The menstrual cycle is an ebb and flow of yin and yang energy. Let’s use an example of a 28-day menstrual cycle. Day 1 to day 14 which is the follicular phase is dominated by the presence of estrogen which is a hormone with more “yin” characteristics. Ovulation occurs on day 14. Day 15 to day 28 which is the luteal phase is dominated by the presence of progesterone which has more “yang” characteristics.

PMDD patients may not necessarily have abnormal hormone levels but they may be more sensitive to the normal hormonal changes within a menstrual cycle. This could be due to their underlying body constitution being more reactive to the increased yang energy in the body before the onset of menses. This is common in those who have stagnation of qi, blood, phlegm-dampness and/or excess heat.

Stress and sedentary lifestyles can lead to stagnation within the body. Diets that are high in fat and sugar content, sleeping past 11pm-12am consistently or inadequate sleep can contribute to heat building up within the body.

Stagnation can cause symptoms such as feelings of depression, breast fullness and pain, abdominal cramping and bloating, and fluid retention. Stagnation can also disrupt the normal flow of energy causing nausea and vomiting. Excess heat in the body can result in anxiety, irritability, anger, insomnia and aggravation of skin disorders.

1) Identifying the patient’s TCM syndrome
Due to the complexity of each individual’s body constitution and lifestyle habits, patients could have a combination of stagnation of qi, blood, phlegm-dampness and/or excess heat. They could also present with certain deficiencies in the body such as yin deficiency which contributes to presence of excess heat or yang deficiency which further worsens stagnation.

2) Tailoring treatment for different phases of the menstrual cycle
Due to the cyclical changes and variety of symptoms in PMDD, treatment could vary greatly among patients. The following are some examples:

• After menses, there is a relative deficiency in yin and blood within the body so those who are yin deficient require herbs that nourish yin and blood.
• For patients who have stagnation within the body, herbs and/or acupuncture are given to regulate qi and blood circulation, especially after ovulation. Cupping can also be done to release tension.
• Those who have yang deficiency may require moxibustion which uses warmth to stimulate acupoints and boost yang energy within the body.

Depression, feelings of sadness are commonly due to qi stagnation coupled with yang deficiency or presence of dampness-phlegm in the body.

Irritability, anxiety and anger are often due to qi stagnation with excess heat and possibly yin deficiency in the body.

TCM treatment can be done to address these conditions according to each patient’s specific syndrome.

What to expect at a TCM treatment:

Acupuncture and herbal medication tailored to one’s condition are prescribed to target qi stagnation and other relevant syndromes, helping in management of the emotional and psychological symptoms. Insomnia that is often present is also an important issue which TCM treatment can address. Emotional stress can lead to presence of physical stiffness, aches and pains which can be treated using acupuncture and cupping to release muscular tension and improve energy flow. Advice on lifestyle changes from a TCM perspective will also be given.

What you can try on your own:

1. Deep-breathing exercises coupled with acupressure can be used to address stagnation.

Place your palms together, sides of your thumbs against the sternum (chest bone) and rub up and down, as you inhale and exhale deeply. Dan Zhong (膻中) is located on the sternum, at the level of the 4th intercostal space, usually midway between the two nipples. It is an acupoint that is essential for qi regulation in the entire body.

2. Herbal Tea
Herbal teas using rose(玫瑰花) and Hehuan flower (合欢花) can help to regulate qi stagnation, helping to improve the mood.

3. Foot Soaks
Soaking your feet in warm water (40°C), for about 15min, at least 1 hour after dinner and 1 hour before bedtime will help to relax and calm the mind, aiding in sleep. Do take note not to use mobile devices, close the eyes and breathe deeply for better relaxation.

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