The Dr Louise Newson Podcast - 216 - All about progesterone: PMS, PMDD, postnatal depression and menopause

Episode Date: August 8, 2023

Progesterone is a hormone produced after ovulation and dominates the second half of your menstrual cycle. It balances the effects of oestrogen, supports the body during pregnancy and is known as the relaxing hormone. But how can progesterone impact your mental health in the run up to periods, after childbirth and during the perimenopause and menopause? Joining Dr Louise this week is Newson Health GP and Menopause Specialist Dr Hannah Ward, whose interest in the menopause and HRT was ignited following her own hormonal struggles after the birth of her children. Here, Dr Hannah shares her personal experiences of progesterone treatment, and takes us through the key differences between body identical progesterone and synthetic progestogens.  

Hello, I'm Dr Louise Newsom. I'm a GP and menopause specialist and I'm also the founder of the Newsome Health Menopause and Wellbeing Centre here in Stratford-Pon-Avon. I'm also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments and often share moving and and always inspirational personal stories. This podcast is brought to you by the News and Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on the podcast, we're going to talk about a hormone that we haven't spoken about much before, actually.

Although it is a really important hormone, we're going to talk about progesterone, but also talk about other hormones and the importance of not just hormones when we're perimenopausal or menopausal, but in younger people as well, so women who've had PMS, PMDD. And I've got with me, one of the doctors who works with me, Hannah Ward, who I've known for a few years now, and is one of the key doctors who works with me in Houston Health. So thanks, Hannah, for coming today to the podcast. Thanks for having me. So I love connections, some of you might know, and the more I find out about people, the more I realize there are connections. And Hannah, you'd been working for us for a few months, really. And then you said, you know, my husband,

don't you? That's right. And your surname Ward is quite a common surname, so I hadn't had the connection. But after I came back from New Zealand, I did a cancer job down in Southampton. It was quite a hard job. And one of the doctors who I got on very well with, who made the job far more enjoyable than it would have been otherwise, was a doctor called Dr. Mike Ward. And he actually is your husband, isn't he? That's right. I'd lost connection with him and you'd been working for a while and then join the dots. And really lovely because he's now a geriatrician. So he didn't pursue a career in oncology and I didn't pursue a career in oncology, but we both help people in different ways. So you've had a, we've all had our own journey, haven't we? And someone was saying to me the other day, one of the ways that people work harder and enjoy their jobs more, whether it's in medicine or any aspect, is if they've had an experience.

And if you've had an experience, it makes you see the world differently. It makes you think differently. And I think if we had met each other when I met your husband many years ago, I wouldn't have been able to have this conversation with you today. And I don't think you would either, would you? Because it was all pre-children. We were in our mid-20s. Having fun. Having fun. Yes. And then things happen, don't they? And certainly many of you all know when I was perimenopausal, it wasn't much fun. And I really struggled to work out what was going on. But your story was actually far worse and you were far younger when your hormones started to play, haven't they? That's absolutely right, Louise. And I think a lot of people in

healthcare do develop a particular interest after they've had their own personal experience. They may have suffered an illness or condition where the recognised treatment just hasn't worked for them. And so they've gone on to do their own homework and their own research and reading to find an alternative. And really, that's what happened to me. And for most people, that might be a lifestyle change or nutritional option, but for me, it was hormones. So what happened to me is, obviously, I'm a GP and I've been a GP for 20 years. But when I was doing my training, 20 years ago, I was pregnant with my first daughter and I was 30. And I remember feeling really very well during pregnancy, and I was really calm and everything was fantastic, even though I was sitting membership exams,

there was lots going on. But I didn't really appreciate how well I felt at the time. And it was something I became aware of in hindsight. So I had my daughter and we had a delight. And we had a delightful first three months while I was breastfeeding. And I really wondered what all the fuss was about because all my friends were struggling with sleep and fatigue and breastfeeding issues. And that wasn't really my experience at all. However, it all began to change in the fourth month. And I became intensely anxious and irritable. I couldn't sleep at all. I had lots of physical symptoms like headaches and muscle aches and dizziness. And I was really tearful a lot of the time. And it became really all-consuming. And I think my daughter must have picked up on these

changes in me because she became fractious and irritable too and she couldn't sleep. But I didn't really realise these were symptoms of postnatal depression because I just thought that was something that you had in the first six weeks after having a baby and no one had really taught me about it. Even though I hasten to add I did spend some time on a mother and baby unit as part of my psychiatry training. It was mostly women with postnatal psychosis though. So I just put everything down to work and going back to work but I did realise how well I felt when I was. I was pregnant and so I was keen to conceive again. So within 12 months of what was in hindsight postnatal depression, I was pregnant again and feeling really well. The same pattern seemed to emerge.

Three months of bliss and then in the fourth month, all of those awful symptoms seemed to come back. And at that point, I did realise that this was probably my hormones, but I didn't really know what to do about it. So I struggled on for the next two years. I was one of three children and I was keen to have another. And I think actually my husband wanted as many as possible because he had connected how well I was during and soon after pregnancy. So in between number two and three, I blame my mood on my job and I move practice. But the day I left, the senior partner said that I had never been happy since I'd returned from maternity leave and he was absolutely right, but I hadn't really realised what was going on. So then I became pregnant for the third time and felt great. And that wellness feeling

was just so much more pronounced because I'd felt so unwell between each of the children. And during that pregnancy, I decided to enroll on a part-time master's degree course in rheumatology at the local university. And this does come into the story later on, okay,

partly as I'd felt so worthless and hopeless for the last few years, and I'd lost all my self-esteem and professional confidence. And the course was due to commence about four months after my third daughter was born. So I thought, I'm done, should I pay the fees as I worried what might happen if I should go downhill again.

But at the time the bill came in, everything was going really well. And I convinced myself that, you know, this wasn't going to be a problem. I was exercising well. I was eating well. We had a nanny. So I really thought, you know, this time it's all going to be okay. And I paid up. But the time the course started three weeks later, everything had deteriorated dramatically.

And this time, it was much, much worse. So I felt I couldn't cope. I had three children under the age of five. I was going back to work. I was doing a master's degree. So I went along to my GP and in typical fashion reeled off all the physical symptoms rather than the psychological ones, the aches and pains, the headaches, the dizziness, the fatigue. And I was convinced I had Addisons or hypothyroidism or muscle disorder. But of course, all the blood test came back normal. So she asked me if I wanted to take some chemicals by which she meant an antidepressant. we didn't mention the words postnatal depression, but we both knew that's what this was. And initially, I did decline the antidepressant but went back a week later after we'd been off to Cornwall on holiday.

I just couldn't function and I was so anxious I had to sort of hide under a town in the journey down there in the car and there's no way I would have been able to drive. So I went back and I started of what was the standard treatment for postnatal depression at the time. It was an SSRI antidepressant certuline. And as a GP, I knew it might take a couple of weeks to work, but I didn't expect to feel 10 times worse. My agitation and irritability were now off to scale and my sleep was non-existent. I did what I always did in times of trouble, and that was escape and seek refuge to stay with my parents. But this involved driving around the M25, and I was so panicked I had to be collected by my father from the hard shoulder. So I managed three weeks on the searcherlene and didn't see any improvement.

In fact, I was worse than when I had begun. So I stopped it and started on my journey to find what else might work instead. I read the leaflet by the Association of Postnatal Illness about Postnatal Depression and how you should avoid the pill due to the synthetic progestogen component. And number one on the reading list of their leaflet was depression after childbirth by Catherine Dalton. And this led me on to her work and of the use of high-dose progesterone impressories for the treatment of postnatal depression. and premenstrual syndrome. And I will admit, I was a little bit naughty. You're not supposed as a doctor

to treat yourself or your family, but I was so deplet, I wrote myself a prescription for psych to jest. And I remember it well, it was Mother's Day, so it was a Sunday. So I had to wait till the next day, till the pharmacy was open. And that's when I made what was to be my miraculous discovery. I felt I had nothing to lose, so I started the progesterone pessories on the Monday night, and the next day I woke up having slept well and I felt completely back to normal and I just couldn't believe it. I was absolutely stunned. Well, that's amazing, isn't it? It was. It was overnight, literally. And so I did go and see my GP who was amazing and we both sort of looked a little bit sheepish, as we looked in the BNF and neither of us had any appreciation previously that this was a treatment

for P&D because it had gone out of fashion and she agreed to carry on with the Pesseries twice a day. And from that point, I became absolutely fascinated by progesterone. And that's, you know, the body identical progesterone, which is often confused with the synthetic progestogens. So the hormone of pregnancy, but also the hormone that's produced after ovulation. And in fact, I went on to do my master's dissertation about progesterone and bone health. Very interesting because, I mean, I remember years ago, actually, listening to Nick Panay, who's now the president of the International Manipal Society, talking about Yuchogestan.

never heard of utergestone before and I googled it while he was lecturing and it's micronized progesterone which is obviously natural progesterone and in cyclogest and luteogestepheses, it's just progesterone isn't it? The very natural form. That's right. Whereas I, for many years, decades have prescribed the progesterone only pill it's called but it's not got progesterone in it's got synthetic progestodin. I've prescribed and actually taken myself the combined oral contraceptipa which has a synthetic progestidin in. and they're all different, aren't they, these synthetic progestogens? So some have more side effects in some people than others,

but they're chemically altered, so they don't fit the receptor really well, do they? And it was really interesting because when you started to talk about Catherine Dalton, it was a similar time that one of my, someone I went to school with actually contacted me and just emailed through the clinic to say, oh, Louise, you might not remember me, we went to school together, and I'd just like to say how inspirational your work is.

I'm following you. And do you remember Dr. Dalton coming to talk to us at the school when we were about 12, 13, and you sat there, absolutely all inspired and said, this is why I want to be a doctor. Look at the people she's helping. And I hadn't remembered her name. So I went off and Googled and literally the week after you said, have you read Katrina's books? And I said, no, but that name.

And so another connection, which again, I really enjoyed. But actually, if any of you look at her Wikipedia or read, she actually, actually died quite frustrated, I think, because, well, you can say the story about her, Hannah. Like you, Louise, she was trying to raise awareness about hormones and depression in not just women, but also families, because everyone's affected by these conditions. And she did absolutely masses of work. If you've read her papers and her books, she did lots of research. But equally, she didn't want to put women through placebo-controlled, randomized trial, because it meant 50% of them would not get the adequate treatment.

And also in those days, you know, evidence-based medicine wasn't so much of a big deal. So she did lots of observational studies. As you know, she went into prisons and looked at the timing in the cycle when women were more likely to be convicted of crimes, more likely to make suicide attempts. She went into girls' boarding schools and looked at school performance and behaviour issues. So she's done absolutely lots of work. And then sadly, you know, all of that work seems to have evaporated into thin air. And my view is that possibly it's because SSRIs were developed in the 1990s.

And we know that, you know, these drugs can be very effective for some of these conditions. But they don't work for everybody, do they? No, and I think the problem is also sometimes in medicine, and often I've done it, when we're really busy, you learn from your peers, you learn from other people, you just, and you forget the basics. and I think having worked part-time for many years, I've had the luxury of being able to think and reflect, which you don't always get, do you? Especially in full-time general practice, you're just going through.

And so sometimes, especially if medicine doesn't work, it's a really good time, rather than layering up something else, thinking what's going on, what's the underlying cause? And, you know, her books and her work is so obvious, but it's almost too obvious. So we're even looking at some of her articles that were actually published in the BMJ, weren't they, saying that people more likely to go to pre-MJ, prison and the time before their period, more likely to commit a crime then, more likely to

commit suicide. And obviously, what happens before our periods with our hormones, Hannah? Well, they all fall away. So progesterone falls away for that week before your period. Eastern drops away. And so this is really what should be given back to top of those hormones. But unfortunately, the current guidelines for the treatment of those conditions have been, you know, extensively evaluated to, but they don't even. include progesterone and I really can't understand that and I think one of the reasons is that people who take the synthetic progestergens can be very sensitive they can give similar side effects and so they're always told that they're progesterone sensitive when actually they're

progesterone sensitive and maybe they actually would do better with more body identical progesterone yes and one of the things you were talking about using it as a suppository so that's either vaginally or rectally it then just gets absorbed as the pure progesterone doesn't it, whereas even progesterone that we take orally still has to be digested and metabolised and get broken down into other substances too, doesn't it? Yeah, and so you get a very, very small dose when you take it orally, whereas when you take it vaginally or rectally, you might get 10 times as much. And a lot of Catherine's Dalton's work focused on the fact that you need much, much higher doses of progesterone because it's measured

in nanograms rather than peak grams. And so to get that level up, you might need a thousand milligrams a day and quite often in menopause we give 100 milligrams a day. So it's, you know, the dose is important, but also she talked about the receptors are really important that your receptors are working well. And these progesterine receptors of which there are loads in the brain and the limbic system can be kind of blocked if you're stressed, if you've got adrenaline in your system, if you're not eating regularly, because if you don't eat regularly, your blood sugar drops and then you'll go to spurt of vaginolin. So there are lots of other factors as well as just progesterone.

And I think it's so complicated that maybe people miss the opportunity to look at it like that. And I have no doubt other things help as well. Yeah, for sure. And it is complicated. But when you break it down, it's actually, it's all very simplistic. It's almost going back to the basics. And I always, or I don't always, but I often think about in the 70s. And I suppose I think about that time because my father was alive.

We were more of a happy family unit. but things were simpler then. Our food was simpler, our food choices. We had less, we didn't have mobile phones, we didn't have all that technology, we had less stress as well. So things were easier. And a lot of people are saying,

well, why are you talking about the menopause now? It's been around for ages and no one's talked about it. Well, of course, people were misdiagnosed. You know, look at the, in the Victorian times, women locked up in asylums. Well, even now they're still sectioned. But there was less mental health issues, maybe, because we exercised probably more.

we had more fresh air, we ate differently, and maybe we had less hormonal effects because we weren't having these big sugar spikes and everything. But she writes so clearly about the role of diet, which again is very forward thinking because, you know, I'm sure it's the same for you at medical school. I was really not so much about diet. And reading her book about diet and the effect with stress hormones, like you say, that's really avant-garde, really way ahead of her time. And what I also thought was very interesting is when she started to prescribe progesterone to some patients. She got hauled in front of the GMC, didn't she, to say, what are you doing? Why are you prescribing such high doses and inappropriate compared to other

doctors in the practice? And it's sort of a bit of pattern recognition, really, because some of you might be aware there's still some pushback about dosing of HRT for what we do often and we do try and bespoke the doses and some people need higher doses than others. And there's still this pushback and it was interesting that, you know, 40, well, 50 years ago, she was getting pushback, wasn't she? She was and she had to go to a tribunal to justify the doses that she was prescribing, but she had lots of evidence. She collected data avidly to provide the evidence that she needed to justify that position. Yes, and that must be very scary. I think what happens now, I feel very scared with what's happening to me and people trying to silence me,

but, you know, there's a lot more female doctors now. In her day, they were very few female doctors. And it's easier for us to collect the evidence because we do it all online so we can look at audit data and we can constantly analyze what we're doing, which of course we do in the clinic. Whereas when it's all paper records and she was quite on her own, you know, I'm very supported, you know, obviously you work with me, but we've got lots of clinicians that work together and we all see the effect. And, you know, there is something different about prescribing body-identical hormones to prescribing chemicals, like you say. But there is still a pushback.

And in fact, just over a week ago, the British Medical Association did a webinar about hormones. And I was listening to it. And twice they referred to HRT as poison. And I was just really, what is people so worried about? Why are we so scared about hormones? And, you know, you've already said the role of progesterone in our brains, in our limb, system so important and a lot of time in medicine, especially with psychiatric disorders,

there's no biochemical test we can do to test for depression or psychosis or schizophrenia or manic depression or PMS or PMDD hormone blood tests are not useful either, are they? So often in medicine we do what's called a therapeutic trial is a test of a medicine to see whether it helps or not. And so you had a therapeutic trial of your SSRI and clearly it didn't work and you say made worse. So then you tried something that actually was treating the underlying cause by giving yourself a higher dose of hormones. But isn't it a shame?

And I don't quite not understand why. And I don't know if you do. Why there's so much stigma about hormones as opposed to other medication? I really don't know either, Louise, because actually all the reading that have done since I became fascinated with progesterone and estrogen shows how safe it is, how good it is for our bones or cardiovascular. vascular system and that, you know, it's, I think, again, the confusion between the synthetic hormone-like drugs that are found in the pill and the mini-pill that may be where the confusion

lies. But I admit, before I went through this experience, I remember, you know, dealing with menopoles or women in my training year and being a little bit scared of HRT, to be honest. And there was this big list of about 20 options and I really didn't know what to choose. But now, absolutely, you would choose the body identical. and if it was estrogen transdermal and if it was progesterane, the body identical progesterone again, and testosterone too. Yes, and what's really interesting, the more patients that I see, and we see in the clinic, the more we learn that everyone is different.

So there are still some women who don't tolerate progesterone very well. And whether it's because, like you say, the dose is too low and it needs changing or it needs changing from oral to rectal or vaginal, it definitely has a difference. there's some people who don't tolerate estrogen very well. And sometimes people even who've had a hysterectomy and don't need the progesterone to protect the lining of their womb, there are some women that find, and I've got some patients who really miss not being on progesterone. They've been on it before. They've had their womb removed with hysterectomy and then being told, well, you don't need progesterone because you haven't got the lining of the womb to protect, quite right. And then they've found that they can't sleep. They feel more anxious. then we've gone through everything else. There's no other obvious triggers. So I said, well, would you like to try the progesterone back? Oh, yes, please, if that's okay. Of course it's just a hormone. And then within days often, they feel better again. And it is all about balancing on for the individual, what suits one woman doesn't always suit another and finding the right combination of

hormones is key, isn't it? Yeah, absolutely. And, you know, often it can take a little while to have an effect as well. I know with you, there was obviously a quick effect, but some patients it can take, I always say try three months before you train, unless obviously you're feeling really awful, then you wouldn't want people to carry on feeling awful. But sometimes it can take a little while, can't it, for the body to adapt. And I think especially with PMS and PMDD, like you say, a lot of people have more stress and I'm sure the stress is related to the way that they feel it's this cycle. And then most people, or a lot of people who've, when they're low in estrogen and progesterone have sugar cravings as well. So they often don't eat very well. And we've all done it,

I'm sure. I'm not the only person that's comfort ate when you feel rubbish. You think, oh, I really don't care. I'm going to eat some rubbish. And the only thing that stops me doing now is it would trigger migraines. But most people can still have those times. And like you say, that's going to affect progesterone receptors, probably other receptors as well. So it's looking in a really holistic way. But sometimes in the guidelines and PMS, it talks a lot about diet. But to do, just diet on your own without thinking about hormones is only really half treating someone often, isn't it? And it's very hard, as you say, when you don't feel well to make those dietary changes. And I will say that although I had a miraculous recovery with progesterone, as you know, Louise,

four or five months later, when I stopped breastfeeding, my periods came back, it all came back with vengeance and certainly turned into a cyclical problem. And I did go on to Eastern as well. So I think if your brain is very sensitive to hormone changes, it's probably going to be sensitive to all of them. and again getting the balance right is so important. And Dr. Dalton did show that some women, you know, only by sticking to her three-hourly starch diet, which is really small, regular snacks. So you divide up your daily diet into small meals every three hours so the blood sugar doesn't drop.

That can actually be all that's required to improve symptoms of premenstrual syndrome and post-natal depression. So it's amazing that with diet alone, even before starting progesterone, that might be enough to help some women. It's incredible, isn't it? And I do think, and I worry a lot about postnatal depression because we know it's one of the commonest causes of mortality in young women is suicide from postnatal depression. And trying to engage people to think about hormones is really important because it's safe. It might have an effect. The doses might have to be higher. But we desperately need research in this area, don't we? Because otherwise we're never going to move forward. We're always going to be. hypothesising or worrying about hormones, but actually, you know, I worry about the women who are suffering and, you know, we started to see women, haven't we, with PMS and PMDD in the clinic, and it can be very transformational. And, you know, helping perimenopause and the menopause

of women, we know is transformational. But helping younger women is even more rewarding, isn't it? Because they've got so much more. It is because we're picking them up on a journey. They've got longer to live like this. And we know that they're all going to struggle when they get to peri-men. metaport. So if you can pick them up early and give them help and advice, it's definitely really useful. Yeah, so some of the things really for those listening to pick up thinking could I have or could my someone I know or also as a family member, I picked up PMS at one of my children because we were in lockdown and I realised beginning of every month, she became very flat and monosobalic and wasn't really engaging in the family in the way that she normally does. And I said, oh,

there's a bit of a pattern here. But so looking at a pattern is really important, isn't it? A lot of are relieved when their period comes or they'd feel worse just before their period. Or if women have been pregnant, often when people say to me, I felt amazing when I was pregnant, you sort of think I bet their brain is more responsive to hormones, don't you find? And Dr. Dalton did some work showing that the postnatal blues of which 80% of women experience, often they did research looking at progesterone level through saliva, that women whose progesterone levels were highest at the end of pregnancy often suffered most with the postnatal blues. So there is plenty of evidence. It is quite old, but it's there. It's a shame that we can't sort of bring all this

back and get the psychiatrists involved with knowing about hormones and mood changes at different times of women's reproductive lives. Well, I think we will. We're quite determined. Some of you might know we recently did an educational day in Stratford-Pon-Avon, and in fact, you spoke about your story in more detail. And we had a psychiatrist from Oxford talking, didn't we, Sophie, who was amazing actually, talking at the holistic approach. And then we had Rekka Lewis also talking about the role of hormones in mental health. And so trying to align people together is really important because once you see it and experience and listen to women and allow women to have the choice of trying their hormones. And some people need hormones as well as psychiatric medication. That's absolutely

fine and there is some evidence that psychiatric medication, especially SSRIs, work better when people have hormones on board as well, don't they? They do, but I'm not going to try, Louise. No, no. And that's where it's so important though, isn't it, to be in control to allow patients have a choice. And I know you wrote actually your story to try and get it published because in the British Medical Journal, you can have your own story really, can't your personal journey? Because like we said, right at the start, you often learn from your own experience and you want to share it with others actually because that's often, you know, every day I learn through my patients. Absolutely. Obviously, I learn academically from reading papers, but you're putting it into practice with

patients and you wrote up your story as a case and it wasn't accepted, was it, its publication? No, it wasn't, no. But it's on balance instead now. So yes. Yes. So it is on the balance website. But it is just a reflection that doctors are not that interested in. hormones, sadly. But we've got to change it because hormones are so important. And for women, but also for men, so for everybody, hormones are really important. So I hope talking today has just made people think a little bit more about progesterone. And I thank you publicly, Hannah, for enlightening me more about progesterone, because I know you've gone on quite a lot about it to the extent that I haven't been able to ignore you. And actually, the more I read,

And you did say that I would be addicted to Dr. Dawson's work. And I am actually not just her books, but some of the papers. And having been at an all-girls boarding school where our periods seem to go in sync after a few weeks, have been back after summer holidays and seeing mood changes throughout the school at certain times. You know, she was right. She wasn't making this up because she was learning all the time. So we need to reactivate some of this and get it back onto the agenda. so more people think in a bigger way.

So before we finished, Hannah, you know I'm going to ask for three take-home tips. So what three things do you think are the most important when considering PMS and PMDD? Well, I was first going to say that progesterone is not just for endometrial protection, which we just mentioned. It has other really important roles in the body. It has been shown in studies to be helpful in traumatic brain injury and recovery from stroke. it is part of the bone remodeling cycle, so it helps bone osteoblasts build new bone. And it's also very safe on the breast tissue.

So, you know, progesterone has effects all over the body like estrogen, testosterone. And I think in terms of postnatal depression, if you've had postnatal depression, or you think you might have, because actually I had it twice without realizing it, and many women don't realize that they're feeling unwell, that this is what it is, because it's an atypical type of depression, then I think it is. important to realize that you may well experience similar symptoms in the perimenopause and that you should seek out help and advice and consider HRT relatively early on really. And I think if you currently have postnatal depression or PMS and it's not responding to the treatments that you've

been advised to use, which would probably be an antidepressant, then perhaps it is worth seeking out a healthcare provider who might consider discussing the use of body identical hormones either progesterone alone or estrogen and progesterone to treat you currently. And can I be cheeky and add a fourth one, Louise? Yeah, go on then. It's really an extension of the third and something that you've mentioned before, and we've talked about before, but we talk about HRT hormone replacement therapy. In some countries, it's MHT menopausal hormone therapy.

But actually, really, there are many conditions in younger women that respond to hormones and it should just be hormone therapy. and I think they get a war deal because they're not menopausal and so they're told that they can't have hormone replacement therapy. Yeah, I think just hormone treatment. Yeah. Because therapy sounds even more, doesn't it? Because, you know, it's such a shame because it is just hormones.

And certainly, like we've said before, there's no harm trying. Absolutely not. But once you've got the knowledge and there are the books that are harder actually now because I think so many of us have bought through Amazon by Katrina Dalton, But there is information on the website. And actually, even in my book, Hannah's written, and we've written about PMS and PMDD. So I hope that's been helpful.

And thanks again for your time today, Hannah. It's much appreciated. Thank you for invite to me, Louise. You can find out more about Newsome Health Group by visiting www.newsonhealth.com. And you can download the free balance app on the App Store or Google Play.