Most women of reproductive age experience at least mild premenstrual symptoms at some time in their lives (O’Brien 1987). However, around 2–10% of women have premenstrual symptoms that severely disrupt daily living (O’Brien 1987, DTB 1992, Wittchen 2002). These more troublesome symptoms are usually termed ‘premenstrual syndrome’ (PMS), if they comprise recurrent psychological and/or physical symptoms that occur specifically during the luteal phase of the menstrual cycle and usually resolve by the end of menstruation (O’Brien 1987).
Diagnosis of PMS is based on the presence of at least five symptoms, including one of four core psychological symptoms, from a list of 17 physical and psychological symptoms (Steiner 2001; Freeman 2001). The 17 symptoms are depression, feeling hopeless or guilty, anxiety/tension, mood swings, irritability/persistent anger, decreased interest, poor concentration, fatigue, food craving or increased appetite, sleep disturbance, feeling out of control or overwhelmed, poor coordination, headache, aches, swelling/bloating/weight gain, cramps, and breast tenderness.
The cause of PMS is unknown, but hormonal and other factors (possibly neuroendocrine) probably contribute (Rapkin 19917; O’Brien 1993). The aim of conventional treatment is to improve or eliminate physical and psychological symptoms; to minimise the impact on normal functioning, interpersonal relationships, and quality of life; and to minimise adverse effects of treatment (Kwan 2009).
Drugs such as spironolactone, valprazolam, metolazone, NSAIDs, buspirone and gonadorelin analogues are used to treat the main physical and psychological symptoms of PMS (Kwan 2009). Surgery is indicated only if there are coexisting gynecological problems.
Freeman EW, Rickels K, Yonkers KA, et al. Venlafaxine in the treatment of premenstrual dysphoric disorder. Obstet Gynecol 2001;98:737–44.
Kwan I, Onwude JL. Premenstrual syndrome. Clinical Evidence. Search date July 2009
Managing the premenstrual syndrome. DTB 1992; 30: 69-72.
O’Brien PMS. Premenstrual syndrome. Oxford: Blackwell Scientific Publications, 1987.
O'Brien PMS. Helping women with premenstrual syndrome. BMJ 1993;307:1471–1475.
Rapkin AJ, Morgan M, Goldman L, et al. Progesterone metabolite allopregnanolone in women with premenstrual syndrome. Obstet Gynecol 1997;90:709–14.
Steiner M, Romano SJ, Babcock S, et al. The efficacy of fluoxetine in improving physical symptoms associated with premenstrual dysphoric disorder. Br J Obstet Gynaecol 2001;108:462–8.
Wittchen H-U et al. Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psych Med 2002; 32: 119-32.
How acupuncture can help
A systematic review (Cho 2010) located ten randomised controlled trials and found some evidence to suggest acupuncture reduces PMS symptoms. However, trial quality was generally poor and further studies are needed to confirm this. (See table overleaf.)
Acupuncture may help reduce symptoms of PMS by:
- increasing relaxation and reducing tension (Samuels 2008). Acupuncture can alter the brain’s mood chemistry, reducing serotonin levels (Zhou 2008) and increasing endorphins (Han, 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states.
- stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987, Zijlstra 2003, Cheng 2009);
- reducing inflammation, by promoting release of vascular and immunomodulatory factors Kavoussi 2007, Zijlstra 2003).