Latest / The Dr Louise Newson Podcast / 66 – PMDD and mental health: what’s really going on?

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66 – PMDD and mental health: what’s really going on? · The Dr Louise Newson Podcast

• 0:02
  So Izzy, it's great to have you on my podcast.
• 0:04
  You're a doctor over in Australia.
• 0:06
  I'm a doctor over in the UK. And guess what?
• 0:08
  We see similar patients with similar problems, but also we've
• 0:13
  learned a lot on the way, like our own personal journey,
• 0:16
  professional journey. Every day we're learning new
• 0:19
  things and medicine is an art and a science.
• 0:22
  You know, you have to know the science and Physiology when
• 0:25
  we're talking about hormones. But actually putting it into
• 0:28
  clinical practice, listening to our patients, understanding the
• 0:32
  nuances of prescribing, you know, we learned so much and
• 0:35
  it's great talking to you because, you know, we have the
• 0:38
  similar challenges, similar problems, and similar patients.
• 0:42
  So thank you for coming today. My pleasure, I'm so excited to
• 0:45
  be here and just talking a little bit more about, you know,
• 0:47
  my own personal journey and where I think medicine's going
• 0:51
  to go for Women's Health over the coming years.
• 0:52
  It's a really exciting time. We're absolutely in the trenches
• 0:55
  of turning things around. And I think it's one of those
• 0:58
  ones where, you know, I've had the privilege of looking behind
• 1:01
  the curtain being a medical practitioner, but for a number
• 1:04
  of years I was really quite unwell during my early uni years
• 1:09
  and, you know, nearly was successful in taking my life.
• 1:12
  It was an awful time. And now that I'm stable on
• 1:14
  treatment, I've come such a long way.
• 1:16
  And so, yeah, the whole concept around premenstrual dysphoria
• 1:20
  disorder, I'm excited to talk about my journey.
• 1:22
  I really wouldn't be surprised if there's probably going to be
• 1:24
  some tears with us chatting today because it's, it's a, it's
• 1:28
  a hard story, but I think it's one that I really do need to
• 1:31
  share that it's, you know, it's hard for clinicians as well to
• 1:35
  be heard in this space. And I was gaslit awfully during
• 1:39
  my time and it really took me having to take control.
• 1:43
  And I was just really fortunate that I had incredibly supportive
• 1:46
  parents. I wouldn't be here without of
• 1:48
  them having helped get me through this journey.
• 1:50
  And I just think of all the women out there who may not have
• 1:53
  that support or, you know, they're juggling busy families,
• 1:56
  and it breaks my heart. So whatever I can do to help now
• 2:00
  is a as a health practitioner who sees a lot of women, it's,
• 2:03
  yeah, really exciting place. It's so important and actually I
• 2:05
  was talking to someone yesterday and it was probably about 10-11
• 2:09
  years ago now. I sat in someone's clinic,
• 2:12
  professor of gynecology, and he's sadly no longer alive.
• 2:16
  But I started in his clinic and there was a young lady, lady
• 2:18
  that came in who was 24 and it was the first follow up
• 2:21
  appointment for her. And she said, oh, thank you so
• 2:24
  much, you've saved my life. Like my whole life has been
• 2:27
  turned around. And she was saying, has she had
• 2:31
  PMDD? Which is something I hadn't
• 2:33
  really, even as a, you know, very established Dr. hadn't
• 2:36
  really thought much about. And she said the gels that you
• 2:41
  gave me, the tablets that you gave, you know, the treatment
• 2:44
  has been transformational. And it was a lovely, lovely
• 2:46
  story. And then when, when she left, I
• 2:49
  said, oh, John, I, I'm really confused because you've just
• 2:52
  given her hormones. They, I was taught to give
• 2:54
  antidepressants to these women for two out of four weeks when
• 2:57
  they weren't getting symptoms. He said, Louise, come on, think
• 3:00
  properly. In medicine, you treat the
• 3:02
  underlying cause, and the cause is hormones.
• 3:05
  And I've given her actually progesterone, testosterone and
• 3:08
  Estrogel because she needed all three.
• 3:10
  And, you know, look at the results.
• 3:12
  And I just sat there and thought, well, why didn't anyone
• 3:14
  teach me that before? Why have I been a doctor then?
• 3:17
  I've been a doctor for 20 years now.
• 3:18
  I've been a doctor for 30 years. Well, why?
• 3:21
  And I always was a bit scared of those patients because they
• 3:24
  change so quickly. And sorry, mental health is very
• 3:27
  scary because you've got a huge responsibility of a doctor to
• 3:31
  decide whether this person is so mentally unwell that they need
• 3:34
  sectioning, what treatment they have or who they're supporting
• 3:37
  at home. And you're, you're sort of
• 3:38
  dealing with a crisis rather than thinking what's causing it
• 3:41
  often. And so I've reflected a lot over
• 3:44
  there else, you know, 20-30 years and thought, gosh, how
• 3:47
  many women have had hormonal issues that I haven't
• 3:49
  understood. And so now in the clinic, we see
• 3:53
  a lot of women with PMS, premenstrual syndrome and PMDD,
• 3:56
  premenstrual dysphoric disorder. And the stories are almost more
• 4:01
  horrific. And I don't know whether it's
• 4:02
  because these women are younger or just because it's more
• 4:05
  severe. And I think it's probably both.
• 4:07
  Yeah. So if you don't mind, tell me
• 4:10
  just a bit about what what's what happened to you.
• 4:12
  Is he? Yeah, so I think I, so I have a
• 4:15
  diagnosis as well of ADHD and his spectrum disorder, which we
• 4:19
  know if there is a coma morbidity with that.
• 4:20
  I got my diagnosis when I was in year 12 and I first started
• 4:25
  menstruating when I was in year 8.
• 4:27
  My periods initially weren't too bad, like I was just, I felt an
• 4:30
  emotional teary teenager. I felt the ADHD symptoms were
• 4:33
  definitely a lot worse. As with a lot of women, there
• 4:36
  was a traumatic episode in year 10.
• 4:38
  And I think after that event, that's when things really
• 4:42
  started to change for me. And it got to the point where,
• 4:44
  you know, at school people would actually make a comment.
• 4:46
  They're like, oh, you're clearly on your period and this sort of
• 4:49
  stuff. And I felt it was said more to
• 4:51
  me than other people. Like I was very angry, very
• 4:53
  aggressive, wanted to like literally fight sort of thing.
• 4:56
  I just was out of control. And I think part of the pressure
• 5:00
  cooker of year 12, that sort of thing.
• 5:02
  And then eventually went off to year 12.
• 5:04
  And I saw a university and during this time we had tried
• 5:08
  using different contraceptives to get on top of my symptom.
• 5:10
  We, we knew pretty early on that there was something hormonally
• 5:13
  going wrong. But you know, they put me on the
• 5:15
  usual Yas, Diane. We tried the Nuva ring and it
• 5:18
  just, I had so many side effects from fatigue, nausea, weight
• 5:22
  gain, just feeling really depressed and flat that, you
• 5:24
  know, we switched me, I tried the copper coil for
• 5:28
  contraceptive means and that was kind of my first year of, of
• 5:31
  medicine managing that, but still cycling and I was getting
• 5:35
  worse. And so in my second year of
• 5:38
  medicine, when I moved out of college, I moved in with some
• 5:41
  really great housemates and I just could like I just was
• 5:47
  barely getting to uni. I was barely passing.
• 5:49
  I was really struggling and it really felt like I'd have these
• 5:52
  awful weeks and then I'd have weeks of lucidity and you gas.
• 5:57
  I was gaslighting myself being like, oh, it must have just been
• 5:59
  stressing uni. I probably didn't have my diet,
• 6:02
  right. And it wasn't until third year
• 6:04
  medicine when I had to go to clinical practice where I
• 6:07
  couldn't squirrel myself away in my bedroom And I had to turn up
• 6:11
  to, you know, the hospital system and interact with
• 6:13
  patients and have a certain amount of energy and engages my
• 6:16
  peers, that that was when things got really hard.
• 6:19
  And I was on one antidepressant, you know, during 1st and 2nd
• 6:23
  year and then very quickly within third year I was on, you
• 6:27
  know, sodium evaporate, Brintellix, duloxetine
• 6:29
  recommended for risperidone because I couldn't cope.
• 6:32
  And the doses were then increasing during my menstrual
• 6:35
  cycle, like during the luteal phase and just into my first day
• 6:39
  of the bleed and I couldn't get out of bed because I was so over
• 6:43
  sedated. I was like.
• 6:44
  These are heavy duty drugs, you know, they're more than just an
• 6:47
  antidepressant, aren't they? And it wasn't helping.
• 6:50
  And this was the most awful part was I think this is where I
• 6:56
  really knew I had to get this sorted because we know that like
• 6:59
  one in three will attempt suicide.
• 7:01
  And I was already having quite bad intrusive thoughts.
• 7:04
  And it became apparent to me that I needed to take a step
• 7:08
  back from Med school and actually go home and move back
• 7:10
  in with my parents because we had to park.
• 7:13
  I had to park my car, you know, 500 meters from hospital.
• 7:16
  I couldn't afford, you know, private parking sort of thing.
• 7:18
  So I had to park on the street and there was a four lane busy
• 7:22
  Rd. in front of the hospital. And in the times where things
• 7:28
  are really hard, I would walk along the side of the road and
• 7:32
  buses and trucks would go past and I would not only get this
• 7:36
  voice, but a sensation to step in front of it.
• 7:38
  And it was just constantly, it was like step in front of the
• 7:41
  bus, step in front of the bus, step in front of the bus.
• 7:42
  And the hardest part was it was my own voice and it was my own
• 7:46
  body wanting it. And I had to intellectualize and
• 7:48
  be like, you've got a medical career, you've worked so hard to
• 7:51
  get here. Like don't do that sort of
• 7:53
  thing. And it got worse and worse and
• 7:55
  worse and I couldn't not go to work because I had to pass
• 7:59
  attendance requirements. And I just, there was so many
• 8:03
  days where I was, you know, I was really plagued with these
• 8:07
  thoughts and I eventually called mom and dad and just went, we
• 8:10
  need to figure this out because I'm, I give this two years.
• 8:13
  Like I put a date on. I was like, I actually can't do
• 8:15
  this. If I can't do medicine, I don't
• 8:17
  know what I'm going to do. And I was losing 3 months of the
• 8:20
  year. When you add it up, if I'm
• 8:22
  losing a week and every month, that's three months of the year
• 8:25
  where I'm essentially having these thoughts to kill myself
• 8:29
  and harm myself. And not only was it the mental
• 8:32
  health stuff, but there was a functional decline.
• 8:34
  I couldn't cook for myself. I couldn't go out to get my
• 8:37
  groceries. I had to stay indoors.
• 8:39
  And I would do a lot of painting and journaling and that sort of
• 8:41
  stuff. But it really wasn't a quality
• 8:43
  of life. And I was not pleasant to be
• 8:47
  around because I was, there was so much despair and despondent.
• 8:50
  And so I moved home. And this is where it gets worse.
• 8:53
  So not only am I suffering with this and mum and dad are great,
• 8:57
  they're being really supportive. But I was referred first to an
• 9:01
  An obscani. I think this is partly where
• 9:02
  some of the problems are is 4 hormone issues were sent to an
• 9:05
  obscani first. So I was sent to an Obscani and
• 9:09
  we put a Mirena in and I didn't tolerate it.
• 9:11
  I vomited for seven days straight and I was just like get
• 9:14
  this thing out of me, you know, despite my arenas not having
• 9:17
  systemic uptake. So I was really quite sick.
• 9:20
  They took it out and the next thing that she recommended was
• 9:23
  that I should have an endometrial ablation as a 21
• 9:26
  year old. And for what reason that.
• 9:28
  So for those listening, endometrial ablation is
• 9:30
  basically where they, there's different techniques.
• 9:32
  You can do it with heat or microwave or, or or even water
• 9:36
  sometimes, but it basically strips the lining of the womb.
• 9:39
  But I don't understand how that would help your hormone
• 9:41
  imbalance. So she, her thing and I remember
• 9:45
  this so clearly her statement was that if we, the, the
• 9:50
  endometrial lining has hormonal receptors in it, and if we get
• 9:54
  rid of that, then it may help the imbalance.
• 9:56
  And both mom and I just went, oh, that doesn't seem quite
• 9:59
  right. And so that prompted us to get a
• 10:01
  second opinion from a different obstgyny.
• 10:04
  And he just looked at us and went, I would never, ever allow
• 10:07
  that to happen if, if you were my daughter, that is not an
• 10:10
  option. And so that's when you know, I
• 10:12
  can, I have access to the medical guidelines as a medical
• 10:14
  student. I went to, I'm like, you know,
• 10:16
  the next stage. I've done the antidepressants,
• 10:18
  I've tried the contraceptive. I feel like we're at the point
• 10:21
  of looking at a GNRH agonist, which is something that turns
• 10:24
  off at the hypothalamus and stops me from having my ovaries
• 10:28
  being active. And he agreed to do so.
• 10:31
  But the he, his thing was is that he has, you know,
• 10:35
  theoretically that hormones can cause psychosis.
• 10:38
  So he'll give me the GNRH agonist, but he will not give me
• 10:42
  add back hormones. So this is really like quite an
• 10:45
  extreme. I think it's an extreme
• 10:47
  treatment because it's basically switching off your hormones.
• 10:49
  It's giving you a big chemical menopause.
• 10:52
  So and we know people with PMDD that it can be the fluctuation
• 10:56
  of hormones rather than the absolute level that can trigger
• 10:59
  symptoms. So it sort of makes sense if
• 11:02
  you're just sitting down the reading a textbook.
• 11:05
  But actually we know, and a lot of you as listeners know that if
• 11:10
  you don't have any hormones in your body, I mean, there's
• 11:13
  health risks of that, but there can be real negative effects,
• 11:16
  especially on the brain as well. Yeah, and that's exactly what
• 11:19
  happens. The first week things felt like
• 11:22
  they kind of stabilized a little bit and I think it was just
• 11:24
  everything quietened down. And then in the second and third
• 11:28
  week of treatment without the back hormones, I got into a
• 11:32
  really dark place. And I'll actually read you one
• 11:34
  of the so this is day 15 of Zoladex.
• 11:41
  This is your diary that you're reading.
• 11:42
  This is. This is my diary that I was
• 11:44
  tracking everything at the time and what I've written.
• 11:50
  Like I'm, I feel like I'm an articulate person.
• 11:52
  But even reading this back, I it's, it's so basic and it's I
• 11:55
  just want to be dead. I should put myself in front of
• 11:58
  a bus. All I feel is that I'm a burden.
• 12:00
  Do I deserve to even be alive when I don't appreciate it?
• 12:04
  I keep getting all these self loathing thoughts.
• 12:06
  They don't feel like mine but they're in my head.
• 12:09
  I went out. It's really sad, isn't it?
• 12:11
  And you know, it would be great if you were the only person in
• 12:14
  the world that had that. And clearly you're better now.
• 12:16
  So we don't want to dwell on the negativity, but some of you
• 12:20
  might have listened to the podcast that I did with my my
• 12:22
  daughter Jess, and she's got PMDD and I've just done another
• 12:27
  recording with her actually. And you know, she wouldn't be
• 12:30
  here. I'm pretty sure she had some
• 12:32
  really dark times and she has awful migraine as well.
• 12:35
  So the two together, the days before her periods when it
• 12:38
  migraines were worse, everything was worse.
• 12:40
  There was just no point to her life.
• 12:42
  And you know, it's so hard when you really love someone and you
• 12:47
  don't know what to do because I can give that person and like
• 12:52
  your parents, I'm sure all the love in the world.
• 12:54
  But when you have those thoughts, you know it's a but
• 12:58
  it's a chemical imbalance it's causing.
• 13:01
  Feelings. It's not because you're
• 13:03
  stressed, it's not because of past trauma.
• 13:05
  It's a chemical problem. And I think this is where it's
• 13:09
  not addressed because people think it's just hormones and
• 13:11
  hormones are to blame. So let's remove those hormones
• 13:15
  and let's go around and skip and think everything is fine.
• 13:19
  And then if women are fitting like this, there must be a
• 13:22
  psychological or a psychiatric condition it's causing.
• 13:26
  It, and this is probably for the listeners, probably the best way
• 13:30
  that I can describe the sensation is it's like just as
• 13:33
  you're thirsty or just as you're hungry and that sensation lives
• 13:36
  within your body like that feeling of despair and
• 13:39
  despondence that's as palpable as it was.
• 13:41
  And it was awful. And you know, it was four days
• 13:45
  after that that I took actually a massive overdose and ended up
• 13:48
  in hospital for four days. And when I woke up, I had
• 13:52
  terrible double vision. I couldn't feed myself.
• 13:54
  And you know, for the 1st 2448 8 hours, I thought I'd done some
• 13:57
  serious damage to myself. But you know, fortunately things
• 14:00
  got out of the system and it was actually the first time when the
• 14:03
  psychiatrist came to see me, he said, well, of course, like this
• 14:07
  has happened, no wonder you've had a psychotic break because
• 14:10
  you've got no hormones. The first thing you need to do
• 14:12
  when you leave this hospital is you need to go and get hormones.
• 14:15
  And he recommended for Liviol, which is a synthetic type of
• 14:19
  hormone replacement. And I was discharged home.
• 14:22
  I started on the HRT and it was, I remember looking at o'clock
• 14:26
  and it was 2:00 in the afternoon and I remember feeling better.
• 14:30
  And I was like, no, like this, this, it can't be this simple.
• 14:34
  And then again, like, I'm tracking my mood and I've got it
• 14:37
  here in front of me. So in the mornings, I'd wake up
• 14:39
  with an anxiety that was about six to seven out of 10.
• 14:42
  And by the end of the afternoon, it was down to 0, obviously when
• 14:45
  the medication had kicked in. And I never looked back from
• 14:49
  that point. As soon as I was restarted on
• 14:51
  HRT and everything was, was level, Yeah, I had some
• 14:54
  problems. You know, I had vaginal dryness
• 14:56
  and you know, I had a little bit of weight gain or, you know, I
• 14:58
  lost a bit of muscle mass, But I've now, you know, addressed
• 15:00
  all those sorts of things that I I can't see another way of
• 15:05
  living. But it like I am, you know, as
• 15:07
  you mentioned, NRHI guess it's a pretty significant treatment
• 15:11
  option. And now I'm staring down the
• 15:13
  barrel of, I have tried to come off it and stay just on the HRT,
• 15:18
  but for some reason I do decompensate and it has made
• 15:23
  relationships hard because a lot of men want children.
• 15:27
  And that's something that I don't know if I can do with what
• 15:31
  I've got. And so now that I'm stable,
• 15:34
  there's a lot of other questions that I need to answer.
• 15:37
  And no one's, none of the clinicians know how to handle
• 15:41
  this. It's a really interesting
• 15:45
  experience to to go through as someone who is also a doctor,
• 15:48
  someone who is also seeing a lot of perimenopause and menopause
• 15:51
  patients. It's there's just a paucity of
• 15:54
  any understanding. It's really awful because so
• 15:57
  many times that you say humans, if there's a problem and go to
• 16:00
  gynecologists, and I have nothing against gynecologists,
• 16:04
  but their only training is in the womb and the ovaries in the
• 16:08
  reproductive tract. Psychiatrists often don't think
• 16:12
  about hormones. So it was amazing that your
• 16:14
  psychiatrist did that time. So no one's really connecting
• 16:17
  the dots. And then people get very scared
• 16:19
  of talking to social young women, especially when you start
• 16:22
  talking about fertility and changing hormones.
• 16:24
  And, you know, but we need to support and learn.
• 16:27
  And you know, in our clinic, we've reactivated a lot of
• 16:31
  Katrina Dalton's work from the 1950s and 60s, Who I've
• 16:35
  mentioned on this podcast before, but she was a very
• 16:37
  inspirational doctor. And she spoke a lot about
• 16:40
  natural progesterone, not synthetic progesterone.
• 16:43
  But when she was working, especially in the 60s, all the
• 16:46
  synthetic contraceptives were coming to market.
• 16:49
  So there's a massive push for these.
• 16:51
  And everyone called them hormones, but they're not,
• 16:53
  they're chemicals. So when she was giving higher
• 16:56
  doses of progesterone, especially as a pessary, the
• 16:59
  medical establishment really tried to take her part and take
• 17:02
  her down and they didn't like what she was doing and she was
• 17:05
  reported to the authorities. But she was right actually.
• 17:10
  And you know, especially when we give the right dose of natural
• 17:13
  hormones, especially progesterone, actually for women
• 17:15
  with PMDD, it can make such a difference.
• 17:19
  But you have to be quite bold to prescribe differently to other
• 17:24
  people. But I think when you take a step
• 17:26
  back and think, what am I going to, I can continue this patient
• 17:29
  on an antipsychotic and an antidepressant or am I going to
• 17:33
  try a natural hormone? They we've got to weigh out all
• 17:36
  the time in medicine. We weigh up potential benefits,
• 17:39
  potential risks, potential side effects, interactions and so
• 17:43
  forth. And it's sort of just makes a
• 17:45
  bit more sense to give hormones often doesn't.
• 17:47
  It absolutely well, I mean, one of the antidepressants I was put
• 17:50
  on the mocha gene, I developed like the initial stages of
• 17:53
  Steven Johnson syndrome, like I got the rash and had to come
• 17:56
  off. It was put on high doses of
• 17:57
  steroids. You know, my mom also had it as
• 17:59
  well when she tried the medication.
• 18:00
  So that's an awful condition that essentially renders you as
• 18:04
  a burns patient. And you know, the advice I was
• 18:06
  given around that was, oh, you might get a rash, just keep an
• 18:09
  eye on it for between day 1421 sort of thing.
• 18:11
  And I was pretty on to it. Again, being within medicine, I
• 18:14
  gave a lot of credence to that. But 100% it's the we will reach
• 18:18
  first for something that modulates the symptoms as
• 18:21
  opposed to taking a step back and being like as a young woman,
• 18:25
  what is probably the biggest thing that is changing within
• 18:27
  her life apart from social circumstances, it's actually her
• 18:30
  hormones. We know that in the early stages
• 18:33
  of puberty, women are typically in an estrogen dominant state.
• 18:36
  Pedestrian does lag. And it's not until those early
• 18:39
  20s that pedestrian should actually start to catch up.
• 18:41
  But from what I'm seeing within my practice is as all of the
• 18:44
  kind of traumas that are within our society, from poor, poor
• 18:49
  food, true like literacy and choices to drugs where it comes
• 18:53
  from nicotine, vaping, alcohol, poor choices around sleeping.
• 18:57
  Like our lives are so much more chaotic now that I think a lot
• 19:00
  of young women are getting these physio physical harms that is
• 19:04
  changing the Physiology of their symptoms.
• 19:06
  We're seeing a rise in, you know, endometriosis, Pecos, and
• 19:09
  we're seeing a lot of women starting to struggle with
• 19:11
  fertility. And the question is, is well,
• 19:13
  why are we losing our natural hormones?
• 19:16
  And I have seen a number of young women who have been put on
• 19:19
  say a contraception like Yas and they have complete suppression
• 19:24
  of their estrogen and progesterone.
• 19:26
  And I have a case from 2022 where I actually called up the
• 19:29
  path lab and went, I've never seen bloods where it's
• 19:32
  completely 0 for estrogen and progesterone and testosterone.
• 19:36
  I have her sitting here with the clinical picture of can't fall
• 19:39
  asleep, can't stay asleep, has crippling anxiety, has weight
• 19:43
  gain, is really struggling and what she needed them was natural
• 19:47
  add back hormones to be able to rectify the situation.
• 19:50
  She's now often, which is great, but Needless to say she's also
• 19:52
  off the contraceptive pill and so it does worry me how much we
• 19:56
  are playing around with a system that we really do not know much
• 20:00
  about. Yeah, I totally agree.
• 20:02
  And, you know, we know that progesterone really balances and
• 20:07
  helps with cortisol stress hormone as well.
• 20:11
  So when we have high cortisol, we often have low progesterone.
• 20:15
  And then there are lots of endocrine disruptors that we
• 20:18
  still don't know about. So, you know, the number of
• 20:20
  products that people put on their skin on their faces, you
• 20:24
  know, that are marketed through TikTok to teenagers.
• 20:27
  We don't know the effect this is having, you know, the toxins
• 20:31
  that you say in, in our diet, in our environment, there's all
• 20:33
  sorts of things that we, we can't change because it's, you
• 20:36
  know, beyond our control often. But actually, how is this having
• 20:40
  effect on our hormones and especially our progesterone?
• 20:44
  You know, increasingly just giving back even a low dose of
• 20:48
  progesterone to younger people can make a difference,
• 20:51
  especially like you say, with PCOS as well.
• 20:54
  We said an endometriosis, which is an inflammatory condition.
• 20:58
  You know, we have to, I think, be thinking differently and
• 21:02
  wider because we're trained in general medicine.
• 21:06
  We can prescribe any medication and we're used to prescribing
• 21:10
  lots of medications and sometimes we're used to
• 21:12
  prescribing two or three medications at the same time.
• 21:16
  And I feel This is why as a General practitioner, a general
• 21:20
  physician, we're better suited to looking at hormones and women
• 21:24
  because we can make two or three diagnosis at the same time.
• 21:28
  We we often, especially in a crisis situation, we will start
• 21:32
  medication, but then we will also de prescribe and remove the
• 21:35
  drugs that we and can't helping as someone improves.
• 21:39
  But somehow often in women with PMDD, I've seen them for years
• 21:44
  and years, they've been on these other psychiatric medications
• 21:48
  that have long term side effects as well, and still no one's
• 21:51
  thought about their hormones. And unsurprisingly, as you can
• 21:54
  imagine, I'm not on any antidepressants.
• 21:56
  Now. I like if you speak to my
• 21:58
  parents. I was always a glass asshole
• 22:01
  half full kid like I was very bubbly and bright and then there
• 22:04
  was a really dark transition and as literally as soon as the
• 22:07
  hormones started getting out of back I like through the 80
• 22:09
  depressive so I was like I'm fine.
• 22:11
  I haven't had a panic attack sick since and I was riddled
• 22:14
  with them during that time. And on that thing is
• 22:17
  progesterone and it's important. It makes sense when we take a
• 22:20
  step back from an evolutionary point of view.
• 22:22
  Cortisol is largely our fight and flight hormone or it allows
• 22:25
  our systems, you know, regulate and mobilize glucose levels and
• 22:28
  this sort of stuff. We do want to suppress
• 22:30
  progesterone because we don't want to meander away from the
• 22:33
  tiger. We want to run and Sprint.
• 22:34
  And so it makes sense that when we have a lot of, you know, it's
• 22:38
  a death by 1000 paper cuts, lots of little things that are
• 22:41
  communicating to our body and all our body is trying to do is
• 22:44
  actually protect us bodies trying to take in that data and
• 22:47
  be like, this could be dangerous.
• 22:48
  I need you to be on alert for this.
• 22:50
  But so we do see the cortisol start to increase.
• 22:52
  So we know that women have a more sensitive to a blunted
• 22:56
  cortisol curve. And it means that they're going
• 22:58
  to be more in that hyper vigilant state and they are
• 23:00
  going to be more sensitive because as a woman back in
• 23:04
  caveman era, we couldn't protect ourselves when we were nine
• 23:07
  months pregnant. We were actually dependent on
• 23:09
  the community. And it's just evolutionarily our
• 23:12
  body hasn't progressed as far as what society has.
• 23:15
  We've made massive changes in the last hundred, 200 years and
• 23:19
  I don't think our bodies have been quite ready for that.
• 23:21
  And we are starting to see those issues emerge within within
• 23:25
  young women. Yeah, and we have to be aware of
• 23:28
  it. And the other thing is we can
• 23:29
  try things in medicine and if they don't work, we have to
• 23:33
  think again. And if they do work, we learn
• 23:35
  from that experiences. So you know, for you as a
• 23:37
  practising clinician now and, and you know, thank you for
• 23:41
  sharing your story, but I'm sure it's made you look at things
• 23:45
  differently and ask different questions as well to patients.
• 23:48
  Oh, God, yeah. The probably the I've become an
• 23:50
  amazing listener. And I think that's one of the
• 23:53
  things that it's this and all the nurses that I've been
• 23:56
  working with on like the Women's Health program that I'm
• 23:58
  building. It's the piece of feedback that
• 24:00
  so many patients have given is I feel heard, I feel validated.
• 24:03
  There's often a lot of tears. And it's because when they tell
• 24:06
  me that they've got, you know, all these joint aches and pains
• 24:08
  and hot flashes, I go, that's awful.
• 24:11
  Like, who would want to live with that?
• 24:12
  You know, you're juggling a busy family.
• 24:14
  You want to be thriving, not surviving.
• 24:16
  So let's do something about it. And also the language I've I've
• 24:19
  used has definitely evolved. Instead of it being very
• 24:22
  clinical, you take this and come back and see me in three months.
• 24:26
  It's actually like this is a journey you and I are going to
• 24:28
  go on together. I'm going to get you allowed to
• 24:31
  have access to the tools and your body is going to tell us
• 24:34
  what works for you. And here is a spectrum of where
• 24:36
  you can like what medications you can take and what dose.
• 24:39
  And this is going to keep you safe.
• 24:41
  And you titrate yourself. You know, it might be two pumps
• 24:44
  of estrogen one day and, you know, might be 3 pumps the next.
• 24:47
  And that's fine. But it's my job to keep you
• 24:50
  safe. It's your job to to listen to
• 24:51
  your body and patients really like that.
• 24:53
  And it's about harmonizing that whole whole process.
• 24:56
  So yeah, definitely a better listener and putting myself more
• 25:00
  on the patient's shoes. If they want to be well, they
• 25:02
  want to turn up for their their family.
• 25:04
  And you know, you see it in medical practice all the time.
• 25:06
  And I've heard horror stories where, you know, the clinician
• 25:09
  turns to the woman and goes, oh, but you're a 50 year old woman,
• 25:12
  why do you want to have sex? Your driver diet is part of it.
• 25:14
  And it's just. Like, it's just awful, isn't it?
• 25:17
  And I do think, you know, empowering our patients with
• 25:20
  knowledge is the most important thing we can do.
• 25:22
  And, you know, recently my daughter was having worse
• 25:25
  symptoms. And, you know, it's always hard
• 25:27
  to know, is it something else going on or is it hormones?
• 25:30
  And then, you know, she also said, but mummy, I'm getting my
• 25:33
  palpitations are back. I've got cystitis again.
• 25:35
  My skin's really itchy. Right.
• 25:38
  Well, that's more likely your hormones.
• 25:39
  Yeah. And so changed her preparation,
• 25:41
  not her dose, because it was quite warm and the patches were
• 25:44
  just not sticking properly. And so, and that's made a
• 25:48
  difference. But in the past I would have
• 25:50
  concentrated on her mental health issues if she was a
• 25:53
  patient, you know, 10 years ago, someone with similar symptoms, I
• 25:57
  would just be asking about mental health.
• 25:59
  But because I know more and she knows more, she can recognise
• 26:02
  symptoms. And it is empowering patients
• 26:04
  because, you know, when we have short consultations, we rely on
• 26:09
  our patients actually a lot. And I think this is where things
• 26:12
  are changing and going to change more in the future because, you
• 26:16
  know, women are going to quite rightly understand more and
• 26:19
  quite rightly ask maybe for different trajectory and
• 26:23
  different treatments. And we need to learn as
• 26:26
  clinicians, we need to be kept up to date and our our patients
• 26:28
  keep us on our toes. And I love it.
• 26:30
  But some doctors, I think, find it a bit threatening, don't
• 26:33
  they? Exactly.
• 26:34
  I was going to say that I think some find it, you know, they
• 26:36
  label the patient as a headache or, you know, overbearing.
• 26:39
  It's like actually, for the most part, this is largely just a
• 26:41
  person who wants to live a better life.
• 26:43
  And you know, that's where your application, your app has been
• 26:46
  amazing is because part of the whole process, this is a
• 26:50
  qualitative diagnosis for PMDDPMS, for carrying menopause
• 26:54
  and menopause. It isn't actually a blood test
• 26:56
  that we can reliably utilize. So it comes from collecting data
• 26:59
  points. And that was the same with my
• 27:01
  story. Like no one put together that it
• 27:03
  was hormones until I took the initiative to go, something's
• 27:06
  going on here. And so it's just all those sorts
• 27:09
  of things I think is going to change and patients will come
• 27:12
  better armed with the information and a higher
• 27:14
  expectation of clinicians to be like, this is a condition that
• 27:17
  affects pretty much 100% of women by 55 for perimenopause
• 27:20
  and menopause and increasing rates for PMS and PNDD.
• 27:24
  I need you to support me. So it's a very exciting time,
• 27:29
  but still a lot of women are suffering.
• 27:31
  So we've got a lot to do by joining forces and really make a
• 27:34
  difference from each side of the globe.
• 27:36
  So before you finish, three tips.
• 27:39
  So a lot of people will be listening to this thinking I
• 27:41
  wonder if me or my friend or my daughter or whoever has PMS and
• 27:45
  P or PMDD, So what are the three things that they could do to try
• 27:48
  and help themselves make the diagnosis?
• 27:51
  So I think most important is you have to build your case and it
• 27:56
  might not be PNDD and it's not to say that what you're feeling
• 28:00
  isn't, you know, a hormonal related, it could actually be
• 28:02
  multiple things. So you need to build the case
• 28:05
  around, well, is there a hormonal component to it or is
• 28:07
  there a micronutrient deficiency?
• 28:09
  So get your data obviously, like download Louise's app and track
• 28:13
  your menstrual cycles, track your symptoms.
• 28:15
  That was what fundamentally allowed me to get my diagnosis.
• 28:18
  And then the blood tests were what confirmed that my iron
• 28:20
  levels were fine, that I wasn't zinc deficient, that everything,
• 28:24
  I didn't have an infection, things are fine.
• 28:26
  So absolutely you got to arm yourself with those data points.
• 28:29
  The more detail you can have the better and about how your
• 28:33
  day-to-day life is being affected.
• 28:35
  What's the functional impairment that you're experiencing?
• 28:38
  I think, you know, for all of the parents or partners who are
• 28:44
  looking, you know, because hearing their daughter or their
• 28:46
  sister or their wife in, in this conversation, probably, you
• 28:51
  know, really just sit down with them and, and have that open
• 28:53
  conversation and I can see you're suffering.
• 28:56
  What can I do to help you? And for me, it was mum attending
• 28:59
  all the appointments with me because in the times where
• 29:03
  obviously my brain wasn't functioning properly, I needed
• 29:06
  to have a second set of ears there to help advocate for my
• 29:09
  case. So getting your community around
• 29:12
  you is, is an exceptionally important part of this process.
• 29:16
  It is a little bit of a long journey and there will be highs
• 29:18
  and lows and then finally your lifestyle choices.
• 29:21
  It's being having ADHD and autism, I have to be really
• 29:26
  dialed in on my sleep and my diet and my exercise and who I
• 29:29
  surround myself with. And it's not to say that it's
• 29:32
  going to replace the impact of hormones, but those things will
• 29:35
  impact how my body responds to hormones.
• 29:37
  So, you know, making good lifestyle choices around that is
• 29:40
  really important. And acknowledging that when you
• 29:42
  are in those dark times, accessing those good decisions
• 29:45
  is really difficult. And it's not necessarily your
• 29:48
  fault, but it's something that shouldn't be ashamed of, but
• 29:51
  should be seen as a a northern star of.
• 29:53
  I look forward to one day knowing that I don't have to
• 29:56
  drink myself during, you know, the, the times where I'm really,
• 29:59
  really dark, I don't have to have 5 beers at night or I don't
• 30:02
  have to sedate myself with three antidepressants.
• 30:04
  Like, how exciting is that going to be?
• 30:07
  But yeah, the, the lifestyle choices do really impact.
• 30:09
  I feel this condition trajectory.
• 30:12
  Absolutely, and that's where it's so important that we think
• 30:15
  very holistically, but we can't just do lifestyle without
• 30:18
  hormones and hormones often enable us to have a better
• 30:21
  lifestyle. So I'm so grateful, Izzy, for
• 30:23
  you to be so open and transparent and I'm pleased
• 30:26
  there's a happy ending as well. Of course, yes.
• 30:28
  We're still here and we're we're running the gauntlet for women.
• 30:31
  And I'll be the loudest person on the block shouting, you know,
• 30:34
  that we, we need to keep working on this.
• 30:36
  So thank you so much for having me.
• 30:37
  I really appreciate it. Thanks, Izzy.
• 30:39
  That's great.