Over the course of a lifetime, it’s estimated that a woman will have around 450 periods. Not only is that a lot of tampons, but a lot of PMS, too.

While each of us has our own unique cycle and what is considered ‘normal’ will vary from person to person, the key is to not bury our heads in the sand when it comes to our periods. 

“It is imperative that a person who menstruates understands each phase of their cycle and their associated symptoms to understand what a healthy menstrual cycle looks like for them,” explains Traditional Chinese Medicine practitioner and founder of The Dao Health, Elizabeth Cullen. 

“The greatest gift is the menstrual bleed as this provides a monthly report card of how well the body responded to the previous month including how you moved your body, what you ate, whether you had adequate sleep and your stress levels over the month. 

“And by tuning into your menstrual cycle, this allows the opportunity to understand associated hormonal symptoms and how to manage these when they are affecting your quality of life.”

A ‘normal’ period

Research indicates one in three Australian women report that menstruation bears a heavy load on their lives, with 40 per cent claiming it impacts their ability to work and 41 per cent unable to maintain a regular daily routine due to symptoms like fatigue. 

Thus it’s vital we give our periods the attention they demand. 

“A good indicator of a healthy rather than ‘normal’ cycle is a regular cycle ranging from 24–35 days with efficient ovulation occurring from cycle day 10–21 with a healthy menstrual flow of 3–8 days,” explains Cullen. “A healthy menstrual cycle involves a smooth transition between the three phases from follicular phase to ovulation and then the luteal phase which should not affect your quality of life.”

Learning to ‘read’ and better understand our cycle is therefore key to managing and coping with any PMS-related symptoms that might come our way. 

But while most of us are familiar with the more common symptoms associated with ovulation and PMS – including hormonal breakouts, feeling bloated or fluid retention, headaches, mood swings, sugar cravings, restlessness or insomnia – there remain a few problematic PMS symptoms you’ve likely never even heard of.

What are problematic PMS symptoms? 

“The definition of a problematic symptom will differ on the individual—but increased PMS symptoms are a reflection of a hormonal imbalance and can be managed and treated,” says Cullen. 

“Four problematic symptoms that can be associated with PMS and the menstrual cycle include:

PMDD

Premenstrual dysphoric disorder is a condition which can present as severe premenstrual depression, irritability or anxiety in the second half of the cycle. PMDD can be debilitating and is often misdiagnosed as PMS.

Menstrual and pelvic pain

Pain leading up to and during the menstrual bleed should not be assumed as a symptom that is expected to be dealt with, and should always be investigated beginning with your GP and/or gynaecologist.

Hormonal acne

It’s always the day before the party when that angry period pimple likes to rear its head. But this is different to consistent hormonal acne which flares during the luteal phase, which can affect one’s mental health and quality of life and should always be investigated internally as well as externally to manage symptoms.

Dyspareunia

Otherwise known as painful sex, this often can be cyclical with the menstrual cycle and should always be investigated with your GP and women’s health physio.”

Cullen also recommends tracking your cycle and keeping a diary of your pain and any associated symptoms so that when you do seek support, you’re already equipped with as much information as possible. 

“If we circle back to seeing the menstrual bleed as a monthly report card, then we can also view changes in the menstrual cycle at times where there may be higher physical and/or psychological demands such as overworking, overtraining, undereating or undersleeping,” she says. 

“By tracking your cycle, you’ll be able to notice those subtle changes in the cycle that have occurred due to lifestyle demands such as a change in the length of the cycle, changes in bleed duration, change in the bleed colour from a healthy cherry red colour to a dark bleed with increased frequency and size of clots and/or irregular ovulation.”

It’s these changes that may signify something more problematic. 

“If there is a change over your cycle for over three months, if there is an onset of pelvic or menstrual pain, or you are experiencing painful intercourse then these symptoms should be investigated,” says Cullen.

So, what’s the solution?

With PMS, an individualised approach is key – which also requires being in tune with your body and advocating for yourself when something doesn’t feel right. 

Working with your regular GP and the right specialists to achieve a diagnosis or tailored care is key too. Those experiencing painful cramping or dyspareunia should seek a referral to a gynaecologist to investigate a possible endometriosis diagnosis, and for hormonal acne, your dermatologist is the best place to start. 

Similarly, those with PMDD or particularly debilitating PMS should speak to a psychologist to get the right support. 

Cullen also advocates for including Traditional Chinese Medicine as part of your approach to diagnosis and treatent. 

“Traditional Chinese Medicine approaches premenstrual syndrome by addressing the underlying balances in the body rather than treating the specific symptoms,” she explains. “Diagnosis from a Traditional Chinese Medicine perspective involves looking at the organs, their relationship with one another and whether there is harmonious balance in the body.”

In terms of treatment, Traditional Chinese Medicine also offers a number of effective approaches. 

“Modalities including Acupuncture, Chinese Herbal Medicine, Chinese Dietary Therapy and Moxibustion which focus on reducing inflammation in the luteal phase to reduce menstrual and pelvic pain and cramping as well as PMS symptoms, supporting blood circulation to the reproductive organs to reduce menstrual and pelvic pain and support healthy blood flow and calm central nervous system to relieve PMS symptoms and provide stress support can all be helpful,” explains Cullen.

Working with your practitioner to time your treatments specifically to your cycle can also be beneficial and help to ameliorate symptoms. But what’s most important is to be consistent and trust that your body might take a few cycles to settle and rebalance. 

As women, we also need to remember that we experience many seasons and transitions in terms of our hormonal life – with puberty, pregnancy, postpartum and menopause obviously being the most significant. 

“In Traditional Chinese Medicine, these periods can also bring the potential for a weakness in both the emotional and physical body if entered into from a place of deficiency rather than abundance – which can affect the body, with increased hormonal imbalances presenting as more severe symptoms,” explains Cullen. 

“A principle of Traditional Chinese Medicine is when signs and symptoms of disharmony arise, they need to be listened to and attended to rather than ignored to restore balance, nourish Qi and Blood and preserve Jing, one’s vitality.”

So next time your cycle has you feeling a little, well, off – don’t just shrug in defeat as you grab the hot water bottle and dive beneath your doona. Instead, try to approach your PMS symptoms with a little more curiosity. 

“See living with the seasons of your menstrual cycle as working with your hormones rather than against them,” says Cullen. And remember, pain of any kind is never ‘normal’ and should always be investigated.

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