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PMS: It May Be Common But It's Not Normal!

by Alexa Gilmore, LAc, MAcOM

(This is first in a year-long series on women's health that I'll be contributing to ELM Magazine.)

I talk about menstrual cycles all the time—every day, multiple times a day.  I talk about menstrual cycles so often and in such detail that I forget it’s not “normal” to do so.  When we do talk about menstruation in our culture, it’s typically to lament the the PMS, the pain, or the messy inconvenience of it all.  What we don’t talk about is what is actually happening in our body every month, or the way our cycles can provide a striking window into the status of our overall health.

As a practitioner of Chinese medicine, the details of a woman’s menstrual cycle will inform my treatment plan for any issue related to her cycle (of course), but it will also inform my approach in treating almost any other complaint.  Every aspect of your menstrual cycle tells me something important about the state of your  general health: the length of your cycle, the volume of blood, the color of blood,  the timing of ovulation, your basal body temperature, any pre-menstrual symptoms, and the presence or absence of cramping are all quite revealing.  Positive changes in your cycle as we move through treatment also serve as a useful barometer to track your body’s journey back toward balance; this is true even if your primary complaint had “nothing” to do with your menstruation.

Bottom line?  Menstrual cycles matter.  

We’ll start here with PMS and the biggest menstrual myth: that PMS is normal. PMS is not normal!  It may be common—up to 80% of women report some constellation of PMS symptoms leading up to their menstrual cycle—but it’s not normal… which brings us to the second biggest myth: that if you have PMS you must simply suffer through.  Wrong again!  In the vast majority of cases, PMS is both preventable and treatable.  

PMS: It May Be Common But It's Not Normal!,       PMS: It May Be Common But It's Not Normal!,

So what are we talking about?  What is PMS, exactly?  PMS (pre-menstrual syndrome) is a constellation of symptoms that occur anytime from ovulation—usually about two weeks after the start of your period—until your period starts again.  Some women suffer for the full two (or more) weeks, others experience symptoms just a day or two in advance of their period.  Symptoms include breast tenderness, water weight gain, fatigue, irritability, depressed mood, night sweats, acne, bloating, constipation, diarrhea, migraine, cravings, anxiety, and insomnia.  All of these are responses to the body’s post-ovulatory/pre-menstrual hormonal fluctuations.

As your body approaches your period, it has to break down hormones to shift  you from “pre-menstrual” to “menstrual.”  An optimally functioning body does this efficiently, and you are gloriously oblivious to the process and symptom-free.  A body that’s functioning less optimally will have a harder time navigating this transition, and this is when symptoms show up.  Think of PMS as a monthly stress test; like anything under stress, the weakest links are the likeliest to break down.  Do you tend to have bowel changes, nausea, or cravings?  Your digestion needs attention.  Does PMS show up as fatigue, anxiety, or insomnia?  You’re likely to be more generally run-down.  Is it breast tenderness, irritability, or headaches that show up for you?  From a Chinese medicine perspective this points toward stagnation specifically in your Liver* system;  Western translation?  Your detox pathways need support so they can process hormones out of your system more efficiently.

The good news is that in supporting and strengthening the systems that are exhibiting symptoms, we can alleviate your PMS.  In doing so, we also course-correct your body more generally.  Why should you care?  The more optimally your body is functioning in any given moment, the more likely it is that we’ve staved off larger health issues that might have otherwise accumulated over time.  The best part?  We’ve freed up your energy so you can get out there and live your most extraordinary life!

So what to do?  How to manage PMS symptoms on your own?  For most women, getting back to the basics of sleep, nutrition, exercise, mindfulness, hydration, and play goes a long way.

Be brazenly boundaried about your sleep.  Sleep is when your body can finally take care of itself, unencumbered by the daily demands you place upon it during your waking hours.  Honor your body by honoring that time.  Treat your bedtime like an appointment you wouldn’t dare miss.  Keep consistent sleep and wake times whenever possible to support hormone regulation and regulation of all the other systems in your body.

Optimize your digestion.  Your food can only nourish you if your body is properly absorbing it.  If digestive distress is a chronic struggle, seek out professional help.  Acupuncture and Chinese medicine can be enormously beneficial; other modalities have their own, sometimes more appropriate interventions.  Interview providers and find a good fit.

Eat real food. Every day we’re bombarded with some new health craze around food.  Bottom line, in the words of the brilliant food journalist Michael Pollan: eat real food.  Sounds simple, but it’s far less common than you think—and not always easy.  Eat a wide range of of seasonal and organic foods.  Limit processed foods, refined sugar, alcohol and coffee, and increase your fiber intake.  We can *all* benefit from this advice, but it’s particularly important if you suffer from PMS; making these changes will help your body eliminate estrogen more efficiently and less uncomfortably.  If you’d like to go deeper, a skilled practitioner of Chinese medicine will have dietary suggestions specific to you and the support your individual system needs. 

More specifics of what to curb:

Quit the caffeine: I know!  I also love a good cup of coffee in the morning, but it’s true that caffeine can make PMS worse.  It constricts blood vessels—including those supplying blood to the uterus—making it even more of a no-go if you tend to cramps.  It can increase irritability—the opposite of what is most often required during a premenstrual time.  And from a Chinese medicine perspective caffeine (and especially coffee) stresses the Liver energetic, leaving you more susceptible to many common PMS symptoms.

Avoid the alcohol:  Coffee AND alcohol?!  I know!!  But have you picked up on all this talk about PMS and your liver?  A glass of wine may feel like welcome relief at the end of a long, irritable, pre-menstrual day, but it’s actually only adding insult to injury.  We know alcohol inhibits hormone regulation—the opposite of what we’re aiming for.  Do your Liver a favor and skip it, at least during the second half of your cycle.

Reduce salt: Too much salt = extra bloating and water retention.  The biggest offenders are typically processed and pre-packaged foods, which you’re avoiding already, anyway, right?

Red meat and dairy:  To be clear, red meat and dairy are not inherently bad.  Assuming the meat and milk is from pastured, organic cows, there are some folks for whom one or both can be absolute positive game-changers in terms of their health—not so much if you’re a PMS sufferer.  Red meat and milk contain a substance known as arachidonic acid that stimulates prostaglandins and intensifies cramps.  If you’re craving iron pre-menstrually (or menstrually), and prone to cramping, better to reach for plant-based sources like chickpeas, beans, and lentils.

Sugar and refined carbohydrates:  We’d all be well-served to eliminate or dramatically reduced our intake of these pro-inflammatory substances, but this is true for none more so than the PMSer.  They increase inflammation in the body, contribute to fatigue and bloating, and can wreak havoc on your volatile PMS moods as they manhandle your blood sugars.  Set them free.  If you need help managing cravings, seek out acupuncture for support.


Move your body in a joyful way:  Walk, run, stretch, breathe, lift, dance, laugh, love.  Your body was meant to be fully inhabited.  Find a way to move it that lights you up and makes you smile.  Repeat often. 

Practice mindfulness:  We hear this all the time, but what does it mean?  Incorporating mindfulness into your daily life doesn’t have to be a huge (stressful) undertaking.  Do you brush your teeth every day?  Drive your car every day?  Wash your dishes every day?  Turn on your computer every day?  Make a habit of punctuating the start of any recurring event with a moment of attention.  All you need is a pause, a slow deep breath in, and a slow deep breath out.  Be still.  Notice that are you doing what you’re doing.  We throw our attention mindlessly out into the world all day, every day.  Start to pepper your day with brief moments of drawing that attention back into your body, back in to the right now.  If you’re unsure of where to start, start there.  


Remember how we said PMS is like a monthly stress test?  Our goal with these lifestyle and dietary interventions is to reduce the overall stress load on your system.  Think of your body as a rain barrel.  All kinds of general stressors fill up the barrel—lack of sleep, poor nutrition, a fight with your partner, sitting all day long.  We ignore the fact that our rain barrel is filling up because often we cannot “see” the level in the barrel.  Then one day—in this case, one pre-menstrual day—the rain barrel overflows and we experience symptoms.  “My boobs hurt!”  “I’m pissed off!”  “That car commercial made me cry!!”  We tend to look to the last drop of “stress” that fell into the barrel and blame it for our symptoms, as if that drop were working the joint all alone.  “You!! Yeah you!! You’re the problem!”  In fact, if the whole stress level in the barrel was lower to begin with, that “last drop” of stress would not have had any visible effect—we would have managed our pre-menstrual hormone shift just fine.  If you had instead been well rested, or eating healthfully, or peaceful in your primary relationship, or walking every evening, you likely would have have gone into your pre-menstrual time with your stress barrel far less full.

It is important to note that in some circumstances, dietary and lifestyle interventions alone will not be enough to resolve your symptoms.  Have no fear!  There is no shame in seeking out professional help; sometimes life hands us more than we can manage or regulate on our own.  Acupuncture and Chinese medicine are incredibly effective at restoring balance to your system, and can dramatically improve all aspects of a woman’s heath.  Seek out a provider with an affinity for women’s health and she or he should be able to get you back on track, lickety split (or within a few months).  Happy menstruation!


*In Chinese medicine your “Liver” represents your liver organ but also (and more often) your whole Liver system—a collection of physical and emotional processes that are governed by the “Liver” energetic.

Top Ten Tips for Healthy Travel

by Alexa Gilmore, LAc, MAcOM

Top Ten Tips for Healthy Travel,

I’m currently sandwiched between two airplane trips.  It’s Wednesday.  I was on an airplane last weekend, and will be on one again tomorrow.  I’m coming to terms with the fact that I do this a lot—often in the service of learning more to serve you better!  

I’ve gotten good at packing my bag with items to keep me at my best, even under the inevitable stress of travel, and even when I’m faced with the disruption of the healthy routines I have in place at home.

Here’s what will be in my bag this this weekend:

1) Neti pot and sea salt: I shower and rinse my sinuses as soon as I can upon arrival at my destination.  Airplanes are full of recycled air, and I want to clear out any potential exposure before it has a chance to settle in to my system.  Also, airplane travel just makes me feel sticky and gross.

2) Fresh snacks: Sliced carrots and celery, apples, and a bag of nuts are a fresh, healthy alternative to the mostly terrible airport/airplane fare.  Having a bag on hand also means I’ll get at least *some* fresh food if I’m unsure what my dining options will be at my destination. 

3) Chia seeds: Soak these in water overnight and slurp them down in the morning for regularity; travel constipation in the worst, right? If you’re prone to this particular affliction, you may also consider backing off on food in general on the day you travel and into the next morning.  Lightening your digestive load during the stress and immobility of travel can help your body get back into the intestinal swing of things more quickly. Drink plenty of water while you wait to regulate.

4) A few bags of my favorite Jasmine Green tea: For an afternoon pick-me up and to promote digestion after lunch.

5) Melatonin: For sleep.  I think there are better ways to manage chronic insomnia, but for the occasional difficulty in getting to sleep when traveling, melatonin can be a great help.  It’s a no-brainer for me if jet-lag is involved.

6, 7, and maybe 8) Chinese herbs: In case I feel a cold coming on.  When I get sick it usually starts with a sore throat, so I always keep some Yin Qiao San on hand.  (If you’re more a cougher or tend to headaches at the onset of a cold, or if “colds” bypass your sinuses and land directly in your chest, your go-to travel formula may look quite different from mine.)  I also bring Gan Mao Ling, a more heavy hitting anti-viral formula.  I’ll take this preventively if I’m the lucky one next to the sneezy coughy guy on the airplane, or if my cold starts to transform into something more ominous.  If I’m worried about food quality at my destination, there are digestive support and anti-diarrheal herbs I also wouldn’t leave home without.

9) Portable yoga mat: I have a very thin one that folds up nice and tiny yet still creates the sticky traction I need to bring my Downward Dog and Warrior 1 to hotel rooms across the nation.  Sticking to my morning routine in this way helps keep my whole body regulated.

10) A good pair of walking shoes: When I travel for seminars—which is the primary reason for much of my travel—I refuse to let the all-day sitting and stale conference room air get the best of me.  I bring walking shoes and utilize at least part of the lunch break to get outside, breathe fresh air, and move and stretch my body.  If time allows, I walk at the beginning and end of the day, as well.  Good for me, and a great way to explore a new city.

Consider packing some of these items on your next adventure. Let me know what else you bring that keeps you on a healthful track.

Case Study: Eczema and Excessive Uterine Bleeding

by Alexa Gilmore, LAc, MAcOM

This case study showcases some of what I love about Chinese Medicine: two seemingly disparate sets symptoms that are in fact totally intertwined. One gives you insight into the other, and in treating one you can't help but treat the other. Chinese Medicine at its best.

Your Gifts Are My Mission

I love what I do. SO. MUCH. And I've been doing a lot of thinking lately around clarifying my vision. What is it about what I do that I love so much? Who can I best serve? What *exactly* do I want to be doing with the skills that I have? I had a moment of inspiration this morning that I wanted to share: 

I am here to help you cultivate and consolidate your vitality in the service of the gifts you have to offer the world.

Watch the video for details. (Spoiler alert: it's not nearly as hippy dippy as it sounds.)

Soup: Winter's Salad

As the weather turns colder it's increasingly important to heed Chinese medicine's wisdom around food--particularly if your digestion is less than robust. For many, my most important piece of advice this time of year is to reduce the intake of cold, raw foods. People look at me when I make this suggestion, shocked and confused. "But what about my salad?!" they cry! "Salad" has become synonymous with "healthy," and many of my patients are loathe to give it up. To their cries I answer: "Soup!" Think of soup as winter's salad; this is one of my favorite soup cookbooks.

Soup: Winter's Salad,

Rebecca Katz does a wonderful job showcasing simple, tasty, deeply nourishing soups without falling prey to nutritional hype. I cook her stocks in large batches and freeze them to have on the ready. This time of year I usually spend Sundays with a pot on the stove, cooking two soups for the week: one to serve as or supplement lunches and dinners, and one blended soup for a quick but nutritious--and *warm*-- breakfast when I'm on the go.  (Those 7:30am appointments come early, folks!)  

My latest favorite is her Very Gingery and Garlicky Chicken Soup, made with her Old-Fashioned Chicken Stock I had stored up in the chest freezer:

Soup: Winter's Salad,  

Soup: Winter's Salad,

If you suspect your digestion is less optimal than it could be, be sure to reach out to the clinic. After years of working through the lens of Chinese medicine, it *still* surprises me how often minor tweaks to a person's food choices or eating routine can exact major changes in digestive health. If your issue turns out to be more complex, a series of acupuncture treatments and/or herbal medicine may be just the ticket to get you on track. In any case, reach out--we're here to help!

On Counting Calories

A headline in The New York Times’ Smarter Living Newsletter caught my attention this morning: “Is Counting Calories Harmful?  Helpful?  Should We Even Bother?)”

The question of counting calories comes up a lot in clinic.  In short, I believe there are far better ways to orient ourselves toward a healthy diet and a healthy relationship with food than in the tracking of a number.  

In the words of the author Michael Pollan in his book Food Rules, my first recommendation is simple: Eat Real Food. Too simplistic?  In a country where most grocery stores contain more food-like-substances than actual food, eating real food is far more difficult than it sounds.  For many people confused by the maelstrom of nutritional “guidance” bombarding us on a daily basis, the simplicity of this mandate is a welcome change. Eat real food.  This is where we begin, and real food doesn’t list calories. How do you measure the calories in the bowl of home-cooked garlic-ginger chicken and vegetable soup you had for dinner?

The second big piece is to encourage you to give your body back to yourself.  Counting calories turns your relationship to food into something external.  I want to turn your attention inward. I want you to be curious about yourself and pay attention to your body.  I want you to get to know and trust yourself again.  I want you to notice when you’re hungry and full, when you’re snacking and why, and how these factors affect your digestion, your mood, your sleep.  Is eating the only thing you’re doing, or are you juggling work, driving, social media and Netflix all while mindlessly moving fork to face? If it's the latter, of course you can’t tell when you’re full--you're too busy to notice!! The argument for calorie-counting in the service of portion control readily evaporates in the face of actually paying attention to the fact that we’re eating.  Then there’s the physiological piece. For example, from Chinese medicine’s perspective on metabolism, the number of calories you eat is irrelevant if you never experience a healthy grumble in your tummy—we need to stimulate and/or decongest your digestion. Similarly if you snack because your belly aches when it’s empty, then that’s where we focus our energies— worrying about the calorie count of the snacks is a distraction. 

Next of course come personalized recommendations based on your individual constitution and presentation… but that’s for another post (or office visit).  For now, eat real food, and savor it while doing so.

Health Preservation Exercises, Part 6

by Alexa Gilmore, LAc, MAcOM

Did you think I forgot about you?  We're back with exercises 9 and 10...