Dear Kath,
A friend of mine suffers from PMS: she gets irritable and cries the week before her period and has terrible cramps. Can Acupuncture help with this? It sure would be great to find something that could help her so she doesn't have to go through this every month.
EB, Asheville, NC

I'm happy to report that acupuncture resolves PMS complaints, including moodiness and physical symptoms such as breast swelling and tenderness, cramping, headaches even hives and acne occurring around the menses. In my practice, I see these symptoms resolve quickly: often within two to three menstrual cycles.

How do we do this? Acupuncturists use a combination of acupuncture and Chinese herbal formulas to treat the condition. We begin by doing a comprehensive health evaluation to examine not only symptoms relating to the menstrual cycle, but also evaluating all the other organ systems in the body to see what other imbalances may be playing a role. We develop a Chinese pattern diagnosis, unique to each individual. We group related complaints together that form a pattern of symptomology, which may include several different western systems in the body.

When a woman experiences PMS complaints, the TCM (Traditional Chinese Medicine) Liver System is always involved. The Chinese Liver System is responsible for moving Qi (pronounced "chee", meaning your body's energy) throughout the body and through the organs; so the muscles have energy to move, the organs can perform their functions of digestion, pumping blood, breathing and so on. When we get stressed or tense, we tighten up and this stops Qi from moving through the muscles and organs. When Qi doesn't move we feel pain such as headaches, menstrual cramps, and muscle and joint pain.

Qi flows throughout the body in a vessel system referred to as channels or meridians. The meridians begin at the fingers and toes, and then go through the abdomen. We name them after one of the organs they pass through: hence the Liver Channel begins at the big toe, goes up the inner leg and through the reproductive organs, then continues up the sides of the chest (through the liver and breast) and then up to the head and eyes.

When women experience PMS symptoms, generally they have some stress in their lives (often job or family related) that causes them to get tense, stagnating the Liver Qi all along the channel. The liver stores the blood (in TCM theory) and sends it down to the uterus for menstruation to take place. When Liver Qi gets stuck before the menses, problems get compounded because it's not able to move the blood to the uterus. This stuck Qi causes us to get angry or irritable. When Qi doesn’t move, the physical depression leads to an emotional one, and we cry or feel sad. When Qi stops moving in the channel it cannot circulate the fluids, causing breast swelling, tenderness and bloating. Stagnate Qi and Blood causes pain along the channel, hence menstrual cramping or headache.
Acupuncture moves Qi in the meridians. Acupuncturists insert tiny, hair-like needles where the Qi is blocked. There are Chinese herbal formulas that are 2,000 years old, well tested and proven effective at resolving PMS problems.

Let me give you an example of a recent PMS case that responded very well to Chinese Medicine. A woman (I'll call her Sarah) had PMS mood changes affecting her work and family life. She described feeling like Dr. Jekyll and Mrs. Hyde. One part of the month life was great and she was very happy and positive. The other half of the month Sarah was depressed, snapping at her husband and co-workers, sad and cried easily. She slept poorly, waking during the night and had breast tenderness and cramping before and during her periods.

I began weekly acupuncture treatments and prescribed a customized Chinese herbal formula that Sarah drank as a tea. After the first week, her sleep had improved. After two visits, Sarah had a period with less cramping than usual. After four visits her sleep was normal, four days before her period: her emotions were normal and she felt breast tenderness only occasionally. After five visits she had another period. Her emotions were normal, she had no breast tenderness, and she felt sad and cramping for only one day. At this time a time conflict arose regarding childcare between she and her husband. A dutiful mother, Sarah offered to stay home and cancel her acupuncture treatment, but her husband said, "No honey, you need to go". He had seen such a change in his wife that he didn't want her to miss a treatment. As Sarah’s symptoms had improved dramatically, I reduced visits to biweekly. After seven treatments, when she was again pre-menstrual, Sarah told me her "home life was good" and that she had no cramping or breast-tenderness. This is a typical scenario of how quickly PMS symptoms can resolve with Chinese medicine.
Herbalists often include Peppermint in Chinese herbal formulas designed to treat PMS symptoms because it helps to move the Liver Qi. I often suggest that patients who experience anger or irritability around the menses or due to stress to drink Peppermint tea to help soothe the emotions.