PMS: Common, but Not Normal
I talk about menstrual cycles all the time—every day, multiple times a day. I talk about menstrual cycles so often and in such detail that I forget it’s not “normal” to do so. When we do talk about menstruation in our culture, it’s typically to lament the PMS, the pain, or the messy inconvenience of it all. What we don’t talk about is what is actually happening in our body every month, or the way our cycles can provide a striking window into the status of our overall health.
As a practitioner of Chinese medicine, the details of a woman’s menstrual cycle will inform my treatment plan for any issue related to her cycle (of course), but it will also inform my approach in treating almost any other complaint. Every aspect of your menstrual cycle tells me something important about the state of your general health: the length of your cycle, the volume of blood, the color of blood, the timing of ovulation, your basal body temperature, any pre-menstrual symptoms, and the presence or absence of cramping are all quite revealing. Positive changes in your cycle as we move through treatment also serve as a useful barometer to track your body’s journey back toward balance; this is true even if your primary complaint had “nothing” to do with your menstruation.
Bottom line? Menstrual cycles matter. This article is the first in a year-long series for ELMTM Maine chronicling different aspects of women’s menstrual health. My hope is that by the end, you’re as comfortable and curious as I am about the monthly event common to half of our population.
We’ll start here with PMS and the biggest menstrual myth: that PMS is normal. PMS is not normal! It may be common—up to 80% of women report some constellation of PMS symptoms leading up to their menstrual cycle—but it’s not normal… which brings us to the second biggest myth: that if you have PMS you must simply suffer through. Wrong again! In the vast majority of cases, PMS is both preventable and treatable.
So, what are we talking about? What is PMS exactly? PMS (pre-menstrual syndrome) is a constellation of symptoms that occur anytime from ovulation—usually about two weeks after the start of your period—until your period starts again. Some women suffer for the full two (or more) weeks; others experience symptoms just a day or two in advance of their period. Symptoms include breast tenderness, water weight gain, fatigue, irritability, depressed mood, night sweats, acne, bloating, constipation, diarrhea, migraine, cravings, anxiety, and insomnia. All of these are responses to the body’s post-ovulatory/pre-menstrual hormonal fluctuations.
As your body approaches your period, it has to break down hormones to shift you from “pre-menstrual” to “menstrual.” An optimally functioning body does this efficiently and you are gloriously oblivious to the process and symptom-free. A body that’s functioning less optimally will have a harder time navigating this transition and this is when symptoms show up. Think of PMS as a monthly stress test; like anything under stress, the weakest links are the likeliest to break down. Do you tend to have bowel changes, nausea or cravings? Your digestion needs attention. Does PMS show up as fatigue, anxiety or insomnia? You’re likely to be more generally run-down. Is it breast tenderness, irritability or headaches that show up for you? From a Chinese medicine perspective this points toward stagnation specifically in your Liver* system; Western translation? Your detox pathways need support so they can process hormones out of your system more efficiently.
The good news is that in supporting and strengthening the systems that are exhibiting symptoms, you can alleviate your PMS. In doing so, you also course-correct your body more generally. Why should you care? The more optimally your body is functioning in any given moment, the more likely it is that you’ve staved off larger health issues that might have otherwise accumulated over time. The best part? You’ve freed up your energy so you can get out there and live your most extraordinary life!
So what to do? How to manage PMS symptoms on your own? For most women, getting back to the basics of sleep, nutrition, exercise, mindfulness, hydration and play goes a long way.
Be brazenly boundaried about your sleep. Sleep is when your body can finally take care of itself, unencumbered by the daily demands you place upon it during your waking hours. Honor your body by honoring that time. Treat your bedtime like an appointment you wouldn’t dare miss. Keep consistent sleep and wake times whenever possible to support regulation of your hormones and all the other systems in your body.
Optimize your digestion. Your food can only nourish you if your body is properly absorbing it. If digestive distress is a chronic struggle, seek out professional help. Acupuncture and Chinese medicine can be enormously beneficial; other modalities have their own, sometimes more appropriate interventions. Interview providers and find a good fit.
Eat real food. Every day we’re bombarded with some new health craze around food. Bottom line, in the words of the brilliant food journalist Michael Pollan: eat real food. Sounds simple, but it’s far less common than you think—and not always easy. Eat a wide range of seasonal and organic foods. Limit processed foods, refined sugar, alcohol and coffee, and increase your fiber intake. We can all benefit from this advice, but it’s particularly important if you suffer from PMS; making these changes will help your body eliminate estrogen more efficiently and less uncomfortably. If you’d like to go deeper, a skilled practitioner of Chinese medicine will have dietary suggestions specific to you and the support your individual system needs.
More specifics of what to curb:
- Quit the caffeine: I know! I also love a good cup of coffee in the morning, but it’s true that caffeine can make PMS worse. It constricts blood vessels—including those supplying blood to the uterus—making it even more of a no-go if you tend to cramp. It can increase irritability—the opposite of what is most often required during a premenstrual time. And from a Chinese medicine perspective, caffeine (and especially coffee) stresses the Liver* energetic, leaving you more susceptible to many common PMS symptoms.
- Avoid alcohol: Coffee AND alcohol?! I know!! But have you picked up on all this talk about PMS and your liver? A glass of wine may feel like welcome relief at the end of a long, irritable, pre-menstrual day, but it’s actually only adding insult to injury. We know alcohol inhibits hormone regulation—the opposite of what you’re aiming for. Do your liver a favor and skip it, at least during the second half of your cycle.
- Reduce salt: Too much salt = extra bloating and water retention. The biggest offenders are typically processed and pre-packaged foods, which you’re avoiding already, anyway, right?
- Red meat and dairy: To be clear, red meat and dairy are not inherently bad. Assuming the meat and milk is from pastured, organic cows, there are some folks for whom one or both can be absolute positive game-changers in terms of their health—not so much if you’re a PMS sufferer. Red meat and milk contain a substance known as arachidonic acid that stimulates prostaglandins and intensifies cramps. If you’re craving iron pre-menstrually (or menstrually), and prone to cramping, better to reach for plant-based sources like chickpeas, beans and lentils.
- Sugar and refined carbohydrates: We’d all be well-served to eliminate or dramatically reduced our intake of these pro-inflammatory substances, but this is true for none more so than the PMSer. They increase inflammation in the body, contribute to fatigue and bloating, and can wreak havoc on your volatile PMS moods as they manhandle your blood sugars. Set them free. If you need help managing cravings, seek out acupuncture for support.
Move your body in a joyful way: Walk, run, stretch, breathe, lift, dance, laugh, love. Your body was meant to be fully inhabited. Find a way to move it that lights you up and makes you smile. Repeat often.
Practice mindfulness: We hear this all the time, but what does it mean? Incorporating mindfulness into your daily life doesn’t have to be a huge (stressful) undertaking. Do you brush your teeth every day? Drive your car every day? Wash your dishes every day? Turn on your computer every day? Make a habit of punctuating the start of any recurring event with a moment of attention. All you need is a pause, a slow deep breath in, and a slow deep breath out. Be still. Notice that are you doing what you’re doing. We throw our attention mindlessly out into the world all day, every day. Start to pepper your day with brief moments of drawing that attention back into your body, back into the right now. If you’re unsure of where to start, start there.
Remember how we said PMS is like a monthly stress test? Your goal with these lifestyle and dietary interventions is to reduce the overall stress load on your system. Think of your body as a rain barrel. All kinds of general stressors fill up the barrel—lack of sleep, poor nutrition, a fight with your partner, sitting all day long. We ignore the fact that our rain barrel is filling up because often we cannot “see” the level in the barrel. Then one day—in this case, one pre-menstrual day—the rain barrel overflows and we experience symptoms. “My boobs hurt!” “I’m pissed off!” “That car commercial made me cry!!” We tend to look to the last drop of “stress” that fell into the barrel and blame it on our symptoms, as if that drop were working the joint all alone. “You!! Yeah you!! You’re the problem!” In fact, if the whole stress level in the barrel was lower to begin with, that “last drop” of stress would not have had any visible effect—you would have managed your pre-menstrual hormone shift just fine. If you had instead been well rested, or eating healthfully, or peaceful in your primary relationship, or walking every evening, you likely would have gone into your pre-menstrual time with your stress barrel far less full.
It is important to note that in some circumstances, dietary and lifestyle interventions alone will not be enough to resolve your symptoms. Have no fear! There is no shame in seeking out professional help; sometimes life hands us more than we can manage or regulate on our own. Acupuncture and Chinese medicine are incredibly effective at restoring balance to your system, and can dramatically improve all aspects of a woman’s heath. Seek out a provider with an affinity for women’s health and she or he should be able to get you back on track, lickety split (or within a few months). Happy menstruation!
*In Chinese medicine your “Liver” represents your liver organ but also (and more often) your whole Liver system—a collection of physical and emotional processes that are governed by the “Liver” energetic.
Alexandra Gilmore, LAc, MAcOM is a practitioner of acupuncture and Chinese medicine in South Portland. She knows you have extraordinary things to bring forth in the world, and her mission is to amplify your vitality in the service of that greatness. She brings to the table a unique understanding of your physiology and symptoms, a comprehensive treatment plan, and the opportunity to cultivate a different outcome for your health and your future. She has a special affinity for all things women’s health and dermatology, and loves the challenge of a complex case. She lives in Portland with Oscar, her 90-pound “puppy” and office mascot. www.atxacu.com or www.atxskin.com.