Complementary & alternative therapies

There are many alternative approaches that aim to improve the experience of menstruation. Some are supported by good evidence while others may simply improve women's sense of wellbeing.

Physical therapies

Research suggests some physical therapies such as local heat application (heat packs), TENS (transcutaneous electrical nerve stimulation), acupuncture and acupressure are helpful for reducing menstrual pain and cramps. Physiotherapy may also be helpful for lower back pain associated with PMS.

Yoga and mindfulness meditation

If you are stressed, you are more likely to suffer severe symptoms of PMS and experience poorer quality of life. Regular relaxation may be helpful in reducing severe PMS. Yoga has been used for thousands of years as a wholistic approach to health and wellbing. Some women may find yoga helpful in easing menstrual pain.

Massage

A small study found that weekly massages over five weeks improved the level of pain and mood disorders and reduced fluid retention experienced by women during their menstrual cycle.

Herbal remedies

Some herbal remedies may have benefits for women with PMS. It's very important to check with your doctor that it is safe to use herbal remedies and treatments, particularly if you are taking other medication.

Listed below are the best-researched herbs for the treatment of PMS, and the possible risks associated with taking them. 

Chaste tree or Chasteberry (Vitex agnus-castus) (VAC)

• Relieves PMS symptoms: irritability, mood alteration, anger, headache, breast fullness and discomfort, abdominal bloating.
• May help regulate menstrual cycle; PCOS.    
• Dose: 20 mg  VAC extract, one capsule daily    
• Generally safe but may cause gut disturbance and rash.
• Avoid in pregnancy.

St John’s wort (Hypericum perforatum)    

• Relieves depression, mood disorders, premenstrual disturbed mood.    
• Dose: 300 mg two to three times daily.   
• Avoid taking with oral contraception, anticonvulsants and other antidepressants. 
• Check with your doctor if St John's wort interacts with your medication. 
• Avoid in pregnancy. 
• May cause dry mouth, gastrointestinal discomfort, skin rash.

Evening primrose oil (Oenothera biennis)    

• May help reduce breast discomfort.    
• Avoid if you suffer seizures or epilepsy.

Red clover (Trifolium pretense)    

• May relieve premenstrual breast pain.    
• Dose:  40–80 mg daily.   
• Avoid if taking blood thinners or if you have suffered oestrogen-sensitive tumours such as breast cancer.

Traditional Chinese medicine    

• May help with PMS, hormonal disturbance.    
• Must be prescribed by a trained Chinese herbalist.    
• Check with a Chinese health practitioner about contra-indications and side effects.

Sleep, sunshine & vitamin D

Sleep, sunshine and vitamin D play a vital role in our general health and may help to improve our menstrual health as well.

Studies have found that sleep disturbance is common in women who suffer severe PMS. Poor sleep can also contribute to mood disturbance, hormone irregularities and disturbed menstrual cycles. You may be able to improve your sleep with the following:

• Exercise daily.
• Avoid stimulants such as coffee and green tea later in the day.
• Avoid heavy meals or spicy foods just before bed, especially if you are prone to reflux symptoms.
• Develop a regular bedtime routine.
• Relax before bed with a warm bath or shower.
• Deal with any stress or worries that might be keeping you awake by speaking with a friend, or ask your GP for a referral to a counsellor.
• Reduce your stress with yoga or meditation.
• Valerian, passionflower and chamomile teas may help induce sleep.
• Melatonin supplements may be helpful in some cases.
• If you continue to have trouble sleeping, see your GP.

Sunshine and vitamin D

Sunshine may play a role in regulating hormones and sleep patterns by affecting the melatonin circadian rhythm. Melatonin is a hormone produced in the pituitary gland,  from the chemical melanin. Melanin is produced in the skin through sun exposure. Melatonin helps with inducing sleep.

Sun exposure is also an important source of vitamin D. Ninety per cent of the vitamin D we get comes from skin exposure to sun, and less than ten per cent from food sources such as fortified milk, eggs and some fish. Early research suggests that vitamin D may help normalise menstrual cycles, and may help relieve muscular pains and mood disorders such as depression.

Vitamin D is important for bone health, and adequate blood levels are required for calcium absorption for the prevention of osteoporosis. Ask your GP about checking your vitamin D blood levels, especially if you are dark-skinned (pale-skinned women don’t need as much sun exposure), spend more time indoors or wear clothing to cover your skin for religious or cultural reasons.

Exercise, diet & periods

Diet and exercise bring a range of health benefits as well as improving your experience of having periods. 

Exercise

Studies have found that women who exercise regularly are less likely to suffer menstrual pain, cramps and mood disturbance. We are not certain why exercise is helpful for PMS but studies demonstrate that exercise can release ‘happy’ hormones such as serotonin and endorphins, which may explain the benefit.

Diet

A growing body of evidence suggests diets rich in omega-3 fatty acids such as fish, calcium and vitamin D, and low in animal fats, salt and caffeine may reduce the risk of troublesome PMS symptoms. Avoiding salt can help reduce fluid retention, abdominal bloating, breast swelling and pain. High caffeine intake can cause irritability, poor sleep and menstrual cramps.

A healthy diet is high in vegetables (five serves daily), fruit (two serves per day), nuts, seeds, fish (up to three servings per week) and other sources of omega-3 foods such as flax or chia seeds, low-fat dairy food, proteins such as legumes and eggs, and a variety of wholegrains such as rice (brown, basmati, doongara), traditional rolled oats, buckwheat flour, wholegrain breads (rye, essene, spelt, kamut), wholemeal pasta, couscous, millet or amaranth.

Lean meat (red meat or chicken) is an important source of iron and protein, especially for women with heavy periods. Avoid saturated fats such as butter, cream, bacon and potato chips; limit salt and caffeine. Drink more water and herbal teas such as chamomile.

Increase your intake of calcium-rich foods such as nuts, low-fat dairy products, fish with bones such as salmon and sardines, tofu, broccoli and bok choy.

Nutritional supplements

Many women take supplements such as vitamins, minerals and amino acids to help with symptoms of PMS; however, not all supplements have been shown to help. Below is a list of supplements for which studies have demonstrated some scientific evidence for benefits, although with all of them, more research is required. Check with your doctor to ensure there are no risks with you trying these supplements. Some supplements may interact with medication.

Vitamins B6 and B1

• May help with PMS.
• Reduces pain, cramps and mood disturbance.    
• Do not exceed 50 mg of vitamin B6 daily or 100 mg vitamin B1.
• Best if combined as a multi-B vitamin, not as single nutrients.   
• Avoid high doses of vitamin B6 (more than 50 mg per day) and prolonged use, as this can cause nerve toxicity such as tingling, burning and shooting pains.

Vitamin E (natural alpha-tocopherol)    

• May help reduce pain and menstrual blood flow.    
• Dose: 200 IU vitamin E daily; commence two days prior to periods and continue for three days from onset of periods.    
• May cause gut upset.
• Avoid high doses over 400 IU daily. 

Vitamin D    

• May help regulate your cycle, relieve muscle pains, improve moods.    
• Dose: 1000 IU daily or more; check with your doctor, who will advise a suitable dosage for your needs.   
• Vitamin D toxicity is rare and may occur when taking very high doses of vitamin D. This results in raised blood calcium levels leading to feelings of malaise, loss of appetite, feeling thirsty, constipation or diarrhoea, abdominal pain and muscle weakness, fatigue, confusion.

Magnesium    

• Relieves menstrual cramps.
• Improves premenstrual mood changes, especially irritability and anxiety. 
• May help with muscle relaxation, muscle cramps and sleep.    
• Dose: 300 mg one or two times daily (best taken at night with calcium).    
• May cause diarrhoea and loose stools; reduce dosage if this occurs.
• May cause palpitations.
• Avoid if you have renal problems.
• May lower blood pressure and cause heart arrhythmia, drowsiness and weakness in high doses.

Calcium    

• May help with PMS.
• Reduces menstrual cramps, fluid retention, mood disorders and food cravings.
• Dose: 1200 mg daily.   
• May cause constipation and flatulence.
• Avoid if you have renal disease or suffer high blood calcium levels.
• May interact with blood pressure and heart tablets.

Zinc    

• May help relieve menstrual pain, cramping, depression.
• May aid immune system.  
• Dose: 30 mg one to three times daily.    
• May cause nausea, gastrointestinal upset, metallic taste in mouth.
• Avoid long-term use.

Fish oils    

• May relieve menstrual pain, cramping, depression.    
• Dose: 1 g taken one, two or three times daily.   
• May cause nausea and gastrointestinal upset. 
• In high doses, may ‘thin’ period blood (this may be useful if you suffer dark, thick menses). 
• Avoid if allergic to seafood.

Attitudes & healthy periods

It’s thought that the attitude women develop towards their period can affect their experience of it.

You may have developed a particular way of thinking about your period from women around you. Your early experiences of having your period may also affect your experiences into the future.

Think about your earliest experiences.

• Were they positive or negative?
• Did you feel confident and prepared?
• Were you a little confused?
• How do you think about your period now? 
• Do you welcome it or dread it? Is it an irritation or an affirmation?
• How does your partner respond to it?

Studies suggest that women who have supportive partners, friends, family, teachers and employers deal with symptoms of menstruation better.

A history of verbal, sexual and physical assault is very likely to affect your health and your experience of your periods. It is a good idea to talk to a doctor about your experiences. Your doctor may refer you to a psychologist who can help you to understand your feelings, and how they affect your body and the symptoms you may be experiencing with menstruation.

Cultural influences

Some cultures celebrate the onset of periods and the beginning of fertility and others encourage women to take time out and to relax when they menstruate. In western society periods are often thought about as a nuisance. How do you think about your periods? Do you welcome your period and think of it as a positive experience? Try thinking about what your body is doing and your period's relationship with fertility. If it’s possible for you, try thinking about your period as a time of rest as other cultures do. This may help you to think of it as a time of relaxation and timeout rather than an irritation.

Counselling

A number of studies have found that counselling or cognitive behaviour therapy – that addresses negative thinking about periods and encourages positive thinking and behaviour patterns – may help women feel more control of their bodies, and help reduce symptoms of PMS.

When you feel good about yourself, you are more likely to eat better, exercise more, rest and look after yourself. Counselling can also help you to explore any stress you suffer and deal with mood problems such as depression or anxiety. This helps you to deal with mood changes that may occur during your cycle. Counselling can also help women to address recurring or chronic pelvic pain.

Bleeding after menopause

Menopause is the time after you have your last period. Because your final periods can be irregular, menopause is confirmed 12 months after your last period. Bleeding or spotting after this point is called postmenopausal bleeding (PMB).

Postmenopausal bleeding needs to be checked out by a doctor. Mostly the cause will be something very simple and treatable but occasionally it is a sign of more serious disease.

It is not normal to bleed or spot 12 months or more after your last period.

Bleeding after menopause is usually a sign of a minor health problem but can sometimes be an early sign of more serious disease.

When detected early, most conditions causing bleeding after menopause (including cancer) can be successfully treated.

What causes bleeding after menopause?

Bleeding after menopause is rarely cause for concern. It does need to be investigated, however, because in very few cases it will be an indicator of something more serious. 

In about 90 per cent of cases, a particular cause for bleeding after menopause will not be found. This is not a cause for alarm, if there is a serious problem it will be identified through investigations. Most of the time, postmenopausal bleeding is caused by:

• inflammation and thinning of the lining of your vagina (called atrophic vaginitis)
• thinning of the lining of your uterus
• growths in the cervix or uterus (called polyps) which are usually not cancerous
• thickened endometrium (called endometrial hyperplasia) often because of hormone replacement therapy (HRT)
• abnormalities in the cervix or uterus.

These are generally not serious problems and can be cured relatively easily.

However, about 10 per cent of the time, post-menopausal bleeding is linked to cancer of the cervix or uterus and so it is very important to have it investigated.

Treating post menopause bleeding

If you have postmenopausal bleeding it is important to have it investigated.

You will most likely be referred to a gynaecologist who may:

• ask you questions about the history of your health
• examine you
• do a blood test
• look at the inside of your vagina and cervix using special tongs (called a speculum). At the same time, they may take a tiny sample of your cervix for testing (called a Pap test).

The kind of treatment you have will depend on what is causing the bleeding.

• Atrophic vaginitis and thinning of the endometrium are usually treated with drugs that work like the hormone oestrogen. These can come as a tablet, vaginal gel or creams, skin patches, or a soft flexible ring which is put inside your vagina and slowly releases the medication.
• Polyps are usually removed with surgery. Depending on their size and location, they may be removed in a day clinic using a local anaesthetic or you may need to go to hospital to have a general anaesthetic.
• Thickening of the endometrium is usually treated with medications that work like the hormone progesterone and/or surgery to remove the thickening.

Before treatment there are a number of tests and investigations your gynaecologist may recommend.

• An ultrasound of your pelvis to get a picture of your cervix, uterus, endometrium and ovaries. An external ultrasound is a small hand held device (called a transducer) that the doctor will move over you belly. An internal ultrasound is a small wand that the doctor inserts into your vagina to get a better image of your cervix and uterus.
• A pipelle test to take and test a sample or biopsy of your endometrium. This can be done without anaesthetic in a day clinic with a thin tube (or pipelle) which is put into your uterus (through your vagina) and gently sucks up a small sample of cells.
• A hysteroscopy to take photos of your cervix, uterus and endometrium. A sample or biopsy of your endometrium may also be taken for testing.  A hysteroscopy involves putting a long, narrow instrument (called a hysteroscope) into your uterus through your vagina.  It can be done under local or general anaesthetic.
• A dilation and curette (D&C) to scrape away part of your endometrium and test it. This is done under a general anaesthetic.

All treatments should be discussed with you so that you know why a particular treatment or test is being done over another.

Premenstrual conditions

It is common for women to experience physical changes as well as changes in their mood a week or so before their period starts each month. These changes are called premenstrual syndrome (PMS) or premenstrual tension (PMT).

PMS can include:

• irritability, moodiness, impulsiveness, anxiety and/or feeling a ‘loss of control’
• a depressed or lower mood
• difficulty concentrating
• bloating, swollen and tender breasts, and body aches.

These changes can be mild, moderate or severe. They can last for a day or two, or right up until when your period arrives. Some women only have physical symptoms, others only mental ones and some women a mix of both.

PMS can be so strong that it can affect your ability to do the things you normally do.

A very severe kind of premenstrual disorder called premenstrual dysphoric disorder (PMDD) can significantly affect your quality of life.  Around eight per cent of women are affected by PMDD and experience both severe physical and mental changes.

What causes premenstrual conditions?

Unfortunately, we don’t know. Researchers agree that there are physical or biological factors at play, not just psychological ones. Recent research also suggests that abnormal hormone levels are not to blame, and that women who suffer from strong PMS or PMDD may in fact be particularly sensitive to the normal hormone changes of a menstrual cycle.

Some hormone medications can cause PMS or PMDD in some women, but this is usually when they are used to treat menopause symptoms. This is also easily fixed by switching to a different type of hormone medication.

Treating premenstrual conditions

If you find your symptoms are difficult to manage it will help you to see a health professional to get further advice and assistance. You may find that very simple strategies help or you may need more complex care.

If you are someone who normally has anxiety, depression, epilepsy or migraines, you may find that your symptoms worsen just before you get your period. These can look and feel very similar to premenstrual conditions, but need to be treated differently. It is important to tell your doctor about any existing medical problems you have so they are not mistaken for PMS/PMDD.

Visit your GP

• Tell them about any physical or emotional changes you have had.
• Let them know if you have any other medical conditions or health problems.

They may:

• ask you questions about the history of your health
• examine you
• refer you to a mental health specialist
• ask you to keep a record of your symptoms for two months. This usually means making a note each day of how you felt, what changes you noticed and when your period started and stopped.

Treatment for PMS/PMDD

Antidepressant medication is the most common treatment. Certain antidepressants increase the level of serotonin in your brain which can change the way your hormones affect your mood. These come as a tablet that you take either every day or just in the week before your period.

Cognitive behavioural therapy involves activities and work with a psychologist who guides you to challenge your thinking style and alerts you to the way your thoughts affect your emotions and behaviour.

Hormonal therapies control the hormones that may contribute to PMS and PMDD. Taking the contraceptive pill daily is the most common hormonal therapy. Occasionally, this can involve taking medication that stops you from releasing an egg (ovulating) each month. This is usually only an option if other treatments haven’t worked.

Problem periods

Most women will have no problems with their periods. Others may worry that their periods are not ‘normal’. 

When your periods begin it can be hard to decide what is normal and what's not. For many young women, there is no pattern to their periods at all. As you get older though, you can expect your period to develop a regular monthly pattern. If a pattern doesn't develop or you start experiencing problems with your periods, it is a good idea to visit your doctor.  The following describes common complaints that are not considered 'normal' and should be investigated by your doctor.

Pain

You might need to visit your doctor if:

• your pain is not relieved after taking painkillers
• you have to take painkillers regularly throughout the day to be able to work or study
• you have to take time off work or study
• pain regularly wakes you during the night.

There can be many reasons for very painful periods. Your doctor or gynaecologist will do a number of investigations to rule out more serious disease and work with you to manage your condition.

Bleeding between periods

It can take a little while for some young women to establish a regular bleeding pattern. Some young women will 'spot' or bleed very minimally when they ovulate, this will happen 14 days before the next period. Other than that, bleeding between your periods is something that should be investigated by a doctor. Bleeding after sex should also be investigated by a doctor. 

Late periods

There are many reasons why your period might be late. Again, when you are first getting your periods it might be that your pattern is still being established. Stress, medications, illness, and changes to your diet, weight and lifestyle can also cause your period to come late. Using a progestogen IUD (such as a Mirena or other hormonal intrauterine contraceptive) can also affect how regularly you bleed.

You may also be pregnant – even if you are using contraception.

You may need to have your doctor investigate if your periods:

• come very infrequently, for example, every six weeks (called oligomenorrhoea)
• arrive a number of days early/late for more than three months in a row
• do not come back straight after you stop taking the contraceptive pill
• have not happened for more than six months and they used to be normal and you are not pregnant (called amenorrhoea)
• have not yet had a period but you are 17 years or older.

Recording your menstrual symptoms

Self-monitoring and recording your symptoms in a diary or on a calendar can help you to understand your cycle and body better. A study found this helped women to feel more comfortable with their symptoms, and reduced the severity of some of their premenstrual symptoms such as depression and moodiness. There are now many free apps you can download to help you chart your symptoms into a calendar. You can learn more about your cycle and even estimate when you are most fertile using this method, although it is not entirely accurate