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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.
Some of the most common symptoms recognized by women are:
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:
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.
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:
MENSTRUAL CUP MEASUREMENTS
**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:
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.
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 .
Again, only bioidentical hormones supplementation is offered. I commonly prescribe prometrium capsules, which are taken orally. The generic brand is just as good and ot costs much less. Prometrium (micronized progesterone) is truly a bioidendical hormone formulation which can be purchased through a regular retail pharmacy. 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.
Sometimes the Prometrium or generic micronized progesterone that is purchased 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.
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.
Naltrexone (off-label use):
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:
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. Naltrexone can only be purchased with a prescription. The Low doses capsules (4 mg to 8 mg) are only available through a compounding pharmacy. You can view a list of
compounding pharmacies that I frequently work with here.
A typical treatment titration regimen would be:
Rx# 1: naltrexone 4 mg:
#30 pills total for Rx # 1.
Rx#2: naltrexone 8 mg:
#60 pills total for Rx #2.
Rx#3: naltrexone 50 mg (available at either retail pharmacy or compounded)
#30 pills total for Rx #3.
*** 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.
Low dose naltrexone- Effects on medication in rheumatoid and seropositive arthritis. A nationwide register-based controlled quasi-experimental before-after study (pdf)
DownloadLow dose naltrexone in multiple sclerosis- Effects on medication use. A quasiexperimental study (pdf)
DownloadCochrane Review- Low dose naltrexone for induction of remission in Crohn's disease (pdf)
DownloadSafety and efficacy of low dose naltrexone in a long covid cohort; an interventional pre-post study (pdf)
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