PMS: Premenstrual Syndrome from Chinese Medicine Point of View (PART1)

It is thought that more than 90% of women who have their monthly periods experience premenstrual symptoms. The list of PMS symptoms is long and it varies from one person to another depending on factors such as one’s body constitution and health state. The symptoms can be physical or emotional. 

Among the physical symptoms that you can experience are joint or muscle pain, abdominal pain/cramp, headache, fatigue, weight gain related to fluid retention, abdominal bloating, tender breast, acne flare-ups,change of bowel movement pattern, constipation or diarrhea. As for the emotional symptoms, you can suffer from tension or anxiety, depression, crying spells, mood swings, irritability or anger, appetite changes or food cravings, compromised sleeping quality and poor concentration.

Exactly what causes premenstrual syndrome remain unclear, Common causes from modern medicine’s point of view included:

  • Hormonal imbalance or cyclic changes in hormones. Modern medicine believes that hormonal fluctuations can trigger premenstrual syndrome It also believes that PMS may reduce or disappear with pregnancy. 
  • Chemical changes in the brain.  Another possible reason for PMS is the fluctuations of serotonin. Serotonin is a brain chemical (neurotransmitter) that plays a crucial role in mood states and could trigger PMS symptoms. Modern medicine believes that insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.

From a TCM point of view, PMS is mainly rooted in the change or disruption of yin yang balance during the menstrual cycle. It  also reflects the patient’s body imbalances.  Patient who has blood stasis, Qi or blood deficiency, or imbalance of a particular organ system, like liver and kidney system, may suffer from more severe PMS symptoms

Pain is one of the most common PMS symptoms experienced by women. From Traditional Chinese medicine ‘s POV, pain such as cramps, lower back pain, breast tenderness and others can be simply categorized into 2 types which are:

  • Pain caused by blockage or interrupted flow of qi and blood
  • Pain due to lack of nourishment, which is normally associated with suboptimal blood profile, or lack of energy in certain organ system

As a rule of thumb, the pain caused by blockage is more sharp and intense, and those caused by energy and blood deficiency tend to be milder and more chronic.

Abdominal Pain & Cramps

A very common menstruation related symptom is lower abdominal pain or cramps.  It can happen up to 2 weeks before the 1st day of menstruation, and can linger till 3rd or 4th day of menstruation. It can be a persistent mild aching which happens around the 1st day of menstruation flow. When this happens, it is mainly induced by a hormone (called prostaglandin ) which triggers muscle contractions in your uterus and expels the lining. Meanwhile, qi and blood deficiency could be the cause if the pain is heavy during menstruation. 

 If the abdominal pain is sharp, unbearable, or extremely heavy,  it is mostly due to blockage in the uterus or abdominal area.  Common causes include trapped coldness in the uterus, or blood stasis or blood clot in the reproductive system.  It may also be secondary to other medical conditions such as

Endometriosis. This is a painful medical condition in which cells from the lining of the uterus grow in other parts of the body, usually on the fallopian tubes, ovaries, or tissue lining the pelvis.

Fibroids in the uterus. Fibroids are noncancerous tumors that can put pressure on the uterus or cause abnormal menstruation and pain, though they often don’t cause symptoms.

Pelvic inflammatory disease (PID). PID is an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted bacteria that cause inflammation. 

TCM normally treat these pain conditions through addressing the root cause and strengthening the patient’s general body constitution. Maintaining and restoring the Yin Yang balance is also a treatment target. 

Lower Back Pain

Heavy contractions (induced by hormone) during menstruation can lead to low back pain, as the pain can radiate from the lower abdomen into the low back. Women with endometriosis  or PID may also experience more severe low back pain during the menstrual cycle.

From a TCM point of view,  lower back pain is closely related to the qi deficiency of the kidney system.  In our clinical practice, our traditional Chinese medicine practitioners’ common approach to address this is to enhance the energy of the kidney system through herbal medicine, acupuncture and/or moxibustion. 


As for headache experienced in association with PMS, here is a quick summary of its causes, symptoms and ways to relieve it.

Causes: Stagnation of liver qi

Symptoms: Distending or pulsating pain on one side of the head, accompanied by emotional depression, chest stuffiness and occasional belching

TCM’s method to relieve the pain: Soothe the liver, relieve stagnation, regulate qi and stop pain

Causes: Hyperactivity of liver yang

Symptoms: Distending pain in the head, accompanied by dizziness, blurred vision, ear ringing, irritability, insomnia, mouth dryness and flushed face

TCM’s method to relieve the pain: Calm the liver, subdue yang and nourish yin

Causes: Blood stasis obstructing the collaterals

Symptoms: Persistent and steady headaches, pricking or pulsating pain, accompanied by forgetfulness and palpitations

TCM’s method to relieve the pain: Activate blood, unblock collaterals and stop pain

Causes: Retention of coldness and static fluid

Symptoms:Headaches with cloudiness and heaviness sensations, or feel like a tight band around the head, accompanied by distention in the chest and upper abdomen, nausea or vomiting, excessive sputum, stomach upset that tends to be alleviated by warmth, cold limbs, no appetite and fatigue

TCM’s method to relieve the pain: Warm the middle burner and restore its normal qi flow, eliminate dampness and resolve phlegm.

Watch out for the second part of this PMS blog series wherein our Chinese medicine practitioners Dr. Clara Chan and Dr. Michelle Zhang will extensively cover how yin yang imbalance causes PMS. They will also cover in the next blog their first hand success stories of treating patients with PMS and helping improve their chances of fertility.

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