Her Discussions by Dr Faye - Stop Letting Your Period Control Your Life | PMS & PMDD

Starting point is 00:00:00 If you have no idea why at certain points of the month you feel like you could burst into tears at any moment. And then at other points of the month, you feel absolutely fine. Then this video will not only help you understand exactly why that happens, but give you actionable tips to implement into your own life from today to manage those symptoms and stop them controlling your life. If the Lucille phase trend on TikTok has taught us anything, it's that too many women are just accepting the negative consequences of having a menstrual cycle, and letting them control their life.

Starting point is 00:00:32 And that might come in the form of brain fog, procrastination, low mood, or even ruining relationships because you end up saying something you wouldn't normally say when you just feel so much more on edge. But that ends today because by the end of the video, you'll be equipped to handle all these symptoms. And why should you listen to me? Well, my name's Faye. I am a doctor obsessed with women's health.

Starting point is 00:00:54 But not only that, I have ADHD. And women with ADHD are much more likely to. experience PMS and PMDD. And if you've never heard either of those acronyms before, then do not worry by the end of the video, you will be a pro. So without wasting too much time, let's get straight into it. What is PMS and PMDD? PMS stands for pre-menstrual syndrome and PMDD stands for pre-menstrual dysphoric disorder. There are lots of different studies on PMS and PMS likely affects about 50% of women who get a cycle. I say this varies because it completely depends on the culture and the context. So, for example, France seems to be the country with the lowest rates of PMS at just 12%. Whereas studies on

Starting point is 00:01:42 Iran show that the amount of women who experience PMS is about 98%. And it's all those symptoms that, as women, we're just taught to grin and bear. So low mood in the week or two weeks leading up to your cycle, bloating, tender breasts, changes to your bowel habits. Irritability. One of the most annoying symptoms for me personally is difficulty, sleeping, anxiety. And essentially, with PMS and PMDD, the biggest factor when it comes to diagnosing these conditions is the impact it has on your life. So if any of these symptoms are stopping you from living your everyday life, that should not be considered normal. It is not normal to have to put your life on pause. in the two weeks leading up to your period. And this is something that really bugs me about the

Starting point is 00:02:33 Lusiel phase trend on TikTok. I think it just perpetrates this idea even further that women should just grin and bear it. And there's no need for them to go seek medical help. It's just part and parcel of being a woman. And there are so many things that you can do to help with these symptoms. It doesn't need to just be taken as giving. So that's PMS. PMDD is often considered PMS's more severe sister and a lot of women with PMDD don't really like it being described as that because PMDD is a very, very, very serious condition. Some studies have shown that women with PMDD may be seven times more likely to end their own life by suicide than women without PMDD. And I don't think anything that increases your risk of suicide by that much should ever be swept under the

Starting point is 00:03:26 or taking as just part of being a woman. But PMDD is essentially the symptoms of PMS that have more of an impact on someone's life. So if you find at certain points of the month, you are having arguments with your partner that you are just inconsolable. Like nothing they say or do can resolve that argument because your nervous system is so on edge and you just cannot seem to resolve that. Or if at certain points of the month, you literally feel suicidal. That is more likely to be PMDD, but the most important thing is you go and see a doctor. This is not a diagnosis that I can give you over a podcast. But what I can do is make sure that you're aware of those symptoms and raise the alarm belt in your head that something is not right. And later in the episode, we will be coming on to how to approach a doctor's appointment if you

Starting point is 00:04:17 are worried that you've got PMS or PMDD because I think that is extremely important in this world of medical misogyny when often these symptoms are just dismissed. So when we think of the symptoms of PMS and PMDD, we can separate them out into three different categories. So psychological, physical and behavioural. So psychological symptoms like mood swings, irritability, low mood, anxiety, and feeling overwhelmed. What's really interesting is we have science to explain why these symptoms happen. And I have no idea why this science is not. more widely known because I for one know that if I understood the science of what was happening in my body when I was a teenager, I would not have blamed myself for all those days when I felt probably

Starting point is 00:05:05 too depressed to get out of bed and go to school or arguments I had with people that felt really out of character that when I was at a different phase in my cycle, I looked back on and held a lot of shame against myself for those things. The next set of symptoms are the physical symptoms. So breast tenderness, bloating, headaches, back pain, weight changes, acne or digestive issues and the actionable tips that we're going to come on to later. Some of them target the psychological symptoms and others will help target the physical symptoms. Finally, there are behavioural symptoms and my ADHD gurleys out there. This one is really for you because I know my brain fog in my lucile phase is debilitating. I feel like I cannot follow a single.

Starting point is 00:05:51 thread of thought often. So these symptoms are difficulty thinking clearly, even food cravings can be different in this phase. But what's really interesting is you can even be more accident prone. But before I come on to some actionable steps that are actually going to help you manage these symptoms, let's talk about my favorite thing in the entire world. Well, not really my favorite thing in the entire world because it causes me a lot of trouble every month. But the most interesting topic in my head. I find it so, so, so interesting. And that is what is happening in your brain and your body for women with PMS and PMDD in their Lusel phase. So you probably already know in your menstrual cycle, two really important hormones are estrogen and progesterone. And if you don't know

Starting point is 00:06:34 what the phases of the menstrual cycle are, let's do a really, really quick recap. Number one is the menstrual phase. So this is when you are bleeding. That's all I have to say on that one. The second phase is the follicular phase. This is just after. your period and before you have ovulated, this is when estrogen is climbing and you may feel more energized, more alert, like a better version of yourself. Then you ovulate, which is just where an egg is released, which is the third phase of the menstrual cycle, which brings us on to the luteal phase, which gets a really, really, really bad rep. This is when progesterone is rising and estrogen is lower than in the follicular phase. We have estrogen and progesterone and, and

Starting point is 00:07:17 And progesterone is broken down to a lot of things in the body. One of those things is called allopregnolone. And that is an important compound that I'm going to need you to try and remember for just a couple moments. Now I want to talk about another compound in the body, which you may not have ever even heard of. And it really shocks me that more people do not know about this chemical because it is so, so, so important for your body's ability to relax. And that is Gabba. So Gabba is your body's inbuilt chill switch. And essentially, when GABA binds onto GABA receptors, it literally changes the amount of electrical

Starting point is 00:07:54 activity that can happen within cells. And when less electrical activity can happen within cells, it literally relaxes your entire body. If you've ever had general anesthetic, so you've been put to sleep for a surgery, or you've ever taken a benzodiazepine, or even had a chamomal tea, you have taken substances that target the GABA receptor and have the aim of relaxing you. If that all seems a little bit complex, I want you to imagine your brain like a busy airport where GABA is like the air traffic controller. So when there are lots of planes circling, it's getting very, very, very busy. The air traffic controller is there saying, you have to wait your turn. You're not allowed to land right now. We've got enough going on. They are in control of making sure that there's not too much

Starting point is 00:08:44 going on essentially. Now we need to come back to alopregnolone, which is that product of progesterone, the important hormone in the lucile phase of your menstrual cycle. So alopregnolone binds to gabber receptors in the body. Now, what's really interesting about this is in theory that should have a calming effect on our body. But in women with PMS and PMDD, it doesn't have the effect that we expect. This is where the science gets a little bit complicated. It doesn't seem to matter how much progesterone or estrogen you have. What seems to matter in women with PMS and PMDD is the change in levels of progesterone and estrogen.

Starting point is 00:09:26 What scientists think happens is the GABA system, so like your airport, has gotten use to a certain amount of aloe pranolone. So like imagine that as planes. And suddenly there is a change in the number of planes and the GABA system cannot cope. So like a small local airport, not really knowing what to deal with the change in air traffic. So your body's inbuilt chill switch, it is not working properly. So that is why something might happen in work that on any other day would not make you react. In any sort of way,

Starting point is 00:10:05 you'd be able to handle it and get on with the task at hand. But that same thing can happen in your Lucille phase and you may need to go lock yourself in a toilet and cry or your partner might do something that doesn't annoy you the rest of the month but at that point of the month you are so much more annoyed by it and it's not just that they have become more annoying there is a physiological process going on that is preventing you from relaxing the same way that you would normally relax and it's not just the gabber system that is affected in women with PMS and PMDD. You may have also heard of serotonin aka the happy hormone. And that also might be a big factor for women who experience PMS and PMDD. What I find most interesting about the involvement of serotonin in PMS and PMDD is the response time when we treat women with

Starting point is 00:10:59 PMS and PMDD with SSRI antidepressants. SSRI antidepressants are selective serotonin re-uptake inhibitors, which basically means that they increase the amount of serotonin, the happy hormone that is available. And SSRIs are antidepressants that are commonly prescribed to women with mood-related symptoms for PMS and PMDD. So if you've ever heard of fluoxetine, search reline, these are all SSRI antidepressants. Now, when they're given in depression, they can take about two to six weeks to start working. When they are given in PMS and PMDD, they can take a couple of days to start working. So if there's anyone who has ever heard, oh, it must be that time of the month and had these low mood symptoms dismissed by someone, that difference in response shows us that there is a different process going on in our body between people who are depressed and people who have PMS and PMDD. That is not to say that depression is any less serious than PMS or PMDD.

Starting point is 00:12:07 it's to say that we have evidence that this is just something different entirely. It also gives us hope that there are things that we can do to mitigate the effects of this low mood. But I will come on to that a little bit later on. There's also some really incredible emerging evidence about the role of inflammation in PMS and PMDD. And whenever I see the word inflammation on social media, it does make me cringe a little bit because I think on social media at the moment it is being used as a blanket statement to just mean bad. And inflammation is a much more complex topic than social media would let us believe, like a lot of medical topics in general.

Starting point is 00:12:45 But we are seeing emerging evidence that there is increased levels of inflammation in women with PMS and PMDD. The last scientific topic that I want to cover when it comes to PMS and PMDD before I come on to the actionable steps is something that I think will really help you come to terms with maybe some experiences you might have had in your. your Lucille phase in the past and maybe some guilt that you might hold for them because I know that there's a lot of things that I've done that I still hold a lot of guilt for. And that is brain scans that have been done on women with PMS and PMDD. You may have heard of the prefrontal cortex. This is the area of the brain that is responsible for executive functioning. But I like to refer to it as the part of the brain that stops you from doing silly things. On brain scans of people with ADHD, they also have some changes in the area of the brain that stops them from doing silly things,

Starting point is 00:13:40 the prefrontal cortex, which is why people with ADHD are far more likely to be impulsive, to have addictive personalities, you know, just do things that maybe people who don't have ADHD may not do. In PMS and PMDD, there looks to be less activity in the area of the brain that stops us from doing silly things. So for me, on a personal level, I know that I should not be allowed access to my credit card for the last two weeks of my cycle, if I'm being completely honest. I notice a lot more impulsivity and a lot less forward thinking when it comes to making decisions that are sensible for future Faye. The other really interesting difference on brain scans is increased activity in the amygdala. Now, the amygdala is the emotional processing centre of the brain. So the part of the brain that is responsible for fear, and anxiety, which explains why during that last two weeks of your cycle, you may literally feel more anxious. So when people say it's all in your head, yes, arguably it is, but it is there on the brain scans in your head. And hopefully that legitimises those feelings that you might have been having for the last decade or so and had no idea why they happen. So finally, the community question, what are the best ways to manage PMS and PMDD?

Starting point is 00:14:59 So the first thing I will say to anyone, go and see your doctor. I love a herbal tea as much as the next girl. If you have PMDD and you are literally seven times more likely to kill yourself, that is not something that you should be managing with a supplement that someone is trying to sell you on the internet. And if I sound like I'm getting a little bit firm and stern with you, it is because I'm sick to death of seeing people on the internet try and flog vulnerable individuals' products. instead of encouraging them to seek medical help. And oh my God, I know that doctors can be so dismissive, especially when it comes to women. I have seen that firsthand myself. And I know whenever I speak to any of my friends

Starting point is 00:15:43 and they come to me with a medical problem and I tell them to go and see their doctor. And they say to me, what on earth is the point of fate? They're just going to turn me away. They're just going to not take me seriously. I know that that is a huge deterrent for people going to seek medical help. But I promise there are some good ones out there that will listen to you, will take you seriously and will offer you solutions that can actually help. So please just go and see your doctor. Ideally, go to your doctor with a symptom diary already. That can speed up the process a lot because likely what the doctor will do is ask you to complete a symptom diary, which does prolong the process. And then you've got a book in another appointment. And Lord knows, we all live busy lives and not everyone has time for that.

Starting point is 00:16:24 But if you can, keep a symptom diary, it doesn't need to be pens paper. This isn't the nine You can pop it down on the notes app on your phone. Just keep track of when your last menstrual cycle was, how long it was for. And then the symptoms you experience on a day-to-day basis. There are so many apps that let you do this. But the notes app on your phone is also perfectly fine. I know if you've got like Apple Health or an Apple Watch, you can literally export your menstrual cycle data as a PDF and just email that directly to your GP, which is super, super, super helpful. After you've kept a symptom, diary, the doctor will then take a thorough history and try and asserting whether it's PMS or PMDD and the severity because also it depends on how severe the symptoms are, what treatment is offered. One of the treatments the doctor might offer is SSRI antidepressants, which I've spoken about. There are other antidepressants they might also offer you, but another medication they might offer you, and please don't roll your eyes when I say this, is the combined contraceptive pill. I am a little bit passionate about this topic because the combined contraceptive pill gets a really, really, really bad reputation. And for good reason, in some ways, I personally have had bad experiences on the combined pill and a lot of other hormonal birth control. I know a lot of my friends have. But this is the instance where I really, really, really hate the birth control pill online. Because for some women, the birth control pill is a lifeline. If you've had a bad experience,

Starting point is 00:17:59 with the birth control pill. I know that can seem completely alien and really difficult to understand, but our bodies respond differently to hormones. Like the example I gave where alopregnolone should, in theory, cause a relaxation of the GABA system and it doesn't, is an example of the body not always behaving in a linear way. Or for example, benzodiazepines as a medication. In about 80% of people, these will have a relaxing, calming effect and then also bind to a GABA receptor, but in about 20% of people, it will have the completely opposite effect. It will make people more anxious. Our bodies are not the same. Our bodies will have different reactions to the same medication. And that's really important to keep in mind if you

Starting point is 00:18:45 are someone who has PMS or PMDD and the doctor suggests the combined contraceptive pill, and you've heard that your friends have had a bad reaction to that. Their experience is completely valid but I would just encourage you to keep an open mind because that might be what works for you and it might not and then you might go back to the doctor and say absolutely never again that was a whirlwind and I wish that we had better options than just giving women medications and seeing how they get on it's not fair to expect someone to just go away and check whether it makes them depressed or not it's not realistic we've all got things to be cracking on with with our life I personally know that I can't just take three months to check whether a birth control makes me depressed or not.

Starting point is 00:19:27 Like, that would put my life on pause. And I hate that we do not have a better option to give women, but that really is the best that we have. And obviously, if you're in a position where your cycles are completely limiting your life, it's worth staying open to the options that might help. But I haven't even said how the birth control pill works. So where we know the levels of hormones of people with PMS and PMDD don't really differ. It's their response to the change in these hormones. So by taking the combined birth control pill, you're essentially keeping those hormone levels steady.

Starting point is 00:20:02 So there isn't these big fluctuations, these ups and downs that can trigger these changes in mood. So that's the theory. Doesn't always work? I think it works for about 50% of women. And if it doesn't, that's fine. There's also no shame in going back to your doctor and saying that was absolutely not for me.

Starting point is 00:20:20 Those are the most common medical treatments available. but there are other options and new emerging treatments that I won't get into, but you can discuss with your doctor if the first two maybe don't work. There are also lifestyle changes that you can make. And the first one I know is not going to make you happy. And I promise I don't want to sound like a preachy doctor on the internet. And I'm sure you've heard it before, but reduce alcohol. There was this really interesting meta-analysis that was done in 2018 that looked at 19 different studies. So huge, huge numbers of participants and it suggested that we could potentially prevent one in 12 PMS cases in Europe, which is an area where there is a lot of drinking by reducing our alcohol

Starting point is 00:21:03 intake. Alcohol also affects our serotonin and GABA systems. So if you've ever experienced anxiety the day after a heavy night of drinking, you will have experienced the impact alcohol has on your GABA system, that anxious, overthinking, on edge sensation. That is similar. That is similar to what a lot of women experience in their lucile phase. So I'm sorry to say it, cutting down alcohol should be top of your list. Another important thing that I do not think enough women know is that during your lucile phase, you may actually burn an extra 300 calories. This may be why we end up having these extra cravings. And personally, I know that when I'm not eating enough, I do definitely get quite hungry. So during my lucile phase, I like to ideally add on maybe one to two

Starting point is 00:21:48 extra snacks in the day. Best if those snacks are complex carbohydrates because there's some weak evidence that complex carbs can contribute to the production of triptophan and triptophan is essential basically for serotonin production. The evidence isn't brilliant, but making sure that you are eating enough of good nutritious food is pretty solid advice for anything. In terms of supplements, we have really strong evidence for calcium supplementation and vitamin B6 supplementation.

Starting point is 00:22:20 However, with B6 supplementation, there is a very fine line that can tip you into having too much and that can have really serious consequences. So with any supplementation, it's really important to see whether you are deficient, first of all, and have that guided by a doctor because one of the biggest issues I see personally on social media is this idea that supplements are completely benign and harmless.

Starting point is 00:22:43 Supplements can do real damage when they are not used appropriately, and you don't want to be causing more issues for your health in an effort to prevent these health issues that you're dealing with. A final point on lifestyle is reducing stress. Now, how on earth do you reduce stress in this world that is constantly go, go, go? And it feels like stress is worn as a badge of honour. But I think with stress, it's really important to remember that a little bit of stress is good. A little bit of stress keeps us motivated. What I find helps me manage my stress is keeping stress. And, chill time segregated. So first thing in the morning, I kind of want to be a little bit stressed. I want to plough through my to do list. But when it comes to 5pm, I want to be able to shut my laptop,

Starting point is 00:23:27 switch off completely, turn on Netflix, have my Cammer Malti and set my body and my brain on this slow, relaxing trajectory towards my bedtime. So I can get into bed and I'm not thinking about all these different things that are happening in the day. And also, I don't expect my brain to just immediately switch off when I expect it to. Our brains are not an on and off switch. You need to give yourself time to relax to relax to relaxes to the stresses from the day, whether that is relaxing with your calm mal tea or getting your energy out with some exercise. And look, I know it can all sound very fluffy and woo-woo saying reduce your stress. If you are struggling with PMS or PMDD, if there's one step, I want you to take away that could motivate you to try and make a change with your stress. It's

Starting point is 00:24:16 92% of studies reviewed found stress is a predictor of PMS or PMDD, which is pretty striking as a percentage. Thank you so, so much for listening. If you did want to learn more about cortisol and your nervous system regulation, then you can find those videos on my YouTube. If you want me to upload those videos onto Spotify as well, just let me know in the comments. Thank you so, so much for listening.

Her Discussions by Dr Faye - Stop Letting Your Period Control Your Life | PMS & PMDD

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