PMDD: Parsing the Pain, Power, and Progress

Hello and welcome to the Ark Woman Podcast. This is an exploration of woman kind. Here we discuss what it is to be a woman in the modern world while utilizing ancient and modern modalities in tandem to create a bounty of health for the body, mind and spirit. Hello beautiful women of the world and welcome back to the pod. I am on day two of my bleed. I am feeling very juicy and slow and you know kind of intended just to do the research on PMDD today but then I realized I have done so much research on PMDD previously. I didn't feel like I needed to top up on it so I thought you know what I'm just going to record it even though I'm not feeling very you know outward and bubbly and you know and extroverted. I just thought you know what that's actually kind of what we need when we're talking about PMDD because it's such a sensitive topic and I just don't think it would be appropriate for me to be like a mid-offulatory super happy talking about PMDD because I know the women who are going to be listening to this are just having a hellish time with PMDD and I just let you know what day two is the perfect time to record this. So here we are. Hopefully everyone is having a beautiful day mid day afternoon evening wherever you are. If you're listening to this you're either a really beautiful friend partner, colleague, sister, brother, auntie, uncle, mother, brother who has someone in your life who has PMDD and thank you so much for listening to this and educating yourself on PMDD. I think that's really wonderful and we need more people talking about PMDD and understanding what it is because it is almost an invisible disability for women who have PMDD and if you are a woman with PMDD I am giving you the biggest hug ever. I love you. I hope you're okay. Please know that that there is a way to manage this condition. I have seen complete reversal of PMDD as well. You know, it can happen in some women with a genetic variability but just know like this isn't the sentence that people tell you it is. I think it definitely can be managed. It's a systemic thing. So once we look at how it impacts the body and how the body interplays with the symptoms of PMDD we find very quickly that there are common causes and correlations that we see with women with PMDD and therefore we can find solutions for PMDD. So I really believe that the body can heal and really believe in mental health. They really believe in you. So let's get into it. So what is PMDD? So PMDD is a condition that's really similar to PMS. So preemonstral dysphoric disorder is what PMDD stands for. PMS is preemonstral syndrome. So 85% of women have some PMS symptoms. I have PMS symptoms even if I teach cycle syncing and I'm a nutritionist and I should be amazing at this but I still have you know like a maybe we'll cry a day before my period but that's not PMDD. PMDD is very very different to PMS. So PMDD causes more severe symptoms than PMS including depression, irritability, tension but also things like suicidal ideation. So a lot of women will have PMS but it's not appropriate to say oh my gosh my PMDD is you know I mean hell week ha ha ha no not appropriate because you know PMDD affects up to 5% of women in childbearing age but many women with PMDD also have anxiety or depression. So not something to joke about not something to just use loosely. Don't say you have PMDD unless you've been diagnosed with it because I feel like that takes away from women who have got PMDD because it's a really intense right and so what we generally see what's the difference between PMDD is that it's so severe. It's almost like PMS on crack that's kind of what I've heard women with PMDD say to me that it's the most intense PMS you've ever experienced in your life and you know very often women will experience it pretty much after ovulation. As soon as they've ovulated I've heard of women saying you know I don't feel it up until you know late luteal and then it comes out into my follicular as well so that can happen to but what we generally see is that it's pretty debilitating so it affects women's career, their relationships, overall health. And so once I even estimated that women suffering with PMDD actually lose around three to four years of their lives on average due to the misery they experience on a regular basis. So you have to keep in mind the luteal phase. So luteal is just up to your ovulated up until you get your period. That ranges from around nine to 18 days. It's the longest phase in your cycle. So if you are odds with this phase in your cycle then you're going to be at odds with yourself for half of your cycling years which is a whole quarter of your life. So you know that's a there's a long time you know it's around 15 to 25 years you know what I mean. So this three to four years I'm like hmm I feel like that's the tip of the iceberg really for women who have PMDD. It's really overlooked as well so that's the thing it's dismissed. It's overlooked by a traditional medical community as with so many issues that are related to female holes. So what are some of the symptoms? So lasting irritability or anger and rage that's something that I hear of a lot. I am you know women just fly into fits of rage feelings of sadness or despair and very often suicidal ideation. So thoughts of suicide feelings of tension or anxiety panic attacks mood swings or crying often like of interest in daily activities and relationships trouble thinking or focusing so brain fog tiredness low energy we also see food cravings and binge eating here as well because we want to get a dopamine fix and we will be talking about the neurotransmitters and how they interplay into PMDD. Also things like sleep trouble we see in Somia is a strong strong comorbidity as strong as anxiety and depression with PMDD. And also physical symptoms so cramping bloating breast tenderness headaches joint pain or muscle pain that again those are things we see with PMS but I'm talking about the women who have PMDD can't walk up stairs without clutching their boobs because they're in so much pain whereas PMS is like if someone accidentally knocks your breast and you're like how that hurt a little bit you know very different. So as we're talking about PMS and PMDD what's the difference? I've just spoken about it a little bit but I just want to really reiterate this the difference between PMS and PMDD is its severity frequency and duration. So PMS you will have occasional cravings you'll have occasional mood swings here and there but women with PMDD they have headaches extreme fatigue serious breast tenderness massive bloating and you know fits of age you can't control suicidal ideation all of these things we've spoken about. And so these symptoms they will interfere with school working relationships. So with PMS we know with PMS we can push through a little bit right PMS you know symptoms start usually five to seven days before you get your period. PMDD very often we see as soon as a woman has ovulated she has symptoms and they're severe they're frequent and the duration is long and it might even spill out again into her period and into her follicular phase as well. PMS and PMDD as I've spoken about and reiterated multiple times really really similar so you're probably wondering okay how can we tell the difference between PMDD and PMS. So the diagnosis of PMDD is made using the diagnostic and statistical manual of mental disorders in its fifth edition. So it only made it into the DSM-5 I believe in 2013 so and it takes about what 17 years for avant-garde research to reach the forefront. So of course doctors and health professionals are still having a really hard time diagnosing this and it's just going to get better with time and hopefully with people being more knowledgeable about PMDD and knowing the symptoms and advocating for yourself and perhaps even sending this to your doctor or health care practitioner because unfortunately I find a lot of women when they're in the doctor's office with their health practitioner they have to educate them and so if you have PMDD you expect that you have PMDD then you know this is a great one to send off to your health practitioner they're open to being educated and learning a little bit more unfortunately a really is up to the woman who has the condition to educate the doctor and say hey it actually is in the DSM-5 I show most of the diagnostic tools associated with this please diagnose me. So from the list of symptoms we need five or more to be present the week before your period so during that ludio phase and they have to resolve once your period starts which I have a problem with because sometimes women with PMDD their symptoms can go out beyond your period. So before you dive into this and use self-diagnose understand that the symptoms aren't occasionally bothersome in PMDD they are downright destructive they hijack your life they sabotage your relationships and they make it really really difficult for you to function right really difficult so you might think about breaking up with your partner you might quit your job like PMS you can push through a little bit PMDD is completely destructive so you need to have one or more of the mood symptoms that are present so anger irritability the next one is mood swings sudden sadness the third is depressed mood feeling of feelings of hopelessness negative or self-critical talks and then underneath that as well could possibly be and most probably would be suicidal ideation also the fourth here is anxiety tension and feeling on edge very often women with PMDD are like tick tick tick tick I've got all four okay and so the next one is one or more symptoms from the list that you can reach a total of five so cravings over eating and change of appetite so this can also be nauseous like you don't feel like eating the smell of food makes you feel nauseated and we will be talking about that as well second is brain fog or difficulty concentrating and also you might also see ADHD and we do have a podcast on ADHD and we do talk about PMDD in that one so if you have ADHD just know that there is a strong comorbidity between ADHD and PMDD. Decreased energy or easily fatigue and also physical symptoms that we spoke about before. So that breast tenderness, the swelling, the joint pain, weight gain, muscle pain and bloating as well. And so the bloating as well can be in the legs and arms as well. Sometimes can we see that in PMDD. Next we have insomnia or sleeping in excess, so either all. Lack of interest in usual activities and the last one is general sense of overwhelm or lack of control. If you're one of those women who have listened to every single one of those and said, yeah, at some point in my cycle, there is some intensity of each of these. Then the chances of you being diagnosed with PMDD are pretty high. I feel like we've just set such a beautiful foundation for understanding PMDD. And before we go forward, I think we should just understand neurotransmitters because neurotransmitter function in the body has so much to do with the symptomology of PMDD. Because PMDD, you know, there is a plethora of different symptoms that we exhibit, but the most ones that women will be focused on and feel like are the most intense are the impacts that PMDD has on their emotional selves and on their sensations in their body. So brain fog, focus, mood swings, all of those things, depression, anxiety, suicidal ideation. So what's governing all of these things is neurotransmitters and neurotransmitters are these amazing little molecules that attach to receptor sites in our central nervous system. And they will elicit different feelings and responses in the body. So for example, dopamine has a lot to do with cognitive performance and mood. Serotonin is a lot about how we can focus and also how happy and calm and stable and you know, our appetite as well. Also things like GABA. So GABA is a neurotransmitter that promotes relaxation. It reduces anxiety. So once we understand those neurotransmitters are the bedrock of the emotional body of all people, but also women who have PMDD. Then we understand also that that's probably other crux of most of the symptomology that women showed with PMDD, right? And then we understand PMDD only affects women, right? So we know that as a hormonal piece to this, right? And we know that estrogen and progesterone both impact both the up regulation and the production and the binding of different neurotransmitters like dopamine, serotonin and GABA to the central nervous system. So I think it's really important, first of all, that we understand three of these neurotransmitters, how they connect to the reproduction system and each of these hormones. And so then we can understand what's actually happening over the course of the cycle. So just to get this started, you might be listening to this, you might not know anything about the cycle. So I'm just going to run you through it very, very quickly. So at the start of our cycle, I like to teach it from follicular because I really believe them and sees is the end of the cycle. It's a culmination of everything that's happened in the previous cycle. So you've led this is your first dry day after finishing your period, right? So follicular stimulating hormone is traveling from your hypothalamus and your pituitic gland in your brain. It's going to your follicles and it's going to stimulate them to grow. As they grow, they are going to produce estrogen. Estrogen reaches a high set point and then you're in your ovulatory phase. When it reaches a high set point, your pituitic gland will release something called lute-nancing hormone. And so that causes you to ovulate and then you're in your post ovulatory phase, right? So follicular lasts for about five days ovulatory lasts for about five days as well on average. Don't worry if you're outside of this. It's around three to seven days for each of those phases, follicular and ovulatory. Once you've ovulated, right? You have a corpus ludium which is the old follicle sticking around and that's going to make progesterone. And then your progesterogenic luteol phase is nine to eighteen days long. So the longest phase in your cycle, right? And at the end of that, progesterone comes to a low set point if no pregnancy has taken place and that causes your uterus to open your and contractions to start happening and you get your period which is from three to seven days. So that's what happens over the course of this cycle. And estrogen and progesterone are the ones we're going to be focusing on here in relation to neurotransmitter upregulation, binding and release in the body. Estrogen and progesterone, they are quite opposite. So estrogen is really extroverted and confident, you know, she's associated with the highly fertile phases of the cycle. Whereas progesterone, she's very different, she's very calm, she's very intuitive, she likes to stay home and read books, you know, she likes to stay calm. And they do lots of other things in the body as well. So estrogen and progesterone, they impact our thyroid hormones, our metabolism, the GI tract, our brain, right? And our mental health because of how they impact on neurotransmitters. So right off the top, let's talk about estrogen and how it impacts dopamine. So estrogen enhances dopamine synthesis, release and receptor binding. So it enhances its production, how it's released in the body, and it's binding to receptor sites. So we find that when estrogen is around, it binds to its receptor sites for longer periods of time and to key areas in the brain, such as the prefrontal cortex. So it does this by upregulating the enzyme that makes it called tyrosine hydroxylase. This is involved in dopamine production and by increasing this dopamine receptor density as well. So particularly the D2 receptors. So we're making more receptors on the cells to receive this dopamine as well. This is going to lead to heightened dopamine allergic activity, right? So we have more of a dopamine activity in the body. So what is that going to look like? Dopamine is a crucial neurotransmitter that's associated with reward, motivation, mood regulation, attention, and motor control. Estrogen's modulation of dopamine can improve cognitive performances, mood, which is often why women feel a lot more focused and energized during the estrogen dominant molecular and ovulatory phases of the menstrual cycle. Estrogen, she's a busy girl. She's not just upregulating the release production and binding of dopamine, but she's also doing that for a different neurotransmitter, which you probably heard of serotonin. So estrogen boost serotonin production by increasing the expression of triptophane hydroxylase. This is an enzyme that is responsible for making serotonin. So serotonin synthesis, if you're scientific. It also enhances serotonin receptor sensitivity. So specifically this one receptor called the 5-HT2A receptor. So we're producing more of these receptors to capture more of the serotonin to exhibit more of a serotonergic response in the central nervous system. We're also reducing serotonin reuptake by downregulating the serotonin transporter, CERT-SERT. So this is going to lead to more serotonin in the body. So CERT, so serotonin reuptake, we often see antidepressants are CERT inhibitors, right? So we're inhibiting the uptake of it. So serotonin stays around for longer. So your body kind of does this naturally when estrogen is around as well, which is endlessly fascinating. The connection between our neurotransmitters and the central nervous system, the gut and our hormones, is that whole axis, the reproductive system, the gut and the brain axis is so, so interested, especially when we talk about women's health. So what does serotonin do in the body and for our central nervous system? So it regulates mood, emotional stability, it's also the precursor for melatonin. So in the morning, when we exercise and we get sun in our eyes and we are doing things that increase and support the production of serotonin, that's also going to give us a better sleep later night, right? Because serotonin makes melatonin. So it also governs appetite. So by increasing serotonin availability and receptor activity, estrogen contributes to feelings of happiness and calmness. So feeling really elated, connected and calm. So this is really evident during follicular and ovulatory and it tends to really drop off when we're in our luteal phase, right? And so we feel a natural decline in the luteal phase anyway, because when we have ovulated, we have something called a corpus ladym around that's producing and releasing progesterone. And progesterone loves a different neurotransmitter in the body called GABA. Progesterone interacts with GABA journey activity through its metabolite, aloe progenolone. So progenolone is the mother hormone, but you don't need to know about it too much. So this acts as a positive alosteric modulator of GABA receptors. So this means that it enhances GABA binding and amplifies the calming effects of GABA on the nervous system. So pretty much the opposite of estrogen, they're pretty much polar opposites and how they impact the central nervous system. Progesterone also increases the expression of GABA receptors in certain brain regions that tend to be more prone to activation. So things like the prefrontal cortex and the amygdala, we generally see more GABA during that part of the phase of the cycle. So in your luteal phase, so what does GABA actually do? So GABA is the brain's primary inhibitory neurotransmitter. So it promotes relaxation, it reduces anxiety, and it promotes sleep quality. During the luteal phase, when progesterone is higher, these calming effects can help you offset stress and prepare the body for potential pregnancy. However, if we have a sudden drop in progesterone before menstruation, this can lead to reduce GABA activity, which is going to contribute to irritability or anxiety during PMS and also during PMDD. So if you're PMDD and you're listening to this and you're like, "Oh my god, this makes total sense. maybe in your post-avulatory phase. So when you're in luteal, you don't have enough progesterone around. So you're really, really irritable. Maybe you're having mood swings. Maybe you're feeling a little bit manic because you have so much serotonin and dopamine around maybe, because one of your roots is estrogen dominance, which we can talk about. Or vice versa, maybe you don't have enough estrogen around. And maybe you have a gut problem and you can't actually make that much serotonin. And so you have this wide and tiredness going on. So your symptomology of PMDD is going to be insomnia because you don't have enough serotonin to make melatonin. So you're not sleeping at night, but you're also feeling really fatigued during the day. So this is why I feel like PMDD, I'm really happy that we have a diagnostic tool for it. But I feel like it is just that, we're just repeating the same medical model again and again, where we are making a diagnostic criteria we're putting women into it. And there's no distinction for like a woman that might have estrogen dominance and maybe has mania and you know, it doesn't have enough GABA around as opposed to a woman who might have psilocyte alladiation because she doesn't have enough serotonin and maybe she has too much GABA. You know what I mean? So there is really a big big push from me at least and a lot of different health practitioners. Thank goodness that are really pushing for PMDD women to find practitioners who are going to look at the symptoms and go okay, this is what we're seeing and this is how your body is exhibiting symptoms that we would pigeonhole as PMDD. There is such a good case with women with PMDD for individualized healthcare. I really don't believe in just pigeonholing women into a little box and saying you have PMDD, you know, take a SSRI or the pill and that's gonna get rid of it because I feel like the answer to PMDD is a lot more interesting and if we can get down to the reason why we have these symptoms and why we have neurotransmitter problems and maybe we're not releasing serotonin at the right time or maybe we have a receptor agonist problem. Maybe we have a sluggish liver and we can't get estrogen properly. You know, all of these things I feel like are probably at the roots of PMDD and therefore hold the key for women to heal and it's going to look different for everyone. Just from that short conversation we've had with neurotransmitters, I feel like all the women listening to this with PMDD are going to have different symptomology and therefore their care and their healthcare provider is going to have to treat them as individuals. Okay, I just spoke about a few of the possible roots and predisposition. So let's get into that. So the first one I wanna talk to you guys about is genetic variance. So there's a link between PMDD and genetic variance and traumatic life events and this really highlights the intricate interplay between biology and environmental factors. So PMDD has been identified as a condition rooted in abnormal genetic sensitivity to hormonal fluctuations of estrogen and progesterone that occurred during your menstrual cycle. So recent studies have actually revealed that women with PMDD may carry a genetic variant in genes such as the ESR1 so the estrogen receptor alpha gene and PGR so the progesterone receptor gene. So these regulate how the body responds to these hormones and these variants can heighten sensitivity to hormonal changes. And so this in itself can trigger extreme mood and physical reactions that are characteristic of PMDD. What's really interesting though is that PMDD may remain dormant in some women until a traumatic life event kind of unlocks these genetic predispositions. So we have in our genes we have something that holds them together called histones and what we know is we have environmental factors and maybe in events that happen in someone's life that can loosen these histones. So you might have had a genetic variability that made you more sensitive to that ESR1 estrogen receptor alpha or the PGR progesterone receptor but you didn't have that gene variant express itself and still until maybe you had a traumatic life event. So maybe you had a really bad car crash or your parents had an insane divorce when you were 13 or 14 years old or maybe you know you hurt yourself like all of these things are really traumatic life events. And so that trauma can impact your genes in a way. They can't change your genes but what it can do is change our expression of those genes. So you can either loosen the histones that wrap around these genes and that allows the proteins in our cells to go over to those genes and express what is actually happening in our genes. Which means if you didn't have PMDD and then you've had a traumatic life event and now the sum you have PMDD, that's why. You've always had that gene there that's made you a little bit more sensitive to estrogen or progesterone or perhaps both but it wasn't expressed until you had that traumatic life event. So if that's you, then a lot of what you're going to need to do is focus on how you can regulate your emotional body and how you can maybe go to therapy, maybe talk to someone, maybe do EMDR. So rapid eye movement therapy with a psychologist in Australia that's the only ones in Australia that can do it. To desensitize yourself from that traumatic event so you stop presenting those genetic variabilities. Anyway, trauma is thought to interact with genes involved with stress regulation such as the Comtagene. So this influences the breakdown of stress hormones like cortisol. So that means that that hormone cortisol is going to stay in your body for longer which means it's going to make that gene for PMDD express itself, right? And we also have the MAOA gene which also regulates neurotransmitter metabolism. Trauma can also alter the function of a hypothalamic pituitary adrenal axis. So your hypothalamus which is a gland in your brain, your pituitary, a gland in your brain and your adrenals which are glands on top of your kidneys that deal with a lot of different hormones to do with stress, one of them being cortisol. So this is really closely tied to hormone regulation and mood. Epigenetic changes where trauma modulates gene expression without altering genetic codes itself. And I'll repeat that. Epigenetic changes where trauma modifies gene expression without altering genetic codes itself can further amplify the sensitivity of genes related to hormone and stress pathways. Really interesting. This explains why some women develop PMDD later in life, often following a significant stressor as their body's hormonal and stress systems become dysregulated in response to a genetic and environmental trigger. The next predisposition is something that I see a lot and I've just made a podcast about this last week, estrogen dominance. So this is a key factor in PMDD. It contributes to the severity of its symptoms in this condition, excess estrogen builds up in the body, often due to the liver not processing estrogen effectively, or the gut failing to eliminate it properly. So this imbalance can intensify the hormonal fluctuations that drive PMDD. And this leads to a heightened mood swing, anxiety and physical symptoms like bloating and headaches. Supporting the body's ability to process and eliminate estrogen is really essential when you're managing PMDD. This might not be you. I talk about the labs, the symptoms, all of it in the previous episode that I did on estrogen dominance. So if you have PMDD, please go and listen to the ADHD episode and the estrogen dominance episode. I feel like that would give you a lot of good information to get started and get healing. This can be achieved by prioritizing liver health through nutrient-dense foods, like cruciferous vegetables, balancing adrenal function with stress management and maintaining a healthy gut microbiome through fiber, probiotics and hydration to ensure proper estrogen detoxification. We will be talking about solutions at the end of this podcast as well. So we can get into different labs specific for PMDD and healing protocols for PMDD as well. The third predisposition I'm going to be talking about here is histamines. So the histamine estrogen relationship is really interesting. So estrogen increases during the menstrual cycle when we're ovulating, right? This stimulates the release of histamines from mass cells. And this is because estrogen will upregulate the immune system, which makes total sense because when estrogen is at its highest, that's when we're most likely to be having sex. And when we're having sex with somewhere and we're close to them physiologically, which means we're going to pick up other pathogens from them. So flu's, colds, even things like STIs, even Passover of yeast as well can happen. So the body goes, okay, we're going to know, we know that this is when a woman is going to be having the most sex because this is when she's going to feel the most libido because testosterone is around at this time. We're going to think ahead and we're going to mobilize and upregulate the immune system, which can be a problem because when we upregulate the immune system, we're upregulating massed cells, which are a type of white blood cell, and they release histamines. So histamines intensify inflammation, they contribute to anxiety and affect neurotransmitter activity. They particularly serotonin and dopamine. So it can upregulate serotonin and dopamine a lot. So if you have PMDD and if you're super, super, super high, maybe even a little bit manic, when you're ovulating and then you feel a huge drop off, you might have a histamine sensitivity. So women with PMDD are often more sensitive to these hormonal changes and the heightened histamine release during the luteal phase can also exacerbate symptoms like irritability, anxiety, and mood swings. Progesterone, which rises after ovulation, normally acts to stabilize massed cells and reduce their histamine activity. However, women with PMDD, they have an imbalance with these two hormones and the neurotransmitter. transmitted as associated with them, right? So, progesterone deficiency or resistance can leave your histamine really unbalanced and unchecked. And generally, we see that a lot with women who have elevated and perhaps even estrogen dominance as well. So, elevated histamines can also impact physical symptoms like bloating, headaches and fatigue, which are really common in PMDD. So, this histamine sensitivity creates a vicious cycle of inflammation, mood instability, discomfort. So, taking histamine regulation into your area of interest if you have PMDD is going to be really, really great. I've heard of women taking anti-histamines around the time that they're having PMDD flares. And for some women, that's really, really effective. Also, just avoiding foods that are really high in histamines, which we will be talking about later in this episode as well. The end of itself is really effective. I also just wanted to say a piece about the genetic predisposition to having anxiety and depression. So, if your mother or father or anyone within either side of your genetic lineage has depression or anxiety, you are a little bit higher predisposed to have PMDD. And we do see a comorbidity between anxiety, depression, suicidal ideation and PMDD as well. So, that's there. So, if you have PMDD and someone in your family has had a history of mental health issues, then you have a higher incidence of developing and exhibiting symptoms of PMDD as well. We understand the predispositions fairly well. And I will say, I probably will make another PMDD episode in another five or 10 years because there is, it's a new area of research. We're finding out new things all of the time. The past five to 10 years for PMDD research have been amazing. So, hopefully, in five or 10 years, we'll have amazing findings. We might have a blood test, you know. But what are some things that you can do right now to test for PMDD? Because we understand it's not a pigeonhole situation. We understand it's very complex. And there are multiple different organ systems and vital systems that are at play with the symptomology of PMDD. So, what are some labs that you can do? So, first off, sex hormones. So, testing estrogen, progesterone, also testosterone, I think is really important in your luteal phase. So, luteal phase is going to last from nine to 18 days, right? So, they usually say test on day 21, but that's just for a 28-day cycle. And, you know, 15% of women have a 28-day cycle, but what about the other 75 to 85% of women who don't have a 28-day cycle? So, you want to be testing in the middle of your luteal phase. So, if you have a nine-day luteal phase, you're going to be testing on day four or five. If you have an 18-day luteal phase, you want to be checking on day eight or nine, right? No, 14, maths. We love maths. For me, my luteal phase is, you know, 14 or 15-day cycle. So, whenever I'm doing hormone labs, I know I need to check on day seven or eight personally for me. So, those are the ones I want you to test. You can also do something called a dutch test, which, you know, is all about peeing and spitting into little jars throughout the day. So, if you are able to time a dutch test at the right time in your luteal phase, and you have a day off or you feel comfortable, you know, going to the bathroom multiple times a day and collecting your wee at work, or maybe you can organize to work at home or a day off. I think that would be really great as well, which is a dutch test. It's far more accurate, I would say, but I always recommend a blood test to my patients and to my clients just because it's a lot easier just as long as we're doing it on the right day. Next one is thyroid panels. So, thyroid dysfunction is associated with mood symptoms like depression and anxiety. In addition, women with these conditions can also experience insomnia, irregular periods, fatigue, headaches, joint pain, brain fog, and more. So, again, is it PMDD or is a combination of different organ systems and vital systems that need support, right? So, what thyroid panel things can you look at? So, free T4, free T3. We wanna be looking at TSH, prolactin. We also wanna be looking at reverse T3 and TTPO, and we also wanna be looking at thyroid binding globulin, right? Working with a practitioner to make sure that they are all within normal ranges. Also, adrenal function. So, having a morning, ACTH and cortisol blood test can provide some really useful data in regards to ruling out disease. So, if you're looking into dysfunction and optimization, you'll want to do a four-point urinary and salivary test. So, if you're going for that sex hormone test, that Dutch test, you're gonna be, you know, spitting and peeing into little capsules throughout a day. But again, that four-point urinary and salivary cortisol and ACTH test is amazing for mapping out optimal adrenal function because, again, high cortisol is going to give you a stress reaction. And as we know, when we have cortisol around, it can be made from progesterone. And so, say you had a traumatic life event and your set point of cortisol is pretty high because you have unresolved trauma and your body and your body's really trying to keep you safe. So, it's turning all that progesterone into cortisol, which means you don't have enough GABA around, which means you have PMDD symptoms. You follow. So, I think it's really important for women with PMDD to go and get ACTH and cortisol checked out as well. And last but certainly not least is blood sugar. So, checking your blood sugar health is a really good idea for every single woman, regardless of if you have PMDD or not. So, a fasting insulin, HDA1C and fasting glucose can really help to determine your symptoms and if they're related to blood sugar. So, again, this can account for symptoms like fatigue, cravings, nausea, weight gain, in ability to concentrate, sleep disturbance, anger, irritability, mood swings and anxiety. So, is it PMDD or is it blood sugar regulation? Is it the chicken or the egg? We don't know. So, do those tests. Hopefully that'll give you some really great information on what's going on with your body. And again, work with the practitioner when you're doing these to make sure that you're adjusting things appropriately. Right after my labs, I usually go, okay, here are all of the holistic solutions for PMDD, but because PMDD is of recognized psychiatric disorder by the DSM-5, the FDA and a bunch of other health governing policy makers in the Western countries like the US and Australia have made guidelines and approved medications for PMDD. I have mixed feelings about using things like antidepressants and birth control pills for PMDD. Number one, because PMDD is not depression. As we've just spoken about, it's vastly different. And, you know, depression is its own thing. We could have a whole podcast on depression. I feel like I know a lot about it from my personal life and people in my life, unfortunately, having depression and helping them with that. I have clients who have depression, but it's a completely different thing. When I have a client who has depression or a client who has PMDD, it's completely different. You may as well be on a completely different planet. You know, the symptomology of them are very, very different just because there's overlap, doesn't necessarily mean that you can treat them. But what I will say is I don't feel like, I don't want to add any of the stigma associated with antidepressants. If you are on antidepressants, all the power to you, I think they're life-saving medication. I feel like they need to be used mindfully. I don't think it's safe to use over a long period of time and that's something that you need to figure out with your healthcare practitioner and your doctor. And if they just want to keep you on antidepressants for a long period of time with no game plan for swapping out a different medication or managing dosages because of long-term negative health outcomes, I feel like that's really concerning. But if it works for you, that's wonderful. And if you have PMDD and you're taking an SSRI, like surgery, that's wonderful if that works for you. But I have mixed feelings about them because PMDD is not a pressure. And the Food and Drug Administration FDA, they've approved SSRIs, three SSRIs to treat PMDD. And I've seen my clinic, women who are on SSRIs and they are completely ineffective. And I just, I think that's really, that's just where we're at with the research. Anyway, that's my piece that I wanted to say on SSRIs, if they work for you, that's wonderful. I have no stigma attached to them. But I just don't feel like, I feel like they're being overused in our medical system and I feel like they've been doled out to women. And then these women are taking SSRIs for a long period of time. They're not working and then they're going back to their doctors and they're being getting gas lit about their symptomology and how it's not working. So if you are on a serotonin reuptake inhibitor, SSRI, and it's not working, it's not in your head. That's just all they wanted to say about that. The other medication that is proposition to women with PMDD as a cure-all is birth control. And you know, nine times at a time, I've had women in my clinic say, I was put on birth control for my PMDD and it was completely uneffective and I'm not surprised because you know, birth control, although it might patent interrupt that HBA access, it doesn't fix anything. And if your issue is estrogen dominance and you're taking a synthetic estrogen as a part of your birth control and of course it's going to make things worse, or maybe it'll balance it out a little bit. Again, if you're taking hormone or birth control to manage your PMDD, please don't think any less of yourself. I don't want to add to the stigma. I don't want to add to any of that. But I just really believe in making sure women understand the risks of the medication that they're taking and the fact that we often see. But when women are taking birth control and synthetic hormones to deal with PMDD, it just doesn't help because what happens if their issue is blood sugar regulation problems we know that birth control can worsen insulin sensitivity, can increase blood glucose, which is going to worsen that. It can put more pressure on your liver if you're taking them internally. so an oral contraceptive. So I feel like the risks associated with hormone or birth control over a long period of time, so over six months of time, the benefits do not outweigh the risks. I feel like in a short period of time, if your PMDDs is insane, unmanageable, it's corrosive to your life, it's ruining your life, you cannot function. Yes, I really believe that birth control pills can be amazing medication, life-saving medication, but we need to have an exit plan. If we have a doctor or a healthcare practitioner that is absolutely comfortable keeping you on that medication for long periods of time with no exit plan or no change of medication in sight when things inevitably go pear-shaped, that's an issue, right, because we know that they're a long term negative health consequences associated with birth control. I do find it really concerning that we are just giving already-made medication to women that it's not designed for PMDD, just it might help some women, it might not help others, right, so we don't have medication specific for PMDD just yet. I feel like hopefully we will have some soon, I'm not against medication for PMDD because I just have seen in my clinic with my patients that it can be really corrosive to their life and sometimes we do need a band-aid on that situation, and if that is an SSRI or a birth control pill and that works for you, that's great, but unfortunately for a lot of women that just isn't the case and they aren't effective. The other pills that are recommended to women with PMDD are ibuprofen and aspirin, and also antihistamines, which I'm all for, especially in those times of the cycle where you have histamine intolerance problems, like in that ludio phase or even in your ovulatory phase as well. Now that we've got what the medical system can offer women with PMDD out of the way, let's focus on what are some solutions that you can do that are holistic, easy to implement, and relatively cheap, that you can start doing two-day that are going to positively influence the symptomology of your PMDD. So number one, eat your neurotransmitters. So L-tyrosine makes dopamine and L-triptophan makes serotonin, right? L-tyrosine and L-triptophan, they are amino acids. When we eat foods rich in these amino acids, or we can supplement in these amino acids themselves, it gives the body more ingredients to make the neurotransmitters. So say in your ludio phase, you are fatigued, you can't focus, you keep losing your keys, yeah, eat foods that are really rich in L-tyrosine and L-triptophan, turkey, chicken, eggs, mainly your legumes and protein-rich foods are going to have those amino acids because amino acids make protein. You can also supplement with GABA in of itself. If you have irritability, you can't sleep or insomnia in that ludio phase, you might not have enough GABA around, you might not have enough progesterone around, maybe it's converting into cortisol to readily, and so we don't have that progesterone to bind GABA. So we can take GABA as a supplement as well. So again, please under the guidance of a health care practitioner to make sure you're dosing everything properly, but mainly eating protein-rich foods and trying to get 90 to 120 grams of protein every single day is going to give your body ample amounts of these amino acids that are going to make those neurotransmitters. Okay, so any other protein to support the production of neurotransmitters, but as we're talking about before, where are our neurotransmitters made? Our neurotransmitters for the most part are made in the gut. You cannot have neurotransmitters being made successfully and productively and efficiently in the gut if you have microbiome dysbiosis. So microbiome dysbiosis is when you have pathogenic bacteria, yeast or fungi hanging around, so maybe an overgrowth of Candida Albacans. Maybe you have H. Pylori, which is a different type of bug that likes to drill into the side of our intestines and create an alkaline environment. I talk about that a lot in the iron podcast episode. I digress. If we have a microbiome that is dysbiotic, so we don't have a healthy diversity, we have inflammation, then our body is not going to be very good at making those neurotransmitters, which is going to worsen the symptomology of our PMDD. So what can you do? You can support the gut with probiotic rich foods like fermented foods. Kim Chi, you want to be going for your sour cry out, your water kefir, your coconut kefir, your coconut water kefir, we love kefir over here. Yogurt, you can also have things like sourdough, they're filled with pre-biotics, which are going to be the fibers that are probiotics used to eat and proliferate themselves, so eating enough fiber, getting at least 30 grams of fiber in every single day on my god. We are looking down the barrel of some really scary statistics around bowel cancer. Please don't listen to dickheads online telling you not to eat five arts. Oh my god. Anyway, I'm not going to go there. We need a healthy microbiome to make neurotransmitters, so eating fermented foods and having a good quality of probiotic, life-changing for PMDD, bifur bacterium and lactobacillus crispitis, we need those specific species of bacteria in large amounts, so we're talking to billions and trillions in our probiotic as well. So taking a probiotic, eating more fermented foods and eating lots more fiber is going to really help your gut. Third is blood sugar balance. Our mood is directly linked to blood sugar, so avoid snacks, avoid refined carbs and sugar and eat at regular intervals. It sounds so simple and it really really is. If you're eating at the same time every single day, the body knows when to release a hunger hormone known as grellen, and then the counter-hormone to that is when you feel satiated and full is lectin. The body is like a toddler needs to know when things are happening, so please eat a regular intervals in the day. Please eat breakfast. Oh my gosh, the overlap between women who have PMDD and women who do not eat breakfast is a circle. It's not a van diagram, it's just a circle. So eating breakfast is really, really important. Please don't try intermittent fasting or fasting to your cycle if you're PMDD, unless you are under the guidance of someone who really knows what they're talking about. So maybe fasting is not for you, eating it regular intervals. So if you're going to work at 8 o'clock in the morning, eat at 7 o'clock, if you're at home at around 6, please eat dinner at like 6.30 and make sure you're not eating too late. Don't snack in the day, it's going to spike your insulin in your blood glucose multiple times in the day, which is going to spike your stress levels as well. So we really need to make sure that the body is calm, it knows when to expect food, it knows when to release those hunger and satiation hormones, it knows when to boost insulin, it knows when it's getting what it needs. If we don't eat at regular intervals, the body immediately goes into this stress response, and that releases cortisol, which is going to eat up all of your progesterone, which is going to mean you have less gaba, which means you're going to be irritable and you're going to have fatigue and you're going to feel like you have insomnia and you might not be able to sleep. You see how these things kind of snowball and how the simplest things can be the most effective. Yeah, eating it regular intervals, don't eat super sugary foods, eat lots of fiber and protein of void snacks, you're going to be fine. Next up is liver support. So the liver does about 5 to 600 jobs in the body, incredible, such an incredible organ, and it's the only organ that can grow back, which I think really shows how important this organ is to our body. We need to eat lots of protein to support this because liver, it regulates our blood sugar and it regulates our hormones and it regulates the toxins in our body, it responds to environmental toxins. It does so many things in the body, the liver is so, so, so important. How it does this is by producing these little building blocks called enzymes and they do all of the work in the body, right? So they express the hormones in the body and they get rid of toxins. So the liver is really, really important especially if you have estrogen dominance, really, really important. So making sure you're eating enough protein is the most important thing that you could be doing because that's going to support the production of enzymes in the liver that are going to do all the work. So before we go for herbs like st. Mary's thistle, cacumen, burdock root, or even things like green tea, we want to be making sure the foundations of liver support are really downpats. So getting enough sleep, eating enough protein, eating enough fiber, hydrating, eating it regular times in the day. Those are so basic, those are free, those are really easy to implement and they are going to form the bedrock. 50% of the work is going to be done if you get those downpats because you're going to be supporting your liver and then we can stimulate the liver with st. Mary's thistle, cacumen, burdock root, and green tea. So these things are really beautiful to integrate. St. Mary's thistle and burdock root is so bitter. So most of the things that support your liver are going to be quite bitter and horrible to eat. So tinctures are really effective if you can stand it. A dry perp extract is also really effective. Also taking a supplement of cacumen, which is that active pigment in turmeric is going to be really effective at stimulating the liver to get rid of excess toxins, excess estrogen, which is going to make your P&D symptomology a lot better in the short term and the long term. Next door to the liver, we have the adrenals. The adrenals are an endocrine gland that sit on top of each of our kidneys and they release a whole host of hormones. The one that you hear about the most in the zeitgeist of holistic healing and health on Instagram is cortisol. So cortisol, we need it around to really great for energy, but what we generally find in P&D is that it's fairly dysregulated. So how can we regulate it? The free thing that you can do in the morning is as soon as you wake up and you're waking up at the same time every single day, right? Because your body likes to know what it's going to be. going to sleep and waking up. You know that, right? So as soon as you wake up, going outside in the first 10 minutes upon waking and getting sun in your eyes. So light is measured in lux LUX. And so 10 minutes of full sun in the eyes is around 10,000 lux and that takes about 10 minutes. As opposed to ambient light, I actually had a client who said, you know, my whole window or my whole bedroom is just windows. I was like, it's not the same as going outside like you have to go outside because if you're sitting inside and getting light from outside into your eyes, it's going to take about 30 minutes to get that same 10,000 lux, which you need in the morning to boost cortisol. So we have a lot of conversation online about cortisol and how we want to lower it. And I will admit I have added fuel to that fire because we do see pretty high cortisol for modern women. But with PMDD, what you need to keep in mind is that we need cortisol around. We need cortisol around for everyone. It's an amazing molecule of energy and modulation of the immune system, both of which we absolutely need to survive and thrive in the modern world. But we do see women in the modern ages that it's getting amped up too late in the day, which means it's going to negatively impact your sleep rest cycle. So in the morning, when we wake up in the morning, getting sun in your eyes, first thing in the morning is going to boost up your cortisol. And you want your cortisol to boost up first thing in the morning. And that's also kind of when you want to be doing your exercise and movement. So even going for a 30 minute walk outside in the morning with your cup of tea, maybe even if you meditate or do a breath work like myself in the morning, going outside and doing that and getting sun in your eyes first thing in the morning is such an amazing thing to do. Just to make sure that cortisol is at its highest point in the first part of the day, which means it's going to reach its lowest point when it needs to be at its lowest point when you're in your deepest part of sleep. That's around three or four o'clock in the morning. And we want it to dip, you know, to a kind of relative to low level just before you're going to sleep because otherwise it's going to keep you up. So it's such a simple thing that you can do. Another thing that you can do, if you have PMDD and you're having that 3 p.m. slump and you might be getting irritable and angry around this time or just fatigued, have a adrenal fatigue cocktail. So half a cup of coconut water, half a cup of coconut of orange juice, a little sweet teaspoon of salt, a little bit of cream of tartar, which is a byproduct of the wine industry, you can get it organic. Blend that up or shake that up and have that at three o'clock every single afternoon. The whole feed vitamin C is really going to help to modulate the immune response aspect of cortisol and then all of the electrolytes in the coconut water and the cream of tartar, which is really rich in potassium, is going to help your adrenals recover as well and your kidneys recover because they're doing a lot of work with PMDD, the pumping out a lot of cortisol, especially if you're one of those women who had PMDD appear after a traumatic life event, right? So that's some amazing really simple things that you can do to support your adrenal support and also make sure that your cortisol has been regulated at the right time in the day. We were just talking about that sleep wake cycle and we're just talking about cortisol, so let's talk about sleep support and insomnia because this is something that I see a lot of women with PMDD struggling with, right off the back, please go to sleep and wake up at the same time every single day. This simple thing is so cheap, it's free actually and it's easy, you know what I mean? It's going to take a little bit to integrate, it's not going to be perfect, you are going to be tired for a couple of days, maybe you won't have an amazing sleep, but you're already not sleeping properly anyway. So what is there to lose, right? If you have an irregular sleep wake cycle, it's going to put your body into a stress response because it's not regulated, right? A body likes to know when to release different hormones, it likes to know when to start turning serotonin into melatonin. So going to sleep and waking up at the same time every single day is really, really important. Don't doom scroll at night. If you have PMDD, you have like a 45 to 55% comorbidity with ADHD, right? So you're going to be searching for dopamine because you have a deficiency in that, right? What's going to give you that? Seven second reels on Instagram and TikTok. They're going to give you a huge boost of reward activity in the brain for finishing something. So we need to stop that because the blue light exposure is igniting that cortisol response, right? It's boosting up that cortisol. So you're dysregulating your cortisol, which means you're going to have bad sleep. So go to sleep, wake up at the same time every single day. If you have an irregular work schedule, either figure out a sleep wake cycle that meets you halfway in the middle of your recreational and time off and your work time. So I know a lot of women who work night shift and I have a few women in my clinic with PMDD who have night shifts and that's really, really hard to manage. If that's going to be a long term thing, then maybe find a different job that you're not working night shift because I feel like sleep is such an important aspect of the symptomology of PMDD. What are some things that you can take though? So magnesium glycinate, you can take 400 to 600 milligrams of that. You don't need to take it before you go to sleep. You can just take it in the morning. I feel like it's a little bit nicer for women to take magnesium glycinate in the morning because it generally activates more of that GABA and it also modulates your serotonin and dopamine. It also supports your thyroid hormones. It also supports your gut. It also supports inflammation. Magnesium glycinate, if you're going to take one supplement for PMDD, please take that. So 400 to 600 milligrams a day, it takes about two to three weeks for it to be effective. If you feel it straight away, then you've had a magnesium with deficiency for a long time. So eating foods that are really rich in magnesium like black beans and avocados is super, super helpful as well. You want to be aiming to get eight to nine hours of sleep a night. Women on average need far more sleep than men, so please aim for that. We spoke about it previously, but histamine. So avoiding foods like, and this is a huge list, stay with me, aged cheeses, fermented foods like sauerkraut, kimchi and miso. So if you have a histamine intolerance, going for those fermented foods is not going to be good for you. Opting for a probiotic is going to be a lot better. Cured meats like salami, pepperoni and prosciutto, smoked fish, shellfish, alcohol, especially wine and beer. Vinegar, pickles, soy sauce, tofu, citrus fruits, tomatoes, spinach, eggplant, avocados, bananas, strawberries, pineapples, dried fruits, specifically apricots, raisins and dates, chocolate, cacao, nuts, especially walnuts, cashews, peanuts. So if you avoid those in Ludiel, you're going to avoid any histamine overload. Before you avoid these foods, I feel like doing a stool test or doing some type of test that's going to check your histamine and mast cells, that's going to be really helpful. You can do an allergy test as well. I feel like that might be helpful as well. Or when you're having PMDDs and flare-ups, you can take an anti-histamine and see what that does. If an anti-histamine really helps, then you know you have histamine sensitivity. You know that your mast cells are producing and releasing too much of this histamine. You know that your immune system is overactive. We might also have estrogen dominance as well. So avoiding those foods when you're having flare-ups is going to be amazing. I know that's a really intense list. Hopefully you're not doing that for a long period of time. I really believe that we can manage histamines and you know going on low histamine diets for a short period of time can be really helpful, but they are restrictive. So I'm not a big fan of staying on them for a long period of time. So again, please work with the practitioner. Going off into a different tangent and kind of talking about the trauma aspect associated with PMDD, super important. So there are some ways that you can very gently dip into trauma recovery. So parasympathetic breathwork. So doing things like box breathing, you can do the extended exhale. So box breathing is breathing in two seconds, holding on an inhale two seconds, breathing out two seconds, holding the exhale two seconds. If you do that for five to ten minutes, repetitively, that's really going to stimulate something called the vagus nerve, which is a part of your central nervous system that's associated with your parasympathetic nervous system, which is your rest and digest, whereas your sympathetic arm of the nervous central nervous system is your stress response, which is more associated with things like cortisol. So you can put your body into a rested state because physiologically, you know, as you're going to sleep very often people sigh and they take deep breaths and like deep, deep belly breaths that kind of activate that parasympathetic nervous system. So if you're feeling stressed out, irritable, angry, doing the breath style that your body attunes with your parasympathetic nervous system will switch your parasympathetic nervous system from, you know, rage or anger or irritability. So that sympathetic nervous system into parasympathetic, which is calm and happy and content. So doing that type of breathwork is really, really great. I love doing breathwork, I do it every single day. So box breathing, the extended exhale. So breathing in for four seconds, breathing out for six to eight seconds, doing that is also very, very effective. Extended breath holds on the exhale, also really beautiful. You can also do things like ice plunging in follicular. They will boost your cortisol first thing in the morning. So if you have dysregulated cortisol and your sleep wake cycles all over the place, when you're in follicular, having a cold chair or cold bath in the morning is really, really effective. And I have had sleep problems in the past and that's really helped me to re-regulate my sleep wake cycle. You can only do it in follicular because otherwise it messes up your cycle. Soreners, so 15 minutes in a dry hot sauna, cold, 15 minutes in, cold. And see how many times you can do that. I usually do that four to five times in a session once a week and that really helps my central nervous system. Massages, so things like Kahuna massage. They're really great for the lymphatic system. Really be for calming down the system, so going for a relaxation massage. I remember when I first started getting massages, my brain wouldn't turn off and it was so frustrating and I hated myself at the end of it because it was like, oh my god, I just paid $220 to hate myself and not turn my brain off. But eventually you do get better. So massages I think are really beautiful. Just the power of touch I think is incredible. And therapy, oh my gosh, finding a good therapist, a psychologist, just is life-changing. If your PMDD is attached to a traumatic event and it isn't complex PTSD, so complex PTSD is lots of little T-traumas and maybe of a collection of big T-traumas as well. When we have non-complex like post traumatic stress disorder, we can use something called rapid eye movement therapy, also called EMDR. And so this is where a therapist is going to move their hands really rapidly in front of you, your fingers rapidly in front of you, they might also use the lights and other tools. And so going deep and deep and deep into the traumatic event and talking about all of the different emotions and layering of experiences that you had in that traumatic event, desensitises you to it and you feel separate from it. And it stops affecting your cortisol in the body and your stress. And so it can actually turn those genes that would turn off originally back off again, which I think is really fascinating. So talking to a therapist about the traumatic event that's happened in your life, that's activated this PMDD is going to be one of the best investments you can make. And last but certainly not least is exercise, run, lift weights, both of these things not only are going to up-regulate the production of serotonin in the gut, which is the precursor to melatonin, that's going to help you sleep later in the day, but it also increases microbiome diversity. So exercise, just like cold and hot therapy, is a good stressor. And so good stress is good for the body. It amplifies the microbiome diversity in the gut, which means we're going to be better at making all of these serotonin dopamine and gather as well. It's also going to really support your mood. So when we exercise, we're releasing stress. And we're almost telling our body that we've run away from the bear or the tiger and that we are kind of closing that stress cycle in a way. And I think it's just also amazing because if you have PMDD and maybe it's estrogen dominance, it's also going to help with reducing estrogen dominance. It's going to support your liver detoxification. It's going to move your lymph around the body. It's going to up-regulate muscle. It's also going to help with bone density. Exercise is something that you should be doing every single week. So you need to be exercising, doing some type of resistance training three to four times a week. And maybe putting in some cardio there as well. So maybe what you could do is wake up in the morning, getting that light in your eyes, having a 10 to 15 minute walk. So you're getting some cardio in. And then in the afternoon, you can go and do a hit class or you can go and lift weights or you can do some Pilates or yoga. Just as long as you're doing long holds in body weight positions that you're actually building muscle, I'm happy. If you wanted to go up from that, lifting weights is really, really great. I know it can be intimidating, but all of those big scary guys in the gym are just sweethearts anyway. And if you're scared about learning how to lift weights and doing it properly and not hurting yourself, hire a personal trainer or buy some weights and do it at home and watch some YouTube videos just to make sure your form is good. So you don't hurt yourself. All right, hopefully this episode on PMDD helped you a lot. I know this was very basic, but I just felt like all of the PMDD podcast that I listened to when I was researching either were talking about it to to vaguely in a way that I just couldn't really grasp what was actually going on with PMDD or you know, it was personal stories, which I think you're very affirming for women with PMDD or it was doctors just talking about the specific drugs and you know SSRIs and birth control methods that you can use. And then all of the literature as well, I've pulled in together to talk about this because I really believe that PMDD and its symptomology isn't just to be pigeoned hold, although I think that diagnostic can really help women and affirm them to know that they have something that is in it in itself an invisible disability. But I just don't believe that we should just pigeonhole women, give them an SSRI and birth control and just call it a day. That's not the solution. That might be a step in the right direction as we create some space to find holistic solutions, but that's not the end all and be all. And I'm really looking forward to more research coming out. The research on estrogen dominance in histamines has been fascinating in the past few years just that HVA access and how all of our vital systems are connected to our mental health and our reproductive health is also really fascinating as well. If you've liked this episode and you wanted to book in with me, you can book in with me through my website rquoman.com.au. Also look out for other amazing research around PMDD. I do have an article on my Patreon that talks about the possibility of using things like psilocybin microdosing and cannabis to look after women with PMDD and help them with the symptomology of their mental health during PMDD episodes like anxiety, suicidal ideation and depression. If you loved this episode, please subscribe and please like and comment and share. It really helps me and maintains the ability of me to be able to keep pushing out all of this free research and free information to women across the world. I hope you have a beautiful morning afternoon and evening wherever you are and I will see you next time.