat smaller amounts more often. Eating 5-6 small meals throughout the day will help stabilize your blood sugar, energy, and Blood production. A deficient Spleen also does better with easily digested food. This means food warm, moist, cooked foods. Eating cold or raw food, or drinking cold drinks, puts an additional burden on our digestion. All of these things keep Qi from stagnating, helping to prevent all the issues described above.

Depending on what is happening in the body different herbs or supplements will be helpful. For instance, if there are some Liver Qi and Blood deficiency, along with water accumulation from a Spleen issue, this can create symptoms such as cramping pain, bloating, diarrhea, and dizziness. With confirmation from the pulse, the formula Dang Gui Shao Yao San (Angelica and Peony Powder) might be appropriate. Or perhaps there along with the Liver Qi and Blood deficiency, there is more dryness and yin deficiency, leading to dry skin, insomnia, dizziness, and agitation, along with constipation and moodiness. Here it might be better to give Wen Jing Tang (Warm the Menses Decoction). Each person is unique, so there is no one-size-fits-all solution.

Exercise is regarded in popular culture as always helpful, but Chinese Medicine says otherwise. Exercise helps move the Qi and Blood in the body and therefore will relieve symptoms due to stagnation. If the stagnation is coming from a deficiency, an exercise that is too intense will deplete you, and over time things will get worse. Many people have a certain amount of Blood deficiency; any exercise that forces the body to sweat will further deplete the Blood since sweat is produced from Blood. It’s good to move, but be careful of overdoing it.

Stress is one of the defining issues of our time. Reducing stress tends to make everything better, not just PMS. In Chinese Medicine stress primarily affects the Liver and the Heart, so treating these two organ systems is very important. Helping the body let go of any past trauma, whether physical or emotional, is absolutely essential; if you carry your stress with you all the time how can it go away? Developing body awareness, such as paying attention to the breath, is a good way to help let go of stress. Massage, meditation, yoga, baths, good company, all can be helpful.

Acupuncture can be incredibly helpful with PMS. As a way of communicating directly with the body, acupuncture can help free up stagnating Qi and bring awareness to patterns of held tension, whether in the muscles, the connective tissue, the nervous system, or the organs themselves. Acupuncture can also speak to the emotions since the mind and body are intimately connected.

Homeopathy is another great treatment approach. Though homeopathic remedies can be used on a more symptomatic level I prefer to prescribe based on the whole person. This takes not only menstrual symptoms into account, but focuses on the way you move through life and respond to all of life’s stresses, at a physical, emotional, and mental level. Prescribing a whole-person remedy can result in profound changes. 

Some things are easy to implement on your own, and with others, it’s helpful to have the guidance of a trained practitioner. Schedule an appointment with your Whole Systems Healthcare provider.