Dr Louise Newson: [00:00:00] This podcast today is a solo episode because I want to talk to you about PMDD, PMS, the so-called luteal uglies that have been spoken about a lot recently. Because it's important as women we understand what our hormones can potentially do to our bodies and brain and others should know about it too. So this is a really important episode that you should listen to and share with as many people as possible because it's so important we have this knowledge and understanding. So enjoy.

So there's been a lot in the media recently about the so-called luteal uglies, which really frustrates me and also excites me as well. So the frustration is that why are we called ugly. Why is it that women are defined by how they look? There's so much to unpick here. But actually, what does this term really mean? What it really is talking to is the changes that occur in the luteal phase of our cycle. And I want to talk about this today because there's a lot of misunderstanding and a lot of mislabeling of women when actually we need to just take it back to the basics and think about our hormones and how they change throughout our menstrual cycle. As hopefully many of you know, hormones are chemical messengers that are secreted by different organs in our body. They go into the bloodstream and then they work on every cell, every tissue, every organ in the body and they have defined and unique properties. They also have defined and unique chemical structures, so they're all different. And we've got dozens of different hormones in our body, and they work together very closely. It's incredible the way our endocrine or our hormone system works in our body. And all the hormones have to balance each other. If one hormone is out of kilter, it can affect levels of other hormones. Or if one hormone level is low, other hormones might try and take over. So this constant flux and balance of hormones is really important for our bodies to be functioning as well as possible and be as healthy as possible as well.

I'm particularly interested in just three hormones progesterone, estradiol, testosterone and for many years they've been referred to as sex hormones or reproductive hormones which actually really frustrates me because they're not actually about gender because men have progesterone and estradiol and testosterone in their bodies and women have testosterone, estradiol and progesterone in their bodies too. They're not about sex either because they obviously can improve libido but they're not just about libido at all so we need to be taking away thinking about them as sex hormones. Then the whole reproductive hormones is really frustrating too because so many people think that it's gynaecologists that are in charge of these three hormones and often if women want menopause advice, support and treatment, they have to be referred to a menopause clinic which is run by a gynaecologist. That doesn't make sense either because gynaecologists really are specialists in the reproductive organs. But our hormones, progesterone, estradiol, testosterone are made in our ovaries, they're made in the adrenal glands, they are made our brain, they are also made in other tissues and organs in our body. So why decide that gynaacologists need to control our hormones? It really doesn't really make any sense to me as a clinician.

But our hormones do help with reproduction. So we have to have the right balance of those three hormones at the right time in our menstrual cycle for us to ovulate, produce an egg and then also to get our womb ready for implantation. So if an egg is fertilised, so if we have sex at the right time, the egg is fertilised by a sperm, then it actually needs to embed into the lining of the womb to start the pregnancy. So the womb has to be prepared. So the balance of those three hormones is really important and changes throughout our menstrual cycle. So really after our period, we start to have this so-called follicular phase where we have an increase in estradiol, there is some increase in progesterone, and then in the middle of our cycle is where we usually ovulate. And there's a peak of all three hormones actually. So testosterone peaks as well because testosterone is important in fertility as well. The second half of our cycle, we have a rise and fall of those hormones as well. Just before our periods, if we don't become pregnant and don't conceive, then there's a massive decline of those hormone levels. So we know that the hormones work on every cell, organ, tissue in our body. So when we have changing levels of those hormones, it can cause a myriad of symptoms. We know that because those changes in hormone levels can cause perimenopausal symptoms, menopausal symptoms. But they can also cause symptoms throughout the menstrual cycle.

So on Balance app, and also throughout our clinic, on my website we have a symptom questionnaire that is important for anybody that has hormonal changes. It's not just a menopause questionnaire, it's a questionnaire that anybody can use to just think about, any of those symptoms on the questionnaire can be related to changing or low hormone levels at any time of a woman's life, including during her menstrual cycle. So we all are used to seeing graphs of how our hormones change throughout our menstrual cycle. But there's a lot of confusion and I want to hold something up which for those who are just listening, I'm going to talk through as well. But if you see here on this picture, this is what hormone levels, the estradiol being red and progesterone being green. This is the start of our menstruial cycle. There's a peak in ovulation. And then the second half of our cycle, there's an increase in estradiol and an increase in progesterone. But those graphs really are not to scale, and that's really confusing because actually, if you look at the levels of progestorone in the luteal phase relative to estrogen, this is what happens. The progestrone is really high and then falls off a cliff very quickly. And so it's hugely more significant and you could say more important than estradiol. And in the luteal phase, this change in progestorone level can really trigger a myriad of symptoms for many, many women. And it's not always the absolute level in the body, it's the change. Because our body likes things to be constant. Our bodies are designed for something called homeostasis, which means that we need to have the right balance of a condition, especially in our brain, to function properly. So if, for example, we've got this big drop or even a big increase of hormone levels over a short period of time, that upsets the kilter and that can really trigger a lot of symptoms. So 95% of us will have PMS, premenstrual syndrome and most of us have been told it's just part of growing up. Adolescence is a difficult time, we'll always have symptoms before our periods and people are just being told you're just hormonal and just wait till your period comes you'll feel better and for a lot of people they do just put up with it and increasingly through social media platforms, through other forums, people are learning more that perhaps they shouldn't be suffering in this way.

Many decades ago, they defined the term premenstrual dysphoric disorder, PMDD, after they defined PMS, premenstal syndrome. And what they really are saying is that it's more severe symptoms. The symptoms are the same, but they affect people in more severe ways. In the 1960s and 70s, it really was, PMDD was made a psychiatric condition, which I think was a real problem actually when you look back in the history of medicine there's a few things that have really damaged women and this is one of them because the antidepressants had come to market, the drug companies were working very closely with psychiatrists, psychiatrists were writing guidelines for lots of psychiatric conditions and they then decided to make PMDD a psychiatric condition and say first line treatment is psychiatric medication. Before that time in the 1950s and 60s Katharina Dalton, a doctor, had done the most amazing work talking about PMS, PMDD, doing some research, seeing hundreds and hundreds of women throughout her clinics with PMS and PMDD and giving them natural progesterone with often transformational effects because she was creating a constant level of progesterone in the body at the right amount. So there wasn't this big high and low progesterone in the luteal phase. She wrote a lot about it. But the medical establishment didn't want to believe her, they didn't want to listen because she was, inverted commas, 'only' a GP. She wasn't a gynaecologist, she wasn't a psychiatrist. And because there was a big push at that time when she was prescribing natural progesterone for synthetic progestogens, for the synthetic contraceptives to be launched, and also all the psychiatric medications as well. So her voice was drowned by the medical establishment, by guideline writing committees. By pharmaceutical companies as well.

But this is where we have to think about basic physiology and basic science. So when there is a problem in medicine, we try and treat the underlying cause. So PMS or PMDD can really negatively affect quality of life because symptoms of low mood, anxiety, irritability, brain fog, poor sleep, memory problems, fatigue, muscle and joint pains, palpitations, skin changes can all really affect a woman's ability to function at work and at home and just day to day. And to normalise those symptoms and give us yet another label, so talking about these luteal uglies in a way that's just quite amusing and funny actually really upsets me because we know that around 80% of women with PMDD actually have suicidal thoughts. I spoke to a lady yesterday in my clinic who has PMDD and she says that her boyfriend's very close to leaving her. She becomes very cross, very argumentative. One day in her month, she actually feels like ending everything. And she's got a strong family history actually. Sadly, her mother did end her life and she thinks it was related to her hormones. Her sister also has similar symptoms and two of her nieces too as well, but they don't know where to go to. They didn't even know that there was a treatment available. So they've just been trying to support each other. And a lot of people who write the PMS and PMDD guidelines are funded by pharmaceutical companies. Guidelines still to this day in 2026, they still write about antidepressants, even antipsychotics, but also when they write about hormones, they only refer to synthetic hormones, which are not actually hormones. Hopefully some of you have read my book, The Power of Hormones, or know from some of the work that I produce, that contraception, although they're called hormonal contraception they do not contain hormones. They contain a synthetic chemical which has a similar but different chemical structure to our own hormones and in that way they block the action of our own hormone working in our body. So to block a hormone that has beneficial effects in our brain and body does not make sense when we're trying to help women with PMS and PMDD and this is what Katharina Dalton knew, wrote about extensively decades ago and is still ignored. So women who have any symptoms in their menstrual cycle, the first thing I would do is do a symptom questionnaire and maybe do it at different times of the menstrual cycle. So do it just after your period then do it in the middle of your cycle then do before your period and compare and a lot of people have a lot more symptoms in the second half of their cycle. It might just be for a day or two before the period, it might be for few days, it be even for two or three weeks. So you might have the majority of time with symptoms. And often as we age and our own hormones generally decline in levels, people can have more severe symptoms for longer with PMS and PMDD. So if you do have any symptoms and they're affecting you, then that's when you need to try and seek help, support and treatments.

The other thing, as many of you know, is when we prescribe hormone treatments, we do it for two reasons. One is to help people feel better. And as a doctor, it's really lovely to help people feel better. But the second reason is to improve future health, because our hormones work on every cell in our body, including our immune system. So they help improve and reduce inflammation in the body. They help our mitochondria to improve in function and our mitochondria are the powerhouse of our cells. They help the energy production in all our cells and we need our cells to work as well as possible to reduce the risk of inflammatory diseases, including cancer, as we age. So we know that those hormones are so crucially important, but if we're not having the right amount or level in half of our cycle, or a third of our circle, a quarter of our second, or few days of our cycles, that means on those days there's more inflammation in our body, there's worsening mitochondrial function. And we know from studies and data that when women have PMS and PMDD, their future health is not as good. They have a higher risk of inflammatory conditions, including osteoporosis. heart disease, diabetes or metabolic conditions, autoimmune diseases because it's the same pathophysiology, the same underlying cause, the menopause and perimenopause. So we can't just be saying to these women, never mind about your symptoms, just try and do a bit of exercise or meditation or just bail out for a few days a month because we're harming their future health. And as doctors, we have a responsibility to try and keep our patients as healthy as possible for as long as possible if we know, in an evidence-based way, a treatment that can help that. And we certainly do know that with natural, bioidentical hormones. So when we're thinking about PMS, PMDD, the so-called luteal uglies, why are we normalising it? Why are we allowing people to just shrug it off or just cry it off often because so many women I speak to feel very isolated, very alone. They feel that they don't really know who to turn to and they find it very difficult to speak to people because it's like Jekyll and Hyde. When their period comes and they feel well, they think, what's the fuss about? I feel amazing. I feel great. I could conquer the world. And then it happens, and then mood changes and plummets. They feel very isolated. A lot of people become housebound. They don't want to go out. They have very intrusive thoughts. A lot women self-harm as well.

Anyone who's got any mental health condition who's self-harming, being diagnosed with a personality disorder, with anxiety, any mental health condition. If they're a woman, the first thing the psychiatrist or the mental health team or the clinicians should be asking is, are you feeling the same throughout your menstrual cycle? And if you're not, we have to be thinking about hormones as a priority. Because so many psychiatrists are not trained in hormones, and so many women who have hormonal changes that have been diagnosed are referred to gynaecologists who have no training in psychiatry. So people are just falling in the middle, and a lot of GPs aren't trained about PMS and PMDD and treatments, or they look at the guidelines, which is what I used to do as a younger GP, and I used follow the guidelines and prescribe antidepressants, prescribe synthetic hormones, but my patients never really got much better. And so it's only with a lot of academic interest and research and curiosity, and also learning about Katharina Dalton's work, have I thought differently about our hormones and how we can prescribe natural bioidentical hormones to women of any age.

So when we think about treatment, the hardest part is making the diagnosis and seeing the right people. In our Newson Clinic, we see a lot of younger women. We're insured for people over the age of 18, and we see lot of women who have PMS and PMDD. Women can make the diagnosis themselves. They don't need to have an actual, there are criteria that are written in the psychiatry guidelines, but actually, in my mind, if anyone's having symptoms that are affecting their quality of life, that are in line with their menstrual cycle, so that the symptoms fluctuate throughout the menstrual cycle, then they will have PMS, or if it's more severe, PMDD. There's no magic blood test, there's no magic scan to make this diagnosis, but women are quite intuitive. If they think it's related to their hormones, then their usually right. And as doctors we have responsibility for listening to, understanding and believing our patients and so often that isn't done and so often the right questions aren't asked. So if your doctor isn't asking your questions about is there a change in your mood throughout your menstrual cycle then you should be telling them and informing them and saying this is related to my menstrual cycle, I need to be thinking about a hormone treatment as well as any other treatment you might be giving me because first-line treatment should be hormones. Because we can correct the hormonal imbalance and really improve symptoms in women.

So when we talk about hormones, I can't reiterate enough. I really want to be clear that we should be giving hormones. We should be prescribing like for like. If someone had a deficiency of vitamin D, I wouldn't say to them, take iron, take another vitamin. I would say take vitamin D. If someone has a hormonal imbalance, especially progesterone, estradiol throughout their cycle, so in the luteal phase they're having symptoms due to the hormonal changes, then I give the actual hormones back and we're very lucky because we can prescribe the natural, bioidentical progesterone and estradiol. So when I say bioidentical, all I mean is it's the same chemical structure as our own hormone. So when it goes into our body, our body recognises it as its own hormone and starts to utilise it throughout the body in every cell, every tissue, every organ in the body in the way that they would if we had our normal levels of hormones in our body. And so then the brain starts to work better, the tissues work better, the cells work better and mitochondria work better our inflammation is reduced. And so it can really make a huge difference. Medicine is an art as well as a science. So obviously we follow the science but the art form is individualising care.

So usually with women with PMS or PMDD or the so-called luteal uglies, we need to be thinking about the right balance of hormones. Often I'll start with progesterone. Women are still having hormones if they're having periods because they need to have those hormones for periods to occur. But the levels and the balance of those hormones are usually not right because they're getting symptoms. So we often prescribe progesterone. There's different ways of having progesterone. It can be given as an oral capsule, which is a micronised progesterone, so it's been micronised into a sort of fine powder, if you like, suspended in oil, and then it can get absorbed orally, because otherwise it doesn't get absorbed very well orally. So there's an oral progesterone, or we can prescribe it as a suppository or pessary. So in the UK we usually prescribe Cyclogest and then that can be used, like I say, in the vagina or the rectum in a way that if the dose is high enough it gets absorbed through the vaginal or rectal mucosa into the bloodstream and then can work on every cell in the body and brain. Usually the dose is quite high and Katharina Dalton used to prescribe around a thousand milligrammes. So there are 200 or 400 milligrammes of Cyclogest pessaries. Sometimes we give 200 milligrammes once a day. I've got other patients that take 400 milligrammes three times a day, it really depends on the clinical response. Some people, if their dose isn't the right dose for them, they can get side effects and think they've got progesterone intolerance. So being guided by someone who's got a lot of experience in prescribing progesterone is really important actually.

Often I'll do testosterone and estradiol levels of women. And if their levels are low, then I might talk to them about having testosterone and estradiol as well, especially if they're still getting symptoms with just progestorone on its own. So a lot women use estradiol, sometimes as a gel or a patch, but gel can be really useful because you can change the dose. And that can be very useful in the luteal phase as well. So I have a lot of patients who just use some estradiol to top up their lower level of estradiol in the second half of their cycle, might be for a few days or a week or two. And they can do that quite safely. And then a lot women are low in testosterone, more women than we realise actually because low testosterone has been normalised. If you look at the article that's on my website about testosterone levels, you'll see that it's absolutely terrible what's happening to women. Because they're saying that low levels are normal for women. Like, how can that be? It doesn't make sense, actually. So a lot of women have symptoms of low mood, reduced energy, poor concentration, low libido, muscle joint pains, and they've been told that they have fibromyalgia, chronic fatigue, depression, anxiety, personality disorders, all sorts of labels are given to women. But then if you measure their level of testosterone and it's low, often I'll talk to them about having a therapeutic trial of testosterone and more and more when I see people in those clinical scenarios and prescribe testosterone for them, their whole life is transformed. It can make a massive difference to their mood, energy, concentration, stamina, muscle and joint pains, migraines, headaches, all sorts of conditions can really improve or melt away rather when they're prescribed testosterone.

So we can't just be thinking about progesterone, We have to think about other hormones. And obviously it's really important to look more than just about progesterone, estradiol, testosterone. So we always do thyroid function test, iron levels, vitamin D levels, vitamin B12, you know, look to see if there's another underlying treatable cause. And then also, and Katharina Dalton was amazing because she wrote a lot about this as well, looking at nutrition, looking at the type of food people eat, looking at exercise, looking at sleep. All these important pillars are really, really important because they can affect progesterone levels. If we've got more stress in our body, it actually lowers progesterone. And we need to make sure that we have the right balance of progesterone because a lot of people who have stress, burnout, they've had trauma in the past, they have very low levels of progesterone and so we need to, rather than just looking at how we reduce our cortisol, how we would do stress in a body, we need be thinking about how can we balance those hormones which will then help reduce our cortisol and stop us having this sort of low grade stress in our body the whole time. And that's where progesterone can be really beneficial as well. So having the balance of hormones with a balanced lifestyle is really important.

What saddens me when I go onto social media platforms and websites and read information about PMS, PMDD, and now the luteal uglies that I've read a lot about, people are just being told to have supplements, to exercise, to change their diet, and all of those of course are important, but actually if we're not treating the underlying cause, which is related to the hormonal imbalance, how are women going to really feel better? We know it's so hard for women to access hormone treatments, especially when they're younger, and a lot of teenagers have a progesterone deficiency. We've known that for many decades a lot people with PMOS, what used to be PCOS, irregular periods, heavy periods will be low in progesterone. Decades ago, in fact, Katharina Dalton used to give a lot of progesterone to teenagers and really helped reduce the heaviness of their periods, helped them to be less heavy and also less painful as well. Really interestingly, in the 1940s, they gave testosterone to women with heavy painful periods with good effect too. So when teenagers often go to their doctors for help with bleeding problems, with PMS, PMDD. They're often given the hormonal contraception. Now, like I said at the start, hormonal contraception doesn't actually contain hormones. It contains chemicals that are made to be like hormones, but they're not the same. They block the action of hormones working in the body. They can stimulate the receptors a little bit. But we know from the evidence, and the evidence is limited because so few good quality studies have been done, but we know there's an increased incidence of stroke, clot, heart attacks, cancers with people who take a hormonal contraception. We know that they block the action of hormones on the brain so that they can increase incidence of depression and suicidal thoughts, especially in teenagers. So why are we giving something that's synthetic with risks to teenagers, just because maybe a guideline says so, or another doctor's told that doctor that they should be doing that? We should be thinking about the safest approach for our patients, and it's a lot safer to give natural, bioidentical hormones than it is to give synthetic hormones to, especially teenagers, because we don't want to be harming our patients going forwards. So we need to be going back in time and thinking about what Katharina Dalton did. We need to thinking about basic science. And if anyone is struggling with PMS, PMDD, luteal uglies, whatever it's called, a hormonal imbalance in their menstrual cycle, then see someone who understands hormone treatments.

So I hope that's been helpful for everyone. I really want you to share it, learn from it, listen to it again. There's a lot of information there. So I'm going to end with three take-home tips. The first tip is, it's not normal to be suffering if you have a hormonal imbalance in your menstrual cycle. Don't just be given a label. Don't just be told it's a luteal ugly and you have to just sit it out. Think about the hormonal imbalance. So number two is if you think you've got a hormonal balance, see a doctor, a clinician who understands hormone treatments. You might not get the first doctor who can really help you. If you feel you're getting nowhere, see your second, third, fourth doctor because this will really have a very beneficial effect on your future life and health if you get the right balance of hormone treatment in the right dose, the right formulation of a bioidentical hormone. So seek help. The third tip is share this information because it's really important. The only way that I can do the work that I do is because women share and talk. It's so important that our children, that our work colleagues, that our relatives, our friends understand about hormonal imbalance and the importance of treating it rather than normalising it. So, thank you for your support. I hope you found that enjoyable and interesting and look forward to the next podcast with you.