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	Menstruation/Pre-menstrual syndrome (PMS) What is menstruation? Menstruation is the monthly (usually 28-day cycle) shedding of the uterine lining. The blood and tissues leave the body through the vagina. Menstruation is a normal, natural process that occurs in all healthy adult women who haven't reached the stage of the menopause. Girls can begin to menstruate at any time between eight and eighteen; women might reach the menopause anywhere between forty and sixty. Some women have their period every eighteen days, some every thirty-six; some women bleed for two or three days, some for seven or eight; all these and everything in between are quite normal. The various cultures of the world have taken a wide variety of attitudes toward menstruation, seeing it as a sacred time, an unclean time, and everything in between. Western societies tend towards the "unclean" end of the spectrum. Menstruation is "the curse"; or something dirty.  There is a culture that we can watch pad and tampon ads on the television, but we can't let anyone know we're actually using them. Many women are embarrassed about their bleeding, an attitude which our society encourages.  But menstruation isn't a shameful thing, any more than eating or sweating or sneezing or urinating is. It's a normal process that happens to all of us. What is premenstrual tension? Premenstrual tension or PMT, also known as premenstrual syndrome (PMS), is a mixture of symptoms that women can experience for up to two weeks before each menstrual period. The bodily symptoms are accompanied by emotional changes, and PMT is more common in women over the age of 30 years. The symptoms usually stop when a period starts. No one knows the exact cause of PMT,  but some conclusions about it are: Hormone imbalance – lower levels of progesterone and higher levels of other hormones cause water retention and the characteristic bloated feeling. Food related – some people think that the symptoms may result from or be aggravated by a lack of nutrients such as vitamin B and magnesium, although there is not much evidence for this; yeast infections (such as thrush) have also been blamed for PMT. Occasionally, a problem with the ovaries or womb, such as a tumour, can produce symptoms that resemble PMT. Symptoms A long list of symptoms have been attributed to PMT/PMS. Symptoms tend to begin about a week to 10 days before the start of the next period. Some of the more common ones are: Bloated feeling Weight gain Distention or pain in breasts, back or lower abdomen Irritability Depression Sadness Aggression Anxiety and tension Tiredness Loss of concentration Headache Dizziness Insomnia Distention in sternocostal region Edema A more severe form of PMT/PMS is called premenstrual dysphoric disorder (PMDD), in which the emotional symptoms, such as depression, mood swings, anxiety and tension are exaggerated. It occurs in only a small percentage of women with PMT. If a woman goes to see her doctor with these symptoms, she is given a full examination by the doctor to check that no problems have developed with her womb or ovaries. No specific tests are available for PMT/PMS, but the doctor may take some blood tests to measure hormone levels. It may help the doctor if the woman keeps a diary of her symptoms before the first visit or between subsequent GP visits. If the doctor feels that a woman has PMDD, a referral may be suggested to a specialist.                                                                                                                                                   Back to top Treatment of PMT/PMS PMT/PMS is a debilitating disorder that can significantly affect the lifestyles of women. Many women tolerate it believing it to be a normal part of being female. PMT/PMS is, however, a treatable condition, and anyone with symptoms should consult their GP. Different women find that different remedies help and it may be that several have to be tried before finding something that is effective for the particular person. The symptoms tend to stop with the menopause or after a hysterectomy. A woman can do several things that to reduce the problems of PMT/PMS, such as: Do regular exercise, such as aerobics or jogging. It has been found that exercise helps with the symptoms, but it must be done all the time, not just when symptoms are present. Try to avoid stress at home and at work in the time before a period is due. Try to pinpoint and avoid any emotional triggers or stress that make the symptoms worse; discuss these with your partner or a friend and ask for their support. Some people have found that a diet high in protein and with vitamin B and magnesium supplements has helped, and others suggest a yeast-free diet. Medicines Many different remedies have been tried, which include: Evening primrose oil. Mefenamic acid, starting about 12 days before the next period and increasing the dose during each period. The combined oral contraceptive pill. Progestogens, taken for the week before the period is due. A weak diuretic (water tablet), taken for the week before each period helps to alleviate water retention. Mild tranquillisers can help reduce anxiety. Anti-depressants may be indicated in PMDD. Bromocriptine is especially good if breast tenderness is a major problem. Acupuncture and PMT/PMS Stagnation of Liver Qi Abdominal and breast distension and pain before the period, irritability, clumsiness, moodiness, depression, hypochondriac pain and distension, dizziness, headache, tendency to anger.Dark red (Dark red, purple suggest stagnation) tongue. Treatment would focus on soothinge the Liver, eliminating stagnation, removing obstruction in the channels to promote blood circulation. Phlegm fire harassing upwards Agitation, depression, slightly manic behaviour, aggressiveness, a feeling of oppression of the chest, a red face, blood shot eyes. Red with greasy yellow coat tongue. Treatment would be resolving phlegm, clearing heat, calming the mind. Deficiency of Heart and Spleen Premenstrual palpitations, restless sleep, lack of vitality with general weakness, cold limbs, excessive thin clear leucorrhoea. Pale with white coat tongue. Nourishing the Heart to calm the mind, reinforcing the Spleen to remove dampness treatment. Liver and Kidney Yin Deficiency Slight breast distension and irritability before the period, sore back and knees, dizziness, blurred vision, poor memory, insomnia, dry eyes and throat, five centre heat. Red without coat tongue. Treatment- nourishing the Liver and Kidney Yin. Spleen and Kidney Yang Deficiency Slight premenstrual tension with depression, slight abdominal and breast distension, premenstrual edema in the face and limbs, dizziness, listlessness, drowsiness, loss of appetite, loose stool, lassitude in the loins and legs. Pale and swollen with teeth marks, moist white coat tongue. Treatment plan: strengthen the Spleen and warm the Kidney.                                                                                                                                                Back to top