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A deeper look at pre-menstrual mood disorders · Women of the Well | Women's health, done differently

• 0:57
  Hello, welcome to another episode of Women of the Well.
• 1:01
  I'm Sam Lindsay-German.
• 1:03
  I'm Thea Bowler.
• 1:04
  And Peta Wright is here too, having a drink of water.
• 1:08
  Today, we're going to talk about PMDD and PME, which stand for premenstrual dysphoric disorder and premenstrual exacerbation of an underlying mental health condition.
• 1:19
  Sorry, I was eating peanut butter and toast.
• 1:22
  or premenstrual mood issues is probably better.
• 1:25
  Like a more generic or general term for that.
• 1:28
  we spoke in a previous episode about the physiology of the luteal phase the hormonal shifts that are going on in the time before a period and I guess the impacts that that can have on our mood in a totally normal way.
• 1:42
  Fashion and we in that episode discussed lots of different strategies to help manage that time which can be more crunchy see a lot of women who come and they might have like self diagnosed or they've seen A GP or a psychiatrist and they've come because these symptoms that they're experiencing are either they're fine for the first half of their cycle and then the second half of their cycle sometime after ovulation, either the whole time or just the week before their period, they might start to have a real worsening of their mood.
• 2:12
  So more depression, more anxiety, sometimes real issues with self esteem, self worth, body image.
• 2:19
  Either can't sleep, too much sleeping either like cravings for lots of salty, sweet carbohydrate y food that they find difficult to control sometimes more pronounced physical symptoms, like, which is, I guess, an amplification of the normal physical symptoms that come across the cycle, so, like, more distressing awareness of bloating.
• 2:42
  Headaches, breast tenderness, fluid retention, that kind of thing.
• 2:46
  Some women that I see report feeling like, almost like a switch has been flicked, like they're a completely different person especially in terms of rage or irritation around relationships in their lives.
• 2:59
  And many women You know, also report feeling like so bad that they may be suicidal or have suicidal ideation during that time, or find that they're unable to go to work or school or you know, their relationship completely blows up at that same time, every month.
• 3:16
  And lots of people report a sense of sort of regret, like once they enter their good weeks.
• 3:23
  like remorse and regret about the way they were in their bad weeks and almost like a sense of dread about the oncoming time.
• 3:32
  And a deep sense of shame they would often report having after they've you know might have behaved in a way that they might not have if they were in their First part of their cycle or their follicular phase.
• 3:42
  Yes.
• 3:43
  Normally these symptoms improve with the onset of their period or within a few days.
• 3:49
  Sometimes it can be a little bit different to that.
• 3:52
  It can be a, it's not always completely typical.
• 3:55
  But really like what's happening is there is a sensitivity in the brain to the hormone levels that our ovaries make.
• 4:03
  Like, The fact that our ovaries make such powerful hormones that affect our whole body and our brain and our nervous system, and the fact that we are all just, you know, are told to go on the pill at the age of 13, I think is like, this is a prime example of how powerful these hormones are.
• 4:18
  And when our estrogen and our progesterone and testosterone are higher, like towards the middle of our cycle, that tends to, as we've talked about in previous episodes, upregulate serotonin and GABA, which can make us feel more energetic and happy and less anxious and better sleep.
• 4:36
  And in that seven to 10 days as our hormones falling they're going down.
• 4:40
  And so if we have very sensitive hormone receptors in our brain, we're more likely to react.
• 4:45
  And so we react very strongly to that, like almost like a drug withdrawal.
• 4:48
  So we know that the vast majority of women experience some changes in their mood.
• 4:52
  And so PMDD is a diagnosis, and I mean, I'm not a massive diagnosis person.
• 4:58
  I feel like it can be helpful for some people to put words and describe what they're feeling.
• 5:03
  but I also think we, I also think we have to be careful with diagnoses because it often makes the person having the issue pathological rather than the effects of the environment around them, which have a lot to do with their symptoms as well.
• 5:17
  And so mostly it's at seven to 10 days when the hormones are falling.
• 5:21
  Some women, they can have this kind of paradoxical reaction to progesterone.
• 5:25
  So progesterone is supposed to have that nice effect.
• 5:28
  It turns into a neuro hormone called allopregnenolone, which is.
• 5:31
  where the good effects of progesterone happen on the brain.
• 5:35
  Some women have like a funny paradoxical opposite effect and they're just totally progesterone intolerant.
• 5:41
  And they would often present with like the whole second half of their cycle being not very good and often a history of really worsening mood with progesterone.
• 5:51
  contraceptives or the pill or things like that.
• 5:53
  Yes.
• 5:54
  And often if they've had children, they often will have had postnatal depression or anxiety as well.
• 5:59
  And the other like main risk factors, uh, so I would talk about like big shifts in hormones, like postpartum and that's not just the hormonal shifts, but it's also the social structure or lack of support that we have around motherhood in our society.
• 6:15
  There's a massive correlation between trauma, developmental trauma, and PMDD or PME later on in life.
• 6:24
  And this makes complete sense to me.
• 6:25
  There's an amazing psychiatrist called Professor Kulkarni, she's from Melbourne, and she does a lot of work with, uh, women's hormones and mental health.
• 6:33
  And she's done some great studies that, that show that real strong correlation between adverse childhood events and developmental trauma.
• 6:43
  What's probably happening is the effect of that trauma on the HPA axis, so the brain adrenal axis or our stress our nervous system.
• 6:51
  So when we're young and we have a vulnerable nervous system, similar to pain and other things persistent or high levels of stress or trauma wire that immature nervous system and can make us more sensitive to danger, perceived danger outside of us To keep us safe and also changes inside the body and that's the word called interoception.
• 7:13
  So we can have like much stronger reactions to changes and including hormonal changes inside inside the body.
• 7:21
  So that's a big risk factor.
• 7:23
  I just as you were saying that what I was thinking is it's that.
• 7:26
  Not being able to control, and it's that because obviously if you've suffered from childhood trauma or those any form of trauma in the younger years, one of the main things that you learn to do is cope by controlling.
• 7:39
  And obviously when our hormones start to do something that feels that I can't control it, then that becomes hugely overwhelming and that's it.
• 7:48
  So we.
• 7:48
  We feel out of control.
• 7:51
  And of course there is a little element of that, but it's not knowing what to do with that or why that's happening.
• 7:56
  And then the uncertainty.
• 7:57
  And of course, in our society where we don't talk about our periods, we don't say I'm at that stage of my month, I might need to have some care or some support, then we just, hide it even more and it becomes a massive kind of volcano.
• 8:12
  Absolutely.
• 8:12
  And so that's the other thing, that lack of understanding around women's cycles, that lack of support for that cyclical living and the expectations of our society and our culture, that women should operate exactly the same all the time.
• 8:26
  And if you don't feel like I can operate exactly like that.
• 8:29
  In that premenstrual phase, you automatically feel like your failure and your stress, uh, cortisol and adrenaline rise and your window of regulation shrinks even further and your ability to cope with life in this vulnerable hormonal part of your cycle becomes even narrower.
• 8:48
  Well, your capacity to be good runs out and, and, and this is a big thing.
• 8:53
  You know, are the expectation for women to be good, to achieve, to, you know, just sort of.
• 9:01
  Do the right thing.
• 9:02
  So, which we can sort of do quite well under the veil of, you know, the earlier part of our cycle, but when it comes to this and there is that shift, if we've been doing things we don't want to do, then again, it just becomes very apparent to us, you know, and we can't cope with that because if we don't really want to be pleasing people all the time and yet that's what.
• 9:24
  People want us to do.
• 9:25
  Which makes me feel angry just talking about it.
• 9:27
  And then we, and then, and then what makes me feel angry is that then we have to make the diagnosis of, that the women have the problem where, you know, I for the vast majority the environment has a massive impact on these symptoms.
• 9:41
  Like if we lived in a world where we were allowed to, Go inward, nurture ourselves, have people actually look after us.
• 9:48
  Stop.
• 9:48
  Especially when we've had, you know, children or we've got small children or even have people to talk to.
• 9:54
  I feel like there's a lot of women that actually don't have other women they can honestly talk to.
• 9:59
  And so being open, you know, I often talk about, you know, who are the people you can be a hundred percent yourself with?
• 10:06
  You know, you can take off the masks and just say it all like, Today I hate my children.
• 10:10
  You know, if we can't say those honest things, then we feel that there's something wrong with us and it compounds it, brings about even more shame, and then we get stuck in the cycle.
• 10:19
  And what occurred to me listening to what you were saying about, you know, the oral contraceptive and the way that shuts down, is if we were someone who went through adverse childhood trauma and then was put on the pill, And we have not learned to regulate at all, so then when it comes to the point where we think, oh, I think I have a child, and we take ourself off the pill, that's like crescendo.
• 10:40
  Uh, but that's so true.
• 10:42
  I was just going to say that is one of the other risk factors, and I don't know if it's written anywhere, but I certainly find this, and I talk to my patients about it, because I think if early, if people are put on the pill early, Early because if we think about it, like we go from pre pubertal, not having the rises and falls and the ebbs and flows of hormones.
• 11:01
  And then we get put on the pill, which flattens everything.
• 11:05
  Really that time of our teenage years, it has that bad rap of like emotional teenagers and whatever.
• 11:11
  That is actually a time where our body and our brain are getting used to riding the rollercoaster.
• 11:17
  And We are developing hormonal resilience, which is a real term about how to deal with the effects on our physiology of those changing hormone levels, which is harder at first, which is why teenagers get such a bad rap, but then we usually get into the groove.
• 11:33
  And when, and I see this very often, if a woman has been put on the pill very early and then has been on it for 10 years and comes off it, particularly if they have that history of childhood trauma.
• 11:45
  And then they have to deal with, but even if they haven't, because they just haven't developed that hormonal resilience, and then they come off, they've had no education about the fact that, hey, you can have four distinct hormonal cycles, it will change your brain and how you feel, and you just have to pretend, like, cope the same like you've been on the pill for the last 10 years where your hormones have been so different.
• 12:03
  The same.
• 12:04
  They actually have not developed that hormonal resilience and they haven't had those years of practice, and all of a sudden they've, they're like thrust into the stressful nature of adult life, which compounds everything.
• 12:16
  It's like I always say, you have to do each phase of life.
• 12:18
  Mm.
• 12:19
  And so if you miss it because you, uh, put on something that suppresses those hormones, you're going to have to go back and do it.
• 12:25
  We have to do every stage of life.
• 12:27
  It doesn't matter if you miss it, for whatever reason, you will, at some point, go through it again.
• 12:32
  I see that time and time again.
• 12:34
  And I think, you know, what just occurred to me was if you are a young girl who's been put on the pill and who's.
• 12:40
  mother is on the pill and you never actually have experienced watching hormonal fluctuations and you don't have anyone to talk to about it.
• 12:48
  So the mother will be scared by your fluctuations when you start to get your hormones coming in and your first bleed.
• 12:54
  And then that's kind of compounds a problem because if you're looking at someone who is trusted and who you see as someone to look up to, and they don't know what to do with you, then.
• 13:05
  You're going to think there's something wrong with you which compounds your feeling of being you know being normal being part of the Belonging and then the medical industry then the mother brings the daughter to the doctor And how many times have you heard a mother say just level her out give her something to level her out?
• 13:22
  And you're like, but she doesn't need to be leveled out.
• 13:25
  Everyone just needs to be regulated enough to be able to sit with feelings and then we wonder why no one can feel anything.
• 13:32
  Yes, exactly.
• 13:33
  I would say the people who most commonly come in with the idea that they might have PMDD is the 39, 40 year old mum.
• 13:41
  And often it is, they've been on the pill and they've stopped and they've had their children and they've often had periods back in between, but perhaps not for very long.
• 13:51
  And then they've finished their family and periods are back well and truly.
• 13:57
  And that's a point I think where lots and lots of people notice these symptoms a lot more.
• 14:02
  Because, which I think is hugely important.
• 14:05
  due to the pressures of life.
• 14:06
  Do you know what I mean?
• 14:08
  Like I think the pace that we're living at, the caregiving that we're expected to do really makes that time incredibly difficult for all the reasons we've talked about.
• 14:16
  But I would say that's a time where people start to really Notice their cycle in this way.
• 14:21
  Yeah, and because it's not just early changes to our nervous system that can set us up for this sort of environment or, or way our brain works, but it's also like, current stress.
• 14:32
  Yes.
• 14:32
  And we know that current stress and cortisol can have an impact and make our brain receptors more sensitive to that drop as well.
• 14:39
  Also, the other group of people, all that you'll see often with referrals are so and so who has PMDD, ADHD maybe ASD, autism spectrum.
• 14:50
  And I mean, I think now we're just like word salad ing it.
• 14:53
  Like it's, these are, I think people who have, who are neurodivergent are more sensitive and they often have, not all of the time, but they also have often experienced.
• 15:04
  developmental trauma, which can sometimes be you know, maybe for some people a causative factor in their symptoms.
• 15:12
  And again, it's just representative of the increased sensitivity to any internal or external things that are going on.
• 15:20
  at that luteal phase, which is more not as consistent as the early part of the thing.
• 15:25
  And so, and I guess the other thing is, Thea, can you just, you, you said PMDD and PME.
• 15:31
  Technically, like, what are the differences with that?
• 15:34
  So for people to understand, because I say we get a lot of people who say they have PMDD.
• 15:38
  Yes.
• 15:39
  But they also have ADHD or depression or anxiety.
• 15:42
  And.
• 15:43
  Yeah.
• 15:43
  Well, I mean, the definition of PME is premenstrual exacerbation of an underlying mental health condition.
• 15:48
  So that would mean that you already may have anxiety or depression or any other, yes, label ADHD which continues to be managed or to be an issue, but then tends to flare.
• 16:02
  In the luteal phase, or might get a bit worse in the luteal phase.
• 16:05
  Again, for all the reasons that we've talked have lower resilience.
• 16:09
  That's right.
• 16:09
  In that, because you're more vulnerable in that part of your cycle.
• 16:11
  Because everybody's more vulnerable.
• 16:12
  That's right.
• 16:13
  If you're already more vulnerable, then it's going to have more of an effect on you.
• 16:15
  That's right.
• 16:15
  Like we've said in previous episodes, every woman who's not on something to switch this off, will feel this part of her cycle.
• 16:21
  It's just the extent to which it affects them.
• 16:22
  Impacts and that's why we don't like the diagnoses because, it can impact you a little or it can impact you a lot.
• 16:28
  It's also that even that's what you're saying about impact When we say impact what we mean is it's it impairs our capacity to fit into the societal norm, which is not based on women.
• 16:40
  And that's the main issue that these women are feeling.
• 16:43
  I can't continue to function how I'm expected to function.
• 16:47
  Therefore, I want you to change me so that I can conform to the society.
• 16:51
  and fit in to what I'm expected to do.
• 16:54
  And the, my rage that comes up makes me say things because I feel lost and unsure of how to control my environment.
• 17:01
  And therefore I lash out of those I generally love the most.
• 17:05
  And afterwards I feel that shame, which just spirals me into that sense of not belonging even more.
• 17:11
  And the truth is if every woman was able to say how they felt at this and we all had a much more open relationship around it.
• 17:19
  We wouldn't have to feel this, but the point is society wants us to continue to fit in.
• 17:24
  And yeah, you can't, you can't function in the same way.
• 17:27
  And we need to be able to say that, I can't function at this time in this way.
• 17:31
  What I'm doing right now isn't making me happy and I'm going to need to take some time out.
• 17:35
  Not, I need to suppress this with some drugs.
• 17:38
  And that's why we have, I think, diagnosis where it pathologizes women is such a problem.
• 17:43
  And I bet, I think that is the only thing that women feel that they have, like that's the only help that they have in order to have this diagnosis, which is why they often want that or find comfort in a diagnosis because it provides them the only model of help that we have in our society, which is this, medical help and the thing is wrong with you and then we can help you rather than there's something wrong with our society and maybe we need to take a big look back and see because I always think if you Have your luteal phase and your, I don't know, like living in a caravan in the back garden and getting up and picking flowers and being able to like write poetry and not have to be bothered by people or like going into a tent and having people, other women like look after you.
• 18:29
  I just don't think that those symptoms would be there.
• 18:32
  It's like a real, it's huge, again it's the same with pain that women and our cycles and the fact that we have a cyclical way of being.
• 18:42
  Uh, canaries in the cold mine of the kind of society that we're in.
• 18:47
  And, uh, you know, going back to what we've talked about many times, the symptoms that we experience in our menstrual cycle are literally telling us or telling a story and helping us to understand what's working and not what's working.
• 19:00
  When I think back to my life, I remember a time where I'm pretty sure I could have been diagnosed with something like that.
• 19:05
  And you know, my husband was away on operations and before he would go away, I would literally lose it all the time.
• 19:12
  Remember him saying, maybe you should take up boxing.
• 19:15
  And, you know, cause I was that angry all the time and I look at it now and listening to you, I go, yeah, that's exactly why I was really unhappy.
• 19:23
  I felt like I was abandoned.
• 19:25
  I was looking after my children, finding it really hard to be a good mother and I was really struggling.
• 19:31
  And now, if I think about where I am in my life.
• 19:34
  I don't have really any symptoms and I haven't had them for quite a long time because I'm quite content my children are older.
• 19:40
  Do you know what I mean?
• 19:41
  I don't have the same level of pressure.
• 19:43
  So I can see that and in hindsight it's always a lot easier.
• 19:47
  But I didn't want to go on any drugs so I didn't.
• 19:49
  But the point is I could easily have done that.
• 19:52
  And I did go to a doctor once and she offered me antidepressants but I said no.
• 19:56
  But the point of what I'm trying to say is, I think we go through, we can see these stages in our life.
• 20:02
  And they are literally signposts to say, what is not working for you?
• 20:07
  Where are you not happy?
• 20:08
  And your body is trying to help you see that.
• 20:11
  And it's such a shame because by labeling it, we just attach, like you've been saying, to that story.
• 20:16
  And we don't actually look at that underlying bigger picture.
• 20:20
  Well, that's right.
• 20:21
  Because the label is a full stop, you know, the label is like, there it is.
• 20:27
  You don't ask more questions.
• 20:29
  It's the label.
• 20:30
  And then the list of things.
• 20:32
  Medications that you can do, that you can take.
• 20:34
  And it's kind of saying the woman has failed, isn't it?
• 20:36
  It is, and yeah, it's pathologizing the individual rather than actually thinking.
• 20:41
  What got them here in the first place.
• 20:42
  And then they often internalize the story of and then now I have to manage my PNDD, like my pain or my endo.
• 20:50
  And I guess I think what women need is less labels, more support, more education and more connection to their bodies so they can understand.
• 20:58
  And I guess like what you were saying is, so say if we have a woman who comes and sees us and they fit the, Criteria for, and pretty much I don't do the criteria.
• 21:06
  I just am like, are you debilitated?
• 21:09
  Are you struggling?
• 21:10
  I didn't care about the criteria.
• 21:12
  Let's help you regardless.
• 21:13
  Right.
• 21:14
  And I find that talking about the things we've talked about and helping them to understand what's happening in their body, the way that in the environment can impact the degree of symptoms and giving women language to communicate with those in their lives is an incredibly powerful tool.
• 21:33
  And I have women who, even if they say I am suicidal, And I, I'm thinking about one person in particular who just this language.
• 21:41
  And then of course I give all of the options for treatment.
• 21:43
  Which we'll talk about in a second.
• 21:46
  She didn't want to do anything else.
• 21:47
  She just wanted to understand and be able to talk.
• 21:49
  And so she then set boundaries in her work and then would say in her work, I'm at my premenstrual time.
• 21:55
  I'm not going to have meetings now, or I need to be able to tell you if I'm not feeling great, I'm going to go home or whatever.
• 22:01
  And she was in hairdressing or something, I remember.
• 22:04
  And when she came back and saw me a few months later, she barely had, like, she had a little shift in symptoms, but not debilitating like she had.
• 22:11
  And all it was, was her understanding and her changing the communication in her workplace and in her life.
• 22:18
  but then it wasn't just her.
• 22:20
  It was the ripple effect that that had on the women.
• 22:22
  in her organization that they too had permission to be, experience all the emotions in themselves, you know.
• 22:29
  And I think that's absolutely the first step.
• 22:32
  That's so wonderful though, because like, because like we were saying, you know, the pathologizing the individual, it almost takes away the need to do any of that stuff.
• 22:40
  And people, I think, are drawn to that because doing those things is often perceived as being harder, like making the life changes is perceived as being harder, but that's a perfect example of how.
• 22:52
  It's not.
• 22:53
  So what else?
• 22:53
  What are the other things?
• 22:54
  education, number one.
• 22:56
  Understanding the hormonal shifts of the menstrual cycle, understanding your nervous system, understanding the factors in your environment that might be contributing to, You know, less resilience in the luteal phase and then thinking about lifestyle is incredibly important.
• 23:12
  So that involves stress, looking at how you're working, looking at the help that you have taking things off your plate.
• 23:18
  Yes.
• 23:18
  Unscheduling, bringing more supports in, And thinking about all of the basics, thinking about sleep, you know, optimizing sleep, moving your body in a way that feels good.
• 23:29
  Not necessarily.
• 23:31
  killing yourself at the gym, doing gentle exercise that feels great to you, eating a diet that's really low in sugar, avoiding processed foods, having lots and lots of whole foods and a rainbow of vegetables.
• 23:44
  Eating enough in this part of your cycle is really important because our metabolism increases.
• 23:49
  So eating more you know, good carbs, protein, and good fats.
• 23:52
  That's going to help you with sleep because I think one of the big things is women might not be sleeping at this time because their mind is whirling.
• 23:58
  And so then they're going to go, well, I can't sleep.
• 24:00
  But chances are if you eat well and you move a bit, even if it's just to go for a walk outside, which is great, you're going to sleep a bit better.
• 24:08
  Yeah.
• 24:08
  Consciously spending time in nature.
• 24:10
  Like there are so many studies that show time in nature improves mood, but also improves all of the physiological markers of stress, heart rate, blood pressure.
• 24:20
  All of the things I often tell people is my top thing is when those things happen and you need to stop it.
• 24:25
  So, you know, when you have something and it's just starts to flare up and you think, I can't quite control, I'm going to say something I don't want to.
• 24:31
  Cold water, like drink a glass of ice water, just wash your hands in cold water, go outside and put the hose on your feet.
• 24:39
  It sounds crazy, but.
• 24:40
  That cold water, there's quite a lot of studies that say cold water helps with our mood anyway, so you can have a cold shower by all means or jump in a pool that's cold, but you can just wash your feet with cold water or drink a glass of cold water, it can kind of give us a little, uh, kind of wake up.
• 24:54
  Well it stimulates the vagus nerve, I think.
• 24:57
  Yeah, so it increases vagal tone.
• 24:58
  Yes, just the way it just, It seems to just immediately give us a, Oh, kind of wakes us up from the haze of the, you know, when we get all dragged into wanting to shout and things like that, it can just give us a quick switch.
• 25:11
  The tunnel vision.
• 25:12
  And anything that increases vagal nerve tone, because that is about.
• 25:17
  Increasing our window of regulation so that we're finding ourselves less triggered and less dysregulated.
• 25:24
  And that is the thing.
• 25:24
  So breathwork, meditation, nature, yoga, things to do is humming, humming, just humming to a song.
• 25:34
  So you don't even have to sing, which is quite.
• 25:37
  A big thing is people are like, singing is very good, but just humming is really, really good.
• 25:41
  It stops you from being able to think.
• 25:42
  So we hum.
• 25:44
  We generally can't go around in tunnels, so put something on you, enjoy and hum to it.
• 25:48
  It's very good.
• 25:48
  Whistling.
• 25:50
  And dancing.
• 25:51
  Of course.
• 25:51
  And dancing's like, Like, you know, I think there are more and more studies all the time showing that that's really great.
• 25:56
  And angry dancing, if you're feeling angry and expressing your feelings or your emotions.
• 26:02
  And I would always say like connecting to yourself.
• 26:04
  We talk about this in lots of podcasts, but every day, like having that 10 minutes, even if, even if it's just 10 minutes, how am I feeling?
• 26:12
  What do I need to support myself today?
• 26:14
  If I'm feeling anger, how can I express that in a healthy way?
• 26:18
  And that might be jogging Boxing.
• 26:21
  Punching a pillow.
• 26:22
  Yeah, punching a pillow.
• 26:23
  Screaming.
• 26:23
  Journaling.
• 26:24
  Writing down all your angry words.
• 26:25
  Screaming into a pillow.
• 26:27
  We have a big pile of bricks here at FIRA that we throw bricks at a brick pile.
• 26:31
  We have tyres that we can hit with mallets.
• 26:34
  Yes, we have tyres.
• 26:35
  We used to have lots of plates that my husband gave me, but we broke them all.
• 26:38
  Angry crayoning is really good.
• 26:39
  Oh, yeah.
• 26:40
  Yeah, that's a very good, satisfying thing.
• 26:41
  You know those wax crayons?
• 26:43
  Mm.
• 26:44
  And sometimes, like I personally find when I'm in this phase and feeling full of rage with The kids around putting on some really loud music and having a dance party together, you know, and you can just dance by yourself.
• 26:56
  You don't have to pay attention to them and they like it.
• 26:59
  I go outside and I live on a property so I can do this and just like scrunch up every part of my body, like tense everything.
• 27:08
  And then I scream really loudly.
• 27:10
  When I couldn't go outside to do that, I would do that in a car.
• 27:13
  So I would go into the car, shut the door.
• 27:15
  Scream in the car because you can, it kind of muffles a lot of sound and then I would just think, okay, that's good or into a pillow.
• 27:22
  Yeah, quite good.
• 27:23
  And then you feel better.
• 27:24
  And I think what I want everybody to know is that it's normal.
• 27:27
  I mean, I'm not saying that we're all normal, but I feel like it is normal to have emotions and then to express them and normalize expressing them without the feeling that you have to be just robots all the time because women are not robots.
• 27:42
  We don't have to be scared of our feelings.
• 27:43
  Yeah.
• 27:44
  Yeah.
• 27:44
  So they're all the lifestyle things.
• 27:47
  And then there are some supplements that have evidence for them.
• 27:51
  For premenstrual mood changes, often if they're very severe, they may not help particularly well.
• 27:56
  But magnesium, vitamin B6, calcium all have some evidence for them and a herb called chaste tree.
• 28:03
  Mm hmm.
• 28:03
  Or vitex.
• 28:04
  Or vitex.
• 28:04
  Yeah.
• 28:04
  Yeah.
• 28:05
  What about ashwagandha?
• 28:06
  Would that work in this case?
• 28:07
  Yeah.
• 28:08
  I think that does sometimes work as well.
• 28:10
  But I think like herbs helpful, but I honestly think it's all about the nervous system and addressing the things that we're talking about, the other things we've talked about.
• 28:20
  But yeah, some people find those things to be helpful and things like chase tree mentioned that has really good evidence for it as well, and it's often used in Europe.
• 28:29
  in England we used to have St.
• 28:30
  John's Wort.
• 28:31
  Yep.
• 28:31
  That was a really, I remember one of my friends would say, Have you taken your St.
• 28:34
  John's Wort?
• 28:36
  Yes.
• 28:36
  No, but I might go and take some.
• 28:37
  It does have, it does have efficacy for depression as well.
• 28:41
  And perimenopausal.
• 28:42
  And saffron sometimes our naturopath uses.
• 28:45
  But, uh, so those can all be good things to explore with your doctor or naturopath.
• 28:50
  if that's not working and people are wanting to do something more, sometimes, and again, evidence based for this isn't amazing, but it can be really efficacious, especially if someone doesn't want to go on the pill or something, is using bio identical hormones, so body identical hormones, kind of like, like a cushion.
• 29:10
  So if we think about that late luteal phase where our hormones are diving down, like off a cliff, we use natural estrogen and progesterone just for that time.
• 29:19
  Sometimes we might use it All the time if mood is particularly unstable, but what it does is it's not turning off our cycle.
• 29:27
  It's just acting like a bit of a cushion or a parachute so that you're not like diving off the cliff when our hormones start to plummet and we're just kind of like cruising a little bit.
• 29:38
  And it's still enough hormone and the natural hormones that will ping our little receptors in our brain.
• 29:44
  And I find that can be really helpful for many women with very minimal side effects.
• 29:50
  It's in fact, hardly any side effects.
• 29:52
  The only thing I would say is that for some people who are truly progesterone intolerant, so some people, a small proportion of people, I think it's about 8 percent might react to natural progesterone in terms of it being detrimental for mood then rather than taking the natural progesterone orally, it can be used vaginally and, yeah.
• 30:10
  then there isn't so much absorption into the bloodstream.
• 30:13
  But they're the women who most likely this treatment isn't going to work for either, cause they're still having their progesterone, but most people that would be quite a good option.
• 30:22
  And then we think more about, I guess, prescription medications or synthetic medications.
• 30:28
  There are a lot of studies looking at antidepressants.
• 30:31
  So looking at SSRIs which are often used at a very low dose cyclically.
• 30:38
  So in the same way that we might use hormones in the luteal phase, you can use a really low dose of an SSRI just in those two weeks, or even if it's a week, just in that week before a period or you can take it.
• 30:49
  continuously as well.
• 30:50
  But if you're taking it cyclically, it's typically at a low dose, so you don't get withdrawal.
• 30:55
  And then we can think about hormones that actually work to switch off the menstrual cycle.
• 31:00
  So, turning off ovarian function so that we're not making the hormones, so that we're not having the shifts that are potentially leading to these.
• 31:08
  Symptoms and that's things like the pill.
• 31:11
  And some certain pills are better than other pills and we can sometimes use the pill plus a little bit of extra estrogen because our brain loves estrogen.
• 31:18
  And that can be really helpful because it gives us that flat, no fluctuation.
• 31:23
  Some people, and I mean by the time people usually see us, we see, happen to see the people who either often have had side effects or don't like or antidepressants haven't worked for or who have been on the pill but found that that worsens their mood.
• 31:37
  So if that's you, then the bioidentical hormones can be a good option.
• 31:41
  For women who've tried all of that stuff.
• 31:43
  there are women who have tried all of that.
• 31:46
  And despite That their lives are really difficult and I think these women, I want, I really, really want to be firm in saying that they haven't created this, like they, it's been programmed from early on, like, there's probably a genetic component and then there's definitely that environmental component with things that have happened around them that have been unsafe and their nervous system has responded to.
• 32:07
  And sometimes, no matter what we do, these women we just can't help in another way, but I want to be really clear and say that there is absolutely effective treatment and this might seem extreme, but for women who are truly like really debilitated and suicidal and just their lives are, and these are, this is the tip of the iceberg.
• 32:30
  This isn't the vast majority of people at all.
• 32:32
  Okay.
• 32:32
  So this is a small, minority of women.
• 32:35
  Things like turning off the cycle with a drug called, we call it Zolidex in Australia.
• 32:40
  It's an injection or an implant that just turns off the signals from the brain to the ovary temporarily.
• 32:47
  So it just, it only lasts for a month.
• 32:49
  And it kind of makes us temporarily menopausal.
• 32:52
  So it means that it's a bit like the pill, but it's not replacing hormones.
• 32:56
  So it's just stopping your ovaries from functioning.
• 32:58
  And so then you get no hormones.
• 32:59
  And if we just left you with that, then you'd be kind of like menopausal while you're taking it.
• 33:05
  So what we do instead, cause that isn't very fun either when you're just like.
• 33:09
  abruptly menopausal, is we replace the hormones with a bioidentical oestrogen first of all, so just the oestrogen and so you have flat oestrogen and no fluctuations for a few months and then you can add back progesterone and then you're getting the natural hormones.
• 33:26
  But at a stable level without having to fight with your underlying cycle.
• 33:31
  And for women who have true PMDD, like often with that progesterone intolerance or whatever, it always works.
• 33:38
  and it's something that can be used for a long period of time for some women, but it is a monthly injection.
• 33:46
  It isn't on the PBS, so it isn't licensed for use with this.
• 33:50
  But it can work, it can be very, very effective.
• 33:52
  And some women say if they're coming to see us and they've had their children and this does work very well for them, because often they'll come and say, I just want a hysterectomy and take my ovaries out from the get go.
• 34:01
  And we would never, ever do that without first trialing this.
• 34:05
  And if, you know, they've been on this kind of treatment for six months and their lives are completely better.
• 34:11
  And often they'll say, I now actually have.
• 34:13
  space to be able to do the other things in the work, which before they couldn't for those women, they may go on to have a hysterectomy and take their ovaries and their uterus out.
• 34:23
  And then what that means is they don't need to have that Zolidex injection any longer and they just are on estrogen until, you know, the natural age of menopause.
• 34:33
  And that can be a very effective treatment.
• 34:35
  So that's not what we do for the, for.
• 34:38
  It's for the minority of women, but by the time people come to us, and I think if you're struggling with this, you'll have a concept, because you might have seen lots of doctors, that there is no effective treatment, and there always is an effective treatment, and that can work very well for people who need that, but many people don't need that.
• 34:55
  That's right, yes.
• 34:57
  And I would also say, studies on this as well as is going to be lacking because again, it's not a drug, but I would say anything that looks at widening our window of regulation, working with our nervous system and our safety.
• 35:09
  So seeing a psychotherapist, particularly not just a talk therapist, but a somatic psychotherapist doing nervous system training with somebody who knows how to do that.
• 35:20
  Those kinds of things , can also be really beneficial and it's also like using this part of your cycle, like that big message that there's something to address and you know, if you can do it and I've had, I've equally had patients who all they've done is work on that and they've, had an amazing effect and haven't needed to go on any hormones.
• 35:39
  But I don't want people to think that if they can't do any of that, then they're a failure because there are certainly people that really, really.
• 35:46
  Like they, they do benefit from those things that seem more extreme, but not everybody.
• 35:52
  It's really individualized, isn't it?
• 35:53
  The way we would do it is we would lay all of those options on the table and patients will, you know, often work through them.
• 36:00
  Often start with one and move through to others.
• 36:03
  And I think starting with those, looking around us first, how can we support ourselves and ask for help first is always the number one goal, like, and you know, I often think about this, I think, gosh, if we had a society that understood The importance of looking after our children and of the impact that the nervous system can have on later life, then we would have less women who end up having to need these more extreme treatments now.
• 36:33
  So I just always go back to, again, how can we, look at how we are how we can regulate our own nervous system, give ourselves what we need, recognize what we need, ask for help.
• 36:44
  And then so we can be regulated around our own children and that flow and effects to all the people in our lives.
• 36:50
  Is there anything else?
• 36:52
  Is there anything else you want to say about any of that?
• 36:54
  no, I think that was really perfect and really good to listen to and very helpful.
• 37:01
  So, thank you both of you.
• 37:03
  There are some resources that can be good.
• 37:05
  There is a website called IMPMD.
• 37:09
  org.
• 37:09
  Yeah, only one D.
• 37:10
  Yeah, only one D.
• 37:11
  org.
• 37:12
  And that's got quite a lot of good information.
• 37:14
  I think it's an American website.
• 37:17
  There's a lot on our website actually.
• 37:19
  Like, I'd just encourage everybody just, I think number one, let's just talk about the fact that we're cyclical and how we can support each other.
• 37:27
  Also, I just think, you know, this episode actually it's, you know, we've talked about quite a lot of things.
• 37:31
  So if you feel that what we talked about has really struck a chord with you or it's made you really consider how you feel and maybe you don't feel good at the moment, maybe you are feeling really low.
• 37:40
  Just know that.
• 37:41
  There are many people that you can reach out to and if you need help, get help for yourself and just go to your GP, tell them that you're struggling and then get the support that you need.
• 37:51
  Don't be afraid to do that.
• 37:52
  That's really important.
• 37:54
  Yes, you're not alone.
• 37:56
  You're never alone.
• 37:56
  No, and see somebody who sees you in your entirety, including the impact of the environment, and who gives you options and choices.
• 38:06
  Because that's really important for our nervous system as well.
• 38:09
  Another resource that could be a really good thing, just you know, it's not particularly on PMDD, but it's on nervous system regulation would be Deb Dana.
• 38:18
  She's a lady who's got a website called the rhythm of regulation.
• 38:21
  She's got a really good podcast that I often recommend on the 10 percent happier podcast where she talks about our nervous system.
• 38:28
  And her book is called anchored and it's really good.
• 38:31
  And Jessica Maguire has a great like vagus nerve masterclass on her website with actual tools and practices to help us to recognize where we are and to be able to change our own nervous system and take responsibility for where we are now.
• 38:48
  So they're really good resources, which we'll link to in the show notes.
• 38:51
  But let's just keep talking.
• 38:52
  We'll keep talking about it until.
• 38:54
  Yes.
• 38:55
  Forever.
• 38:56
  and hopefully more and more people will start to know that it's an okay thing to talk about and then we can support each other and maybe one day, our society will be different, but until then, it all has to start with us.
• 39:09
  Yep.
• 39:10
  Okay.
• 39:11
  Thank you so much for listening and have a great week and we'll see you next time.
• 39:15
  Goodbye.
• 39:16
  Bye bye.
• 39:16
  Thank you.
• 39:16
  Bye bye.