Beyond the Blues: Managing Premenstrual Syndrome (PMS) in Korea

For many women, the days leading up to their period can bring a range of uncomfortable physical and emotional symptoms, collectively known as Premenstrual Syndrome (PMS). From mood swings and irritability to bloating and fatigue, PMS can significantly impact daily life. In South Korea, healthcare providers offer a comprehensive approach to diagnosing and treating PMS, combining modern medicine with traditional Korean healing practices to help women find relief.



What is PMS and PMDD?

Premenstrual Syndrome (PMS) refers to a cluster of physical, emotional, and behavioral symptoms that typically occur in the luteal phase (the week or two) before menstruation and resolve shortly after the period begins. Symptoms can range from mild to severe and may include:

• Emotional/Behavioral: Mood swings, irritability, anxiety, depression, tension, crying spells, difficulty concentrating, changes in appetite (food cravings), sleep problems (insomnia or excessive sleepiness), social withdrawal.
• Physical: Bloating, breast tenderness, headaches, fatigue, muscle aches, joint pain, acne flares, constipation or diarrhea.

When PMS symptoms are particularly severe, debilitating, and significantly interfere with daily functioning, it may be diagnosed as Premenstrual Dysphoric Disorder (PMDD). PMDD is a more severe form of PMS, characterized by pronounced mood disturbances.

Diagnosing PMS/PMDD in Korea

In Korea, a thorough diagnosis is key to effective management. Since there's no single medical test for PMS, diagnosis relies on tracking symptoms and ruling out other conditions. Your OB/GYN (산부인과 - sanbuingwa) will typically:

1. Symptom Tracking: They will ask you to keep a detailed menstrual diary for at least 2-3 cycles. This diary should record your symptoms, their severity, and when they occur in relation to your menstrual cycle. This is crucial to establish the cyclical pattern unique to PMS/PMDD (symptoms appearing consistently in the premenstrual phase and disappearing after menstruation). Korean doctors may use standardized tools like the Premenstrual Symptoms Screening Tool (PSST).
2. Medical History & Physical Exam: A comprehensive review of your health, lifestyle, and a physical/pelvic exam to rule out other gynecological conditions (like fibroids, endometriosis) or medical conditions (like thyroid disorders, depression) that might cause similar symptoms.
3. Blood Tests: While not directly diagnostic for PMS, blood tests may be performed to:

• Rule out other conditions, such as thyroid dysfunction.
• Check for anemia if heavy bleeding is also present.
• Assess hormone levels (though PMS is related to normal hormonal fluctuations, not necessarily abnormal levels).

Western Medical Treatments for PMS/PMDD in Korea

For moderate to severe PMS or PMDD, Western medicine offers several effective interventions:

1. Selective Serotonin Reuptake Inhibitors (SSRIs):

• Considered the first-line pharmacological treatment for PMDD and severe PMS.
• SSRIs (like Fluoxetine, Sertraline, Paroxetine, Escitalopram) can rapidly alleviate emotional symptoms such as irritability, depression, and anxiety.
• They can be prescribed to be taken continuously throughout the month or only during the luteal phase (the 1-2 weeks before your period).
• Cost: With NHIS, the co-pay for SSRIs is generally low (a few thousand KRW per month). Without NHIS, costs would be out-of-pocket, typically ranging from ₩30,000 - ₩80,000 KRW per month.

1. Hormonal Contraceptives (Oral Contraceptive Pills - OCPs):

• Specifically, continuous or extended-cycle low-dose combined OCPs (containing both estrogen and progestin) can effectively manage both physical and emotional PMS symptoms by suppressing ovulation and stabilizing hormone levels.
• Some OCPs are specifically approved for PMDD (though these might be less common in Korea compared to standard OCPs).
• Cost: With NHIS, the co-pay for OCPs is minimal. Without NHIS, a month's supply typically costs ₩10,000 - ₩30,000 KRW.

1. NSAIDs (Nonsteroidal Anti-inflammatory Drugs):

• Over-the-counter or prescription NSAIDs (like Ibuprofen, Naproxen) can help alleviate physical symptoms such as headaches, muscle aches, and breast tenderness.
• Cost: OTC NSAIDs are inexpensive. Prescription NSAIDs with NHIS are minimal co-pay.

1. Diuretics:

• For significant bloating and fluid retention, a mild diuretic (water pill) might be prescribed for a few days before your period.
• Cost: With NHIS, minimal co-pay.

1. GnRH Agonists (e.g., Leuprolide):

• Used only for very severe, debilitating PMDD that doesn't respond to other treatments. These medications induce a temporary, reversible menopause-like state by suppressing ovarian hormone production.
• Often prescribed with "add-back" therapy (low doses of estrogen and progestin) to minimize menopausal side effects.
• Cost: These are significantly more expensive and usually reserved for severe cases, with NHIS covering part of the cost if medically necessary.

Traditional Korean Medicine (TKM - Hanbang 한방) for PMS

Traditional Korean Medicine offers a holistic perspective, aiming to restore the body's balance and harmony to alleviate PMS symptoms. Many women in Korea incorporate TKM as a complementary therapy.

1. Herbal Medicine (한약 - Hanbang Yak):

• TKM practitioners prescribe customized herbal formulas based on an individual's constitution and specific PMS symptoms.
• Common TKM theories for PMS involve addressing "liver qi stagnation" (linked to irritability, breast tenderness), "spleen qi deficiency" (linked to fatigue, bloating), or "blood deficiency."
• Cost: Typically out-of-pocket, ranging from ₩100,000 - ₩300,000+ KRW per month, depending on the herbs and duration.

1. Acupuncture (침술 - Chimsul):

• Acupuncture involves inserting fine needles into specific acupoints to regulate the body's energy (Qi) flow, reduce pain, alleviate stress, and influence hormonal balance.
• Studies suggest acupuncture can effectively reduce the severity of PMS symptoms, especially pain and emotional distress.
• Cost: Typically ₩30,000 - ₩70,000 KRW per session. Multiple sessions are usually required.

1. Moxibustion (뜸 - Tteum):

• Applying heat from burning mugwort to specific acupoints, often used to warm the lower abdomen and improve circulation, which TKM believes can alleviate menstrual discomfort.

Lifestyle and Self-Care Strategies

These are crucial for all women with PMS, regardless of other treatments:

• Dietary Changes:
• Reduce caffeine, alcohol, and refined sugar, especially in the premenstrual phase.
• Limit salt intake to reduce bloating.
• Eat smaller, more frequent meals to stabilize blood sugar.
• Increase intake of complex carbohydrates, fruits, and vegetables.
• Regular Exercise: Aim for at least 30 minutes of moderate-intensity exercise most days of the week. This can significantly improve mood and reduce physical symptoms.
• Stress Management: Incorporate stress-reducing techniques like meditation, yoga, deep breathing exercises, mindfulness, or hobbies.
• Adequate Sleep: Aim for 7-9 hours of quality sleep per night.
• Nutritional Supplements: Some supplements like calcium, magnesium, Vitamin B6, and Vitamin E have shown potential benefits for some PMS symptoms, but discuss with your doctor before taking them.

Cost of PMS Treatment in Korea

The cost of PMS diagnosis and treatment in Korea depends on the services you receive and your NHIS coverage.

• Consultation & Basic Diagnostics (with NHIS): Initial consultation and necessary tests (like blood work, basic ultrasound to rule out other issues) are largely covered. Your co-pay typically ranges from ₩5,000 - ₩30,000 KRW.
• Without NHIS Coverage:
• Consultation: ₩30,000 - ₩100,000+ KRW.
• Blood Tests (Hormone Panel, Thyroid): ₩100,000 - ₩250,000 KRW.
• Pelvic Ultrasound: ₩70,000 - ₩150,000 KRW.
• Medications:
• Oral Contraceptives/SSRIs: With NHIS, minimal co-pay. Without NHIS, expect ₩10,000 - ₩80,000 KRW per month.
• TKM (Herbal Medicine/Acupuncture): Generally out-of-pocket, as mentioned above.

Tips for Expats:

• Prepare Your Symptom Diary: This is the single most important diagnostic tool for PMS/PMDD. Be as detailed as possible.
• Bring Medical Records: If you've been diagnosed or treated for PMS or related conditions before, bring any translated records.
• Be Open to Different Approaches: Discuss both Western and TKM options with your doctor to find what works best for you.
• Communicate Clearly: Don't hesitate to ask questions about your diagnosis, treatment plan, potential side effects, and expected outcomes.

PMS and PMDD don't have to control your life. With the range of diagnostic tools and treatment options available in South Korea, you can effectively manage your symptoms and improve your quality of life.

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