Ladies, you know what I’m talking about here! Some of us may have been luckily spared this phenomenon but the many that I do know (myself included!!) can easily identify with the monthly transformation that happens at the end of a woman’s monthly cycle. We may experience some or all of some rather beastly changes at least once a month: irritation, impatience, frustration, anxiety, cramping pain, food cravings, crashes in blood sugar, fluctuating energy levels, tender abdominal bloating, digestive issues, lower back pain, acne, mood changes and emotional outbursts. This list can (and does) go on but you get the idea. Once a month, some of us in the world are walking around like a spring-loaded jack-in-the-box. One tiny trip on the trigger of the box and out we spring with full explosive force!
I write about this as its something that very much hits home for me, not only because I treat this often in my field of acupuncture. It felt important to write about because I too am a woman and have had my fair share of lupine moments where I swear that sometimes I am convinced I am part werewolf at least once a month into my cycle. My sense of smell for chocolate and other sweets gets even more highly attuned; my intolerance for minor “nonsenses” on my daily commute dwindles to almost zero; my fierceness shoots up and I swear I become almost ten times more beastly strong if something quick-trips that fuse. Not to mention, the pain that sometimes accompanies this transformation (in my case, I often experience sore lower back pain and get a tender tummy).
I have myself been on the receiving end for acupuncture treatments to treat PMS and I have to admit, there’s nothing quite else like this in the world for alleviating some of the symptoms. It’s natural, it doesn’t involve over the counter conventional medication and it’s great for relieving a stressed-out, overly stimulated and maxed-out-on-cortisol mind!
So what causes PMS? Well, to be very frank, there haven’t been too many solid medical theories that have been put forth that can really get a handle on explaining this. We all hear about the concept of hormone changes. And to some degree changes in hormone levels are a very likely trigger for the symptoms that accompany a particular part of a woman’s cycle. As of right now, it is commonly accepted amongst most medical professionals that PMS is really the result of the interaction between the brain’s neurotransmitters and changes in the levels of hormones starting right around the time after ovulation and ending at around the time of the first day of the period. It is at around this time in a woman’s cycle when the progesterone surge she previously experienced post ovulation comes dropping right down, alongside equally plummeting levels of estrogen. Commonly seen symptoms that occur around this time are: bloating and water retention, salt or sugar cravings, disruptive emotional fluctuations, a drop in libido, fatigue, insomnia or interrupted sleep and sometimes weight gain.
Its no wonder so many of us feel snarly, snarky and just plain old “HHHHMMPPPHHHHHHH!!!!!!!”
From my perspective as an Acupuncturist, changes in the levels of a woman’s Yin and Yang energies - relative to each other - are what cause some of the symptoms that are associated with specific times of a woman’s cycle. Even though Yin and Yang are somewhat “esoteric” concepts that may require mental gymnastics to get your head around, most of us do actually have a very basic understanding of Yin and Yang. When we see the basic Yin-Yang symbol, the duality of two distinct (though not entirely independent of each other) concepts is already apparent.
Credit to this picture goes to a really beautiful website (https://liaandrews.com/category/traditional-chinese-medicine/) that I came across while looking for pictures of the Yin and Yang symbol and its corresponding phases that overlap with the monthly menstrual cycle. Mind you, I don't talk specifically about each of the phases listed here as that would probably take this article into novel series level length!! My explanation here is more focused on menstrual cycle activities that happen on either the Yin aspect or the Yang aspect of the cycle itself.
We tend to associate Yin (the darker half of the circle with the white “eye”) with concepts like: feminine, retiring, contracting, cool / cold, moist, fluids, the earth, the womb or containment. And as for Yang (the lighter half of the circle with the black “eye”), words or phrases like: masculine, waking / arousal, expansion, warm / hot, dry, heat, the sun, forward movement and breaking free, tend to describe this energy. It is with this basic concept of Yin and Yang, that one’s understanding of a menstrual cycle, and all its associated physical manifestations, can be explained from an Acupuncturists’ standpoint (well, I will try my best not to lose any of you in the process).
A woman’s cycle starts off on the first day of bleeding when Yin levels are just starting to increase. The first half of the cycle is dominated by a rise in Yin energies and tapers to an end by the cycle’s mid-point at ovulation. Physically, the uterus has been “emptied” of blood at the start of the cycle and new blood needs to flow in to not only thicken the uterine lining for the new cycle to come, it is also required for the growth of new follicles; one of which will become the dominant egg released at ovulation in preparation for potential pregnancy.
Blood is seen as a predominantly Yin substance in the human body and for this reason, the increasing levels of and the act of storage of blood in the uterus and ovaries are seen as Yin-focused processes. Storage itself is very Yin in nature and requires a safe internal place to happen (naturally, the uterus provides a wonderful safe haven for blood). Blood itself is also a very Yin substance (as are all bodily fluids and the “softer” more liquid like components of the human body) and because this stage is characterized by an increase in blood levels in the uterus and ovaries, this alone makes it “The Yin” in this part of the cycle. Clinically speaking, this is the stage where estrogen levels rise and peak just before ovulation. Estrogen is required to grow follicles; one of which will become the only dominant follicle that gets released into the Fallopian tube at ovulation.
Emotionally, the energies here are geared towards storage, safe harbour and bonding. Most of the time, we are feeling good at this point of the cycle; comfortable, benevolent and because women’s bodies are biologically essentially setting up a happy home in the uterus for a potential baby, we tend to be more nurturing around this point in the cycle. We are generally more happy to bond, create social circles and reach out to people now. And why not? This is the period before a potential pregnancy can take place and forging not only romantic bonds with a long-term partner but also larger social bonds (that can help a woman in the raising of her child in the near future) is a primary biological incentive at this point. No wonder we're feeling the love at this time!
In other words, this is the "hunky-dory stage of life" where anything goes and we’re at our happiest, most charming and most social!
The Yang part of a woman’s cycle starts off somewhere mid-point at around the time of ovulation. Now if you recall, Yang energies tend to move outward, are hot, fast-moving, expanding and focused on growth. Ovulation is the time when a fully matured follicle gets released from the ovaries. This act requires a lot of energy and so a maximum of yang energy is needed to allow the mature egg to rupture and get released. I envision a rocket at the very start of takeoff. All those Yang energies that went into creating propulsion and force to allow the rocket to take off into orbit is sort of the NASA equivalent of all the energy that goes into growing the mature follicle and then allowing it to burst through the ovary as a fully grown ova which will be ready to meet up and fuse with potential sperm it may encounter in the Fallopian tube. Lutenizing hormone (LH) is the main hormone that peaks around now at the stage of ova release, followed by progesterone soon after, as the Yang stage of the cycle continues.
The following diagram shows the distinct stages of menstruation so that you can get a better idea of which hormones peak and which ones decline depending on the stage of the cycle (and its associated activities like follicular growth, ovulation, uterine thickening and the subsequent shedding of the uterine lining if pregnancy does not occur). You can see that hormones are at the centre of the whole process of having a period. Superimpose this with the Yin Yang symbol (see above) and you will start to see which phases correspond with the Yin and which ones correspond with the Yang.
This picture was taken from the following website: https://www.britannica.com/science/menstruation.
Yang energies don’t stop growing here. They further increase as the second half of the cycle continues. Emotionally speaking, this is like the equivalent of turning up the thermostat at in a home. This accounts for why a lot of women report symptoms such as feeling flushed, warmer at night, have acne breakouts and have less restful sleep in the few days leading up to their period. This also accounts for why a lot of women tend to feel more irritable, more easily agitated and impatient around this time of the cycle. This is the stage where progesterone starts to increase in response to the release of the mature ova and the accompanying luteinizing hormone surge. The corpus luteum (in the hollow where the egg was released from in the ovaries) is what triggers progesterone release. The main reason for progesterone (despite the discomforts) is retention and maintenance of the uterine lining in case there is a viable pregnancy. I picture progesterone as being the Bob (or Betty) the Builder who reinforces the walls (the uterine lining) of a home and also happens to build an extra nursery for a potential baby to come.
All this building and lining reinforcement activity requires a lot of hot, expansive and growing Yang force so you can imagine, it generates a lot of heat which shows up as what we call stagnation of the Liver (in Chinese Medicine geekspeak). This just cranks up a lot of internal irritation and some of us are more likely to erupt or just be plain old grouchy around this time. These are all physical manifestations of increasing outward flowing and hot yang energy showing up at their peak which is usually right up to the day before the first day of bleeding starts. I joke with friends that this is the time where the inner Bruce Banner just goes into hiding because there is less BB present and a whole lot more Hulk happening (and smashing into candy bars).
If pregnancy does not occur at this particular cycle, the levels of progesterone and estrogen both fall and drop off quite dramatically. This usually signals to the body that it can shed the uterine lining and hence, the next cycle starts off with bleeding during the next period. This is where Yang energies fall and where Yin energies pick up and build up again. When the heat of Yang energies fall, the irritability and crankiness scale back and along with that, focus and energy in general drop as well. This is where a lot of the food cravings kick in and where some of us in the general population may feel compelled by an unnameable force to do midnight donut, ice cream, potato chip and pizza runs. (I guess nowadays there is Ubereats and your identity can still remain anonymous if you do a phoneapp delivery instead of an actual run!).
So where does acupuncture fit in with all this?
It’s a fantastic tool in a whole toolbox of health and lifestyle options (alongside eating whole fresh, seasonal foods - i.e. NOT from a box - regular exercise, adequate sleep and maintaining healthy social ties) that you can use to:
Take your mind off the anxiety, insomnia and/or mental restlessness that may accompany typical PMS symptoms around the time of ovulation onwards (when Yang energies start rising and the heat starts cranking up and making the mind do the funky chicken at 3am when you’re trying to sleep)
Help ease food cravings, sugar crashes and the mind fog that accompanies the end of the cycle when progesterone and estrogen levels drop and you’re feeling like a deflated balloon after a parade
Circumvent the possibility of Godzilla-like destruction on a massive urban scale when you’re grinding and hustling at a few jobs, while trying to pay off the bills and, fend off rising levels of irritability and bursts of anger on a commute; all in the week before you expect your period to start (again corresponding to the more rising Yang levels part of the cycle)
Hey, if you’re not looking for PMS relief but trying to make sure your cycles stay regular if you often miss periods or are going through a rough patch and have earlier than normal or later than normal periods, this is absolutely where acupuncture can help you get your periods under a more regular schedule (super important ladies when you are planning for a future baby and want to make sure you have regular cycles to help you do so!)
Acupuncture works by decreasing levels of inflammation in the body when the needles are inserted into specific acupuncture points. Inflammation leads to a state of pain, discomfort and as you would have guessed it, the sensation of heat. Inflammation happens when the body registers an injury and the body starts a repair process which will often involve swelling, tenderness, heat and pain. Sounds familiar now doesn't it? So all those times that you felt swollen in the lower abdomen, felt pain in the lower abdominal and pelvic area, and also felt sweaty and warm at night - those are all symptoms that accompany a state of inflammation and those inflammatory processes are what get kicked into high gear when the body goes into its more active Yang phase of the menstrual cycle! Cortisol levels rise in response to the body's inflammatory response and with that increase comes an increase in subjective anxiety levels in a patient when they are experiencing a particularly bad bout of PMS.
Acupuncture has been documented as being a great help for many women who go through some pretty severe symptoms because it helps reduce inflammation, pain and swelling and because it helps ease off rising cortisol levels (and rising anxiety levels as a result). Check these links out for further reading: https://www.medicalnewstoday.com/articles/318532.php, https://www.ncbi.nlm.nih.gov/pubmed/12410369, and (for the who want more meat and potatoes research paper style findings) https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2011.02994.x.
So next time you start fretting about a major presentation coming up, or a weekend with the family over the holidays or, you’re about to start a new job and want to show up looking your best but, you’re expecting the pre-period jitters, mood changes, food cravings and sudden outbursts of colourful sentence enhancing curse words that accompany the pre-period period, you may want to consider giving acupuncture a try!
I know it has worked wonders for me and given that we live in such a (perhaps overly) connected, plugged-in world, taking yourself out of the noise of the everyday hustle for just an hour during the week - isn’t that just the antidote an already harassed body needs in order to re-set it’s hormonal signals so that it can function seamlessly in its naturally balanced state and tackle the daily tasks again without breaking a sweat in the process?
*Interesting aside note: Between the time I started this article and today, I have been trying to get my own head around some irregularities in my own cycle (oh the irony right??) since the the time I got home from my visit to Australia and returned to work.
As a practitioner myself, it has been frankly, a little more than unsettling to deal with the same health issues that I see in my own patients. Nevertheless, just so I get a jump on things as I write this and to make sure that my mind doesn't wander into pathology mode, I got my medical requisition papers two days ago from my own doctor and I just got my own initial bloodwork done today. An ultrasound will follow next week (fingers crossed it will be fast and not so furious).
I figured that since I am writing this article and I because I do truly try to talk the talk, while walking (and not texting) as I do the walk, I may as well come clean and let you (who may happen to pass by this page) know that I am working on taking my own advice and being as good a patient as I try to be a practitioner. Though I am nervous myself about the whole thing, it helps to think that there are times when you the practitioner just need to be the patient and ask for help! It sure is a bit of humble pie to be served now when I'm at a good point in my life but sometimes you just need to assemble yourself the best possible health team to help you and lay down your role as team leader for once. Like you, I am learning the ropes and hopefully becoming stronger as I do so!
Fingers crossed that all this will turn out to be is a whole lot of medical test time taken to prove I am absolutely healthy and that the root cause of period irregularities was time-zone travel! (So on that note, if this is the case, remind me to NOT volunteer for intergalactic time and space travel for awhile).
Until then, stay healthy folks!