A Short Primer On The Physiology of the Menstrual Cycle

PART TWO

PMS - Premenstrual Syndrome

Definition of PMS
Reoccurrence of symptoms in Pre-Menstruation with the absence of similar symptoms in Post-Menstruation.

Clinically Defining PMS
The symptoms must increase in severity from ovulation until menstruation, and must be relieved at the onset of a full flow. These same symptoms must be absent in the Post-Menstruation phase.

Note: dysmenorrhea is not considered PMS.

· During Ovulation there is an increase in the level of progesterone. Progesterone is "species specific", it has different functions in different species.

· 70% of woman get PMS S/S. According to studies begun in 1953, there has been an increase of PMS over the last 30 or 40 years.

Testing for Hormones
Serum test is very expensive. The sex hormone binding globulin (SHBG) carries Estrogen. When Progesterone is low the SHBG is also low. A count below 50 is clinically diagnostic of PMS. When given Progesterone the SHBG should rise.

Basal Temperature Chart
The temperature will gradually rise after the period flow and spike at Ovulation. (If no PMS s/s)

Birth Control Pills
Contain higher amounts of progesterone (derived from testosterone). This will create an increase of progesterone in the body and cause a suppression of a woman's natural progesterone. This in turn can worsen the PMS Symptoms.

Pre-disposition to PMS
· After 1 pregnancy - 78%
· After 4 pregnancies - 100%
During pregnancy progesterone production is increased 10-15 times. This causes the woman to feel good. Sometimes there is an alleviation for rheumatoid arthritis.

Puberty
Early menses increases the chances for breast cancer (more estrogen produced) Occasional use of Progesterone cream can stabilize the emotions very rapidly.

Post Natal Depression
Lack of progesterone. Take 1/4 tsp. Progonol 6X day and it can change in a short time.

PMS Symptom Percentages
Emotional swings including depression - 71%
· Irritability - 56%
· Tiredness - 35%
· Headache - 33%
· Bloating - 31%
· Breast tenderness - 21%
· Tension - 19%
· "Violence" - 13%
· Anxiety/Panic - 5%
· Food Craving - 4%
· Misc. (migraines, asthma, sinus, UTI) - 3%
· Sleeping disruptions are also common
Symptoms can vary each month depending up stress levels.

Stress
Causes cortisol production to rise (fight and flight reaction) Increased stress causes the amount of progesterone to drop, which in turn leads to a rise in insulin, which in turn produces sugar swings, which affects emotions. Blood sugar levels are sensitive from ovulation to menstruation, so it is important to regulate it.

Studies have shown that the more children a woman has, the more the tendency for PMS depression. [Of course, there are important social, cultural and economic factors here, e.g., the roles of women in the society relating to child rearing and work.] Family problems tend to increase PMS symptoms of depression and irritability. Also there can be an increase of sexual drive and alcohol craving.

PMS FACTORS
At ovulation, the egg breaks off and there is an increase in the production of progesterone until whether the egg implants or not. If there is no pregnancy, then the progesterone production is shut off and it triggers menstruation. If there is a pregnancy then there is an increase in the amount of progesterone and the placenta takes over.

Each month
· Progesterone increases progressively
· The estrogen amount fluctuates throughout the month.
· SHBG binds Testosterone with Estrogen
· Cortisone binding globulin carries the Progesterone.

When SHBG binds testosterone with estrogen, it locks up the free form estrogen in the blood stream and it is not available to the body. This causes a higher amount of progesterone which activates the production of SHBG and increase the tendency of estrogen to attach.

Progestins/Progestogens
Both are synthetic or semi-synthetic (birth control pills)
Birth control pills do not work in reducing PMS. Synthetic forms actually cause an increase in the severity of symptoms due to a suppression of body functions.

Progesterone - Causes the body to hold potassium and eliminate sodium.

Synthetics - Cause the body to retain sodium and eliminate potassium.
Studies show that elevated (endogenous) progesterone levels during pregnancy produces more highly intelligent children. Synthetics cause alterations in the fetus.

Additional Comments on PMS

Treatment with Western Hormones or Natural Progesterone Creams

· Most PMS is due to a lack of Progesterone.
· Tubal ligation tends to cause the Progesterone levels to drop.
· When treating PMS with Progesterone creams there is no correlation between the severity of symptoms and the need for high dosages. The same dosage applies in mild cases.
· A typical dosage of Progonol (Bezwecken) is 1/4 tsp. 2X daily.
· Birth Control Pills: Can suppress the natural progesterone production.
· Synthetic Progestins: Can cause sodium retention, High blood pressure (maybe due to the retention of potassium) and an increased body temperature.

PMS tends to get worse with age, especially between 30-40 years and does not improve after childbirth. About 12 % of women feel an increased sense of well being before menstruation PMS According to TCM

Symptoms: Four main Groups
· Mood swings, anxiety, irritability
· Depression, lethargy, insomnia, lack of mental clarity
· Breast tenderness, bloating, weight gain, headaches
· Increase of appetite, sugar or salt cravings


CAUSES FOR PMS

Interference with the growth of (Liver) yang from ovulation to menstruation by stagnation of the Liver Qi is the primary pattern causing PMS. This can give rise to a number of disturbances in the menstruation such as dysmenorrhea, irregularity, blood stasis etc.

Liver Qi Stagnation
"The Liver stores the blood, the blood is the residence of the hun; when the liver is deficient there is fear, when excess there is anger. With anger, the Qi rebels upwards and accumulates in the chest." From the Spiritual Axis

Comments
When the liver Qi stagnates it becomes suppressed. This results in an attempt to release the stagnation through anger or crying (tears are the fluid of the liver) sighing or outbursts of anger. The blockage also manifests along the internal and external branches of the liver meridian with symptoms such as breast pain, chest pressure, distention, tension and pain in the neck back, or shoulders, constipation.

If there is emotional stress in ones life throughout the month then they (emotions) will inevitably be magnified during the pre-menstrual phase due to the inharmonious flow of Qi.

"When the Qi and blood course harmoniously, the myriad diseases will not arise"
quote by Zhu Danxi

At puberty the Liver is entrusted with ministerial (Kidney) fire.
The Kidney mingmen fire helps empower the liver to develop assertiveness and begin the transition from a child to an adult. During this time of growth the Qi can be unstable and result in mood swings, anger and hypersensitive emotions. Suppression due to an inability to work with them in an open and honest manner (without judgement, blame, guilt etc.) can result in a pattern of chronic Liver Qi congestion that carries over into the adult years.


LIVER BLOOD AND YIN DEFICIENCY

The substance of the Liver is yin, its function is yang. The liver governs the growth, spreading and rising of yang activity. The yin and blood must be able to support this growth and counterbalance the forceful uprising tendency of (unchecked) yang. Women are prone to blood deficiency due to the monthly bleeding. The liver blood almost always needs some tonification when there is stagnation of the liver Qi.

Spleen Disharmony
When the liver (wood) is excessive, the Spleen (earth) may become weakened and susceptible to invasion by the liver. In addition to harmonizing the liver, the spleen needs to be strengthened in order to guard against the aggressive liver Qi or it may progress into a yang deficiency. (Eventually involving the Kidney yang).

A weakened spleen will also fail to produce enough blood to nourish the liver thus perpetuating the cycle of liver yang rising. Symptoms such as edema and loose stools and fatigue may appear pre-menstrually.

MENOPAUSE SYNDROMES

Western Description - Background information

Key factor
A decline of estrogen and an absence of progestagens.
80% of women will have hot flashes for 1 year.
25-50% for 5 years. Some have them for over 10 years

Hot Flashes
Average length is 5 minutes. There is a surge of LH production by the pituitary. This is not directly caused by LH but by the hypothalmus (heat regulatory center of the brain) which regulates its release.

With a heat loss the body temperature drops and it takes about 30 minutes to regain normal temperature. This overheat/overcool cycle happens through out the day. There can also be sleep deprivation due to sweating, and over time this could lead to psychological [Heart/Shen] problems.

With hormone replacement therapy all symptoms will usually stop within one week.

Key Symptoms
Dry vagina (Estrogen level is low). The capacity to lubricate is directly related to the level of circulating Estrogens. A younger women has more Estrogen.

Other Causes for a drop in Estrogen
Post-partum, diabetes, spinal cord injuries, drugs for ulcers or high blood pressure. Also narcotics, sedatives, alcohol.

Atrophic Vaginitis
With aging the vagina becomes shorter and more rigid and shrinks; eventually it can become atrophied. The protective layers of cells on the walls are reduced and allows the PH level to rise. Bacteria breed more easily and can cause infections.

Estrogen Replacement Therapy (ERT)
· Within 1 month there is an increase in vaginal blood flow.
· Increases the quantity of vaginal fluid.

Heart Attacks
Below 50 years of age, men have more heart attacks than woman. But above 50 years of age, the statistics are more equal. A premature loss of Estrogen increases the risk of a non-fatal heart attack. Surgical removal of the uterus and ovary increases the risk 7.2 times over women not having both organs removed.

1965-73
Hysterectomy rate almost doubled for women 25-34 years old from 7/1000 to 12/1000; the rate for women 35-44 years old increased from 14/1000 to 20/1000.

HRT Hormone Replacement Therapy

Synthetic Versus Natural Hormones HRT

Birth Control Pills
Birth control pills (estrogen/progesterone) can increase heart attacks. This is quite different from ERT (estrogen replacement therapy); the side effects are much worse. Uses synthetic estrogen/progesterone in a high dosage level in order to stop ovulation. This causes the side effects.e.g., synthetic progesterones (from testoserones) can increase facial hair and the tendency to arteriolosclerosis.

HRT (hormone replacement therapy)
Using natural low dosages, transdermal creams or Chinese herbal formulas could both be considered in this category.
HRT cause the HDL to rise and the LDL to lower which protects the body from high cholesterol. Estrogen does protect against death due to heart attacks. Clinical tests show it lowers the chances by 4 times.

When progesterone is added to estrogen there is no carcinogenic effects, but if it is synthetic progesterone it lowers the beneficial HDL levels.

Osteoporosis
HRT can prevent the loss of bone mass. This is the 12th leading cause of death in the USA. Hip fracture patients are 85% women. 35-45% of women will develop osteoporosis. Cortisone therapy increases the chances.
Between 1970 and 1980 there has been a 40% increase, which is almost epidemic. Osteoporosis affects the alignment of the rib cage and vertebrae which can cause multiple vertebrae fractures.

TCM VIEW OF MENOPAUSE

The following changes happen at menopause
· The Ren (conception vessel) becomes deficient.
· The Chong (penetrating vessel) becomes weak (and becomes smaller).
· The Tian Gui (uterus and reproductive organs) are "closed" (atrophy) and become dry.
There's basically a drying, emptying and coldness that are produced.

Major patterns commonly seen
· Yin deficiency of Liver and Kidney
· Or sometimes, Deficiency of Kidney Yin with Heart Fire (Heart Deficiency Fire)
· Deficiency of Spleen (Qi) and Kidney Yang
· Deficiency of both Kidney Yin and Yang
(Generally the Yin becomes deficient first; later the Yang becomes deficient.)
· Deficient Heart Blood
(Or Deficient Spleen Qi with Blood deficiency of the Heart)

Comments
The Most common pattern is Yin deficiency of Liver and Kidney with some Liver Qi Congestion. A common sub-pattern is Heart and Kidney not communicating. Less frequent is Qi or Kidney Yang deficiency unless the woman is predisposed to this pattern. Liver shares a common root with the Kidney Qi, so it usually affected to some degree. If the Kidney Yin becomes depleted than the Liver Yin will also be depleted.

Yin deficiency most easily affects the Yin organs, Heart and Liver. Yang deficiency affects most easily the Spleen function and circulation which can lead to stagnation and phlegm stagnation.

The symptoms you get are basically typical symptoms of Kidney Yin deficiency with Liver Qi Congestion Symptoms include: sweating, scanty menstruation, constipation, dryness, red tongue, breast distension. Liver Qi congestion does not always manifest as obvious anger and frustration, often the only symptom is tightness in the chest or ribs.

With Kidney/Heart not communicating there are Heart fire symptoms with Kidney Yin deficiency symptoms. If you're truly Kidney Yin deficiency, the tongue will not have a coating. It'll be red, no fur and maybe geographic.

If the tongue has a white coating with a pale, swollen and scalloped tongue you are not dealing Yin deficiency (even if there're sweats) and You may not get any results if you decide to give a Yin tonic. So don't get fooled by the symptom of hot flash.