Progesterone's Role in PMS, PMDD, and Mental Health with Dr. Louise Newson & Dr. Hannah Ward

The Personal Journey with Hormones

• 💡 Dr. Hannah Ward shares her personal experience of severe anxiety, insomnia, and depression after childbirth, which worsened with each child.
• 💊 After finding no relief from antidepressants, she self-prescribed progesterone pessaries, experiencing immediate relief and a profound realization about the importance of hormones.
• 🧠 This personal journey ignited a deep fascination with progesterone and its impact on PMS, PMDD, and menopause.

Progesterone: A Neurosteroid's Function

• 🧠 Progesterone is a crucial neurosteroid produced in the brain, not just the ovaries, with functions beyond reproduction.
• ⚡ It acts on GABA receptors, promoting a calming and inhibitory effect in the brain, aiding in mental health and potentially recovery from brain injuries.
• ⚠️ The distinction between body-identical progesterone and synthetic progestogens is critical, as synthetics lack these neurosteroid effects.

Menstrual Cycle and Hormone Fluctuations

• 📈 During the menstrual cycle, estrogen rises in the first half, often leading to feelings of well-being.
• 📉 In the latter half (luteal phase), progesterone rises and then significantly drops, a fluctuation that can trigger PMS and PMDD symptoms in sensitive individuals.
• ⚠️ Women are often more sensitive to the fall in progesterone rather than the absolute level, making progesterone supplementation during this phase beneficial.

Treatment Approaches and Delivery Methods

• 💊 Body-identical progesterone can be administered via pessaries or rectally, bypassing liver metabolism for better absorption and direct effects.
• 🔬 While often used for fertility, progesterone pessaries are safe and effective for PMS/PMDD, though underutilized in this context.
• ⚖️ Treatment must be individualized, considering patient history, symptoms, and response to different delivery methods and doses.

Lifestyle and Holistic Health

• 🍎 Regular eating, especially carbohydrates during the luteal phase, is vital as low blood sugar and stress can negatively impact progesterone's effectiveness.
• 💊 Supplements like B vitamins and magnesium, alongside herbs like Agnus Castus and St. John's Wort, can support hormone balance.
• ☀️ Vitamin D and light therapy are also important, particularly for mood regulation and addressing seasonal affective disorder overlaps.

Addressing Misconceptions and Advanced Treatments

• 🚫 Many women report intolerance to progesterone due to synthetic progestogens in contraceptives; body-identical progesterone is often better tolerated.
• 💡 Hormone replacement therapy (HRT), including progesterone, is crucial for bone and heart health, even after ovary removal.
• 🩺 For severe cases, treatments like GnRH agonists (e.g., Zoladex) are considered, but natural hormone therapy should be explored first.