Massage Therapy Vancouver,
Vancouver Massage Therapy
The following essay on pre menstrual
syndrome is provided to give you an understanding of this condition. Massage
therapists see cases of pre menstrual syndrome in their offices every day. It
is important to make sure that women have a good understanding of pre menstrual
syndrome so they can detect if they or a loved one are having any signs or symptoms.
Definition:
Also known as Premenstrual Dysphoric
Disorder or Premenstrual Tension Syndrome. Pre-Menstrual Syndrome (PMS) is a
disorder mainly affecting menstruating women during the last week of the
leuteal phase of the menstrual cycle. It is a very common disorder, affecting
60% of North American Women between the ages of 20 and 50. It is of importance
to note the difference between the normal physiological changes in a leuteal
phase and the severity of true PMS. It has been argued by many feminist sources
that the diagnosis of PMS is used against women as a general diagnosis when the
true pathology is not obvious, but the increasing awareness and education in
the medical field and society in general has changed this attitude into one of
professionalism and compassion for people with this disorder. The high percent
of women suffering from true PMS means that these women are living during the
childbearing years in a "sick" state every cycle. What this
creates is an incredible fear and negative attitude towards the menstruating years,
as well as an amazing decrease in the general well being, productivity and
quality of life that in many cases may be easily avoided.
Etiology:
The answer to what exactly causes
PMS is as multifaceted and diverse as women themselves. There are many factors,
both externally and internally that plays a role in the onset of this disorder.
The most common ties are those of age, nutritional habits, hormone imbalances,
and overall reproductive/sexual health. The risk for PMS increases over thirty
years of age; with most of the severest symptoms, occurring in women aged
thirty to forty. Nutritional habits seem to be one of the most modifiable
causes, and most of the research has been done in this area of PMS. Diets of
concern include a daily consumption of dairy products, caffeine, animal flesh
and/or fats, refined sugar/flour and over-processed foods in general. Caffeine
found in coffee, black or green tea, colas and chocolate could cause breast
tenderness. Thirty percent of women with breast tenderness as a symptom of PMS
reported relief upon eliminating caffeine. Caffeine also increases anxiety, and
depletes the body’s stores of Vitamin B - thus interfering with the liver and
metabolism. The animal flesh/fats have been shown to lead to increased levels
of the hormone prostaglandin F2, which in excess causes uterine contractions
and cramping. Consuming animal products also causes the excessive estrogen/low
progesterone levels that are often found with PMS. With the recent awareness of
the abundant hormones being added to most commercially produced animals food,
it is obvious how these substances play a major role as they move up the food
chain in the milk and/or meat. It is also interesting to note here that women
who choose a vegetarian and/or vegan diet have been shown to excrete 2 -3 times
the amount of estrogens in their feces than non-vegetarians. In addition,
studies have shown that these women have 50% less plasma levels of unconjugated
estrogens than women who eat meat. Some further common nutritional
characteristics include low levels of Vit. C, E, Selenium, Magnesium, (which,
along with Vit B is needed by the liver to metabolize estrogens) and Essential
Fatty Acids. Other factors that increase the risk of PMS include significant
emotional stresses in daily life and/or poor stress management techniques,
alcohol use and/or abuse, unstable body weight, obesity, being in a marriage or
marriage-like relationship, having children, past pregnancies terminated or
complicated by toxemia, low exercise levels, having grown up in an alcoholic
family, complications during or recent discontinuation of oral contraceptives,
and tubal ligations, especially if done by unipolar electrocautery (which was
mostly done in the 70's and is no longer used).
In patients with PMS, a relatively high
blood level of estrogens is found; this may be either from increased intake or
decreased elimination of these substances. This imbalance is also associated
with Vit B deficiencies. As well, a relatively low blood level of progesterone
is secondary to the high levels of estrogens. Excessive body weight increases
the chances of hyperestrogenism and PMS. The progression of symptoms may be a
downward spiral, for example; when blood-sugar levels dip, the result often is
headaches, dizziness, mood swings, cravings and heart palpitations. One of the
food cravings may be for salt, and the salt intake may lead to further
increasing of the water retention and weight gain, which for some may lead to
emotional distress and guilt over eating habits. The perfect balance of estrogen
and progesterone is important in regular and symptom free menstrual cycles.
When balanced, estrogen has been shown to stimulate production of endorphins,
and progesterone has been shown to have an opiate-like effect, when these two
hormones drop suddenly before moontime, the body has a reaction close to drug
withdrawal. Also found in blood tests of PMS sufferers are higher than normal
levels of prolactin. This particular hormone imbalance may be the cause of
breast tenderness and cysts associated with PMS.
Clinical Manifestations:
The signs and
symptoms of PMS are very numerous and affect every system in the body. The most
common ones are: persistent irritability, anxiety, mood swings, severe
cravings, hypersomnia, joint pain/swelling, muscle pain, tearfulness,
aggression, suicidal thoughts, violent thoughts or behaviors, heart
palpitations, food binges, rage, lethargy, nausea, emotional ability, alcohol
intolerance, sexual desire changes, insomnia, depression, headache, backache,
migraine, acne, water retention, decreased interest in activities, social
withdrawal, less frequent urination, decreased immune system, breast
soreness/swelling, constipation, cramps, extreme fatigue, and dizziness.
Patients often report over ten symptoms. PMS affects every aspect of life; work
productivity, relationships, and self-image.
Treatment:
Some aspects of western medicine
are still searching for the direct cause and direct cure of PMS, and this may
not be found unless a holistic approach to treatment is implemented. This
syndrome is influenced by many factors, making it a particular challenge for
some practitioners of modern medicine. The effects of the emotions, mind, diet,
relationships, childhood traumas, exercise and heredity must not be overlooked
when treating PMS. Common medical treatments include non-steroidal
anti-inflammatory drugs (NSAIDS), Fluexotine (Prozac), Indocin, Motrin,
Ponstel, oral contraceptives, diuretics, and anti-anxiety medication, but these
often mask the problem and create even more dysfunction in the body. Recent
studies have shown that estrogens are directly related to seratonin levels, and
as estrogen naturally decreases just prior to ovulation, so does seratonin,
this may be why PMS sufferers respond well to anti-depressant medications (SSRI's).
It is of interest to note that many anti-depressant drugs actually increase
other PMS symptoms, reduce sexual interest, and can make it difficult to
achieve orgasm. The pharmaceutical Parlodel (bromocryptine mesylate) is used to
inhibit prolactin production and has been shown to decrease breast pain,
depression and bloating, but often has negative side effects. One area of
interest is the use of progesterone as a treatment. When high levels of
estrogen are unopposed by progesterone, the effect tends to be irritation of
the nervous system. Progesterone can come form a natural or a synthetic source.
Natural sources include soy, yam or animal derived. It is available as an
injection, sublingual drops, suppository, or a skin cream/oil. The use of
natural progesterone has been praised mostly for its effect on premenstrual
migraines. These headaches often start with the gradual change in estrogen and
progesterone levels that tend to occur in the years preceding menopause. It is
important to note that synthetic progesterone (progestins) has very different
qualities. This synthetic hormone has been shown to have a list of negative
side effects including bloating; headache, weight gain, and can actually
increase PMS.
More holistic treatments include elimination
of meat, dairy, caffeine, refined sugar/flour and other health-reducing foods,
which often has a positive response in as little time as one cycle.
Alternatives are gaining popularity as awareness increases, such as the fact
that goat's cheese is more easily emulsified in the body or that carob is high
in calcium. These healthy choices are reducing the rates of PMS dramatically in
our society. Other dietary changes are incorporating Essential Fatty Acids into
the daily meals, and increasing levels of Vit C, E, magnesium, selenium, zinc,
and B vitamins. The intake of evening primrose oil in the leuteal phase of a womans
cycle has been shown to decrease the emotional aspects of PMS dramatically (I
can personally vouch for this!) Adding miso to the diet is an excellent part of
treatment, as it has all eight of the essential amino acids, as well as between
12 and 20% protein, compared to cows milk at 3%. Miso also contains acidophilus
and other digestive enzymes and is a useful source of Vit B12, often recommended
in a vegetarian diet. The complete elimination of alcoholic beverages is one
aspect of treatment, as alcohol is directly toxic to liver cells and therefore
disrupts the liver's ability to metabolize hormones, possibly causing a higher
than normal estrogen level. Alcohol also depletes the body of Vit. B and
minerals. Stress reduction and stress management techniques play a major role
in treatments, including yoga, meditation, counseling, and relaxation massage,
visualization and breathing techniques. Herbal Medicine is gaining much
recognition in the treatment of many disorders, and has had substantial results
in the treatment of PMS. Nervine herbs such as valerian and chamomile help to
tone the nervous system and restore balance. Red raspberry leaf and vitex are
well known for their balancing effect on women’s' hormones, as well as burdock,
black cohosh and blessed thistle. Ginger, cramp bark and pennyroyal are useful
in cases of dysmennoria accompanying PMS as they gently relax and tone the
reproductive system as a whole.
Prognosis:
The outcomes of treating PMS are
extremely variable, due to the wide range of treatments available, and the
combinations of them used. Finding relief of one's symptoms depends somewhat on
the amount of energy and conscious thought put into the treatment. For example
it may take extra time and a strong will to have a big change in diet and
counseling may have to be part of the program when dealing with addictions.
Most women find some form of improvement within one cycle from many of the
lifestyle changes listed prior, and this continues to improve over time. Since
most women choose to try smaller scale and less harmful treatments first, it
may take longer to see results if the therapy chosen is ineffective or the
dosages need to be increased. There are so many new treatments gaining medical
approval and public awareness that the majority of outcomes from PMS treatments
are very positive, and these lifestyle changes may in fact be temporary. For
example if the key problem is the liver's inability to metabolize the hormones
due to a build up of toxins, the initial treatment may include fasting or a
liver cleanse program with a following of an only slightly modified diet in the
long term. Although many different areas of treatment may need to be explored
to see which type suits that particular patient, most women find relief from
some form(s) of treatment and this disorder is easily managed throughout their
life. Very rarely is this disorder life threatening, or untreatable.
Implications for the Massage Therapist:
It
is important for therapists to be aware of any PMS symptoms during the client's
menstrual cycles, whether they have been clinically diagnosed or not. As a
registered massage therapist, I believe it is an important part of case history
taking to find out what part of the cycle the client is at for each treatment.
The massage therapy treatment may have to be modified depending on what signs
and symptoms are presenting that particular day. PMS affects the body systematically;
therefore, it is important to take into account what these changes are having
on the person as a whole. From a physiological level, the treatments may
include release of any trigger points found within Quadratus Lumborum,
Iliopsoas, or Erecter Spinae as well as any other muscles or muscle groups that
may refer pain to the areas most commonly affected by menstrual cramps. The
therapist can play an important part in breaking the pain-spasm cycle by
increasing the parasympathetic nervous system. Massage therapy techniques that
increase circulation can help flush the system of excessive build up of
hormones and substances associated with prolonged stress responses happening in
the body.
Relaxation massage has an important effect
of decreasing the stress level. Therapists have the opportunity to teach
clients stress reduction/management techniques such as diaphragmatic breathing,
visualization etc. These techniques can be used as part of a treatment with the
client as well as taught as home care enabling the client to have some control
over situations that may arise.
References:
Premenstrual Syndrome Self Help Book - Susan Lark M.D.
Our Bodies Our Selves - Boston Womens' Health Collective
Womens' Bodies, Womens' Wisdom - Christiane Northup M.D.
Womens' Herbs, Womens' Health - Christopher Hobbs, Kathi Keville
Taber's Cyclopedic Medical Dictionary - F.A. Davis
Holistic Herbal - David Hoffman
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