So often, I hear from patients that they can’t wait for their period to start. If PMS or PMDD is a part of your experience, the immediate and very noticeable reduction in emotional and physical symptoms after your period arrives can bring a dramatic sense of relief. If this sounds familiar to you, read on to learn more about PMS and its much more intense cousin PMDD, and what your treatment options might be.
Everyone is familiar with the old trope about women being overly emotional before their period, but the reality is more complex. Just as often, symptoms are physical. Emotional changes that show up can include anger, irritability, anxiety, depression, feeling overwhelmed, or a desire to withdraw socially. Some people also experience forgetfulness or trouble concentrating.
Some common physical symptoms of PMS include:
- Bloating
- Breast pain or tenderness
- Headaches or migraines
- Fatigue
- Muscle aches and joint pain
- Insomnia
For a more comprehensive list, please check out this article from MGH Center for Women’s Health.
Symptoms can start anywhere from 2 to 14 days before your period begins. For many of my patients symptoms continue for a few days into their period, but many others notice an abrupt improvement as soon as their period arrives.
What is the difference between PMS and PMDD?
PMS can definitely be intense, but someone is said to have PMDD when the symptoms really impact interpersonal relationships and impede your ability to function normally at work or socially. Similar to PMS there is a wide range of symptoms but the key here is the degree that it impacts your life. You might be more likely to experience PMDD if you have a history of an anxiety or depression disorder, experience high levels of stress or have a family history of premenstrual mood dysregulation.
Why Does This Happen? Are My Hormone Levels Off?
Contrary to a lot of what you’ll read on social media, researchers have studied this and found that those with PMS or PMDD don’t actually have hormone levels that are abnormal. Instead, they are more sensitive to normal hormonal fluctuations that occur. This is completely anecdotal, but I have noticed over the years that my patients who are very sensitive to their hormones are often very sensitive to other things such as medications (they might say that they need the lowest dose of medication and it still has a strong effect), changes in sleep schedule, dehydration or change in your normal eating routine. Basically- changes in your routine or environment affect you more strongly than the average person.
What Are the Most Common Treatment Options?
In addition to psychotherapy, a type of therapy called Cognitive Behavioral Therapy (CBT) is often recommended to help with developing coping strategies. Additionally, charting your symptoms often helps because you can anticipate when your symptoms will start and end. As far as lifestyle, we don’t have a lot of research but some studies show regular cardiovascular exercise and reducing or eliminating caffeine, sugar and sodium seems to help.
A type of medication called SSRI’s are often a first line treatment, as well as continuous oral contraceptive pills (OCP).
Could Acupuncture Help with PMS or PMDD?
In my clinical experience acupuncture seems to help make people more resilient to hormonal fluctuations- essentially you become better able to weather the storm because your body and brain’s perception of the stress is reduced. When someone is first beginning acupuncture I normally recommend weekly sessions so we are establishing consistent effects in your body, and so that you’re getting treatment during every major phase of your cycle. As you start to see improvement we can reduce frequency. I have many patients who come in only once a month, about 10 days before their period is expected to arrive.
From an East Asian Medicine (EAM) point of view, there is almost always something called Liver Qi Stagnation present if there are premenstrual symptoms- the Liver is responsible for the smooth flow of Qi, or energy through the body and when it becomes “stuck”, you get signs of physical and emotional stagnation which might mean irritability, anxiety, depression, breast tenderness and joint pain.
Depending on someone’s individual symptoms, there may also be a component of dampness (for example if there is a lot of bloating and fluid retention), Blood Stasis (we might see this if someone gets migraines or has painful, clotty periods) or general Qi deficiency (if there is pronounced fatigue). These are just a few examples as to how we look at each person’s symptoms, and from here we can choose appropriate acupuncture points, herbal formulas and dietary and lifestyle recommendations.
What To Do For PMS/PMDD at Home
For Liver Qi Stagnation some of my favorite recommendations that may help with premenstrual symptoms include:
Apply acupressure to the Liver 3 point (see the link here for the location of this point as well as some other great point options). You can apply firm (but not painful) pressure to this point for 2-3 minutes, several times a day either throughout the month or in the weeks before your period is expected
Sour foods: the taste associated with the liver is sour- so things like fermented pickles, sauerkraut or kimchi in small doses can help
Exercise: Things like kickboxing can be especially therapeutic, but if your energy tends to drop, a gentle yoga class could be more appropriate. The key is to keep things moving.
Self Expression: any creative practice that speaks to you such as art, music, journaling or dancing helps to move the Liver Qi