Relieving pre-menstrual syndrome

Premenstrual syndrome (PMS) is a set of unwanted physical, emotional and mental symptoms that occur after ovulation and are relieved as the period gets started. Most women (and their partners) are well aware of the changes in mood alongside minor physical complaints such as bloating just before the period, and there is nothing ‘wrong’ or unhealthy about this. However when the symptoms go on for up to 2 weeks and cause severe mental and emotional disturbance this can have a very real effect on a woman’s life – her work, her relationship and her self esteem. Women with severe PMS can feel like 2 completely different characters – and to some extent they are!

Below are some of the most common unwanted symptoms of PMS:                                                Mood swings, Irritability, Anxiety and tension, Bloating,                                                                Breast tenderness and swelling, Water retention                                                                 Acne, Tiredness, Weight gain,  Headaches/migraines,                                                            Crying Spells, Depression, Sugar and food cravings,                                                                       Constipation, Dizziness and Night sweats.

So whats going on in our bodies to cause all this? Typically, as with so many problems in women’s health, there is no single causative factor, but a combination of several smaller imbalances that all trigger each other off.

Firstly, just looking at our hormones – oestrogen levels are declining and progesterone is on the up. This shift can affect some women very strongly. A popular theory is that at a time when progesterone should be high, in women with PMS, their oestrogen is actually still too high in relation to progesterone. Many of the physical symptoms such as water retention, breast tenderness and bloating can be attributed to oestrogen.

Secondly, as well as regulating the menstrual cycle, oestrogen and progesterone influence neurotransmitters such as serotonin which will then fluctuate throughout the menstrual cycle. Serotonin is just one of the several mood affecting neurotransmitters likely to be involved and can explain the panic attacks and severe depression and anger that some women experience.

Thirdly, stress is nearly always involved in some way. Although it is unlikely to cause it, it will undoubtedly worsen PMS symptoms. Overworking, not enough sleep or over worrying will all cause stress to pile up. One of the stress hormones, cortisol is thought to block progesterone receptor sites, thereby aggravating the oestrogen / progesterone balance.

The Chinese medicine approach is to look at the whole menstrual cycle. What’s going on the rest of the time? – does the diet support the liver in breaking down oestrogen for elimination and is stress being managed before ovulation for example.                               In acupuncture the first half of the cycle is ‘Yin’ This is a time for nourishing the body and mind, eating and sleeping well. The second phase between ovulation and bleeding is ‘Yang’ which represents movement, warmth and energy. PMS in acupuncture is sometimes seen as too much Yang rushing around the body causing mental and emotional upset so the aim is to ground this energy, and to keep in circulating round the entire body in a more balanced way. We do this by building up the Yin in the first half of the cycle so it is strong and abundant – so strong that in anchors the Yang later on!                 In other cases there is not enough Yang – and so the Yin starts getting sticky, heavy, sluggish and obstructs the Yang from coursing through the body. This leads to stagnation such as constipation, bloating and so the aim is to get the Yang / energy of the body freed up so it can zip through the body, moving all the sludge on the way.

I work with women of all ages to help combat the PMS once and for all. We follow a plan of acupuncture twice a month in between ovulation and her period. This really focuses on getting her yang moving evenly throughout her body and head, and this is the time to keep things moving physically with yoga or swimming. We change her diet slightly to support her Yin in the first half of her cycle and ask her to spend some time slowing down just with herself. I also add in herbs alongside Andrew Chevallier to really support a healthy progesterone / oestrogen balance. After 3 menstrual cycles a substantial improvement is nearly always seen, with most women not needing to continue with the acupuncture.

 

Painful periods – Dysmennorhoea

Woman of all ages regularly come to see me at the acupuncture clinic for help with pain around menstruation. A small amount of cramping and aching is normal on the first day, but for many the pain is unbearable and disrupts everyday life. Painful periods with no serious underlying causes is known as ‘primary dysmennorhoea’ – there is no obvious medical reason why this happens. Pain that is related to conditions such as endometriosis and fibroids is called ‘secondary dysmennorhoea’. This too responds well, though these conditions deserve a separate article to themselves.

In Chinese medicine, pain is seen as ‘stagnation’, and usually with severe period pain we call it ‘blood stagnation’. The underlying cause of this stagnation can be a combination of many things and the job of your acupuncturist is to work out what these may be. Acupuncture visualizes everything in the body in constant motion, slowly and gently. The pain results when the blood and Qi of the pelvis can’t move in the direction it needs to, instead it sits and creates a blockage like a dam, and as the pressure builds up you feel more and more discomfort.

I really see very good results using acupuncture, diet and lifestyle changes. My top tips for managing primary dysmennorhea are the following;

1. Acupuncture regularly – in the second half of the cycle. I usually ask to see my clients twice before their expected period starts. I needle directly on the lower abdomen and the legs using lots of heat to relax the muscles. Sometimes we also work on the lower back and sacrum too. It really doesn’t hurt. The needles just sit under the skin and once in place, the body responds to them by releasing a whole load of various substances which will aid in general pelvic circulation. You can’t usually feel this happening ( some women will be aware of tingling and warmth or muscles relaxing), but it takes around 20-30 mins which is why you will just be lying there listening to music and daydreaming.

2. Discourage ‘bad prostaglandins’ by reducing all meat and dairy produce –  small amounts can be taken (they must be organic). Prostaglandins are present in all cells of the body and most have a beneficial effect. There are a few that are related to constriction and inflammation and too much of these types will cause an imbalance. Women suffering with severe dysmennorhea are found to have higher levels of two particular types of prostaglandins known as PGF2 and PGE2. The fuel the body needs to make these ‘negative prostaglandins comes from arachidonic acid which is abundant in meat and dairy. So cutting these out will make it harder for the body to produce PGE2.

3. Encourage ‘Good Prostaglandins’ – To tip everything in our favour we need to add certain things into our diet. Lots of the ‘good prostaglandins’ will help the uterus contract beautifully and with ease. Adding in lots of oily fish, nuts, seeds and leafy greens will do this. You also need to have adequate amounts of certain vitamins and minerals in your diet so that your body can create these good prostaglandins. Everything should be present in a varied healthy wholefood diet, but if your diet is compromised you may need to take these as supplements short term to boost your levels.

4.  Pelvic stretches – absolutely essential for getting good circulation going. I have a set of yoga stretches I show to each woman that really get deep into the groin. There are plenty of short videos on You Tube for inspiration too. You want to be doing 10-15 mins every 2 days initially. The 5 days before your period you must do every day. Everyone can find time to do 10 mins – once you are familiar with the stretches you can do them in front of the TV in the evenings. After a few months you will probably not need to do them so often as the overall circulation has improved. The one exercise to avoid if you suffer from painful periods is of course sit-ups.

As with many things in natural and complementary medicine – it is the combination of a few small changes here and there which give dramatic results. In acupuncture we don’t accept that severe pain at menstruation is ‘normal’ and something to be put up with. Working with your body requires time and patience and a genuine desire to get to know yourself. Using the 4 interventions above, I see huge reductions in the monthly pain within 6-10 weeks. If you or someone you know suffers with debilitating cramps – please get in touch with the clinic to see how we can help you.

 

Links I like – healthy recommendations in Norwich

I always encourage my patients to make healthier lifestyle changes that will support their constitution and undo the effects of a stressful / sedentary routine. Below are the links to local individuals and groups who provide a honest healthy option in Norwich.

Yoga – yes from stress to insomnia to infertility, I’m always recommending yoga as a cheap and accessible way to improve circulation, calm the mind and get you functioning optimally. Lou Kitchener, Joss GuinJessica McKenna and Michelle Busettil all run excellent regular classes.

Healthy eating – Norwich Farmshare is a great option for locally grown organic veg in which you help support local trade. Norwich Market has an excellent organic fruit and veg shop and of course Rainbow Health Foods in the city centre provides a plethora of food free from GM and pesticides. Harveys are an organic butchers with a brilliant reputation.

Vitamins / supplements / body care - The Natural Food Shop opposite Jarrolds is my first choice. Not only is the stock of high quality but the staff all have additional training in what is and isn’t safe for you to take. Great for body lotions and creams that are free from parabens and sulphates. Simply Soaps are a local skincare company that I have used for years – again beautifully scented with essential oils and not much else!

Herbalist – I often advise people to try herbs – especially for skin and menopausal complaints. Andrew Chevallier is a first rate medical herbalist and has helped many of my patients and family members. Naji Malak uses Chinese herbs and again is absolutely superb and highly recommended.

Massage – Both San Jaspal and Jessica Carey come highly recommended and work in Norwich city centre. San switches between full body, reflexology and head massage which undoes weeks of stress every time.

Meditation –  Norwich Buddhist Centre runs regular drop in sessions for beginners and advanced, there are even short classes at lunchtime. There are also hundreds of short meditation videos on You Tube which can get you in the habit of switching off for 10 mins of the day.

Getting moving in nature – turning your mobile phone off and spending a little time out in the elements can have a wonderfully nourishing affect on the body. Try Strumpshaw Fen, Earlham Park, Marriots Way and Whittingham park for nearby nature.

Getting fit – there are plenty of running groups such as parkrun which do 5km every week. For cardio combined with FUN try zumba queen – seriously the most fun I have had in a long time. The UEA has a great swimming pool – another non time consuming way to keep fit at all levels.

Whether you’re a full time mum or full time office workaholic it”s important to take at least 10 mins of the day consciously doing something for yourself. It can be your short walk in the park at lunchtime – or a 5 min You Tube relaxation video when the kids are in bed. It all adds up. Your body wants to be healthy – it wants to be energised in the day and to sleep soundly at night. And if you’re not feeling that? Well then you definitely need to start making those tiny changes now!

 

What to eat according to Traditional Chinese Medicine

In Chinese medicine we believe how you eat and live has a direct effect on your overall well being and stamina. We also think there is no one super diet that suits all people – by looking at your symptoms, body type and lifestyle we will suggest which of the Chinese patterns fits your constitution and encourage you to eat appropriately. For us foods are not ‘good’ or ‘bad’, but they all have a specific effect on the body. Knowing what foods help or hinder your conditions are key to long term prevention and management of your health.

Starting with ‘Heat’ – heat often shows up as a fast pulse, short temper, headaches, red eyes, high stress levels, dark urine, inflammatory conditions, redness in the skin – especially the face, heartburn, yellow coating on the tongue, dry mouth, thirst and hunger, bleeding gums and short menstrual cycles. Heat moves things along – sometimes to quickly and diet is used to cool and slow down its effects.

Avoid: Coffee, alcohol in general especially wines and whiskies, chilli, beef and lamb.

Include plenty of the following: (generally fresh fruit and plenty of drinking water is good). Avocado, green leafy veg, salad veg, cucumber, green mung beans, rice, oats, bamboo shoot, banana, bitter gourd, clam, crab, grapefruit, persimmon, salt, seaweed, star fruit, sugar cane, water chestnut, watermelon, lotus root, cucumber, barley, bean curd, chicken, egg white, oyster, pear, peppermint, radish, strawberry, tangerine, and yoghurt, broccoli, cauliflower, courgette, corn, tomatoes, pineapple, turmeric, soya.

Herbal teas – nettle, camomile, peppermint, black tea

Food preparation: Steamed, boiled, raw

Exercise: Gentle tonifying like yoga, swimming, walking and cycling. Avoid over exercising.

Some ‘Heat’ conditions have an underlying deficiency of ‘Yin’ – or the natural cooling properties of the body. In these cases we look to add foods that build this coolness up rather than let off steam. A lack of Yin or moisture in the body might display a mixture of the above heat signs and the following; a thin narrow pulse, pale or cracked tongue, dry skin and hair, scanty periods, fatigue, dizziness, poor vision, night sweats, hot flushes, insomnia and a dry cough.

Include plenty of the following; Avocado, green leafy veg, salad veg, cucumber, green mung beans, rice, oats, barley, millet, fish, chicken, spirolina, chlorella, seaweeds, coconut, honey, royal jelly, black beans, kidney beans, sweet potato, root veg, blueberries, blackberries, mulberry, flax, pumpkins, sunflower, black sesame, pork, duck, lamb, eggs, oyster, fresh figs and dates, maca, banana

Food preparation: Keep foods well cooked and easy to digest. Minimise raw food preparation.

Exercising: Gentle restorative like yoga, walking and pilates. Avoid cardio exercise or that which makes you sweat. Make sure you get 8 hours min sleep / night or allow yourself an afternoon nap.

Yin Breakfast:

  1. Mash together – 1 ripe avocado, 1 teaspoon spirolina, 1 tablespoon flax oil, salt and pepper to taste and have on toasted rye bread.
  2. Poached eggs on rye toast with rocket and omega oils.
  3. Oat porridge with chopped pears, figs, dates, maca powder and cinnamon – use rice / nut milk.
  4. Yin smoothie:1 ripe pear, 1 ripe avocado, 1 teaspoon spirolina, 1 tablespoon protein powder and almond milk to taste.
Damp‘ conditions are sticky, heavy and sluggish. Modern food choices contribute to damp accumulation and combined with living in a damp northern hemisphere country, these conditions are the most common and yet often hardest to change since they involve the most abstinence!
Damp can be hot or cold, but it tends to show up in the body in the form of mucus. This might be in the respiratory system, the sinuses, the bowels or the reproductive system. It’s cloying and heavy nature creates muzziness in the head and limbs. In the acupuncture clinic we would look for water retention, bowel problems, weight gain, general fatigue, thick coating on the tongue, and sluggish metabolism.

What to avoid is more important with Damp providing the rest of the diet is balanced and healthy.

Avoid: Dairy, sugar, refrigerated foods, raw uncooked foods, bananas, peanuts, fried foods, beer, mushrooms,  vinegar, refined wheat products, iced water, chocolate.

The following are particularly helpful in supporting damp conditions:  rice, toasted oats, sourdough breads, buckwheat, millet, rye, root veg, pearl barley, aduki beans, alfafa, miso, garlic, onion, cinnamon, ginger, scallion, basil, rosemary, dill, oregano, sage, parsley, cardamom, nutmeg, fennel, anise, clove, coriander, leek, chives, turmeric, asparagus, leeks, stewed fruit- esp. pears,

Herbal teas : dandelion, fennel, ginger and lemon, licorice, nettle.

Food preparation:  Baked and grilled are ideal. Keep all foods well-cooked and chew food thoroughly. Use max 1 tablespoon oil if frying onions for stews. Do not drink water alongside meals – drink plenty before and after. Eat at regular time and never skip breakfast. Start the day with warm water and lemon.

Exercise: All types good for the damp condition though not excessive swimming. Avoid swimming if menstruating.

Lifestyle: Keep long hair dry outside, clothing completely dry, homes dry and well ventilated. Keep moving throughout the day – if doing sedentary work take full advantage of lunch break to walk around town.

Heat-Damp accumulation: Similar to cold-damp what you cut out usually provides the greatest benefit. Additionally avoid alcohol and excessive chilli. Include plenty of bitter and sour flavours.

Keep foods easy to digest, boiled, steamed, baked and grilled. Make sure salads if taken are at least room temp.

 

Examples of cooking for damp conditions:

Porridge made with water, cinnamon, ginger, almonds and chopped figs

Beans on toasted rye bread

Root vegetable stew with 1 tablespoon miso stirred in just at the end

Baked sweet potato with tomato and aduki bean stew

Tahini sauce – tahini mixed with lemon juice, salt and fresh garlic with oat cakes

Grilled fish, steamed greens and brown rice

Warm millet / quinoa salad with rocket, grilled chicken, spring onions and fresh herbs,

Yellow mung bean, carrot and butternut squash soup with turmeric, cinnamon and cumin

Mashed potato / root vegetables with olive oil, coconut cream, garlic and herbs

Baked polenta with ratatouille

Baked fruit stuffed with raisins / dates / nuts and live yoghurt

Chicken soup / casseroles / stews

Dahls with all pulses, grain and green vegetables