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NaPro TECHNOLOGY & Premenstrual Syndrome (PMS)
Premenstrual syndrome (PMS) is characterized by the presence of both physical and behavioral symptoms that occur monthly prior to your menstrual period. Symptoms that occur for only one to two days are considered somewhat “normal” and most likely reflect the normal fluctuations in hormones. However, symptoms that last for three or more days are considered a “medical condition” for which NaPro providers can offer you an exceptionally efficacious treatment.
What are symptoms of PMS?
Some of the most common symptoms recognized by women are:
- Irritability
- Bloating
- Crying easily
- Fatigue
- Depression
- Anxiety
- Anger
- Food/sweat cravings
- Breast tenderness
- Weight gain
- Headache
- Insomnia
What will the NaPro appointment be like?
Your appointments at MyCatholicDoctor with me will be one FULL HOUR in length. Generally speaking, NaPro appts will follow a typical protocol as outlined below. However, every individual is different and your situation may warrant a more expeditious process. Please know, the Creighton Model System (CrMS) is very important. Your CrMS chart will help direct me to what diagnostic tests and imaging tests should be done and what treatment plan would be most appropriate.
First Appt: I will take a comprehensive medical history and provide you with education about normal healthy reproduction and oftentimes about a condition I suspect you may have after we have talked a while.
I will order a pelvic ultrasound which I will ask you to schedule on day 5 of your next menstrual cycle. I will order a series of laboratory tests. Click the "laboratory tests" button below to learn more.
You will be asked to begin charting your menstrual cycles using the Creighton Model System (CrMS). Please choose a Fertility Care Practitioner (FCP) by clicking the "Fertility Care Practitioners webpage" button below to learn more about scheduling an Introductory Session to get started.
Please consider joining me as I pray for you here.
Second Appt: You will be asked to return to the office in 2 mos for a follow-up appointment to review the results of your imaging and laboratory tests. Together we will also review your Creighton Model System (CrMS ) chart to look for specific biomarkers which will help me make a diagnosis.
Please upload an image of your CrMS chart two days prior to all follow up visits and send to me via the portal.
Please add the length of your post-peak phase and your mucus cycle score (MCS) to the R-hand margin of the chart. Your Fertility Care Practitioner (FCP) will calculate your MCS for you.
During this appointment, you may be asked to begin some supplements and/or medications. We will also discuss drawing a full set of hormone panels. We will make a decision if you should have a peri-ovulatory estradiol panel, a post-Peak estradiol & progesterone panel, or both panels.
Hormone Panels:
- Peri ovulatory estradiol panel: start on CD8, go to the lab EOD for an estradiol draw, until you have one draw post-peak.
- post-Peak estradiol and progesterone panel: P+3, 5, 7, 9, and 11. See Handout #3 on the the Patient Handout webpage
- Hormone panels require 2 mos of CrMS charting AND the patient must be able to confidently identify her Peak day.
Many patients will be asked to consider working with a dietitian or a nutritionist to help optimize your reproductive health. Oftentimes I may also recommend a mental health appointment to help with anxiety, depression and/or disordered eating habits.
Third Appt:You will return to the office in 2 mos to review the results of your hormone panels as well as the biomarkers on your CrMS chart. Most often at this time I will have made one or more more diagnoses to identify the root cause of your symptoms. Together we will discuss a treatment plan, which will be implemented.
Follow Up Appts: You will return to the office every 2 months. During this time, I will conduct a comprehensive medical interview to ensure your symptoms have resolved, and to ensure you are responding well and not having any negative responses to the management plan. Depending on the individual patient and your individual diagnosis, I may need to monitor your progress with serial laboratory tests and/or serial imaging.
At any point in time, if a diagnosis has been made, treatment initiated, and/or you are satisfied with the medical management we have implemented, you can schedule annual or biannual visits, per your choice.
BLEEDING KEY: How do I Measure Period Flow on my CrMS Chart?
I will be asking you to tell me very specifically how much you are bleeding. An example of a "detailed flow" is: M, M, H, L, L, VL/B
TAMPON or PADS:
- Very Heavy (VH): changing every 1-2 hours
- Heavy (H): changing every 3-4 hours
- Moderate (M): changing every 5-7 hours
- Light (L): changing every 8-12 hours
- Very Light (VL): changing less frequently than every 12 hours.
MENSTRUAL CUP MEASUREMENTS
- Very Heavy (VH): 60 cc in a 24 hours
- Heavy (H): 40 cc in 24 hours
- Moderate (M): 20 cc in 24 hours
- Light (L): 10 cc in 24 hours
- Very Light (VL): 5 cc in 24 hours
**The Diva Cup comes in 20, 30 and 32 ml cups 32 being the largest but other cups may vary. 1 ml = roughly 1 cc
Other important information about your flow:
- Tail End Brown Bleeding (TEBB): brown bleeding at tail end of period.
- Premenstrual bleeding: pink spotting or brown spotting at the prior to a full period starting.
- Intermenstrual bleeding: bleeding between periods.
Why NOT the Birth Control Pill?
Mainstream ObGyn doctors will almost always recommend the birth control pill as first line treatment. The birth control pill will suppress your normal menstrual cycle and simply provides a band-aide for the underlying problem(s).
Please know NaPro Providers to not prescribe the birth control pill (mentioned briefly towards the end of this video).
To the contrary, we believe the birth control pill is harmful to women physically, emotionally, and spiritually. We pride ourselves on taking our patients OFF hormonal contraception, finding the root cause of their symptoms, making a proper diagnosis and providing superior treatments for all of the conditions we treat.
For more information about the spiritual harm brought into the relationship via contraception, visit my CrMS page, scroll to the bottom and read about SPICE.
Bio-identical Progesterone (Prometrium) for Treatment of PMS
Micronized Progesterone which is a bioidentical hormones. Dr. Lara Briden has an excellent podast where she discusses indications for, safety and efficacy of these supplements. Micronized” progesterone is biochemically identical to the progesterone your ovaries naturally make; it is very different from the synthetic progesterone which is found in many types of contraception pills and devices.
Your CrMS charting is of the utmost importance. If you are prescribed progesterone hormone replacement therapy, this must be timed accurately and specifically to your menstrual cycle. Taking this medication too early or too late can cause more bleeding problems and increase your risk infertility. Whereas, taking this medication timed correctly will resolve these two problems. I will offer you two options for dosing .
- Oral capsules taken at bedtime once daily on P+3 through P+12
- Oral capsules inserted per vagina twice daily on P+3 through P+12
Naltrexone for Treatment of PMS
Naltrexone (off-label use):
- NaPro Protocols recommend full dose naltrexone (50 mg) for PMS.
- Naltrexone is commonly used to help people with addictions avoid alcohol use and or opioid use.
- This medication is an opioid-receptor antagonist (blocks opioid receptors).
- Thus, we call this an "off-label" use of this medication, which is somewhat common to do in mainstream medicine.
- Many NaPro patients report wonderful success using naltrexone to treat PMS.
Prescribing this would always have to be done under the supervision of a licensed medical professional, Personal regimens are variable, as medicine is an "art" and a science. Personally, I prefer to start at a very low dose and slowly titrate up to the full 50 mg dose.
All patients must complete a PHQ-9 screen (Handout#6) for baseline score.
Rx# 1: naltrexone 4 mg (must be ordered through a compounding pharmacy)
- take one pill daily x 10 days (4 mg daily total)
- take two pills daily x 10 days (8 mg daily total)
#30 pills total for Rx # 1.
Pt sends in updated PHQ-9 screen during her final week of 8 mg daily, and I will know to send in her next Rx.
Rx#2: naltrexone 8 mg (must be ordered through a compounding pharmacy)
- take two pills daily x 10 days (16 mg daily total)
- take four pills daily x 10 days (32 mg daily total)
#60 pills total for Rx #2.
Pt sends in updated PHQ-9 screen during her final week of 32 mg daily, and I will know to send in her next Rx.
Rx#3: naltrexone 50 mg (available at either retail pharmacy or compounded)
- take one pill daily
#30 pills total for Rx #3.
**** Each patient must be responsible send in her PHQ-9 screens in a timely fashion, in order to ensure her treatment regimen is not interrupted. ****