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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 Natural Women's Health 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 Charting 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: During your first appt with me, I will take a comprehensive medical history, order a baseline ultrasound which should be done between day 5-7 of your next menstrual cycle. I will also order FSH/LH and estrogen levels, which must be timed to day 3 of your next menstrual cycle. You will be asked to begin charting your menstrual cycles using the Creighton Model System. Please choose a Fertility Care Practitioner by clicking the button below and and learn how to schedule your first Introductory session.
You may choose to record your PMS symptoms using the NaPro PMS Symptom Tracker. Two options are provided for you: a) a PDF form which can be printed and completed by hand, and b) an EXCEL form, which can be printed electronically.
Second Appt: You will be asked to return to the office in one month for a follow-up appointment to review the results of your imaging and lab tests. Together we will review your Creighton Model Chart and your PMS Symptom Tracker. We will look for specific biomarkers in your menstrual cycle.
Please upload an image of your CrMS chart (and PMS tracker) two days prior to all follow up visits and send to me via the portal.
A full GYN physical examination will be preformed (unless you have had a recent well-woman exam) and oftentimes, I will order additional laboratory and/or imaging tests to continue to guide your medical management.
Third Appt: You will return to the office one month later to review the results of your laboratory and imaging studies as well as your CrMS chart. At this time, we will consider ordering progesterone and estrogen panels specifically timed to your CrMS chart. Click the "Laboratory Tests" button below for more detail. You may be asked start medications and/or make an appointment with a specialist such as a dietician, a sleep specialist, or a counselor.
Follow Up Appts: You will return to the office every two months to monitor and/or make adjustments to your medications and treatment plan.
What types of laboratory tests may be done?
Comprehensive Hormone Panel:
- FSH/LH and estradiol (on day 3-5 of your menstrual cycle)
- Prolactin (FASTING)
- 17OH progesterone (Drawn in close proximity to awakening, preferably prior to 8AM)
- Progesterone and estrogen levels, which will be specifically timed to your Creighton Model chart.
Comprehensive Thyroid Panel:
- TSH
- FT4
- Total T3
- anti-TPO and anti-Thyroglobulin antibodies
Health Labs:
- CBC: Complete blood count
- CMP: Comprehensive Metabolic Panel - to look at baseline kidney and liver function.
- Vitamin D level
Dr. Lara Briden
As Lara Briden is a naturopathic doctor. I highly recommend her bestselling book Period Repair Manual which will give you information how to help treat period problems with nutrition, supplements, and bioidentical hormones.
Dr. Briden has more than 20 years’ experience in women’s health and currently has consulting rooms in Christchurch, New Zealand, where she treats women with PCOS, PMS, endometriosis, perimenopause, and many other hormone- and period-related health problems. Read more about Lara’s education, qualifications, affiliations, and scientific advisory roles.
Dr. Lara Briden
If your symptoms warrant hormone replacement, please create a Full Scripts account to allow me to easily guide your therapy. Amazon may offer the same supplements I will prescribe for less money, but you cannot be sure of the quality of their products.
NaPro Treatments for of PMS
As mentioned, NaPro protocols offer exceptionally efficacious treatment for your PMS. Some examples are:
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
Human Chorionic Gonadotropin (HCG): HCG will stimulate your ovaries to increase your own production of both estrogen and progesterone, which is sometimes indicated. Again, timing of administration is very specific and will be based on your Creighton Model Chart. HCG is given via injection only; it more costly and may be a bit more difficulty to obtain. Typical dosing is as follows:
- HCG 2000 IU given either intramuscularly or subcutaneously on P+3, P+5, P+7 and P+9.
Naltrexone:
- NaPro Protocols recommends 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.
We would start at a very low dose and slowly titrate up as follows:
- 0.25 mg 4 x daily for 10 days
- 0.50 mg 4x daily x 10 days
- 1 mg 4x daily x 10 days
- 2 mg 4x daily x 10 days
- 4 mg 4x daily x 10 days
- 8 mg 4x daily x 10 days
- 50 mg, one tab daily, thereafter
PLEASE NOTE: IN ORDER TO INCREASE TO YOUR NEXT DOSE OF NALTREXONE, I will ask you to send in your PHQ-9 SCREENING SCORES via the portal to Emily, our office RN. Emily will review your results and make a recommendation to me if we should or should not increase your dose. Click the "PHQ-9 Screen" button below for more information.
PLEASE SEND IN SCORES BY THE 6TH DAY OF YOUR NEW DOSE, IN ORDER AVOID AN INTERRUPTION IN YOUR MEDICATION REGIMEN.
How can I make an appointment?
Make an Appointment with Sharon Best, PA-C for NaPro Gynecological & Infertility Services.
- In-person/TeleHealth at Women's Health, call 215-939-4251.
- Please feel free to contact me stbest8@gmail.com to schedule a FREE 30-minute NaPro Introductory Session via phone or Zoom.