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Episode 224:
Show Notes
Understanding PMDD
- PMDD is a severe form of premenstrual syndrome that can significantly impair daily functioning and relationships.
- Symptoms include mood changes, anxiety, depression, intrusive thoughts, sleep disturbances, cravings, and physical symptoms like bloating, typically occurring one to two weeks before a woman’s period.
Hormonal Changes
- Women experience significant hormonal fluctuations throughout the menstrual cycle, starting from ovulation.
- The cycle involves an increase in estrogen and testosterone, followed by a decrease leading up to menstruation, contributing to mood changes and other symptoms.
Recognition and Diagnosis
- Many women may not recognise the connection between their symptoms and their menstrual cycle.
- There is a lack of awareness and education about PMDD in the medical community; it was only classified as a disorder in 2013.
Impact on Life
- PMDD can severely affect a woman’s ability to work, attend school, and maintain relationships.
- Symptoms range from mild irritability to severe mood swings and suicidal thoughts.
Interconnection with Other Disorders
- PMDD overlaps with conditions such as bulimia nervosa, binge eating disorder, and ADHD.
- Some women experience PMDD symptoms for the first time after pregnancy or during perimenopause.
Support and Understanding
- Understanding PMDD helps women and their families navigate the emotional and relational challenges that accompany it.
- Shared experiences, especially among mothers and daughters, can provide valuable support.
Reproductive Depressions
- "Reproductive depressions," a term coined by Prof. Jayashree Kulkarni, encompass mood disturbances linked to hormonal changes during life stages such as PMDD, perinatal depression, and perimenopause.
- Hormonal fluctuations, including those from contraceptives, can trigger significant mood disturbances at various points in the menstrual cycle.
Hormonal Influences
- Differences in how hormones are processed in the body and the sensitivity of hormone receptors contribute to severe symptoms, even if hormonal levels aren’t significantly different.
- Katharina Dalton’s research highlights the interactions between noradrenaline, insulin, and progesterone in understanding PMDD.
Treatment Options
- Body-identical progesterone can be ineffective due to dosage issues, and its high cost, particularly in Australia, limits accessibility.
- Hormone Replacement Therapy (HRT), with estradiol and progesterone, has shown significant improvement in PMDD symptoms and is supported by guidelines from the Royal College of Obstetricians and Gynaecologists in the UK.
Misdiagnosis and Treatment Challenges
- PMDD is often misdiagnosed as borderline personality disorder or bipolar disorder, leading to inappropriate treatments that can worsen symptoms.
- Heavy-duty psychiatric medications pose risks, including metabolic disease and hormonal suppression, underscoring the need for better awareness and treatment.
Awareness and Education
- There’s a significant gap in PMDD awareness and treatment among healthcare providers, including GPs and psychiatrists.
- Tracking menstrual cycles can empower women to better understand their health, identify symptom patterns, and make informed treatment decisions.
Normalising Conversations about Menstruation
- It is essential to normalise discussions about menstruation to remove stigma and shame.
- Education about menstrual health should extend to the men in women’s lives to foster understanding and support during menstrual cycles.
Key Takeaways
- Tracking Menstrual Cycles: Women should actively track their menstrual cycles to correlate mood changes with symptoms and aid in treatment decisions.
- Importance of Education: Education on PMDD and hormonal health is crucial for healthcare providers and the public to improve diagnosis and treatment.
- Consideration of HRT: HRT should be considered a viable treatment for younger women with PMDD to relieve severe symptoms.
- Recognising Stigma: Combat the stigma around menstruation and PMS-related mood disturbances to create a supportive environment for women.
Downloadable checklist:
Previous episode 209:
Dr Ceri Cashell
- https://www.instagram.com/drcericashell/
- https://www.healthyhormones.au/
Episode 224:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:23) Hello, lovelies. We are super excited to be bringing you this series in Menopause, where we're interviewing guests on their expert subjects regarding perimenopause, menopause, and beyond. As always, any information in this podcast is just considered general advice and we would urge you to seek medical attention if you have any concerns about your health. If you're interested in exploring the symptoms of menopause or perimenopause, we have a checklist that you can download at our website, www.rlmedicine.com/checklist or as always, you can click the link in the show notes. Thanks, lovelies, enjoy this series!
Dr Lucy Burns (00:58) Good morning gorgeous ones. How are you today? Dr Lucy here. And I am with our return guest. We've got a return guest performance from one of our most favourite podcast episodes, Dr Ceri Cashell is back and I'm super excited to talk to her again, about more things hormones but in particular around a condition that affects lots of women called PMDD. We're going to be going into a deep dive into it. Lots of you may be familiar with the phrase PMS or PMT, but this is really important. Breaking it down into a lot, I guess the symptoms. And we're going to talk about symptoms. We're going to talk about what to do about it. If you've got it, how do we treat it? All of those good, juicy details. Gorgeous ones, I am excited to welcome Ceri back to the podcast. Ceri, good morning, gorgeous one. How are you?
Dr Ceri Cashell (01:45) I'm good. Thank you very much for having me back, Lucy. I'm glad I didn't scare you off the first time.
Dr Lucy Burns (01:50) Not at all. Not at all. Super downloaded episode and anybody who wants to go back and listen to it, it's called, How Do We Know If We're Going Through Menopause? So you can flick back to one of our previous episodes and have a look at that. Uh, not a look, a listen, really. Let's get your senses right, Lucy. Okie dokie. So let's just set the scene. So again, PMDD, I'll get you to explain what it is for us, Ceri, and just help our listeners, I guess, understand if they could have it or if they've had it and why it's important, what we need to know about it?
Dr Ceri Cashell (02:25) Yeah. So PMDD was something I didn't know very much about at all five years ago, and I have learned a lot about it over the last couple of years due to my journey to perimenopause and menopause. And it comes back to this thing about how important our hormones are in our brain and in our body. From the moment that women start to ovulate, or girls start to ovulate, and usually in their teenage years, they'll start to experience a menstrual cycle. Which isn't just about periods, it's about so much more. So in that menstrual cycle, and we talk about day one being the first day of your period, you have your hormones starting to change. And through the first half of the cycle, the estrogen or the estradiol starts to increase and it peaks in sort of the middle of your cycle, just in terms of trying to get your ovary to squish out an egg and out at fires. And there's probably a testosterone surge just before that as well, probably to help you to go out and go and find somebody to make beautiful children with just a little libido burst, a little libido burst to make sure that egg goes somewhere that you want it to, or you probably don't want it to for most of our reproductive lives. We're trying not to get pregnant. So yeah, so you've got day one is the first day of the period and then in the middle of the cycle, you get an estrogen and testosterone surge. And just as the egg then comes out, and that's usually around about day 14, women ovulate on different days, but usually somewhere between day 12 and day 16, and then 14 days after that ovulation, women then have another period if they haven't got pregnant. So if we talk about a cycle sort of, just being a 28-day cycle. When you're sort of not pregnant, then what happens is the progesterone, which is sort of built up to try and make the womb all nice and ready for a little embryo to come in and slot into its nice, cozy, warm lining. If that doesn't appear, then the womb needs to get rid of that lining. So it starts to shed. But what's happening hormonally is that both the estradiol, the estrogen and the progesterone are also starting to fall and they fall in that week before the next period. So this is the week before your period. So they're falling in the womb and that's what causes the period, but they are falling everywhere else in your body. So that is why I don't think there's any woman who hasn't experienced some kind of symptom before their period. Most of us are pretty amazing at forgetting how it happens every month. I know like there would be a day, I would have always had a day, and I don't have severe, never had severe PMS, but I would have had a day where I, you know, probably wanted to get divorced or, you know, throw a child across the room and maybe the lights went out just weren't as bright that day. So, and that's, and that's me. I'm a pretty reasonably happy, healthy person. I've no history of trauma. I live, I've got a good husband. I've got nice kids. I've, you know, I've got a pretty happy life. So I would still get that sort of experience, but one day a month never occurred to me each time it was happening that this might mean my period was about to come. So where are we, but I don't know what's the word forgetful or unaware of why we get these changes.
Dr Lucy Burns (05:49) I think, do you know what I think is also sometimes we're just disconnected from ourselves. We're busy living these busy, busy lives, doing all this busy, busy stuff. And yeah, we're completely disconnected from where we are in our mind and our body. And so again, sometimes bringing back that, just listening, listening to your signals, listening to all of your things can be super helpful.
Dr Ceri Cashell (06:11) Absolutely. And I love, and I think that's something that our, you know, our young generation is doing really, really well is they are tracking their periods. They're watching their mood. We've got some wonderful people on Instagram who are sort of showing how your body shape changes through your menstrual cycle, you know, and that your fluid levels are different and your ability to exercise is different. And, you know, with people like Stacy Sims, who really has done a lot of research and education about how to sort of exercise around the female physiology so you get the best return, but for the average woman, who's not a professional athlete. Just having an understanding that because of the potent effects that these hormones have in your brain, in that week or sometimes even two weeks before your period, some women will experience really significant mood changes. So there's this whole spectrum from the people that just like me, maybe just want to get divorced. Maybe I'm not quite on the mild end, you know, but most people get a wee bit grumpy with women and girls who actually can't function properly to the extreme end where there is a small group of women and girls who get a monthly psychotic episode. So Prof. Jayashree Kulkarni at the Herr Center talks to that and they have had women younger sort of girls and they're actually in their teens who have been admitted, you know, sort of around the age, starting at the age of 14, where their first presentation of a severe premenstrual syndrome has been a psychosis, which must be absolutely terrifying. And because in medicine, I don't think we're very good at taking a menstrual history, except to check that you're not pregnant. Whereas interestingly, when I was at a conference organised by the Heart Center, an Indian-trained doctor said, but surely you always ask, you know, what symptoms are like according to somebody's cycle. And I was no, we never do that. All we care about is, are you pregnant? She goes, no, really? She says, in psychiatry in India, we always ask about the menstrual cycle. And that really blew me away. You know, and it certainly shifted any arrogance I had about my training. So, these women, so there's a group of women and an estimate suggests it's actually up to about 20% of women and girls of reproductive age suffer this disease severe form of premenstrual syndrome, which is called PMDD, which stands for Premenstrual Dysphoric Disorder. It only entered sort of the classification terms. You know, we have a manual that decides whether psychological conditions are severe really deserves a place in the book, which is crazy in itself. So it only got in there in 2013. So it's only been there for 11 years. So it didn't exist when I was at medical school or when I was a GP trainee. And that's the excuse I'm giving. But actually, to be fair, I wouldn't have been taught about it anyway. You're menopause. We've always known about that. And we weren't taught about that. So yes, so it's got, again, so in this manual for psychiatric disease, it's got a whole list of different criteria and I think rather than going through that, because that would be borne as dishwater, is it essentially means that you've got symptoms in the premenstrual period that stop you being able to live life normally. So impair your ability to work, impair your ability to go to school, impair your ability to have healthy relationships with your friends and your family and your partner. And that's often the thing that women really, really struggle with. So symptoms can be anything because of where these hormones work. So again, like perimenopause and menopause, you can get real shifts in your mood. You can become really anxious. you can become really depressed. You can have quite marked intrusive thoughts and some of those thoughts can be about self-harm or even about suicide, which is really obviously distressing for people and also puts them at really increased risk of self-harm and of suicide. It's one of the conditions that has a really high risk of suicide. So that's the sort of mental health stuff. It can really affect your sleep. Some women, you know, cannot stop sleeping and other women can't sleep at all. It can affect things like cravings. So we see women often who want to, who will binge eat, and there's a huge crossover between PMDD and bulimia nervosa and also binge eating disorders. So this real increase in cravings and whether that's a self-soothing thing, I suspect again, it's the interaction of the change of the hormones in the brain and your dopamine reward system. So women often do get into a binge eating pattern and then obviously because their mood's low then they have that overwhelming guilt. So there's, yeah, I think with any of the women that have a binge eating disorder we should be screening them for PMDD. Some women get very aggressive and get very angry so they have a very, you know, can really create a lot of volatility in their personal relationships, which obviously makes it difficult in a partner relationship, but also can make a family life really difficult. You know, when you're trying to deal with, you know, small children or even worse teenagers, and teenage females probably live in an ever spanning world ever present state of PMDD anyway, but you know, so it's, it's can be really, really difficult in those situations. So PMDD is basically in that one to two weeks before your period you have mood symptoms and physical symptoms, which might be bloating, constipation, diarrhea, and just struggling to function. So yeah, so that's kind of basically what it is.
Dr Lucy Burns (11:39) No, and then it all settles once you get your period.
Dr Ceri Cashell (11:43) Yeah, and then suddenly your period comes and usually a day or two, not always the first day, but sometimes it is the first day, then you feel back to normal and then you're like, Oh, fine again. But you know, again, just even like me with my mild PMS, women don't often recognise why they've had this cycling and why they felt awful and now they feel good. And a lot of them live in real fear of the next of that happening again. And because they've had a week or two of being really difficult to live with, often relationships then you know, whether you're as a teenager, you're, you know, the rest of the people in the house don't recover from that. So you can see that there's a real hangover. Even if you yourself start to feel normal, the people around you can remember what you were like last week, even if you can't remember yourself. And you can see how it can almost be pervading the whole cycle because of the effect it's had on the people around you.
Dr Lucy Burns (12:36) Absolutely. I think it's hard too, because I know people will describe that they, they know they're irritable. They know they're cranky. They know they're being unreasonable, but they can't stop it.
Dr Ceri Cashell (12:46) Yes, absolutely. They just, and it's really horrible. Like they feel so guilty, especially the mums that have it and it's something that often does, it may not be there from your teenage years. Some women it is there from the day they got their first period. And it literally their life changed with, you know, their arrival of menstruation, which is horrific, but for others, it may only appear after pregnancy. And I don't know whether there's just some kind of brain shift or it can, it certainly does often appear in the perimenopause, whereas you might've only had PMS. It's sort of a manageable premenstrual syndrome, but in perimenopause, it really becomes this period in your cycle where you can't function. And we don't, know why, we don't know why women get PMDD. It's certainly got a bit of crossover with neurodiversity. So there's an increased incidence of PMDD and women who have ADD, there's certainly an inherited tendency in the women. I often have mothers and daughters in the room and the mum is there with shocking perimenopause, menopausal depression, anxiety, and the daughter's there with PMDD. And that's lovely because you know, they really understand each other. I'm going, you're experiencing the same thing. It's okay. They're like, it's not okay. We're both awful. But it's well, it's obviously very difficult. It's nice to have that shared experience experience and understanding so you know, you know where it's coming from.
Dr Lucy Burns (14:12) Yeah, absolutely. And it's interesting because you mentioned ADHD and binge eating disorder because there's also a big crossover there and yeah, just throw some menstrual changes in it. I think PMDD and perimenopause together, that's like the whole gamut just on steroids, isn't it?
Dr Ceri Cashell (14:32) Yeah. So we call these reproductive depressions. And this is a term coined by Prof Jayashree Kulkarni, who is just honestly, like the guru of women's mental health. And we're just so lucky to have her in Australia. So that would include everything from your premenstrual dysphoric disorder to women who get really quite significant mood disturbance. This is on the contraceptive and certain contraceptions like the contraceptive pill or even the Mirena. And I have to admit, I would have always been quite dismissive of those women and would say, well, I'm sure it's not that, and now understanding how the pill works, of course, it was that. And then often have a history of perinatal depression and then go into quite a difficult perimenopause. So you can see it's, it's just really the same thing happening at different points in the life cycle or the different points in the menstrual cycle. All right. And we think it's sensitive. We don't know why. So there's definitely a genetic. So what is happening in the brain that these women do experience such significant symptoms? So it's not so much that a woman has different hormone levels than another woman. It seems to be potentially ratios of how you're hormones get broken down, but also possibly how the hormone receptors in your brain and your body react to those changing hormone levels. There has been a lot of focus on the progesterone component of it and a fabulous doctor who did a lot of research from the 1950s in the UK called Katharina Dalton, who wrote her book, the PMS Bible, is It's fascinating and was written back in the 80s and she talks about the interaction of noradrenaline and insulin and progesterone and it's written for the ordinary person. It's not a medical book and what she knew back then is incredible and she was, she recognised these girls. She treated these girls, she did observational studies and boarding school. She went into prisons and saw that there was this real high incidence of PMDD and the female prison population because women are more likely to commit a crime in that phase and more likely to get convicted of drunk driving. You know, there's all of these, you know, it's like the knowledge has been there, but somebody forgot to tell us about it. So, yeah, she was working away on the theory that you could cure PMDD just with progesterone, and certainly, it has a big role, unfortunately in Australia, the body-identical progesterone is extremely expensive and women with PMDD often don't respond to a standard dose. There's progesterone has a funny effect on the body where low doses can kind of overstimulate the brain and actually you need to go to higher doses to calm it down. But given a month's supply of normal progesterone, just one a day is 40 in Australia, you know, and a lot of these women probably need up to four a day, you know, so that's 160 a month. And compare that to a box of diazepam or Valium, which is 15 bucks, you can guess, which is on the PBS. You know, this is the craziness of our health system, you know, that we would, we would subsidise a drug that causes addiction and ruins lives as opposed to a drug that is natural, non-addictive and simultaneously improves health as well as symptoms. It’s crazy.
Dr Lucy Burns (17:52) But, you know, it's interesting because I think that, you know, I didn't know that Promethrin could treat PMDD like it's not something I knew. So I'm imagining the majority of GPs don't know this, probably the majority of psychiatrists, majority of people don't know this. So therefore if they don't even know it, then we can't even give women the option of using it. And people spend money on medications. There are people out there spending, you know, 500 bucks a month on Monjaro and 300 a month on Ozempic. If this was even an option for them, and I guess, you know, and again, yes, it should absolutely be subsidised on the PBS. But if we just even offered it to them, people don't even know.
Dr Ceri Cashell (18:44) Yeah, so, and progesterone I would say is just, is part of the picture and some of those women hate progesterone, I think because of this dose issue and we can't get them up to affordable doses or the doses they need aren't affordable, but it just, estradiol also interestingly seems to really work and I think that was the bit of work that was missing from last century. So I would treat a lot of my PMDD patients with just bog standard HRT and like you cannot believe these girls come in a month later and the suicidal thinking and the binge eating has gone with some estrogen gel and some progesterone and these are, so some people would be like, that's horrific. You're giving HRT to women in their twenties. Oh my goodness. That's horrific. But it's a lower dose than the contraceptive pill, and it's identical to their own hormones. So the options that we have for PMDD, and interestingly, HRT is on the guideline from the Royal College of Obst and Gynae in the UK. So I'm not going completely off script and practicing crazy medicine. So on the Royal College guideline, which has done a wonderful summary for PMDD, their first line is lifestyle. So looking at cognitive behavioural therapy, vitamin B6, the second line is interestingly using cyclical antidepressants. And then the third line would be to trial HRT, and I have moved HRT above the antidepressants for so many reasons that I'm sure lots of people can understand, and it does seem to work really well. And sometimes I use both, you know, so it's because antidepressants work differently or seem to work differently in women with PMDD in that they can take them for two weeks and stop them again, which doesn't work in women with other types of anxiety and depression, suggesting that it does something with the brain receptor. It's really fascinating, but I tend to go in earlier with the HRT, but you can use the contraceptive pill. And the one that seems to be the best is one called Zoeli, which has got natural estrogen in it. So that's probably why it's more effective. But certainly can be a bit of sort of chopping and changing and then you're looking at the age of the woman or girl and what are our contraception requirements at the same time and trying to take, and they often have endometriosis, you know, that's re and they could have PCOS. You know, a lot of these hormonal issues run, you know, in a team together, which is lovely for the poor woman suffering it. Yes. So you're kind of juggling a few variables often.
Dr Lucy Burns (21:16) Yeah, absolutely. So I mean, again, I think, I was presenting at a conference recently, which was run by the Australasian Metabolic Health Society, and it was teaching GPs about metabolic health. One of the presenters there was Dr Deepa Mahandra, who is also from Sydney, and she basically said, like you just did, we need to be adding the menstrual cycle in as our basic patient OBS. You know, you take your heart rate, you take your blood pressure, no one, you know, You might take the temperature. No one ever asks about the periods where, you know, what are your cycles like? Where are they? What are they happening? What do you know? Nothing. We're just, it's irrelevant. And I think that's probably come back to a lot of our training originally, which was where all of the research was all based on, you know, 70-kilo white males. And now we realise that actually that's a very small part of the world who are 70-kilo white males. What about everyone else? What about all the different ethnicities? What about all, you know, obviously different sexes, different ages, different weights, different everything and yet everything seems to be back to the 70-kilo white male.
Dr Ceri Cashell (22:33) Yeah, I know. It's just I like sort of when you sort of deep dive into the sort of gender inequity and health research. Again, your mind just blows, you know, that women weren't even included in clinical trials until 1994. Even worse than that only in 2016 were female animals included in preclinical research, and without becoming too boring, it basically means that most drugs when they were trialled in animals weren't trialled in female animals until the last eight years. And even now it's still possible to say that's too difficult, I'm probably just going to use it in men, so I don't really need to use female animals as well. And that applies to nearly every drug that I actually prescribed me. Most drugs that we prescribe are quite old drugs. And it had been around for 20 years. So they were all, none of them had good pre, you know, looking at real, like, so we can kind of see the effect that has been, it's not that they've not ever been tried in women, but we don't really know in terms of looking at a cellular level. Cause you can't chop up human volunteers and trials like you can the per wee rats and mice that are used in experiments. So we missed out on a lot of data. The drugs that have however been trialled extensively in women are hormones. So you know, we do have a lot of safety data on hormones in women. And that's the thing that I find most reassuring about using that as a treatment for this really common condition and women and girls are so grateful like they come back in and they just go. I feel normal all the time. And if you get them when they're 20, as opposed to when they're 35 or 40, you've saved them 15 or 20 years of really struggling to manage their relationships or their work or their study or their family, you know, so you've really saved them and you've saved them all of that heartbreak and potential harm as well as, you know, just making them live, you know, like allowing them to have a really happy life, but they often get misdiagnosed. So a lot of these women and girls get diagnosed as borderline personality disorder or a bipolar two disorder. And then they're treated with quite heavy duty drugs, not just antidepressants, but sort of moving into the antipsychotic family, which not only does it increase their metabolic risk of disease, risk of metabolic disease. It also turns off a lot of their sex hormones. So you almost put these women into menopause on top of their PMDD in their twenties. So, and that's probably why the metabolic disease risk goes up, but you know, we really coming in with these sledgehammers, which is just, you know, crazy.
Dr Lucy Burns (25:16) Yeah, absolutely. Yeah. So it's so interesting, isn't it? So I think You know, takeaways then for people listening and again, you know, you, if you're a woman, if you're a mother, if you're a wife, if you're a sister, if you're a daughter, think about your menstrual cycle and actually sort of take note of it. So you're right. There are lots of apps these days that we can then tune in to. The thing I think for women, women are so robust and so stoic that we will do things like, Oh my God, I had such a bad week. Oh, well, that's gone now. And it's a bit like childbirth. You forget the pain of it once it's gone. And then it comes around again and you can go this, you haven't necessarily tied it into where you are in your, in your cycle or where you are in your reproductive phase of life. And so if we can get a little more clued in, then that can be really helpful then in making treatment decisions.
Dr Ceri Cashell (26:12) Absolutely. I think the time for sucking it up is over. Yeah. I would encourage women to, I think all women and girls should track their sort of their health data, you know, from their teenage years. And, you know, we've got, there's the Flow app for women who think they might have PMDD. There's an app called Me, M E V as in versus. Me v PMDD, which has wonderful information on it. We've got a new app that's coming out called Ovum, which has been created by a junior doctor in Australia, O V U M, and it's going to be phenomenal because it's got AI built into it. There are other apps called Matilda and Charlie as well. So we've got some excellent apps out there that really will, I think, empower women to understand their own health and be able to be partners in, you know, consultations with doctors as opposed to going in and feeling that you're just being told what to do.
Dr Lucy Burns (27:25) Yeah, absolutely. And I just think again, having that idea, you know, because you're, you know, one of our favourite sayings at real-life medicine is you're the boss of you. You are the boss of you. The more knowledge you have about yourself, then the more decisions you can make. If you recognise that every three days before your cycle, you turn into Jekyll or Hyde or whoever it is, you know, you can decide then how would you like to manage this. You know, do I just need to sort of plan for it? In which case that's fine. You can do that. Do I need to know that during those days, I'm going to be much more vulnerable to, you know, highly processed food and I don't want to eat that? So therefore I'd be aware of it. Do I need to go? Well, during those days, I'm usually irritable and cranky. I won't book back-to-back medical appointments. So I won't overburden my schedule that on those few days like you get to decide then how you want to live your life and plan for it rather than just feeling like you're this wildflower in the wind and you get no choice and you just have to come what may.
Dr Ceri Cashell (28:12) Absolutely. I think that's wonderful advice. I think just understanding who you are and planning your life around it and being absolutely the boss of you sounds very sensible.
Dr Lucy Burns (28:23) Excellent. All right lovely listeners, so that's it for PMDD. You've got hopefully some understanding now that yes, it is a real thing. Yes. You're not going crazy. Yes. This is hormonal. Yes, there are treatment options. So the first thing, is track, track, track, track, track your period, track your cycle, track whatever. Even if you're, say, the mother of a teenage girl and you're noticing that you know, there's a lot of tumultuous behaviour, which I may or may not have experienced, been on the end of then, you know, again, we can, you know, talk about it.
Like, I think that one of the things that is so destructive is this idea that you use women's periods as a weapon where people go, Oh my God, she's on a period. Oh my God, are you about to get your period? And it becomes this thing that is then people go, they feel embarrassed or ashamed or, you know, when really it's just normal.
Dr Ceri Cashell (29:24) Absolutely. It needs normalised. I think we have to really be very careful as we educate our sons and our husbands and, you know, the men in our lives. you know, that it's not to be weaponised. It's, you know, this is a time that women need that wee bit more care and understanding. And, you know, that it is, you know, it's not a time to say it's just your period because, you know, there is always the risk that you may get injured.
Dr Lucy Burns (29:52) Oh, I love that. And for those of you listening at home, Ceri had the most deadpan face I've ever seen. But yes, absolutely. All right. Lovely ones. That's it for this episode of the Real Health and Weight Loss podcast. All of those links, including the apps will be in the show notes. So you can head over and have a look. And again, if you want to connect with Ceri Cashel, you can go to Instagram and look her up. Ceri is spelled C E R I and Cashel, just C A S H E L L like cash shell, exactly how it sounds. All right gorgeous ones, have a beautiful, beautiful week and I will talk to you all next week. Bye for now.
Dr Lucy Burns (30:34) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
