If you’ve experienced PMS or PMDD, you know that options are limited as far as effective treatments go, and many times, with a significant risk for side effects. These conditions can quite literally take you out for an entire week or even more impact your relationships, mental health, and work or other obligations. Being a victim of your own body is never a fun experience, and it often leaves us seeking answers in every place we can search. Modern medicine’s approach to PMS / PMDD usually consists of a minimal range of treatment options, including birth control pills and SSRI medications, which both come with a significant risk of side effects. Occasionally, herbs or supplements are recommended, and my personal favorite/not favorite is “just control your stress levels” or “go to therapy.” All of these treatments can be significantly helpful. Yet, they don’t work for everyone for a variety of reasons, and having suffered from PMDD myself, I know firsthand how important finding an effective solution with minimal side effects is. In my practice, I see many patients who suffer from PMS and PMDD; for some, the symptoms are transient and manageable, but for others, the symptoms can take over your life, leaving you with only ten or so ‘good days’ a month. The symptoms of PMDD are also usually exacerbated during perimenopause, which can begin as early as age 35. Getting comprehensive care can make all the difference, so let’s talk about how acupuncture can help with premenstrual issues. Because for some people - acupuncture, Chinese medicine, herbs, and hypnotherapy can be powerful and effective treatments to help manage the symptoms of PMS and PMDD without the list of side effects that come with Western therapies. What’s the Difference between PMS and PMDD?Premenstrual dysphoric disorder, PMDD, is often thought of as a severe form of premenstrual syndrome, PMS, which affects a small percentage of people who menstruate. PMDD is characterized by extreme mood shifts that are severe enough to interfere with and impact daily life and relationships. PMS symptoms and PMDD symptoms occur during the same phase of the menstrual cycle, the luteal phase, but PMDD symptoms can encompass this entire phase, beginning at ovulation and lasting through menstruation. One of the hallmark signs of PMS/PMDD is that you experience relief of symptoms once menstruation has started or is completed. Common symptoms of PMDD include severe depression, feelings of hopelessness, intense anger or irritability, feelings of tension or anxiety, mood swings, difficulty concentrating, brain fog, fatigue, changes in appetite, insomnia or excessive sleepiness, and physical symptoms like breast tenderness, bloating, joint and muscle pain. PMS symptoms are typically bothersome, but they don't impact the person's life in the way that PMDD does. PMDD can strain relationships, work, and family life, significantly impacting the patient's quality of life. The Brain-Body Connection of Managing PMS and PMDDGABA, not to be confused with the medication Gabapentin, is an inhibitory amino acid and neurotransmitter. Low levels of GABA are associated with most mental illnesses, and correct levels of GABA help us to feel calm and relaxed and reduce sensations of overwhelm and anxiety. GABA is the feel calm, relaxed, and not having a care in the world neurotransmitter. If mood issues are part of your health complaints, we need to give GABA some attention. To work with GABA, we can do three different things: increase GABA levels, increase GABA receptor sensitivity, and/or decrease GABA breakdown. Increasing GABA naturally is usually straightforward, easy, and safe. Tea with high GABA content, like green, white, or oolong, yoga, vigorous exercise, meditation, or deep breathing for 20 minutes daily, and foods like beans, nuts, seeds, fish, fruits, vegetables, and cocoa can all increase GABA. Of course, we can also supplement GABA as needed for those times when anxiety levels are high. In addition to these lifestyle modifications that can slowly increase our levels of GABA over time, we can also receive acupuncture treatments and herbal medicine. Our Chinese Pharmacopeia has many unique formulas prescribed based on your unique presentation, symptoms, and history. A favorite of mine for any type of mood issue, but especially anxiety coupled with a sense of despair, is Yue Ju Wan - the Five Stagnation Powder. In studies, this formula was performed similarly to Zoloft medication but without a list of side effects (Zhou et al., 2022). Of course, there are plenty of other formulas we commonly use, Xiao Yao San, the Free and Easy Wanderer Powder, and Gan Mai Da Zao Tang, which I dub the ‘herbal hug for your heart,’ a great food-based formula that softens our experience of grief. The Role of Acupuncture in the Treatment of PMS and PMDDThe main hormones of the menstrual cycle are Estrogen and Progesterone. These hormones fluctuate throughout the cycle, increasing in the Follicular phase and sharply declining after ovulation, tapering down as the period comes at the end of the Luteal phase. It’s thought that the hormone levels themselves aren’t the root of the symptoms we see in PMS/PMDD, but rather our sensitivity to the rapid shift of those hormones. PMDD is linked to unstable progesterone concentrations, so this fluctuation of progesterone is a major factor in PMDD and its treatment of it. Many people are given a combination hormonal birth control as a treatment for PMDD, which can be helpful because it stops the cycling of hormone fluctuations. Progestin-only medications are not indicated as they may worsen mood changes, but this is correlated with synthetic progestin, not progesterone. In contrast, the natural progesterone derivative allopregnanolone is associated with favorable effects (Stefaniak, M. et al. 2023). This is due to allopregnanolone’s interaction with gamma-aminobutyric acid type A receptors, GABA-A. GABA, my favorite neurotransmitter, induces significant anti-depressant, anti-stress, sedative, and anxiolytic effects. PMDD, postpartum depression, and mood changes that occur in the luteal phase of the cycle can all be connected with low progesterone, unstable hormone levels, and/or decreased receptor sensitivity. Acupuncture has been shown to upregulate GABA expression; this not only helps with mood regulation, decreasing anxiety, and easing stress, but it also has an impact on physical pain perception. When it comes to pain, acupuncture stimulates the release of endogenous opioid peptides, another type of neurotransmitter. Acupuncture treatments in the latter half of the menstrual cycle can be very helpful in mitigating the physical and emotional effects of PMS and PMDD. (Zhang et al. 2022) Shifting Our Experience of Symptoms with HypnosisSometimes, the path of healing is long, and change comes in small increments, sometimes too small to really notice. Sometimes, our symptoms are deemed chronic, and treatments may help manage them but never really help resolve them. I’ve been here. It’s frustrating and infuriating sometimes, but it doesn’t mean we’re completely out of options. One of my favorite reframes for those living with chronic conditions is that we don’t need to be cured to heal. This means that even if our condition or symptoms never go away, healing is still possible. I think of healing as becoming more in touch with our true selves, being more able to show up authentically in our lives and relationships, and learning how to be connected to that sense of self regardless of the situation's intensity. When we shift our mindset like this, we can see that even if our symptoms don’t change, many paths exist to help us embody our authenticity more. Hypnosis is a tool I often use with chronic illness patients to help manage symptoms, but also our experience of those symptoms. Think of this example - you’re having the best day ever, everything is going right, and you stub your toe on your coffee table - yes, it hurts, but your mindset and current state help to make your experience of that level of pain seem less intrusive, less significant in the grand scheme of things, it’s a blip in your day, and you move on from it. Conversely, think about the worst day ever; everything is going wrong: surprise bills came in the mail, you forgot an important deadline, you can’t find your phone, and you’re late to work, bam! Stubbed toe. When I think of this scenario, I lose my sh*t and scream at my table; maybe I even cry. The stubbed toe is the icing on my already messed-up cake, and it ruins my day. Our mindset, physiological state, and ability to regulate these states play a bigger role than we often think in how we experience pain or chronic symptoms. By starting to work with our mindset, we can shift our experience of symptoms so that they’re less bothersome, less ‘end of the world’ feeling, and move through those symptoms instead of being sidelined by them. For many of my clients who live with chronic illness, pain, or even with PMS and PMDD, these types of shifts can be profound in managing their condition and living the life they want to live. Managing PMS and PMDD with Acupuncture and HypnotherapyWith my acupuncture patients, we usually begin a course of treatment consisting of weekly acupuncture sessions for one full menstrual cycle. Working with you throughout the entire cycle is very helpful for me in seeing how your body responds to treatment and how your symptoms shift over your cycle. From here, we re-evaluate and determine our long-term plans; this might be weekly sessions for another 4-6 weeks, it might be ‘spot treatments’ when symptoms arise, and most commonly, it will be 2-3 weekly sessions in the luteal phase then taking a break for 2-3 weeks, depending on the length of your cycle. I often prescribe herbal formulas to support your care, and for some patients, this is the most impactful part of the treatment. Those patients may minimally use acupuncture treatments, but we continue care via telehealth and regular check-ins with refills on herbs as needed. To use hypnotherapy to manage symptoms of PMS and PMDD, we begin with a cycle of 3-6 sessions, usually spaced weekly. My goal with hypnosis is to teach you tools and techniques so that weekly sessions won’t be necessary in the long term. We will work together on one specific complaint for at least three sessions and then determine our next steps. You will learn some self-hypnosis techniques, receive recordings to use on your own, and learn other mental and physical relaxation and regulation techniques to help you manage symptoms independently. Sessions are conducted online or in person, and for those in person, I also offer a hybrid acupuncture-hypnotherapy option called ‘hypnopuncture’ which is kind of the best of both worlds. Ready to get started? Click the link below to book a session or free Discovery Call to get started today! References:
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AuthorDr. Kim Peirano, DACM, LAc is the Owner and Acupuncturist at Lion's Heart Wellness, the San Francisco Bay Area's #1 Cosmetic Acupuncturist and #1 Holistic Healer. Archives
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