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premenstrual syndrome, pms

premenstrual syndrome, pms

by sara gottfried, md
Live Healthy | Tips


yoga, not prozac
The corporate pharmaceutical industry would like you to believe that we need to fix the irritability and mood swings that most of us experience in our “moon phase,” or the two weeks before menses. However, integrative women’s medicine and yoga both offer a holistic approach for philosophically and physiologically managing premenstrual syndrome (PMS).

Eighty percent of reproductive-aged women experience PMS, which includes depressed mood to anger, bloating, and breast tenderness. Generally, PMS most profoundly affects intimate relationships, although a woman’s focus and equanimity at work and elsewhere may also be altered. The cause is not yet understood, which makes the wide use of selective-serotonin reuptake inhibitors such as Prozac (repackaged for PMS as Sarafem), Zoloft and Paxil all the more suspect.

If you’ve discussed PMS with your medical provider, perhaps you’ve encountered a more enlightened approach, which may include the bio-psychosocial model of women’s health; that is, we live in a culture that maligns menstruation as unclean, painful, and a failure of the fertilization process. Open a women’s magazine and you’ll find new oral contraceptives with the promise that “you only have to bleed four times a year.” We’ve inherited the belief that we become hormonal before the start of our menses, and that the mood swings are separate from the environment we’ve created for ourselves. In sum, many of us live in culturally-sanctioned unconsciousness about the message PMS may be offering us.

Another view, espoused by integrative gynecologist Christiane Northrup, MD, is that PMS is a message from your body to reclaim your Self. Dr. Northrup states, “What happens if, during our childbearing years, we ignore our cyclic nature, disconnect from the body’s wisdom, and attempt to function as though we were linear beings, with the same drives, the same focus, and the same aptitudes day after day? Very often PMS happens.

“With its physical and emotional discomfort, PMS is one way a woman’s body elbows her every month to remind her of the growing backlog of unresolved issues accumulating within her. Everything from unbalanced nutrition to unresolved relationships can disrupt the normal hormonal milieu, wreaking physical and emotional havoc during the childbearing years. Ignoring these early, relatively gentle nudges month after month sets her up for sharper and more urgent messages. Inconvenient as they are, these pains are our allies begging us to look up and see what’s not working in our lives.”

Dr. Northrup’s view is aligned with the fundamental yogic tenet that life is a journey toward the True Self, an archetypal trip to the center of your being. Through yoga, we develop witness consciousness or, as referred to by Patanjali in the Yoga Sutras, the “Seer.” For most women, the moon phase is the time of the month when they feel most intuitive, insightful and reflective. This may be the ideal time for “clear seeing” or awareness. We can numb the raging parts of our selves with medications or we can see them, hear their truths and learn their wisdom. PMS calls us to yoga – not just to the asanas, but to yoga in the context of ethical, lifestyle and eating practices, meditation and breath work. As in all Eastern traditions, yoga tells us that if you are not creating the right conditions to unfold and discover your full potential, you will suffer.

When I was trained in obstetrics and gynecology, I internalized the model that Prozac was the most efficacious treatment for PMS. When I critically reviewed the literature to support its use, I discovered that the statistical improvement in mood experienced by women with PMS treated with Prozac broke down into a change from about 3 to 5 on a 10 point scale. This is a 20% improvement, but are women really better? While I have had patients with severe PMS or Premenstrual Dysphoric Disorder (an entity defined by the psychiatric community and influenced by the pharmaceutical industry) tell me that they feel much more able to roll with the punches of their moon phase, I have had far more women complain about their nonexistent libido, headaches, and generally feeling “numbed out” on SSRIs. A more evolved approach may be to ask yourself:

• How’s your sleep? Are you restoring yourself all month long, especially in your moon phase?

• How’s your nutrition? Is your diet a healthy balance of complex carbohydrates, protein and fats? Are you getting enough essential fatty acids, shown to improve mood? Are you getting calcium. at least 1200mg per day, which has been shown to be as beneficial as prozac for some PMS symptoms? Do you have premenstrual carb cravings, and what message may that be giving you?

• How’s your personal yoga practice and/or other exercise serving you? Do you need to ramp up the frequency pre-menstrually (5-6 times/week: frequency helps PMS, not intensity)? Does your yoga practice reflect your cycle with more vigorous asanas and pranayama at ovulation, and more restorative before and during your period?

• How’s your socially connectivity? Do you have a confidante?

• Do you want to try nonprescription therapies for the next three months and keep a symptom diary? What’s been proven to be beneficial in randomized controlled trials but without the adverse effects of SSRIs is an ancient herb named chastetree. Listen to the message PMS offers you.

Let PMS guide your path to find growth and wholeness through your cycle, both on and off the mat.





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