Using Aromatherapy for the Effective Treatment of Premenstrual Syndrome
By Nicola Armstrong
Contents
Introduction
Background – the need
Definition – PMS/PMT, symptoms and causes
Treatment with conventional medicine
Caveat
Clinical Studies
Case studies
Treatment with aromatherapy – choice of essential oils
Administering Essential Oils
Additional lifestyle advice
Conclusion
Introduction
Premenstrual Syndrome has only recently been recognised as a real medical condition, yet it is estimated that approximately 40% of women suffer from this condition every month. Conventional medicine offers treatment for associated symptoms, such as mood swings and cramping uterine pain, as well as aiming to balance the hormones. However, these treatments are not without side effects, nor, indeed, the risk of addiction.
Opinions differ on the cause of PMS, and may include hormonal imbalance and psychological, lifestyle, genetic, nutritional and behavioural factors. For these reasons, as well as the fact that symptoms differ for each individual, a holistic, natural approach is definitely worth exploring, and does seem to prove beneficial. This dissertation aims to define the myriad of symptoms presented by women with Premenstrual Syndrome, and recommend aromatherapy oils and applications thereof, which may help to alleviate the symptoms.
Background: the need
Most women have experienced PMS at some point or other in their lives, and the American College of Obstetricians and Gynaecologists estimate that up to 10% of women suffer from symptoms to such an extent that they report disruption to their everyday lives (known as PMDD – Premenstrual Dysphoric Disorder). Given that this condition happens once a month means that there is great incentive for women to want to alleviate this condition.
Definition
Premenstrual Syndrome is a term referring to a group of symptoms that can start up to two weeks before menstruation. The term may be a misnomer, as in some cases, symptoms do not dissipate when menstruation commences, but may occur until the end of the period. Symptoms may fall into a number of categories, including physical, emotional and psychological, and may include:
- Cramping pain in the pelvis and lower back
- Fluid retention and swelling, particularly in the breasts, ankles and abdomen
- Headaches or migraines
- Nausea
- Aches and pains in the upper legs
- Sinus problems
- Acne flare-ups
- Tiredness
- Listlessness, apathy and despondency
- Aggression or violence
- Depression, sadness, crying
- Mental fatigue
- Mood swings
- Insomnia
The exact cause of PMS is unclear, but a common explanation is said to be a hormonal imbalance, caused by excessive oestrogen. Menstrual cramps are contractions to rid the uterus of the endometrium. During a contraction, the blood vessels in the womb are compressed, which temporarily reduces the flow of blood, and oxygen, to the womb. This triggers the release of chemicals, some of which produce pain and others (prostaglandins), which induce even stronger contractions. This vasoconstriction can be further compounded by cold temperatures or stress hormones (adrenalin).
Other determining factors include lifestyle, as exercise is said to improve the condition. Nutrition and diet may also play a part: stimulants such as caffeine and nicotine are said to have an adverse effect on women prone to PMT, as do low levels of Vitamin B6.
Treatment with Conventional Medicine
Conventional medicine for PMT includes addressing the hormonal imbalance and individual symptoms, but does not normally address lifestyle or nutritional issues. Hormonal imbalances are usually addressed with synthetic hormones, such as the progestogen-only contraceptive pill. Acne is sometimes treated with the contraceptive pill ‘Dianette’, also. Some women may choose not to take the seven-day break at the end of the 21-day course of contraceptive medication, in order to avoid the onset of menstruation.
Over-the-counter treatments for the spasmodic cramps include ibuprofen and codeine-based analgesics, with prescription medication for more extreme symptoms, including antispasmodics, sedatives, prostaglandin inhibitors and anti-inflammatories, such as mefanamic acid. They can have various unpleasant side-effects, particularly on the digestive system, and may not be suitable for clients with gastro-intestinal/digestive complaints such as ulcerative colitis or stomach ulcers.
In cases of mood swings, depression and irritability, the patient may be offered anti-depressants by their GP. However, these can take a number of months to prove effective, may be addictive or habit-forming, carry side effects, do not address the root of the problem, and since the symptoms are not constant, are they really the best solution to the issue? Consideration should be given to potential side-effects of these medications, particularly since they are usually intended for long-term use.
Caveat
Since aromatherapists do not claim to diagnose medical conditions, a client presenting with symptoms of PMT should be referred firstly to their GP, who may recommend consultation with a gynaecologist. Once it has been established that there are no more serious health issues, such as diagnosis of polycystic ovarian syndrome, pelvic inflammatory disease, endometriosis or cancers, the aromatherapist can commence work with the client on a bespoke course of treatment.
Clinical Studies
Clinical studies, to determine the effectiveness of aromatherapy on PMT symptoms seem to be limited. However, one study into the use of essential oils in premenstrual teenagers in Korea, proves interesting, yet somewhat inconclusive.
55 high school girls were deemed eligible to participate in the trial as they had rated their pain levels above 6, using a visual analogue scale, and had no diseases of the reproductive organs. The subjects were similar in age, age of menarche, duration and amount of menstruation.
They elected to participate in either research group, according to personal preferences. 22 subjects elected to receive a 10-minute aromatherapy massage, consisting of geranium, ginger, clary sage, marjoram and cinnamon diluted in sweet almond carrier oil, the final dilution being 5%. 23 subjects elected to receive acetaminophen. Both groups had pain levels measured at baseline and 24 hours after treatment by the preferred method.
In their final discussion, the authors of the study concluded that aromatherapy was better than oral analgesics in controlling menstrual pain for a number of reasons: greater efficacy, the fact that painkilling drugs need to be administered at regular intervals, issues with the drug’s potential toxicity on the liver and incompatibility with other medication.
Whilst this study is interesting, there are limitations to the results:
The aromatherapy group originally contained 32 subjects, and 10 chose not to continue with the study, so results may be skewed.
The study concludes that topically-applied essential oils seem to reduce menstrual cramps, but it cannot determine whether the essential oils (stimulating the olfactory and limbic systems) or massage techniques (increasing blood flow to the abdomen), or a combination of both, was responsible for the outcome.
The tests were non-randomised, as the subjects chose their groupings.
Case Studies
As clinical evidence is limited, anecdotal evidence may also be useful in determining the effectiveness of aromatherapy massage and use of essential oils in the treatment of PMS symptoms.
Below are the details of two case studies, both of whom are clients of the author.
Case Study 1
30-year-old female, active lifestyle, stress levels sometimes high.
Symptoms: the client presented with a variety of PMS symptoms, including:
- Water retention/swelling/tenderness in breasts and abdomen
- Abdominal cramps
- Mood swings and irritation
- Inability to concentrate and focus
- Other considerations:
- IBS/constipation
- Stress levels can be high at times
- Low blood pressure
- Client specifically requested no abdominal massage
Treatment:
Client had full aromatherapy massage for six months, with massages being one month or six weeks apart.
Oil combinations included the following essential oils, mixed in a base of sunflower, vitamin E and wheatgerm oil
Combination 1:
Geranium (pelargonium graveolens roseum) – hormone balancing and relaxing
Lemon (citrus limon) – diuretic, digestive tonic, laxative
Rosemary (rosmarinus officinalis) – hypertensive, diuretic, anti-spasmodic
Combination 2:
Geranium (pelargonium graveolens roseum) – hormone balancing and relaxing
Lemon (citrus limon) – diuretic, digestive tonic, laxative
Sandalwood (santalum spicatum) – expectorant, diuretic, anti-spasmodic, sedative
Combination 3:
Geranium (pelargonium graveolens roseum) – hormone balancing and relaxing
Clary sage (salvia sclarea) – tonic for female reproductive system, relaxing
German chamomile (santalum spicatum) – good for digestion problems, relaxing, anti-spasmodic, anti-inflammatory, analgesic, sedative.
As the client felt uncomfortable with abdominal massage during an aromatherapy treatment, she was given a blend of the oils used during each treatment, and advised to apply them herself to the abdomen and lower back on a daily basis one week before her period was due, until the end of the period. Additional lifestyle advice included drinking more water and increasing intake of fruit, to avoid constipation, and to try to reduce stress levels, where possible.
The client’s feedback at the end of six months reported that symptoms were reduced, and she could see the correlation between the improvement in her condition and aromatherapy treatments and lifestyle advice.
Case Study 2
39-year-old female, active, healthy lifestyle, stress levels high on occasion
Symptoms: The client presented with the following symptoms:
- Sever abdominal cramping, lasting from 3-4 days before menstruation until the end of the period
- Tiredness
- Irritibility
- Feeling ‘down’
- Clumsiness
- Reduced appetite
- Congested sinuses
- Other considerations:
- Prone to constipation
- Had laparoscopy performed circa ten years ago, and no other diseases confirmed present
In the past, pain has been so severe that over-the-counter analgesics have proved ineffective, and client has needed to take time off work/college. Client has been recently prescribed mefanamic acid, which has proved very effective, but is concerned about potential side-effects. Symptoms have been reduced with smoking cessation 4 years ago, and client has herself identified that caffeine increases abdominal pain. Blood pressure tends to be a little higher than average
Treatment:
Client has full-body aromatherapy massage every month or six weeks, and treats herself at home, using a combination of the following essential oils (depending on symptoms and time during menstrual cycle) in the bath, or applied to the abdomen and lower back, blended with base oil.
The client has had some training and undergone an aromatherapy course for home use, and has invested in a range of essential oils to help alleviate symptoms. She would commonly use a blend of clary sage, geranium and bergamot for one week before menstruation, and then select additional oils from the following list, depending on symptom priorities:
Clary sage (salvia sclarea) – tonic for female reproductive system, relaxing
German chamomile (santalum spicatum) – good for digestion problems, relaxing, anti-spasmodic, anti-inflammatory, analgesic, sedative.
Lavender (lavandula augustifola) – relaxing, analgesic, anti-spasmodic, pro-biotic (promoting intestinal flora, to aid digestion)
Marjoram (origanum majorana) – anti-spasmodic, muscle relaxant
Rose (rosa damascena) – to relieve anxiety, anger, depression
Ylang ylang (cananga oderata var. genuina) – soothing and uplifting, hypotensive
Bergamot (citrus bergamia) – uplifting, energising, digestive
Geranium (pelargonium graveolens roseum) – hormone balancing and relaxing, aids elimination, diuretic
Peppermint (mentha piperita) – to clear sinus congestion and aid digestion by relaxing the stomach.
After three months of using the basic three-oil blend of geranium, clary sage and bergamot, the client reported a reduction in uterine cramps and feeling emotionally on a ‘more even keel’ both prior to and during her period. She continues to experiment with the various other oils, above, to alleviate other symptoms. She also attributes the improvement in symptoms to the avoidance of stimulants such as tobacco, caffeine and chocolate. The scientific explanation for this may be that stimulants constrict blood vessels and thereby reduce blood flow in the pelvis, which may make uterine cramps worse.
Treatment with Aromatherapy
Aromatherapy can assist with PMT symptoms in a number of ways, such as:
Balancing hormones (oestrogen and testosterone) may reduce symptoms such as mood swings, depression and acne breakouts.
Reducing vasoconstriction in uterine muscles, by reduction of stress levels and therefore adrenalin balance. Massage techniques also promote blood flow.
Promoting regular elimination of waste products from the bowels, to clear congestion in the lower pelvis
Addressing individual symptoms, such as sinus congestion, on an ad hoc basis.
The first three instances are examples of preventative therapy, and the latter is intervention, as required.
The Choice of Essential Oils
The following list demonstrates oils which may be used to promote hormonal balance, reduce stress levels, stimulate digestion and alleviate individual symptoms. It is important to note that it is necessary to treat each client on an individual basis, determining treatment priorities in cases of presentation of multiple symptoms, and perhaps experimenting with different blends over several menstrual cycles.
Balancing hormones: Geranium, lavender
Analgesic – particularly abdominal cramps: Lavender, marjoram, clary sage, eucalyptus, ginger, chamomile, clove, vetiver, yarrow, peppermint, nutmeg, neroli, geranium
Stress reduction: Lavender, bergamot, frankincense
Digestive aid (to prevent constipation): Peppermint, black pepper, cardamom
Sinus congestion: Peppermint, eucalyptus, sandalwood
Nausea: Lemon, ginger, cardamom, fennel, lavender
Addressing lethargy/tiredness: Rosemary, lemon, jasmine, bergamot, grapefruit, fennel, clary sage
Fluid retention: Chamomile, lemon, carrot, cedarwood, juniper, fennel, cypress, peppermint
Headaches/migraines: Grapefruit, lavender
Acne: Tea tree, lavender, thyme, bergamot, chamomile, cedarwood
Aggression/violence: Nutmeg, geranium, bergamot, palma rosa
Depression, sadness, crying: Bergamot, rose, grapefruit, neroli, ylang ylang
Irritability: Nutmeg, geranium, bergamot, clary sage, chamomile
Mental fatigue: Rosemary, basil, peppermint
Insomnia: Lavender, clary sage, jasmine, mandarin, valerian
From this list, it is apparent that many oils address a number of symptoms, so there would be some obvious choices for a woman presenting with more than one. For example, if the top two treatment priorities were pelvic pain and fluid retention, a good choice to address both would be chamomile.
The use of more than one oil seems to produce a synergistic effect – a combination is more effective than individual use. For example, the anti-inflammatory effect of chamomile is greatly enhanced by the addition of lavender in the correct proportion.
Administering Essential Oils
Essential oils work in two ways, either by penetration through the skin, or inhaled and entered through the olfactory system.
They can be used to treat premenstrual syndrome via a number of methods, the most effective being:
Massage: either whole body or more specific to the abdominal area.
A massage blend can be made up for use as required over a number of months. Using a good quality base oil, such as sweet almond or sunflower, the essential oils should be added up to 1 drop per millilitre of base oil, maximum. The blend can be used in a full body massage, or more often in a self-administered abdominal massage, which may be more convenient. The blend should be rubbed from the solar plexus, over the lower abdomen as far as the pubic bone (avoiding the genital area), and over the lower back and buttocks. This can also be used on the pulse points, on the insides of the wrists, below the earlobes, etc. Subtle massage of the base and sacral chakras also be beneficial, with corresponding essential oils.
Bath
A warm bath should be run with doors and windows closed, so that the vapours do not escape. Up to 9 drops of essential oils, in the appropriate combination, may be added. Before entering the bath, the water should be agitated, so that the oil droplets do not sit in concentration on the surface, as this may irritate the skin, particularly mucus membranes. Baths also produce the added benefit of warming the pelvic area, and increasing blood flow, thereby reducing uterine cramps.
Methods of inhalation
The benefits of the essential oils can also be gained by inhalation, in the following ways:
Placing 1-2 drops on a tissue and inhaling the vapours deeply
Diffusers: as per manufacturer’s instructions, up to 6 drops of essential oils can be used. A similar effect may be gained by placing drops of essential oils on a radiator.
Vapour inhalation: fill a bowl or sink with warm water and add 2-3 drops of essential oil. Keeping the face at least 25cm from the surface of the water, cover the head and shoulders with a towel and breathe deeply. This method is particularly beneficial for headaches or sinus congestion.
Additional Lifestyle Advice
Although this article is concerned with aromatherapy, it is prudent to take a holistic approach and providing a client with additional lifestyle advice adds value to their treatment.
Every woman is different, but the following advice will be useful in most cases:
- Avoid stimulants, such as caffeine, alcohol, refined sugar and nicotine for at least one week before a period, and until it finishes
- Reduce stress levels if possible – yoga and/or meditation may be useful
- Exercise to promote good circulation and production of serotonin and endorphins (natural painkillers)
- Avoid constipation by drinking plenty of water and consume adequate amounts of roughage
- Eat little and often, to stabilise glucose levels
- Get plenty of sleep
- Consider good dietary supplements, particularly vitamin B complex and evening primrose oil or royal jelly – a consultation with a nutritionist or ayurvedic medicine practitioner may be useful
Conclusion
The term ‘Premenstrual Syndrome’ covers a myriad of different symptoms, and the main benefit of aromatherapy in treating this condition is its versatility. A woman can mix and match different oil blends to suit her own particular requirements, and adjust it from month to month, if necessary. Aromatherapy is useful in prevention of symptoms, by balancing hormones and reducing stress levels, and if symptoms do present, there are literally hundreds of essential oils which can be used to treat them. In addition, the administration of the oils is usually a pleasant, nurturing experience, which helps to relieve dysmenorrhoea (PMT)by increasing blood flow through massage, or the heat from a warm bath.
In addition to treatment with essential oils, the aromatherapist should encourage the client to adopt a healthy, balanced lifestyle, and to ‘listen to her body’, in order to benefit most fully from the use of aromatherapy to address the symptoms of premenstrual syndrome.
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