每月必經的情緒波動? 中醫調理幫助婦女擺脫經前症候群
2023-06-22 記者 蘇旋/報導
日前,一名年約三十歲的王小姐至柳營奇美醫院中醫部門診就醫,自述每個月總是有幾天特別容易心情煩躁,情緒莫名沮喪而且很容易生氣,同時伴隨著乳房脹痛、下腹脹痛、頭痛以及四肢水腫等不舒服的症狀。經醫師詳細詢問後,發現這些症狀總是在月經來之前,而隨著月經來了之後,一切又恢復了正常,這就是典型的經前症候群。
柳營奇美醫院中醫部簡珮珊醫師表示,經前症候群的定義是在月經來潮前約一周出現,症狀包含生理上的身體浮腫、肌膚敏感、便秘、脹氣、胸部脹痛、頭暈、腰痛等,以及心理上的焦煩、生氣、易怒、憂鬱、無法集中思想等,嚴重時會使工作及人際關係受到影響,通常症狀在月經來潮後開始消退,並在月經來潮一周內完全消失。根據統計,約47%的女性有經前症候群的困擾,其中更有3~8%的人會嚴重到產生經前不悅症(premenstrual dysphoric disorder, PMDD),表示症狀已經嚴重到對日常生活造成實質影響。
經前症候群的原因錯綜複雜,真正致病機轉目前還不是很清楚,可能是和黃體激素和雌激素比例失調有關。另外,營養不均衡(高脂肪或糖鹽過多)、維他命B6不足、甲狀腺內分泌失調、鈣質缺乏、身心壓力、睡眠不良、環境污染等,都可能影響經前症候群的表現。西醫治療常使用的藥物大致可分為抗焦慮藥物、內分泌調節藥物,以及口服避孕藥等。
中醫依據不同證型做不同的治療,最常見的為「肝氣鬱結型」,是指平時容易緊張焦慮,經前焦躁易怒更加嚴重、胸部悶脹、乳房脹痛、胃口不好,治法以疏肝解鬱,理氣散結,處方可選用逍遙散來治療。第二種為「肝腎陰虛型」,症狀常有經前易煩熱、夜睡不安、手足心煩熱、口乾,治法須滋養肝腎,育陰清熱,處方可選用知柏地黃丸加減來治療。
第三種為「氣滯血瘀型」,此類型的人在經前或經期常有頭痛、腹痛、肢體不定處疼痛、經前面貌及肢體腫脹、經色紫黯、血塊多,治法以理氣行滯,活血養血,處方可選用血府逐瘀湯加減治療。第四種為「氣血虛弱型」,可見月經顏色淡質稀、經期時眩暈,或平時腸胃功能欠佳,經前易疲倦、腹瀉、胃口不好,治法須補益氣血,健脾和胃,處方可選用補中益氣湯或六君子湯加減來治療。
另外,根據美國婦產科學院的建議,生活型態的改變也是一個很重要的治療方式,因為經前症候群是一種週期性的症狀,因此到了接近症狀發作的這段期間,應該避免攝取咖啡因、戒菸酒、規律的運動與營養補充如鈣質、維他命B6等,以及保持充足的睡眠,都有助於經前症候群的緩解。
簡珮珊醫師提醒,經前症候群的症狀多樣貌,每個人經歷到的症狀、嚴重程度都不盡相同,也會隨著時間而有所差異。大部分的人症狀輕微,影響不大,會有少數經前不悅症的女性,經前不適程度較嚴重,尤其情緒方面出現憂鬱、焦慮、易怒症狀明顯,或有其他強烈而難以承受的情緒,甚至已嚴重影響生活機能,建議應尋求醫師幫助並積極治療,讓每個月必經的過程不再如此難熬!
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