Do you have emotional symptoms you can’t control?  Are they controlling you?

I remember meeting a patient years ago who felt well for only one week out of every cycle.  Her symptoms of premenstrual dysphoric disorder were so severe that as soon as she ovulated, she felt miserable.   This occurred each cycle and the symptoms lasted until the end of her next menstrual period (3 weeks).  I asked her, “What do you do to help with the symptoms?”  I expected her to list supplements, medications, or exercise regimens that she had tried in the past.  Instead, she looked at me intently and said, “I pray that my husband doesn’t leave me.”  

The significance of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) has been severely underestimated.  These disorders add significant relational stress, both in marriage and between a mother and her children.  Historically, women have been dismissed and told that PMS is caused by “normal physiologic changes.”   

Before we delve further, it is important to understand the medical definitions of PMS and PMDD:

PMS = The presence of both physical and behavioral symptoms that occur repetitively in the second half of the menstrual cycle and interfere with some aspects of the woman’s life.

PMDD (according to the American Psychiatric Association) = At least 5 symptoms must be present the week before the menses and start to improve within a few days after the onset of menses.  One of the 5 symptoms must be severe mood swings, anger or irritability, depression or internal tension/anxiety.  In this diagnosis, symptoms must interfere with social functioning.  

What are the physical and behavioral symptoms of PMS and PMDD?  The most common symptoms women experience are: mood swings, irritability, breast tenderness, bloating, weight gain, food cravings/increased appetite, crying easily, depression, headaches, fatigue, difficult concentrating, insomnia, acne, and gastrointestinal upset.  It is normal for a woman to feel some premenstrual symptoms for 2-3 days before the start of her menses, as the drop in progesterone is necessary to signal the menstrual period.  Having symptoms for longer than 2-3 days is NOT normal.  It is important for women to create a prospective symptom diary as it is difficult to recall timing of onset and symptoms retrospectively.

The suffering experienced is unnecessary because these disorders are easy to diagnose and simple to treat.  Women function with a different set of hormones every day.  If a woman learns a reliable charting method to determine the timing of her ovulation, blood draws can be ordered at specific days of the cycle to test hormones.  By measuring post-ovulation progesterone (the dominant hormone) and estrogen, a physician can determine which of the hormones are deficient.  The treatment is tailored subsequently.  With NaProTechnology, the woman’s hormones are restored to normal with bioidentical hormones and the symptoms improve.  Some women may be taking an anti-depressant for PMS/PMDD or underlying depression and anxiety.  This does not interfere with the diagnosis or treatment of hormonal abnormalities.  Some women may need both modalities of treatment.  Others may be able to wean off their anti-depressants once their hormones are balanced.  Gynecologists often work with mental healthcare providers to determine the best treatment plan.

Why are bioidentical hormones after ovulation (luteal phase) not utilized in general gynecology to treat these disorders?  The use of progesterone to treat PMS has a long history, which was affected by a meta-analysis published in the British Medical Journal (BMJ) in October 2001.   This analysis concluded that progesterone did not improve PMS symptoms, so the treatment was discontinued, and the subject closed.   Unfortunately, the review missed a key point- the timing of the progesterone replacement.  There have been 6 double-blind placebo-controlled trials of progesterone therapy in women with PMS and only one of those studies had significant improvement of symptoms.  This study (by Dennerstein et al in the BMJ) targeted the post-ovulatory phase of the cycle properly, by measuring a progesterone metabolite in the urine.  The other studies used a variety of “calendar” methods.  The key to bioidentical hormone treatment of PMS and PMDD is reliable knowledge of when a woman is ovulating.  Progesterone must be given AFTER ovulation.  If a woman is given progesterone before she ovulates, she will feel worse because it will negatively affect the ovulation event and subsequently diminish the progesterone her own body will make.  

Does a woman ovulate on the same day every cycle?  Absolutely not!  The pre-ovulatory phase of the cycle is variable in length.  This is normal.  If you have a reliable means to determine ovulation each cycle, then it is not problematic to target the post-ovulatory (luteal) phase of the cycle for treatment.

Through the use of NaProTechnology, I have treated more than a thousand women with PMS or PMDD using bioidentical hormones appropriately timed to the post-ovulatory phase of the cycle.  The positive results are dramatic.  Women feel significantly better within 1-2 cycles.  This has an enormous impact on their life and that of their family members.  Some women have experienced deep depression during the luteal phase of their cycle, and appropriate hormonal treatment has literally saved their life.

If you are on an emotional roller coaster ride with no end in sight, consider making an appointment for a hormonal evaluation through Vivify Women’s Health and Fertility.