Dr. Mary Pardee
Natural treatments for PMS
Understanding PMS: Causes and Natural Remedies | Empower Yourself with Effective Solutions
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Are you tired of the monthly battle with PMS symptoms? It's time to take charge of your well-being and discover the underlying causes of premenstrual syndrome.
Join us on this educational deep dive into the fascinating world of PMS. Dr. Sarah Williams and Dr. Mary Pardee unravel the causes of PMS, testing options and treatments behind these often-frustrating symptoms.
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I'm here with Dr Williams today one of the doctors at modern Med we're going to jump right into PMS so welcome first of all it's a great thank you yes I'm so excited to be here I feel like this is such an important topic for us to cover awesome awesome so let's just go into the first I think it's important to set up like what's a normal menstrual cycle to remind everybody about the hormone fluctuations throughout the cycle and let's just take a 28 day cycle for for you sake and and you can kind of talk about what is a normal cycle length to start with um and what happens from you know day one to to day 28 in a cycle absolutely so the cycle itself when we're talking about that is referring to the full month of hormonal changes that we experience versus when we talk about like period that's actually this the amount of days that we are bleeding per month um so that's really important to differentiate they often get confused um so like you said classically we talk about like a 28 day cycle but there is definitely a variation on that so technically 24 to 35 days can be considered normal if they're kind of consistently coming in that time frame every month and then amount of bleeding to can vary for people but usually we say you know seven days or less bleeding is what is considered normal yeah okay absolutely um and it's so common for you know honor paperwork it says how long is your cycle and people will put like five days um so they're confusing the period with the cycle so I think it's important though because when we talk about this it makes it a lot easier if we're all using the same lingo um okay so day one is the first day of bleeding of the period what's going on from day one to day 14. yep so that's considered the follicular phase so the first part of that is the menstruation phase where you're bleeding that's the point in the cycle where our sex hormones estrogen and progesterone are at their lowest um so you might feel a little bit more fatigued at that time um and then once you stop bleeding we move into more of a proliferative phase so this is when we start to actually increase our endometrial lining by increasing our estrogen levels so this is where estrogen is steadily increasing and this is typically when we feel our best in the month so more energy better mood food more social just overall feeling more thriving and vibrant and we associate that with the higher estrogen levels at this time yeah okay and then follicular I always remember is like follicle right so it's preparing your body for ovulation um and so then that brings us to around day 14 which is going to be different for different women but then what's going on at that point yeah exactly so what you said is the higher estrogen causes us to increase our LH which is our luteinizing hormone and then that triggers the ovulation to occur um so that is when we release an egg and then that sets off us to promote progesterone which then puts us into the second phase of the cycle which is the ludial phase so we classically say 15 to 28 for that yeah typically when our testosterone increases as more in the mood better sex drive and still feeling like you have more energies this is usually also a time where we feel our best and make sense from a primal standpoint that we feel that way is to make babies yeah absolutely so you've got a couple of factors there like increasing estrogen helps with libido increasing testosterone definitely helps with libido you're ovulating around that same time how long is ovulation so it's about 24 hours yeah um but you still can get pregnant before and after just because of the length of the duration of the sperm how long they can last and exactly okay so we have our follicular phase which is preparing for ovulation and then we have ovulation and then we have the luteal phase which is preparing for Implement implantation of the embryo if we're pregnant pretty much exactly awesome Okay so we've kind of got the cycle in terms of estrogen more so in the first part of the cycle we do have a small boost in estrogen in the luteal phase as well but progesterone being the dominant hormone of that luteal phase um so let's go into PMS which is focusing on that luteal phase the second half of the cycle um first of all like what is PMS I think it's commonly misunderstood yeah so PMS stands for premenstrual syndromes like you said it's just referring to symptoms that are occurring in the ludial phase that sanket half of the cycle um and so we diagnostically Define it of having at least one symptom in that phase and it must be impairing functioning in some way so there's a wide range it could be impairing functioning so it could be that you're calling out of work more it's impacting your productivity but it could also be like you just you know cancel social events more during that time or how it is actually affecting your relationships in a negative way so it could be really like any of those things that it's affecting you yeah and what are the things that would be affecting them so what are the main symptoms yeah so the main ones we have more of our effective or behavioral symptoms those are things like mood swings irritability anxiety depression but then we also have things like Cravings fatigue breast tenderness headaches bloating sleep changes those are all very common yeah super super common but I think that key factor is it's affecting your life in a negative way so you're having to miss work you're having to change your schedule it's affecting your relationship so if women are needing to go to to see counseling and things like that like it's having a big effect on the quality of life and that's when the diagnostic criteria kicks in is that right exactly yep so if you have one of those symptoms and it's affecting your quality of life during that time then it's considered to be PMs and so reportedly up to 80 of people have reported PMS which is extremely high and that's why it's so important that we're talking about this and how to you know help and support at that time yeah and fewer have probably met the diagnostic criteria but hard to tell too because I think women in general I know it's for me like we don't go to the doctor for everything right like we're like it's just affecting us we probably can't do that much about it as a common thought that I hear women say um so likely not even going in to get a formal diagnosis exactly we think it's normal and like you said there's not much that can really be done about it so yeah okay so before we go into bags I think that we would disagree with that but um before we go into the treatment what causes PMS why do we all have these symptoms in that luteal phase or why do 80 of women report that yeah so it's really fascinating we actually still don't fully know the mechanism what we're currently seeing with the evidence is that it seems to be some cyclical changes that are happening with our estrogen and progesterone in relation to how that affects our neurotransmitters specifically we're seeing serotonin be the biggest one but it also does seem to be impacting our endorphins and our agaba um so it seems to be this interplay between the two that is really important so interestingly we have studies that are showing that people who have PMS have similar levels of estrogen and progesterone as people who don't have PMS so it doesn't seem to be solely just estrogen and progesterone changes there's something else that's happening so we essentially are just saying that people who have PMS have more of an abnormal response to these normal hormonal changes and fluctuations so like more sensitive to these changes and how this is also affecting our neurotransmitter response with serotonin yeah it's fascinating to me in that study when we were talking about it's like the estrogen progesterone aren't different between the two groups of women that complain in PMS versus women that do um and so it's just fascinating to me that at this point we still don't really have like super concrete answers um but I think our treatment approaches give us a little insight and as to like what women actually respond to as well absolutely yeah it's such a fascinating topic with all these hormone changes and that we still don't fully know but there's something obviously going on for all of us to experience this um but yeah I think it's really the serotonin with estrogen progesterone and how that you know changes and you know the ups and downs fluctuations that make us you know be more sensitive yeah absolutely and you do have this so like day 21 is typically when we would test progesterone because it's at its highest and that's really when you start to see a decline um and you do want to talk about I was going to talk about do you want to talk about why the decline in progesterone actually you know happens um I think that gives a little bit of insight too yeah so the decline in progesterone happens if we didn't implant an embryo um so that leads to our bleeding that happens monthly right so your body just figures out you're not pregnant so there's no need to keep on this this path you know we're going to give up this month we'll try again next month so we're going to start to shed the lining and start the process all over again um but that is when symptoms usually really start is the week before the cycle and it's also coincides with that reducing progesterone level and and so that's kind of a hypothesis it's just like this change in progesterone maybe estrogen has a role too but it's more applicable to certain people that are just more sensitive to that drop in in hormones um despite normal you know similar hormones between groups that don't have the symptoms too super interesting and then we throw around the term so we've got PMS which is the common one that you'll hear and then there's the other term which is is pmdd first of all what does pmdd stand for and then what's the difference between PMs and pmdd yeah so pmdd is premenstrual dysphoric disorder so it's essentially just a more severe form of PMS so the way we differentiate the two is with the symptoms we talked about earlier PMS would be considered if you have like one to four of them pmdd is if you have five or more of those symptoms occurring in the luteal phase and one of those has to be an effective behavioral symptom so like the mood swings irritability anger something like that has to be included in it um so yeah five or more of those symptoms would be now considered pmdd okay interesting I didn't notice the effective part you have to have one of those for the inclusion of the code interesting okay yeah um so it's a more severe version of PMs and I'm much less common too so we approximate about two percent of women actually have pmdd got it so not as frequent um and this population typically is seeking care hopefully um I definitely see women that haven't yet so they're still not sure if this is normal PMS or what um it also can be hard to distinguish that from depression and women will have to like kind of learn that like oh it's only happening though at specific times of the month have you seen that in practice as well absolutely it can be really hard to distinguish and I think we just almost don't have that awareness around it so it's something where you know logging your symptoms can be really helpful to dictate how much is it hormonal or is there like an actual mood disorder that needs to be addressed and supported right yeah is it going on different points of the cycle it's not just in that luteal phase yeah absolutely and this is the one that's so important to treat because it's it's usually really affecting quality of life relationships absolutely and it has such a hormonal link to to the physiology that it can be really helped um okay so we let's go through testing which is interesting in terms of my clinical practice I've actually kind of changed a little bit in terms of testing but I'm interested to see what you say what testing should you do around this should you do testing at all around it is what we discussed about like hormones seem to be the same in these two groups but what are your thoughts on this yeah exactly I mean so conventionally testing isn't recommended and because they are similar I see where that thought process is I still find benefit in testing patients um so we are testing in the ludial phase like you said about day 19 through 21 because that's when we should be having our Peak progesterone and then we also look at estrogen and in the relation of the two so that's typically about like five to seven days after ovulation that we're timing it we have the couple different options of ways of testing so we have blood work testing to look at those levels and we typically are looking at other hormones too and how they're all connected um and then another test that I commonly still use in practice is the Dutch test which which is a dry urine hormone metabolite test so that's more of a deeper dive into all of your estrogens so we get to look at all those metabolites which can be really really helpful in how well you're detoxifying and then we also get to look at your cortisol curve which I find really helpful that's our stress hormone so that also can hugely impact our estrogen and progesterone levels too so I think that it's a really valuable test to have on board as well yeah yeah and I agree with you I think you know what I've started to do is just to tell people like hey we have this group of people that have PMS in this group and they seem to have similar hormones so we don't necessarily need to test we could just go on to treatment but also if you're curious about your hormones then I'm happy to order them because sometimes it's just nice to know like is your progesterone at a level that would sustain a pregnancy if you're in those reproductive years and you're going to have a baby absolutely are you ovulating should you experiment with ovulation test strip kits so you know how to use them when you're ready to get pregnant um so all these things they just think are like learning about your body in general anyways yeah very valuable information to have great yeah um okay so testing the Dutch you got the blood work um I do like the the stress hormone profile that you get from the Dutch too I think that's another just learning about your body Peace So now we've got the diagnosis and we're like yep it really looks like this is PMS um actually I'm gonna go back one step what are the other things you want to rule out that could be presenting as PMS because we want to make sure we're treating the right thing I would say thyroid conditions are the biggest so we actually see hypo and hyperthyroid conditions can contribute to PMS like symptoms um so that would be really important and then I would say another one is those new disorders that we kind of talked about as well you know usually you're having symptoms uh you know more of the first half of your cycle two in those cases but it is really important to rule out yeah absolutely it's going to be symptom dependent right if somebody comes in their only symptom is fatigue versus irritability those would all indicate different testing so you're going to do comprehensive testing based on symptoms at presentation but say you've got a woman and she's got symptoms that are day 21 to the first day of her period she feels so much better after her period starts in terms of her mood gets better um and then like every month she has a fight with her boyfriend and I'm not talking about it yeah but um say you have the diagnosis made what are your options for treatment what do you talk about yeah so I always love to talk about the foundation aspects of health so you know looking at diet of course making sure you're getting enough healthy fats and fiber and vegetables working on Stress Management regular exercise actually has really good research on how helpful that can be um and then there's some you know really good herbal options that can be really helpful I would say Vitex or chase tree berry probably has the most um the strongest evidence for being helpful so that really helps promote healthy progesterone levels at that time of our cycle um and then we can really take it a step further and do progesterone replacement topically or oral are both very common um and just use it in that second half of your cycle to help mitigate symptoms too yeah yeah and I was telling you yesterday I've been on oral progesterone now for a few months and it's made a big difference for me personally so I'm thinking I'm going to try it too and I use it I use it with patience for sure but I obviously you can't use things if they don't pertain to you in medicine but this is one where I'm like wow I really feel a difference with it and I feel like I'm one of those women that's just like I'm a little more sensitive to that drop in progesterone around day 21. yeah absolutely I'm glad it's been helpful I think it would be helpful for me to try too so then we have pmdd we won't go in too much to the treatment options um they'll overlap a little bit with PMS but anything additional for pmdd that people should look into yeah a really common um thing that is helpful is an SSRI so a serotonin reuptake inhibitor so this also goes back to what we're talking about as the mechanism of how important serotonin does seem to be playing a role with PMS and pmdd so that just means that we're going to be increasing your serotonin at that time which significantly helps symptoms especially with with people who have pmdd so I think that's a really good helpful therapy to have on board in those cases yeah yeah and I know people women are looking for us for natural options but I do think it's important to note I've had several women that I've worked with throughout the years where this is really the thing that changed their life and it was a big difference between the natural options and the SSRI and so I think it's an important thing to talk about is sometimes we do need some Pharmaceuticals yeah absolutely yeah there comes a point where you have to weigh the benefits versus the risk and how much it's affecting your quality of life so yeah okay we had a few questions come in from people on Instagram so I want to go over those one of them is spotting before your period normal what causes it um and you can go into that a little bit Yeah so spotting a day or two before your period is normal it's really just the brown blood discharge you experience that kind of just shedding the old blood from the last cycle and getting ready for your actual period to start so that's considered completely normal um what is important to distinguish is if you are spotting in other times of your cycle or if you're spotting for many days before your cycle then that could be a sign of a hormone imbalance or an infection or something like that that really needs to be addressed yeah so it's kind of just like easing into your cycle you may have some spotting before the full bleed actually happens yep absolutely and then what causes acne before your period yeah so we see that the fluctuations in estrogen and progesterone before your cycle can trigger your sebaceous glands in your skin to actually produce more sebum oil and that can really clog your pores and cause more acne at that time yeah okay really fun times I know it really really is [Laughter] um all right another one though we do have another one um okay uh this was a question from somebody who's wondering if you can if your period after children can cause digestive issues um so I think there's a couple things there where it's like it sounds like this person had changes after having children like she didn't have this before um I think it's the same kind of um thing that's going on regardless but talk a little bit about that yeah so so obviously it sounds like something changed after having children which is very common or hormones can kind of shift or it can take a while for things to balance out so in specifically with digestive issues it could be that maybe she is promoting more progesterone than she did prior in progesterone can contribute to more constipation if that's what she's experiencing I'm not sure or also there could be changes with the prostaglandins which can promote diarrhea because they're causing contractions in our um GI tract and uterine as well um so that is probably either of those is probably what is happening for her yeah we get this question all the time too I think it's one of the most common things when we're talking about cyclical changes in G eye issues but definitely the progesterone rising at its highest a week before your your period will cause constipation and especially with people that are already prone to constipation and can really worsen symptoms and those people what do you recommend to actually prevent it or treat it or just kind of to educate them about what's going to keep happening so we got to figure it out yeah so I mean obviously hydration is so important but what I find really helpful is magnesium that also just helps alleviate other symptoms too like muscle aches headaches if you're having those symptoms as well and then Ginger is also one of my favorites even just like a turmeric ginger tea or or you know Ginger capsules something like that can be really helpful to mitigate the constipation at that time yeah for sure I totally agree even marking your calendar and saying okay usually I'm getting constipated a week before so that means like nine days before I'm going to up my magnesium or start taking a magnesium preventatively and I love the ginger turmeric tea option I think that's a great one too and then when you get your period sometimes then you swing the other way so it's important to know like you're probably not going to want to decrease the magnesium yeah so uh diarrhea loose stools very common at the start of the period like you said the prostaglandins they're Contracting the uterus but everything else can kind of get contracted and and move a little faster too um so yeah so ease up or stop that magnesium when you feel that coming on yeah absolutely why didn't we cover anything else that we want to touch on today that you think is important um I think that that was really I think that was really it I think we covered a lot of good things yeah me too I think it was a great overview where can people schedule a complimentary call with you yes um and what other things do you like to treat besides hormonal issues in women yes you can find me at modern Med our website you can schedule directly on there and then I'd love to see anything hormonal related bioidentical hormone replacement all of that and then I do a lot of gut health of course so issues with bloating sibo I do a lot of that in my practice and then I would say mole toxicity is probably the other biggest thing that I'm seeing absolutely this is going to live on YouTube there's going to be a link below for scheduling with Dr Williams thank you so much for joining do you have any fun Fourth of July plans I'm actually going to Palm Springs so yeah what about you I love it I'm gonna be um well he won't see this it's a surprise for my boyfriend but I guess he won't be here so I'm gonna be up near like the Santa Barbara area on this weekend oh nice yeah enjoy that sounds really fun
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