Premenstrual Syndrome (PMS)

Most often an initial appt with a NaPro provider will be one FULL HOUR in length. Generally speaking, NaPro appts will follow a typical protocol. However, every individual is different and your situation may warrant a more expeditious process. Please know, the Creighton Model Charting is very important. Your CrMS chart will help direct your NaPro provider as to what diagnostic tests and imaging tests should be done and what treatment plan would be most appropriate for you, personally. For more detailed information about what a typical NaPro diagnostic evaluatin will look like, please click the button below. 

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 a full pad/tampon every 1-2 hours
• Heavy (H): changing a full pad/tampon every 3-4 hours 
• Moderate (M): changing a full pad/tampon every 5-7 hours
• Light (L): changing a full pad/tampon every  8-12 hours
• Very Light (VL): changing pad/tampon less 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. 

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 do not prescribe the birth control pill.

To the contrary, we believe the birth control pill is harmful to women physically, emotionally, and spiritually. We typically will take our patients OFF the birth control pill, find the root cause of their symptoms, and if necessary use cyclic luteal phase progesterone, ie: 10 days every month of a bio-identical (micronized) progesterone.

***** Do not take unless under medical supervision *****

Micronized Progesterone is a bioidentical hormone. 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 produce; it is very different from the synthetic progesterone which is found in many types of contraception pills and other routinely used forms of contraception.

Your CrMS charting is of the utmost importance. If you are prescribed cyclic luteal phase progesterone supplementation, your medication 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. Most often oral and vaginal progesterone is tried first:   

• Oral capsules taken at bedtime once daily on P+3 through P+12.
• Oral capsules or vaginal suppositories twice daily on P+3 through P+12.

Again, only bioidentical hormones supplementation is offered. Bioidentical progesterone can be purchased through a retail pharmacy (eg: CVS, Walgreens, Walmart, etc... it is called "micronized progesterone" as a generic, also known as "Prometrium". This medication is generally well-tolerated. Some common side effects are quite pleasant, eg: you may feel more relaxed or sleepy and your might find your mood may improves. Some more unpleasant side effects may be: next-day fatigue, nausea, headaches, or dizziness. Most often the unpleasant side effects can be easily managed by taking the medication right before you lay your head down on the pillow and/or changing to a compounded formulation. Please know prometrium and generic progesterone capsules contain peanut oil, so you CANNOT take this if you have a peanut allergy.

All progesterone products (synthetic and micronized) will include a package insert which will "warn" of possible birth defects. However, this warning refers to progesterone substitutes that are often prescribed in oral contraception pills, not the bioidentical progesterone we are prescribing.  NaPro providers, who were trained at the St. Paul VI Institute, have been safely prescribing micronized progesterone to many, many women to support pregnancies for over 35 yrs and they have not encountered problems. 

If the oral medication is not strong enough or if the side effects are bothersome, we can try a vaginal suppository. This will be prescribed for you by a specialty pharmacy called a "compounding pharmacy". You can see a list of compounding pharmacies by viewing Handout #21 here.

FREEDOM TO TEACH INSTRUCTIONAL VIDEO: 

Sometimes we will have to use progesterone injections. I will ask you to watch this instructional video and choose someone such as your spouse or a close relative who is willing to administer the injections to you. I would also recommend injections be administered in the upper-outer quadrant of the buttocks (shown in the video) and that you alternate sides. Common side effects of the injections are: soreness, itching and/or mild bruising at the injection site, especially if the injection is done too quickly.       

***** Do not take unless under medical supervision *****

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. 

I do occasionally use the full 50 mg dose of naltrexone in very severe cases. Most often I will recommend "Low-Dose Naltrexone" (LDN) for you namely b/c  there has been some discussion among the medical community that if a patient has been on full dose naltrexone for many years, this may present a conundrum if the patient needs opioid medications to control severe pain, such as after a surgery or after a significant injury has been sustained. The concern is twofold: 

1. If the pt is left on the 50 mg of naltrexone, it may be very difficult to manage his/her pain, because the naltrexone is blocking the pain receptors. 
2. Whereas, if the patient is taken off the naltrexone and given an opioid medication to control his/her pain, a regular dose of the opioid (eg; Percocet) may be too much, and the patient may be at a higher risk of respiratory depression (breathing stops) due to a normal dose of an opioid medication now being too potent, because the patient's opioid receptors have undergone a process called down-regulation, which occurs after long term opioid use. 

My recommended treatment for most cases: 

We would start at a very low dose and slowly titrate up to 8 mg and see how you feel. The 8 mg dose may be enough for most women. Again, in rare cases, we may continue uptitration to the full 50 mg dose, but I would prefer to use this short term. 

I prefer to prescribe naltrexone capsules from a compounding pharmacy.  You can view a list of  compounding pharmacies that I frequently work with here. 

*** If we agree on using the full dose, I will document you have been educated to the risks as noted above, and you would like to take this risk. Also, we would plan to use the full dose for only 4-6 mos. 

Many clinical trials have been published demonstrating LDN is effective to in mitigating chronic inflammatory conditions and pain syndromes (see publications below).