HompesMethodPrac00onerTrainingLevelII

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Lesson Forty Eight – PMS, PCOS, Menopause

PMS:premenstrualsyndrome

•  Ara4ofsymptomsassociatedwithlutealphaseimbalances:–  Lowprogesterone(mostly)

•  Estrogendominance•  Possiblythesuddendropinhormonesbeforeperiod

•  En=relutealphase,orjustafewdays•  Verycommon–  Believedtobe“normal”orworse,“allinyourhead”

PMS:premenstrualsyndrome

“Upto80%womenreporthavingsomesymptomspriortomenstruaYon.

ThesesymptomsqualifyasPMSin20to30%ofpre-menopausalwomen.”

hAps://en.wikipedia.org/wiki/Premenstrual_syndrome

hAp://www.mygynae.co.uk/tag/pre-menstrual-syndrome/

PMS:premenstrualsyndrome

•  Estrogentoohigh?–  Food–  Bloodsugarimbalances–  Highinsulin–  Alcohol(aromatase)–  Estrogenictoxins–  Cosme=cs?–  Pes=cides?–  Thepill,injec=on,patch

–  NOTE:estrogenmaybetoolowinfollicularphaseandnottriggerovula=on,thusleadingtolowprogesterone(highinsulincancausethis).

•  Progesteronetoolow?–  Food–  Nutrientdeficiencies–  Bloodsugarimbalances–  Circadianrhythm–  Emo=onalstress–  Inflamma=on(GI,liver)–  LowT3–  Anythingthats=mulatesthe

HPAaxis•  Eachmoleculeofcor=solis

madefromamoleculeofprogesterone

PMDDpremenstrualdysphoricdisorder

“Premenstrualdysphoricdisorder(PMDD)isasevereanddisablingformofpremenstrualsyndromeaffecYng3–8%ofmenstrua0ngwomen.[3]Thedisorderconsists

ofa"clusterofaffecYve,behavioralandsomaYcsymptoms"thatrecurmonthlyduringthelutealphase

ofthemenstrualcycle.[3]”

hAps://en.wikipedia.org/wiki/Premenstrual_dysphoric_disorder

KeyPMSsymptoms

•  Moodchanges:– Alteredsexhormonelevels– Possibleinterac=onsofthesehormoneswithneurotransmiAers•  Progesteronecalms–an=-anxiety•  Estrogen–an=-depression•  Testosterone–pro-irritable/aggression

KeyPMSsymptoms

•  Fibrocys=cbreasts:– Tissuethatfeelslumpyorrope-likeintexture– Tenderness,nippledischarge– Usuallylutealphase•  Generallyrelatedtouncheckedestrogen,i.e.notenoughprogesterone•  Possibleiodinedeficiency,whichincreases=ssuesensi=vitytoestrogen

KeyPMSsymptoms

•  Bloa=ng/weightgain:– Uncheckedestrogencauseswaterreten=on(i.e.elevatedestrogen,orlowprogesterone)•  Maybeworsewhenaldosteroneisalsoimbalanced(highaldosteroneduetostressreduceswaterexcre=on)

KeyPMSsymptoms

•  Menstrualcramps:– Uterineliningtearsawaybecausethehormonebalanceisnotop=maltoenablesmoothshedding(especiallyprogesterone)

KeyPMSsymptoms

•  Cyclicalheadaches/migraines:–  Couldbeasuddendropinestrogenand/orprogesteroneattheonsetofperiod

–  Couldbenormalprostaglandinreleaseatonsetofperiod•  Possibleroleforomega-3/6therapy

– Mayalsoberelatedtomagnesium,electrolyte,B6status•  B6deficiencycanmasqueradeasomega-3deficiency(RayPeat)

– MayevenberelatedtoH.pyloriorpossiblyotherinfec=ons

KeyPMSsymptoms

•  Acne/oilyskin:–  Elevatedandrogens–  Possiblyduetoinsulin-gene=ccombina=on–  Stress–  Androgensmayincreaseifestrogenandprogesteronearelow(haveseenskinissuesclearuponsuppor=ngestrogen)

KeyPMSsymptoms

•  Fa=gue–  Estrogendominance(suppressesenergyproduc=onandthyroidfunc=on)

–  Lowprogesterone(progesteroneispro-metabolic)–  Obviousinterac=onswithbetweenHPA,HPTandHPG

ArePMDandPMDDnormal?

•  Iftheywerenormal,whydosomewomennothaveanysymptoms?

“Goddidnotcreatewomentoliveinpain”~Prof.RebeccaMurray

PCOS:polycys=covary/ovariessyndrome

•  PCOSiscausedbyanovula=on

•  Theforma=onofcystsintheovaryduetothelackofovula=on.

•  Thecystsaccumulatelikea“stringofpearls”

hAps://www.researchgate.net/publica=on/264813715_Automated_ovarian_classifica=on

_in_digital_ultrasound_images

PCOS:polycys=covary/ovariessyndrome

hAps://www.indiasopinion.in/polycys=c-ovarian-syndrome-epidemic-in-india/

PCOS:polycys=covary/ovariessyndrome

•  Whatcausesanovula=on?–  InsulinmessesuptheFSH:LHra=o–  LH:FSHra=ousually1:1–  AsurgeofLHmid-cycleinducesovula=onandreleaseofthefollicle

– WhenthereisachronicallyelevatedLH:FSHra=o,slightriseinLHdoesnots=mulateovula=on

PCOS:polycys=covary/ovariessyndrome

PCOS:polycys=covary/ovariessyndrome

•  CommonsymptomsonthePCOSspectrum:–  Irregularmenses–  PMSsymptoms–  Heavyperiodswithclots–  Acne(improveswithBCPs)/

historyofacne–  Hirsu=sm(hiddena4erlaser

treatment)–  Nega=veovulatorytests

despitehavingperiods–  Acanthosisnigricans–  Increasingabdominalgirth–  Inabilitytoloseweight–  Difficultyconceiving

PCOSDiagnosis

•  NIH(Na=onalIns=tutesforHealth):•  Hyperandrogenismandoligomenorrhoea(noovarianultrasound–US)

•  RoAerdamconsensus2003-anytwoofthesethree:•  Hyperandrogenism•  Oligomenorrhoea•  Ovarianultrasounddemonstra=ngmul=plesuperficialsmallcysts(<10mm)

•  AndrogenExcessSociety2006:•  HyperandrogenismANDoligomenorrhoea•  OR•  StringofpearlsPCOS

Whyinsulinissoimportant-cancer

Whyinsulinissoimportant-cancer

FromPMStoperimenopause

•  AccordingtoDr.UzziReiss,whilePMSisassociatedwithlowprogesterone,symptomsofperimenopauseareassociatedmorewithlowerestrogen.–  Hotflushes–  Foggythinking–  Lowsexdrive–  Vaginaldryness–  Painfulintercourse–  UTI–  Dryskin/thinningskin

Fromperimenopausetomenopause

•  Keyconsidera=ons:–  Aresymptomsmorerelatedto:

•  Lowprogesterone•  Estrogendominance•  Lowestrogen•  Lowandrogens•  Highandrogens•  Thyroid•  Adrenals

Fromperimenopausetomenopause

•  Estrogendeclinessignificantly–  Depression,brainfog,vaginal/sexual,UTI,thinskin,flushes

•  Progesteronedeclinesevenmore–  Anxiety,fa=gue,insomnia,weightgain,bloa=ng

•  Androgensdeclinesignificantly–  Lowsexdrive,muscleweakness,fa=gue,poormemory

•  Adrenalshavetotakeuptheslack•  Thyroidissignificantlyaffectedbyotherhormones

–  Ifthereisn’tenoughT3,however,thesteroidcascadewon’tfuncYonopYmally

It’sconfusing…

•  Idon’tblameyouifyou’realiAleconfused–Iwas.•  There’ssomuchtolearnwiththehormones,paAernsandpathways.

•  Let’sbegintosimplifythings…

Introduc=ontohormoneassessment

•  Hormoneassessmentisn’tthatdifficult:– Assesssymptoms•  Usesymptomlists(providedseparately)

– Assesshistory•  Bigclues:

–  Chemicalcontracep=on–  Hysterectomy– Miscarriages,fer=lity,etc.

– Uselabs•  Serum,driedurine,saliva

Summary

•  PMSandPMDDareverycommonandareusuallydowntolowprogesterone(absoluteorrela=ve)

•  PCOSisapartlygene=c,mostlyinsulinrelateddisorderthatmessesupFSH/LHandcausesanovula=on

•  Perimenopauseiso4enrelatedtodecliningestrogen.

•  SeveralpaAernscanplayarolea4ermenopause.•  Adrenalsandthyroidareo4eninvolved(youcouldreasonablyassumetheyarealwaysinvolved)

Thanksandnextup

•  Thanksforwatchingorlistening.Nextup,we’regoingtolookatmenforachange:itwon’ttakelongaswe’refairlysimple…J