What's needling you?

Suffering from premenstrual syndrome? It could be liver chi stagnation, according to Chinese medicine. The answer is acupuncture and many women are benefiting, writes Kate Hilpern

Four years ago, Beverly Trigg's premenstrual syndrome, or PMS, got so bad that she used to mark on her calendar when her periods were due and refuse to see friends during that time. "I knew that they wouldn't get the best of me, what with my irrationality, tiredness, depression and general inability to cope," explains the 39-year-old from Norwich. "My husband used to despair because we're not warring people, yet I'd become irritated by the smallest thing. It was terrible."

Nowadays, her symptoms have all but disappeared, and it's not uncommon for her periods to catch her by surprise. The cure, she believes, has been acupuncture. Indeed, according to the British Acupuncture Council, Beverly is one of a fast-growing number of the estimated 300,000 sufferers of PMS in Britain who are finding success in often quite brief courses of the therapy.

It works like this. Traditional Chinese philosophy believes that the body has a motivating energy - chi - that moves through a series of channels (meridians) beneath the skin. If this chi becomes unbalanced it can lead to illness, such as PMS. By inserting fine needles into the skin, you can dip into these energy channels, stimulate the body's own healing response, and help to restore its normal balance.

"According to Chinese medicine, the premenstrual stage is a time when there is a build up of blood and energy around the liver for the oncoming period, which causes a risk of an imbalance of energy around the liver," explains Mark Bovey, co-ordinator for the Acupuncture Research Resource Centre. "This is called 'liver chi stagnation', which is closely associated with emotions. If the liver works properly, there is a free and easy flow of emotion, and emotions are appropriately expressed.

"If there is stagnation, however, emotions may be inappropriately expressed - perhaps through irritability, anger or mood swings. Inserting the fine needles into the skin that affects that area can help to unblock the build-up and reinstate the energy balance."

The effects, he says, can be quick. "I felt the impact on my third visit," confirms Trigg. "It was as if my body was a motorway and the traffic suddenly started to clear. My energy levels rose, my depression dropped, and I felt altogether better in myself."

Some acupuncturists also take into account what Western medicine tells us about the role of particular hormones around menstruation. "These acupuncturists weave the Eastern and Western philosophies together, but it is by no means across the board," says Mr Bovey. "In fact, all acupuncturists work slightly differently."

Mr Bovey admits that scientific evidence is thin on the ground, but research does exist, he says. "One recent study consisted of two groups of women who suffered from PMS. In the group that had acupuncture, there was a 78 per cent success rate in improving symptoms, whereas the other group showed no significant change."

Meanwhile, a study published in the Journal of Obstetrics and Gynaecology found that women who received ear acupuncture, applied to reflex points on the ear that correspond to specific body areas or functions, 30 minutes once a week for eight weeks, experienced a significant decrease in PMS symptoms. Acupuncture - not necessarily on the ear - was also found to be helpful for women suffering from PMS when other therapies were not effective.

Dr Mike Cummings is medical director to the British Medical Acupuncture Society (BMAS), a group of family doctors and specialists who practise the therapy alongside conventional techniques. He believes that the success of acupuncture is difficult to measure. "Acupuncture isn't just about the precise intervention of needles, the effects of which can easily be measured, but also about the therapeutic environment, the expectation of benefit, and the intention to heal by the practitioner.

"All these things in Western medicine tend to be lumped together as the 'placebo' effect and not evaluated. In complementary medicine, however, there is a far greater focus on these aspects of the treatment, which may have a real effect in making people feel better."

Indeed, Frances Cox, whose PMS became so bad that any kind of social interaction became almost impossible in the days leading up to her period, believes that the "counselling" part of her acupuncture sessions has been as helpful as the needle intervention itself. "The PMS was making me feel very anxious and hypersensitive, and it was affecting my relationship with my husband and my friends," says the 41-year-old from Bristol. "I went to see an aromatherapist who said that she couldn't help me, but recommended an acupuncturist. Just having someone listen to me was very reassuring. She'd say, 'Does it feel like "x"?', when 'x' were the exact words I'd been using to describe it to my friends."

Her acupuncturist, Jill Glover, also from Bristol, says that 60 per cent of her work is in women's health - treating women with problems ranging from the menopause through to pregnancy and infertility - and a growing number of women come with premenstrual problems. "There are several reasons," she says. "Acupuncture is finally getting rid of its image in Britain as 'wacky', and it's becoming known that it can treat things such as PMS. In addition, we know that more women suffer from PMS, and for longer in their menstrual life."

Like most acupuncturists, she treats women at certain times of their menstrual cycle, inserts the needles in certain parts of the body, and while she likes patients to start coming once a week, that can soon be reduced. "It depends on the individual," she says. "There is no standard formula because each case of PMS and each woman is so different."

Also, like many acupuncturists, Beverly Dickins from Norwich, finds that 50 per cent of the women she treats for PMS don't approach her with this as their primary problem. "In these cases, the woman has heard that acupuncture might work for her back pain, for example. When we do the in-depth consultation, which is essential in the first session, I find that PMS is a major problem in her life, but one that she assumes she has to put up with. We end up treating the PMS as well as the back pain, even though she would never have thought, 'I have PMS, I'll see an acupuncturist'."

Lynn Pearce, honorary secretary of the AACP (Acupuncture Association for Chartered Physiotherapists), agrees. "Patients tend to approach physiotherapists for pain. With women, this is often pain that's associated with their cycle - perhaps period pains or headaches. By treating the cycle and alleviating pain, everything starts to flow and their mood and emotions change, too. Acupuncture is very much a holistic treatment."

Because women suffering from problems associated with their menstrual cycles are increasingly referred to physiotherapists, and because physiotherapists increasingly use acupuncture, Ms Pearce predicts a growth in the number of women who will receive this therapy for PMS. Meanwhile, a report by the British Medical Association (BMA) recently found that almost half of GPs say that they would like to receive some training in acupuncture in order to treat their patients in the future. "Overall, 79 per cent of GPs agreed that they would like to see acupuncture available on the NHS," says Dr Vivienne Nathanson, head of health policy at the BMA.

People seeking acupuncturists for PMS should always ensure that they choose a practitioner who is properly qualified, cautions the British Acupuncture Council. Sarah Moon, an acupuncturist from west London, adds: "When PMS is bad, I believe that acupuncture shouldn't be a stand-alone treatment. A good acupuncturist should also provide advice on things such as diet and exercise."

Anna Price, 26, one of Moon's patients from Hampstead, points out that, far from being unpleasant, being treated for her PMS with acupuncture is in fact relaxing. "People think, 'Oh no, not needles!'. But the treatment makes you feel really centred and chilled. I really look forward to it."

ALTERNATIVE WAYS TO ALLEVIATE PMS

* The most common symptoms of premenstrual syndrome fall into two main categories: psychological symptoms such as aggression, depression and mood-swings; and physical symptoms such as bloatedness, breast tenderness and period pains.

* The first step in combating PMS is to pay attention to what you eat: "Diet is paramount," says Christine Baker of the National Association for Premenstrual Syndrome.

* Cut down on sugar. Sugar causes fluctuations in blood-sugar levels and therefore in mood. So, if you feel yourself getting tired and irritable between meals, don't go for sweets or chocolate. "Try to eat a small carbohydrate snack, preferably every three hours. Now is not the time for doing the Atkins diet," advises Christine.

* Avoid foods containing caffeine - tea, coffee and chocolate. Such stimulants may make you feel even worse once their buzz has worn off. So chocolate is, unfortunately, a double baddie, as it contains both caffeine and sugar. "But don't deprive yourself of it altogether," says Christine. "This is a time when you really need to be nice to yourself. Just go for quality rather than quantity."

* Various over-the-counter herbal remedies can be very helpful. Agnus castus, the dry extract of the fruit of the chaste tree, has been shown in trials to reduce irritability, mood alteration, anger, headaches and breast fullness. St John's wort can also be helpful in controlling moods.

* And if none of these works, try the advice of Dr Althea de Carteret of the Well Women's Clinic at Saltergate Health Centre: "Cooking a meal for the family after a busy day at work can be the last straw for a PMS sufferer - so just discuss who else can cook it." Sensible woman.

The National Association for Premenstrual Syndrome helpline: 0870 7772177; and website: www.pms.org.uk