Acupuncture for Premenstrual Syndrome (PMS) brings balance back to the liver and allows for the normal flow of blood and Qi. It is a natural modality that has seen much success in many acupuncture practices. PMS being a very common hormonal issue in women, 3 in 4 women have it at some point in their life, and 5% of women get a more severe form of PMS known as Premenstrual Dysphoric Disorder (PMDD). Knowing these statistics in addition to how common it is, you would think that at this point there would be a way to rectify it once and for all. However, there has yet to be one set thing that helps with PMS, nor do experts know exactly what causes it. Acupuncture could very well be the answer to an age-old problem for women the world over.
PMS
Most times, PMS is at the center of a bad joke in reference to women’s moodiness, but it has been a recognized medical issue for thousands of years that many women suffer from month after month. PMS is a disorder that involves hormonal changes that trigger disruptive symptoms for as long as two weeks prior to menstruation. While these symptoms usually taper off with menstruation, it is a hinderance for a good deal of the month for women, and sometimes linger on if they are behavioral or emotional. There are about 150 emotional and physical symptoms that women may experience during PMS.
Most common emotional symptoms of PMS:
- Anxiety
- Mood swings
- Depression
- Sadness
- Anger
- Poor coordination
Most common physical symptoms of PMS:
- Fatigue
- Headaches
- Weight gain
- Skin problems
- Breast tenderness
- Aches and pains
- Swelling in the joints
- Bloating
- Abdominal cramps
- Food cravings
These symptoms can vary from woman to woman, and also month to month. As we said, these symptoms usually can start up to 2 weeks before the onset of the period, but will then decline through the menstrual cycle. On the other hand, there are women, about 2-5%, that experience a more severe form of PMS known as Premenstrual Dysphoric Disorder (PMDD). The symptoms of PMDD are debilitating, and interfere with daily activities. While PMS and its symptoms are a problem that dates back thousands of years, even in today’s age, we do not know a definite cause, although there are theories.
Theoretical causes of PMS:
- Environment – increased use of fertilizers, pesticides, and chemicals which may be linked to increased rates of PMS
- Metabolism – it is believed that some PMS symptoms may be due to a woman’s inability to metabolize fatty acids
- Hormones – PMS symptoms can be brought on by menstrual hormones like progesterone and estrogen
- Calcium – Some experts believe PMS may be linked to calcium deficiency
- Combination – a combination of stress, diet, and vitamin & mineral deficiencies are also said to potentially bring on symptoms of PMS
Additionally, about half of women who have PMS will usually also have another health issue which may worsen in the time before menstruation.
Health issues which share symptoms of PMS:
- Anxiety & Depression – these are the most common overlap with PMS symptoms, and may worsen before and during a woman’s period.
- Irritable Bowel Syndrome (IBS) – this causes cramps, bloating, and gas. These are also symptoms that overlap and can be mistaken with just PMS symptoms as they worsen before a woman’s period.
- Chronic Fatigue Syndrome (CFS) – many women report their symptoms getting worse right before their period.
- Bladder Pain Syndrome – more likely to have painful cramps during PMS
PMS may also interfere and worsen other health problems like allergies, migraines, and asthma.
Women’s lives in today’s world are very different and possibly leave way for higher probability of experiencing PMS symptoms. The constant physical and emotional demands of possibly being a working parent coupled with societal and environmental issues can throw off a woman’s equilibrium leaving room for PMS symptoms to creep in. It is estimated that at least 85% of menstruating women have at least 1 PMS symptom as part of their monthly cycle according to The American College of Obstetricians and Gynecologists.
PMS vs. PMDD & Western Treatments
The majority of women who experience PMS have mild symptoms, but potentially can worsen as a woman reaches her late 30s or 40s during the premenopausal phase. Alternatively, there are a percentage of women as we said that experience a more severe form of PMS known as PMDD. The symptoms of PMS and PMDD are similar in nature, but more severe, especially emotional symptoms.
PMDD common symptoms:
- Panic attacks
- Frequent crying & mood swings
- Intense anxiety
- Feelings of sadness, and even thoughts of suicide
- Trouble focusing or thinking
- Low energy
- Binge eating & food cravings
- Trouble sleeping
- Long lasting irritability that affects others
- Lack of interest in relationships and daily activities
- A feeling of being out of control
- Physical symptoms kin to PMS (bloating, breast tenderness, etc)
There must be 5 or more of these symptoms experienced by the woman to be diagnosed with PMDD. Both PMS and PMDD occur most often in women who are in their late 20s-early 40s, have at least 1 child, a family history of depression, have high levels of stress, and a past medical history of postpartum depression or a mood disorder. Currently, there is no test for PMS, and are solely based on experienced symptoms and how they affect the woman’s life.
Western treatments for PMS:
- Over-the-counter pain relievers – these may help lessen physical symptoms such as headaches, backaches, breast tenderness, and cramps. Examples of these would be Ibuprofen, Aspirin, and Naproxen.
- Prescription medications – these may be offered if over-the-counter medications are not working. These can include the following:
- Antidepressants – these help to relieve emotional symptoms of PMS
- Diuretics – also known as “water pills” can help reduce symptoms of breast tenderness and bloating
- Hormonal birth control – these may help with physical symptoms of PMS, but also may make symptoms worse. It is a bit trial and error with these as a woman may need to try several different types of birth control before finding one that helps.
- Anti-anxiety medication – may help reduce anxiety symptom of PMS
- Antidepressants – these help to relieve emotional symptoms of PMS
Along with medications, western medicine doctors commonly give everyday things that a woman can do that may relieve PMS symptoms. Non-medicinal recommendations usually include things like regular physical activity, not smoking, getting enough sleep, eating healthy, and finding healthy ways to cope with stress like keeping a journal or talking to a friend. Acupuncture is also a great alternative to traditional method, and one that has worked for thousands of years, and works for many women today.
Acupuncture and PMS
Acupuncture for PMS is a natural, safer alternative to medications, and can treat many symptoms at the same time. Using acupuncture along with a healthy diet, and possibly herbal formula depending on the patient’s unique circumstances, helps to promote healing, balance out a woman’s hormonal function, and autonomic nervous system. According to Traditional Chinese Medicine (TCM), the imbalance that causes PMS is Liver Qi Stagnation, and the Qi’s flow is compromised because the Liver is responsible for maintaining the circulation of Qi through the body. This blockage occurs for many of the reasons we mentioned above. Women in today’s world juggle family, career (and the stress and/or guilt of juggling both), and social life all at once, which takes a toll on the body and mind.
Acupuncture works for PMS by:
- Increasing Serotonin – Serotonin is a neurotransmitter involved in regulating appetite, mood, sleep cycles, and many other functions.
- Regulating Opioid peptides – experts theorize that PMS can result from excessive exposure to and/or withdrawal of brain opioid activity during the luteal phase of menstruation. Acupuncture regulates endorphins, enkephalins, and dynorphins involved in reducing the perception of pain.
- Regulates unbalanced hormones & stabilizes hormonal fluctuations – Follicle-stimulating hormone (FSH) which is higher in PMS patients, Estradiol 2 (E2) which is low in PMS patients, serum testosterone, GABA levels which are low in PMS patients, Estrogen which is low in PMS patients, and Norepinephrine (NE) which is lacking in PMS patients.
Although acupuncture is extremely individualized, a good rule of thumb is to have patients come in 2x/week for 4-6 weeks to see significant change even though patients may experience relief after their 1st or 2nd visit. As always, regular acupuncture visits are encouraged to truly create relief and long-term hormonal balance for the patient. The ultimate goal is to remove blockages from the body and balance the hormones. In addition to acupuncture points to meet their specific needs, it is also important to discuss healthy nutrition habits with the patient to aid them from the month to month.
Acupuncture Points & Nutrition for PMS
While we know as providers that everyone comes to us with a different set of symptoms and medical histories, it is important to have certain points for PMS symptoms at the ready that we know are effective for particular symptoms that patients may be experiencing.
Acupuncture points for mood swings:
- Shen men
- GV20 – Bai Hui
- SP6 – San Yin Jiao
Acupuncture points for breast tenderness:
- ST18 – Rugen
- UB18 – Gan Shu
- CV17 – Tan Zhong
Acupuncture points for headache (use reinforcing and reducing needling techniques):
- ST8 – Touwei
- GB20 – Feng Chi
- EX Tai Yang
- LI4 – He Gu
- ST36 – Zu San Li
- GV20 – Bai Hui
- SP6 – San Yin Jiao
Acupuncture points for edema (use reinforcing needling techniques):
- UB20 – Pi Shu
- UB23 – Shen Shu
- SP9 – Yinlingquan
- CV9 – Shui Fen
- ST28 – Shui Dao
- UB28 – Pang Guang Shu
- SP6 – San Yin Jiao
Acupuncture points for skin issues:
- LI11 – Qu Chi
- LI4 – He Gu
- SP10 – Xue Hai
- UB40 – Wei Zhong
- UB17 – Ge Shu
As always, it is important to take the patients’ medical history into account when selecting appropriate acupuncture points and needling techniques. It can be important to also provide your patients with basic go-to acupressure points to use when they are not in the office to maintain their well-being at home such as LV3, LI4, and SP6. SP6 being a key point to use in needling and for acupressure as it is the intersection of the three yin meridians of the Liver, Spleen, and Kidney. Gynecological issues like PMS are closely related to these three internal organs thus making it a crucial point to use.
Nutrition is also a key piece to helping our patients regulate PMS symptoms. In TCM nutrition, consuming cold, raw foods and drinks for long periods of time can weaken the digestive system, and cause more menstrual cramping before and throughout the cycle. Incorporating warm, cooked foods, and room temperature drinks are helpful if patients are experiencing cramping.
Foods that aggravate the Liver & should be limited:
- Sugar
- Greasy/fried foods
- Overeating
- Red meats more than once a week
- Coffee
- Alcohol
- Spicy/hot foods
There is also a natural and inexpensive way to support the female body through nutrition, and that is seed cycling. Seed cycling is the circulation of different edible seeds during the menstrual cycle to help achieve hormonal balance.
Seed Cycling:
- Follicular phase – day 1-14 – have one tablespoon each of flaxseed and pumpkin seeds.
- Luteal phase – day 15-28 – have one tablespoon each of sunflower seeds and sesame seeds.
Not only is seed cycling supportive during a woman’s monthly cycle, but can also balance hormone levels, relieve PMS & premenopausal symptoms, stimulate menstruation if it’s absent, and increase fertility. It can also support healing with more serious conditions like PCOS, endometriosis, and ovarian cysts. Of course, in addition to good nutrition is regular exercise. About 30-45 minutes each session is adequate, and this will help the Qi to move around freely. Tai Chi and Yoga are great options for effective exercise that also rectify feelings of stress and anxiety felt during PMS.
Acupuncture & PMS Works
Although it may take a few cycles for the woman to show an overall improvement, alleviation of many symptoms is often noticed right away. Recent studies also show the benefits acupuncture provides for PMS patients. A meta-analysis from 2019, Acupuncture for Premenstrual Syndrome at Different Intervention Time, and a study from 2018, Acupuncture and Acupressure for Premenstrual Syndrome, both showed acupuncture to have a higher effective rate when compared with sham. More large-scale studies are needed, but the positive results already achieved are undeniable. PMS is a common problem across all women at some point in their life, and acupuncture can help.