Managing PMS with TCM

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By Lauren Barrett, L.Ac, MSTOM

While awareness of PMS (Premenstrual Syndrome) is widespread, most do not fully understand the condition. The undesirable physical and psychological symptoms that women of reproductive age may experience during their luteal phase, around ten to fourteen days before their period, are attributed to PMS. Irritability, anxiety, depression, emotional lability, anger, difficulty concentrating are common psychological symptoms associated with the condition. However, PMS can also present physically as food cravings, bloating, nausea/vomiting, cramping, back pain, breast tenderness, abdominal discomfort, constipation, insomnia, migraines, and fatigue. Some women may also notice an aggravation of existing muscular/skeletal/joint pain, low immunity, and/or low-grade fevers. PMS symptoms can vary in intensity and severity, from woman to woman, and from month to month and occur in seventy-five percent of women. [i] Premenstrual Dysphoric Disorder (PMDD) is a more extreme presentation of PMS characterized by severe and disabling symptoms, affecting five percent of women. [ii]

What causes PMS?

The menstrual cycle involves a careful orchestration of hormones, particularly estrogen and progesterone, which are released from the ovary over the course of the cycle to thicken and prepare the uterine lining to receive an embryo. One likely contributor to PMS is “estrogen dominance”, which refers to excessive amounts of estrogen in relation to progesterone in the luteal phase. This can occur when estrogen is normal, but progesterone is too low in the luteal phase or when estrogen levels are too high. Elevated estrogen levels can be caused by a number of factors including impaired liver function and digestive issues (it is the liver’s job among other digestive system organs to break down and rid the body of extra Estrogen), chronic stress, environmental exposure to hormone disruptors, and gynecological conditions like PCOS, endometriosis or perimenopause. When estrogen is too high in the presence progesterone, it affects hormone-sensitive tissue like the breasts, gut, and brain. In the brain, estrogen and progesterone affect serotonin and GABA levels. [iii] When progesterone is low, GABAergic pathways may be negatively affected resulting in symptoms of anxiety, depression and insomnia. [iii] Progesterone levels also affect dopamine

While the balance of estrogen and progesterone levels are important, the gross fluctuation of these hormones is also significant. The sudden drop of estrogen and progesterone levels responsible for the shedding of the uterine lining (one to two days before the period begins) often causes physical symptoms such as cramping and migraines from the withdrawal. Additionally, prostaglandins released in the uterus in women who experience severe cramping can cause diarrhea due to the close proximity of the bowel. [iv] 

How to Manage PMS 

The menstrual cycle should not be correlated with intense suffering. Because so many women experience PMS symptoms, most assume it is normal and don’t seek help. Diet and lifestyle choices can heavily influence hormone balance and therefore PMS symptoms. Supplements, herbs, and acupuncture can help too.

Dietary Recommendations

1.     Avoid or reduce alcohol, caffeine, and refined sugar

2.    Eat more cruciferous vegetables. 

Broccoli, kale, Brussels sprouts, cauliflower, and cabbage, contain phytochemicals such as Indol-3-carbinol which increase the metabolism of estrogen by the liver. [v]

3.    Emphasize foods high in Magnesium, Zinc, and Iron or incorporate these as supplements. 

4.    Follow a low animal fat, high fiber diet, which has been shown in studies to lower estrogen levels in the blood without affecting ovulation. [vi]

5.    Supplement with Vitex (Chaste Tree berry), which contains dopaminergic substances as well as compounds that influence the pituitary gland and may help progesterone production, which can reduce PMS symptoms. [vii] 

Lifestyle Recommendations

Reduce Stress 

Incorporate mindfulness practices into your daily routine, such as meditation, yoga, and breathing exercises.  Under stress, the adrenal glands produce excess cortisol. Chronic stress disrupts the Hypothalamic-Pituitary-Adrenal Axis (HPA) and prioritizes cortisol production over sex hormones (Estrogen and Progesterone). Stress also reduces the liver’s function to eliminate excess Estrogen. Because of this disruption, stressful or intense emotional events during the course of the cycle have the ability to throw off ovarian function, in turn affecting the cycle and hormone balance. 

Sleep

Sleep is necessary for the body to repair, recover, and renew and depriving the body of sleep is thought to affect hormone balance. Unplug and get at least seven to eight hours of sleep.  If you struggle with insomnia, acupuncture and targeted herbal therapy may help.

Exercise 

Exercise has been shown to improve mood, stabilize blood sugar, and reduce PMS in women.  In Chinese Medicine, PMS symptoms are often attributed to stagnation in the body, so it makes sense to move your body to improve overall circulation, mood, and wellbeing. 

Reduce Hormone Disruptors 

Modern day environmental factors are also a leading cause of estrogen dominance. Environmental factors that interact with the endocrine system are called Hormone or Endocrine Disruptors. Our skin is the largest organ of our bodies. Take a moment to think about everything you put on your skin on a daily basis and what you come in contact with regularly. Often unavoidable, these chemicals can be found in our everyday products such as detergents, beverage and food packaging, toys, plastics, cosmetics, and pesticides. Look out for and avoid products with phthalates (may be listed as DEP, BPA, DHEP,DBP, DEP), PFCs (perfluorinated chemicals), pesticides containing DDT, and flame retardants. Although complete avoidance of these substances is unrealistic, limiting exposure as much as possible is helpful. It may take an extra moment to check labels, but your body will thank you!

Acupuncture and Chinese Medicine 

Acupuncture and Chinese Medicine balance internal regulatory systems such as the nervous system, the endocrine system, and the neuroendocrine system.  Studies show that acupuncture effectively treats and manages PMS symptoms. In a study comparing pharmaceutical treatment with acupuncture, women who received acupuncture were 1.5 times more likely to have PMS symptoms improve compared to those on hormonal medications. [i] Acupressure, was also studied to relieve PMS. In a clinical trial, applied pressure to specific acupuncture points was found to decrease the severity of PMS symptoms, decrease anxiety and depression, and improve quality of life measures. [viii] 

In addition to acupuncture, Chinese herbal medicine can relieve symptoms related to PMS.  A recent study showed that several months of Chinese Herbal therapy successfully reduced the severity and occurrence of physical and psychological PMS symptoms. [ix] 

Think of these signs and symptoms as a signal. This pain and discomfort is the body communicating that there is an imbalance within. Take this time to listen to the body without judgement and treat it with the respect and care it deserves. 

  

i.  Kim, S., Park, H., Lee, H., & Lee, H. (2011). Acupuncture for premenstrual syndrome: A systematic review and meta-analysis of randomised controlled trials. BJOG: An International Journal of Obstetrics & Gynaecology, 118(8), 899-915. doi:10.1111/j.1471-0528.2011.02994.

ii. Pinkerton, J. V., MD. (2017, September). Premenstrual Syndrome (PMS) - Gynecology and Obstetrics. Retrieved from https://www.merckmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/premenstrual-syndrome-pms

iii. Barth C, Villringer A, Sacher J. Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Front Neurosci. 2015;9:37. Published 2015 Feb 20. doi:10.3389/fnins.2015.00037

iv. Csapo Al: A rationale for the treatment of dysmenorrhea. J Reprod Med 1980; 25:213-221.

v.  https://www.sciencedirect.com/topics/medicine-and-dentistry/indole-3-carbinol

vi. Bagga D, Ashley JM, Geffrey SP, et al. Effects of a very low fat, high fiber diet on serum hormones and menstrual function. Implications for breast cancer prevention. Cancer. 1995;76:2491-2496.

vii. Rafieian-Kopaei, M., & Movahedi, M. (2017). Systematic Review of Premenstrual, Postmenstrual and Infertility Disorders of Vitex Agnus Castus. Electronic physician9(1), 3685-3689. doi:10.19082/368

viii. Bazarganipour, F., Taghavi, S., Allan, H., Beheshti, F., Khalili, A., Miri, F., . . . Salari, S. (2017). The effect of applying pressure to the LIV3 and LI4 on the symptoms of premenstrual syndrome: A randomized clinical trial. Complementary Therapies in Medicine, 31, 65-70. doi:10.1016/j.ctim.2017.02.003

ix. Chou, P., Morse, C., Xu, H., & Wiebrecht, A. (2009). A Controlled Trial of Chinese Herbal Medicine for Premenstrual Syndrome. Deutsche Zeitschrift Für Akupunktur, 52(1), 53-54. doi:10.1016/j.dza.2009.02.011 

Menopause: The Second Spring

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By Lauren Barrett, L.Ac, MSTOM

In Chinese Medicine, women are said to age in seven-year cycles. The seventh cycle (age 49), referred to as ‘Second Spring’, is approximately the age when a woman reaches menopause. At this stage in a woman’s life, the creative energy shifts from providing resources for a new being to conserving, sustaining, and nourishing her own body.

Menopause is a natural biological event that signifies the end of the menstrual cycle. Guided by the wisdom of the body, this natural progression helps to balance its systems. A woman reaches menopause when menstruation ceases for one full year. Leading up to menopause and one-year following is a process referred to as perimenopause. Most of the undesirable symptoms that women associate with menopause occur during this phase. 

Acupuncture and Chinese Herbal Medicine provide a holistic approach to manage and treat signs and symptoms associated with menopause.  Similar to menstrual irregularities, menopausal signs and symptoms have become normalized, but they are not something one must suffer through. While menopause is homeostatic by nature, it can exacerbate pre-existing imbalances, presenting as hot flashes and night sweats, vaginal dryness, insomnia, emotional disturbance, weight gain, and migraines. 

Menopause is an event that occurs within the endocrine system, but its symptoms involve many other areas of the body. Research studies show that acupuncture affects internal regulatory systems, including the endocrine, neuroendocrine, and sympathetic nervous system.[i] This is important when it comes to treatment of menopausal symptoms because the occurrence, intensity, and severity of these symptoms involve an interaction of all three of these systems. In a randomized controlled trial, acupuncture treatment was found to significantly reduce hot flash frequency and severity as well as improve sleep, anxiety, memory, and mood compared to no treatment in menopausal women.[ii]Unlike most therapies, acupuncture addresses the entire being and helps to balance the body and mind. It was also studied to stimulate endorphin release and possibly other neurotransmitters including dopamine and serotonin, which can enhance mood. [iii]

Embrace your Second Spring! Menopause offers a challenge and a chance to transform the condition of your health and accept the beautiful process of transition. Adopting more sustainable and supportive lifestyle and dietary changes in addition to Acupuncture and Herbal medicine can significantly prevent and relieve symptoms associated with Menopause. 

 

[i] Stener-Victorin, E., & Wu, X. (2010). Effects and mechanisms of acupuncture in the reproductive system. Autonomic Neuroscience, 157(1-2), 46-51. doi:10.1016/j.autneu.2010.03.006

[ii]  Avis, N. E., Coeytaux, R. R., Isom, S., Prevette, K., & Morgan, T. (2016). Acupuncture in Menopause (AIM) Study: a Pragmatic, Randomized Controlled Trial. Menopause (New York, N.Y.)23(6), 626–637. http://doi.org/10.1097/GME.0000000000000597

[iii] Cheng, K. J. (2014). Neurobiological Mechanisms of Acupuncture for Some Common Illnesses: A Clinicians Perspective. Journal of Acupuncture and Meridian Studies, 7(3), 105-114. doi:10.1016/j.jams.2013.07.008

PGS Testing in a Nutshell

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Opinions on Embryo Screening from an Integrative Perspective

By Mary Sabo, L.Ac. DACM

Patients undergoing a cycle of In Vitro Fertilization (IVF) have the option of screening embryos using a process called Preimplantation Genetic Screening.  PGS testing involves analyzing the number of chromosomes in a few cells of an embryo to determine if it contains the correct number of chromosomes (normal or “euploid”) or the wrong number (abnormal or “aneuploid”).  Aneuploid embryos may contain too many chromosomes (trisomy) or too few (monosomy) and when transferred often lead to miscarriage or failed implantation.  Occasionally, an embryo is “mosaic” and has both normal and abnormal cells, which is also not ideal for transfer.  Another version of testing called PGD (Preimplantation Genetic Diagnosis) looks for specific genes in an embryo that may put a baby at risk for severe inherited health issues such as cystic fibrosis or other genetic diseases. 

PGS testing is a way to improve the likelihood that a normal embryo will implant and develop into a healthy baby.  The technology has been around since the 90’s, but has come a long way in the past 5 years.  Initial PGS testing was done on embryos that were 3 days old (when an embryo is a ball of only 6-8 cells).  It required extracting a few cells, so it ran the risk of damaging the embryo and, due to the early stage of development, was not always accurate.  Currently, testing is done when an embryo is a blastocyst (5-6 days old) when there are enough cells for it to start to differentiate into three regions: an outer shell, the eventual placenta (trophectoderm), and the inner mass (which will become the fetus).  The sample is taken from the trophectoderm so damage to the embryo is less likely. 

When and why should you test?

Women of all ages produce abnormal embryos.  While it is more likely that women over the age of 35 will have a higher number of aneuploid (abnormal) embryos in an IVF cycle, women in their 20s still produce a percentage of abnormal embryos each cycle during an IVF.  If you ask 10 different doctors about whether or not to test embryos, you may hear 10 different opinions.  Some clinics advise testing all embryos.  Other clinics advise against testing, especially in younger patients.  Some let the patient choose.  Why?  Cost can be a factor. A batch of biopsied embryos can add thousands to an already expensive IVF process.  There is also some speculation that some embryos that test mosaic  (abnormal and normal cells) might be able to self-correct over time.  While there are a handful of cases that may support this as a possibility, the overwhelming evidence suggests that the newest technology for testing blastocysts called Next Generation is accurate and trustworthy. 

One major benefit of testing embryos is getting a better understanding of a couple’s fertility struggles.  If a batch of embryos tests better than average (50%), it can be assumed problems conceiving are potentially caused by something other than egg quality.  If the embryos test mostly or all abnormal, it can be assumed the cause of infertility is egg quality and using donor eggs or another round of IVF might be recommended.  If a clinic performs more than two transfers with “normal” embryos and there is still lack of implantation or early pregnancy loss, further testing may be needed to check for uterine abnormalities, blood clotting, or immune issues, hidden infections, or endometriosis.  Another benefit of testing embryos is screening to rule out certain genetic diseases.  If either partner is a carrier of a genetic disease, the embryos can be screened for that disease using PGD. 

Screening embryos also results in fewer miscarriages and reduces the occurrence of multiples (twins, triplets). When embryos have been screened, most doctors transfer single embryos resulting in singleton pregnancies. While twins and triplets are appealing to some couples, multiples pregnancies are much more dangerous for both the mother and babies.

PGS testing is recommended for women over 35 and for couples who wish to reduce the risk of miscarriage.  Women under 35 or those who produce a lot of embryos may also want to test to help decide which embryos are ideal to transfer.  While it can add costs to an already expensive process, miscarriages and subsequent transfers are also costly, as well as emotionally difficult and time-consuming. 

The Basics of Egg Freezing

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By Mary Sabo, L.Ac, DACM

On average, women in developed countries are delaying childbearing until later in life.[i]Many modern women are waiting until their 30s and early 40s to start a family in order to focus on their careers, gain financial stability and find the right partner.[ii]Women who learn to take excellent care of their bodies and health can sometimes delay the appearance of aging and feel great, but unfortunately eggs and ovarian function decline whether they are in perfect health or not, and the age at which they decline can, unfortunately, be unpredictable. 

In Chinese medicine, we support fertility naturally using herbs, acupuncture, and dietary and lifestyle changes. We help women conceive with these tools either alone, or in conjunction with assisted reproductive techniques like In Vitro Fertilization (IVF) and Intra Uterine Insemination (IUI). Acupuncture and herbs can improve hormone balance and overall health, which optimizes fertility at any age. However, the biggest determinant of conceiving a healthy child is the chromosomal quality of eggs and sperm, which declines naturally as we age. We now know that the uterus can remain healthy and able to carry a baby long after the ovarian health and egg quality prohibits pregnancy. For this reason, egg freezing has become a popular option for women to preserve their younger egg health for use later in life. It’s a type of fertility insurance. Egg freezing is more affordable than ever and new advances in techniques have made it more reliable, improving outcomes. 

Plenty of women conceive easily in their thirties and early forties, but the likelihood of struggling with fertility at this age is higher.[iii]Screening for infertility in women not trying to get pregnant is not yet standardized in our medical system and many couples who struggle to conceive are “unexplained”, meaning that all tests look normal but pregnancy is still not possible. Conceiving as an older woman can become a bit of a gamble then. Miscarriage rates are higher in this population and the reasons for both higher rates of infertility and miscarriage are commonly the “quality” or chromosomal makeup of the eggs and sperm. Researchers are exploring ways to influence this chromosomal content, and it is suspected that some agents like antioxidants can influence the overall health of the egg, which can potentially improve the quality, but currently the biggest determining factor is age. The older a woman gets, the more eggs in her ovaries mature with chromosomal abnormalities. Until we understand how to directly influence this development predictably and reverse the effects of aging on eggs, the best way to preserve them is to extract and freeze them when we are young.  

Currently, there is no test to determine egg quality. There are some tests to determine the health of the ovary and the “ovarian reserve”, but they do not assess the health of the chromosomes inside the eggs. According to Reproductive Endocrinologists at CCRM New York and authors of Truly-MD.com, Dr. Jaime Knopman and Dr. Sheeva Talebian, the ideal time to freeze eggs is between 30-34 years of age. Freezing at a younger age, in theory, will produce healthier eggs, but you’ll pay more over time to keep those eggs frozen longer as facilities charge an annual “rent” for your frozen eggs. You also may not need them. Waiting until later means more eggs may be abnormal. However, if you are older than 34 and having a child is nowhere in sight, it’s worth discussing your options with an RE. Egg freezing is insurance, not a guarantee, but it is the only option for women who know they’d like to have a family one day, but it’s taking a bit longer to feel ready than they expected. 

If you are considering freezing your eggs, you can take some steps now to improve your health and potentially optimize the health of your eggs. Dr. Knopman and Dr. Talebian recommend stopping smoking, decreasing alcohol use, and increasing foods that are high in antioxidants for three months before your egg freeze cycle.  I also work with women in those three months before their egg freeze cycles to optimize overall health and egg quality with acupuncture, customized dietary and lifestyle changes, and customized supplement and herbal plans. Because fertility potential and egg health cannot be determined until a woman starts trying to conceive, there is no way to know your fertility status or egg quality, but you can absolutely maximize your chances of freezing healthy eggs with the right support and empowering changes. 

 

[i]Matthews TJHamilton BE. NCHS Data Brief.Delayed childbearing: more women are having their first child later in life. 2009 Aug;(21):1-8. 

[ii]Hammarberg K1, Clarke VE. Reasons for delaying childbearing--a survey of women aged over 35 years seeking assisted reproductive technology. Aust Fam Physician.2005 Mar;34(3):187-8, 206.

[iii]Baird DTCollins JEgozcue JEvers LHGianaroli LLeridon HSunde ATempleton AVan Steirteghem ACohen JCrosignani PGDevroey PDiedrich KFauser BCFraser LGlasier ALiebaers IMautone GPenney GTarlatzis BESHRE Capri Workshop Group. Hum Reprod Update.2005 May-Jun;11(3):261-76. Epub 2005 Apr 14.