Dr Louise Newson: [01:00:00] Everyone needs to listen to this podcast about PMDD. With me today is Anna, who gives her own story about how she was an inpatient in a psychiatric hospital more than once with mental health symptoms related to her changing hormone levels. Yet no-one thought about hormone treatments. No one wanted to prescribe hormone treatments for her. And when she explained that she thought she had PMDD, they thought that was part of her psychiatric condition. This is unacceptable, we need to be helping women, we need be believing them, and we need to be knowing how effective hormone treatments are to improve symptoms of PMDD. So have a listen to this and share it with people. So Anna, thank you so much for coming today. It's a really important topic. I know it's not going to be an easy podcast for some people to listen to, but things need to be said sometimes. And we learn from people's experiences. I learn from patients and I learn from science, but my wealth of clinical experience gives me the knowledge and confidence that I have. But you know, we learn from other people's stories. So you're going to tell us your story, which does have a happy ending, thankfully. But it could have been so different if you hadn't received the right hormonal treatment. So can you just tell me a bit about what's happened? [01:01:21][80.8]
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Anna Salinas: [01:01:21] Yeah, of course. Thank you for having me today. So my story really started in 2010 when I started with PMDD symptoms. I didn't know the term PMDD at the time, but what I knew categorically is that my condition, the symptoms I had were related to my menstrual cycle. Without a doubt, three days before my period, I felt suicidal, utterly depressed, fatigued and severe headaches. In 2011 I went to the GP for the first time. She thought I was nuts and prescribed me antidepressants.  [01:01:53][31.6]
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Dr Louise Newson: [01:01:53] So what did she say to you then?  [01:01:54][0.9]
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Anna Salinas: [01:01:55] She didn't believe there was a direct correlation between the symptoms I had and my menstrual cycle. Even though I said it's obvious it's just about, because it was happening for about three days a month. But I was, I've got two young children, I was working full time, life was busy and hard. And add that three days on and it's only three days...  [01:02:16][20.6]
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Dr Louise Newson: [01:02:16] There's nothing 'only' about that.  [01:02:16][0.1]
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Anna Salinas: [01:02:16] And some people think well, it's only three days, but when you're in those three days you feel like you're never gonna get out of it  [01:02:23][6.7]
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Dr Louise Newson: [01:02:24] Yeah, but you also dread those other days coming, don't you, on the other days? [01:02:27][2.9]
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Anna Salinas: [01:02:29] Yeah,so I took the antidepressant as I was prescribed it. And what happened over the next three years is that I ended up being on the maximum dose of fluoxetine.  [01:02:38][8.5]
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Dr Louise Newson: [01:02:38] Did it help you?  [01:02:39][0.5]
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Anna Salinas: [01:02:39] I would say initially it helped, but I needed more and more till I got to the maximum dose. In 2014, I saw myself sectioned by the police and admitted to a psychiatric hospital. That night, I started my period. And the next day, I felt like a different person. I was utterly dissociated, so my memory of it is limited, although I had to piece it together afterwards. And I can remember saying to the inpatient psychiatrist, look, this is what's happened again, and I know it's related to my cycle. The psychiatrist was utterly dismissive again, didn't really believe it, almost used it against me as if to say this person is not very well mentally, and as well as that, they believe there's something wrong with them related to the cycle...  [01:03:26][46.9]
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Dr Louise Newson: [01:03:27] I've heard that so many times.  [01:03:28][0.2]
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Anna Salinas: [01:03:28] ...and then I was prescribed mood stabilisers as well as antidepressants.  [01:03:30][2.7]
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Dr Louise Newson: [01:03:31] So quite heavy-duty drugs then?  [01:03:33][1.3]
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Anna Salinas: [01:03:33] Heavy duty medication, yeah and the first inpatient admission I had, which was terrifying. And as a result of that, I was later diagnosed with PTSD as a result of a psychiatric hospitalisation where I was utterly terrified, became the archetypal psychiatric patient. I was literally climbing the walls because I wasn't allowed out. Even though I wasn't sectioned, they wouldn't let me go into the garden, I couldn't get any fresh air. It was very, very difficult.  [01:04:01][27.6]
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Dr Louise Newson: [01:04:02] Why wouldn't they let you go outside?  [01:04:03][0.6]
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Anna Salinas: [01:04:04] I wasn't sectioned and again, at the time I was so unwell, I didn't, I wasn't strong enough to stand up for myself. So it was only afterwards that I realised, hang on a minute, I was there voluntary, I'd gone in voluntary, I wasn't sectioned and they should have let me out.  [01:04:18][14.4]
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Dr Louise Newson: [01:04:18] And how long were you there for?  [01:04:19][0.7]
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Anna Salinas: [01:04:19] I was only there for about eight days. In the end, they, in inverted commas, 'let me go' into community care with a crisis team and a community psychiatric nurse.  [01:04:29][9.7]
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Dr Louise Newson: [01:04:30] And how did you take those drugs for?  [01:04:32][1.7]
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Anna Salinas: [01:04:33] So I carried on, that was 2014. Time went on, 2015 I got diagnosed with emotionally unstable personality disorder under a psychiatrist, under a community mental health team. Carried on, changed antidepressants many times. So I ended up with so many diagnoses mentioned severe depression, treatment resistant depression, chronic depression, anxiety, generalised anxiety disorder, social anxiety, health anxiety. The list went on. Yeah, so and that then carried on so I carried on under care. I had difficulties at work and left the job, moved back to where I was living previously, where I had family around and started working again. And again, carried on for a while until things came crashing down again. And then in 2021, by which point I knew the terminology PMDD, I'd done research, but I'd stopped mentioning it because they were using it against me. Using it as saying this woman's not very well mentally and as well as that, she believes there's a correlation between her condition and her cycle. She must be nuts. So at some point during the 10 years between 2011 and 2021, I'd stopped mentioning it. But in 2021, I had a psychologist on the NHS, I was having psychology and one day, my psychologist said to me, have you ever thought, Anna, that you might have PMDD? And I said, yes. I've thought it for the last 10 plus years but I've been dismissed. And she said to, me, well, I can recommend a gynaecologist to you, who I think will be helpful. So she gave me the name of the gynaecologist and I went to see her and I took six months of diary entries with me and I was diagnosed with PMDD for the first time at the end of 2021. [01:06:36][123.1]
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Dr Louise Newson: [01:06:38] Well how did that make you feel?  [01:06:38][0.3]
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Anna Salinas: [01:06:40] Validated, but curious as to what the 10 years could have been like if I'd got the right diagnosis at the right time. So curious, validated, still wondering what the future would hold. And I followed her recommendation, which was to go on the monthly injections to shut down the ovaries working. And then at the beginning of 2022, I had a full hysterectomy with my ovaries taken as well. I was given the strong impression before that an estradiol patch would be enough for me to help me. So I had the operation, physically I recovered very very well, very very quickly, but my mental health absolutely plummeted very very badly and I still to this day don't know how to explain the anxiety I had with being post-menopausal in surgical menopause. I've had anxiety since I was a teenager. This anxiety was something else. I don't even have the words to explain it.  [01:07:42][62.3]
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Dr Louise Newson: [01:07:42] Did it come on very quickly?  [01:07:43][1.0]
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Anna Salinas: [01:07:44] Within a few weeks of having the operation, yeah, I went down and down and down. And then I started having blood tests and it was realised that I wasn't absorbing estrogen. So I tried a couple of patches, tried some gel. At the end of March, I felt so suicidal that I was admitted to a psychiatric hospital again. I was there for about a month. It was, again, a very, very unpleasant experience. It's life-saving, of course, and of course there is a place for psychiatric hospitals, but I can say that it's not a pleasant experience to go through.  [01:08:25][40.7]
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Dr Louise Newson: [01:08:24] Did they talk to you about hormones?  [01:08:26][1.1]
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Anna Salinas: [01:08:26] No, not at all. Nobody...  [01:08:28][1.7]
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Dr Louise Newson: [01:08:29] Even though you'd had a hysterectomy, your mental health had worsened a few weeks after. Did they not join the dots? [01:08:34][4.9]
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Anna Salinas: [01:08:34] No. Fortunately, my gynaecologist did speak directly with the psychiatrist and there was some communication, but still the psychiatrist, we changed my antidepressant, we added drugs in, so on and so forth, and one of the biggest things was sleep. I wasn't sleeping and that made the days so much harder to cope with without any sleep. [01:08:57][23.4]
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Dr Louise Newson: [01:08:58] They didn't talk about progesterone or testosterone? [01:08:59][0.2]
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Anna Salinas: [01:09:00] Not at all.  [01:09:01][0.5]
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Dr Louise Newson: [01:09:02] So they tried with other psychiatric drugs in an environment that probably wasn't very pleasant for a month? [01:09:10][7.9]
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Anna Salinas: [01:09:10] For a month. I was there for a month, I left there, and again, I was very, very unwell. In fact, I would say during that admission I was the closest to psychotic I've ever been. I was severely dissociated. You know, severe memory lapses. I had to get family to fill in bits and pieces for me to piece things together. And I left there still very unwell, given a benzodiazepine to take three times a day, which I realised as I'm a nurse that if I carried on, I'd be addicted within a couple of weeks. But that's what they prescribed and they left me on that to go home with. Immediately, my own psychiatrist took me off that, continued then to change again an antidepressant. By this time, I think I was on about number five or six of antidepressant medication. Came out of there, was still very unwell. Saw my gynaecologist and we decided to go for implants. Had an estrogen implant and it was like, with the blood test and I know blood tests are only part of it because it's more about how you feel but it was my body was so deficient that it sucked this implant up so my levels rose and then crashed again and I continued having a terrible time. At the beginning of July of 2022, I took an overdose and was in a coma for three days and then admitted to a psychiatric hospital for two months this time. It was the longest admission I've ever had. I remember asking the consultant psychiatrist on the ward what he knew about PMDD and how often he treated women with PMDD and with hormone deficiencies. And he told me he came across a woman with PMDD about every 10 years.  [01:11:09][119.6]
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Dr Louise Newson: [01:11:11] That's not accurate, is it? We know that.  [01:11:12][1.5]
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Anna Salinas: [01:11:13] Well, I mean...  [01:11:14][1.4]
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Dr Louise Newson: [01:11:14] Were there other women in the wards?  [01:11:16][1.2]
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Anna Salinas: [01:11:16] There was, I can tell you now, there was a cohort of women between the ages of 45 and 55 ish you could have done a mini experiment to see that there was a clientele group in there that didn't need antipsychotics, they needed hormones. He knew nothing about hormones, he knew nothing about PMDD, again, I was made to feel not validated, completely invalidated, basically.  [01:11:41][25.7]
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Dr Louise Newson: [01:11:43] Even though you had a diagnosis this time.  [01:11:43][0.5]
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Anna Salinas: [01:11:43] Even though at this time i'd got the diagnosis and on the letter they would write PMDD diagnosed by a private gynaecologist as if they didn't quite believe it, as if the NHS didn't fully accept the diagnosis. That is what, in fact, I still feel like that now. I still feel like that now like the NHS, they always put diagnosed by a private gynaecologist.  [01:12:06][22.9]
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Dr Louise Newson: [01:12:07] I get it every day running a private clinic. They think that we're just somehow different. We're not real doctors, which is incredibly frustrating. So they gave you more antidepressants despite you being diagnosed a while ago with treatment-resistant depression. And they gave you antipsychotics or other medication?  [01:12:25][18.5]
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Anna Salinas: [01:12:27] Yeah and sleeping tablets. Two antidepresants.  [01:12:29][2.2]
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Dr Louise Newson: [01:12:30] OK, and that still wasn't treating the underlying cause, of course, was it?  [01:12:35][5.4]
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Anna Salinas: [01:12:37] No, I'd say it took between nine and 12 months to get my body somewhat stabilised on hormones, probably another year plus to really get into a good regime. So I started having then progesterone and then had testosterone implants as well.  [01:12:55][18.4]
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Dr Louise Newson: [01:12:56] How did you get, was that from the same gynaecologist? Ok so she listened to you. [01:12:57][1.6]
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Anna Salinas: [01:12:59] She listened to me and she knew about implants because she trained back in the 80s when they were...  [01:13:05][6.4]
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Dr Louise Newson: [01:13:05] When they were a lot more common. [01:13:05][0.5]
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Anna Salinas: [01:13:06] Exactly, they were much more routinely used.  [01:13:08][2.2]
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Dr Louise Newson: [01:13:08] So despite having had a hysterectomy, you were still given progesterone.  [01:13:12][3.3]
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Anna Salinas: [01:13:13] Yes, when I asked for it.  [01:13:14][1.1]
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Dr Louise Newson: [01:13:15] And did you notice a difference with having all three hormones?  [01:13:18][3.3]
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Anna Salinas: [01:13:19] Yes, absolutely. I felt well with all three hormones and I've had the last couple of years, I would say, where I've been stable. However, in April, because I have my implants yearly, once I got stabilised, having them yearly, I do have high doses, but I was only having them yearly. And I didn't realise until April this year, that there's a massive shortage of testosterone implants in the UK. And they're basically unavailable. So I panicked, thought I'm gonna spiral. This is gonna result in mass deterioration. All these catastrophic thoughts were going through my head and I agreed with my gynaecologist, she tried really hard, she went to compound pharmacists to try to get a testosterone implant made for me, but couldn't get anyone to do it. So before I had tried, is it Tostran? [01:14:22][63.2]
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Dr Louise Newson: [01:14:23] Tostran, yeah.  [01:14:24][0.6]
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Anna Salinas: [01:14:24] 2%. Yeah, I tried that before because there was a couple of years before when there was a shortage when she couldn't get it for about four months. And I tried that for four months and my levels decreased. So I wasn't absorbing it. This time I was prescribed the Testogel and luckily enough, I've started absorbing some of it. So, I'm feeling well again and much relieved.  [01:14:51][26.8]
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Dr Louise Newson: [01:14:52] Yes and because testosterone, in my vast clinical experience, makes the biggest difference actually to mental health. And I didn't realise it and, you know, I feel embarrassed to say 10 years ago, I didn´t know women even produced testosterone. But we see a lot of people who've had severe psychiatric illnesses in the past, which weren't actually psychiatric illnesses. They related to their hormones and testosterone does, but it is all about the absorption and having a range of products is so important because a lot of people, I mean, myself included, the gel just floats off my skin, I might as well not bother. I use the cream and it gets absorbed very well, but it's so important because otherwise, like you had initially with the estrogen, you weren't absorbing enough or you didn't have the right dose, so it's not going to help.  [01:15:36][44.0]
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Dr Louise Newson: [01:15:40] I wanted to take a quick pause from our conversation to tell you about my new book, The Power of Hormones. Many of the topics we discuss on this podcast are explored in much greater depth in my book. I look at how hormones really work in the body, why they've been misunderstood for decades, and how confusion between natural hormones and synthetic hormones has influenced medical practice and public perception. Most importantly, I explain why understanding hormones is essential for improving both current health and future health. So if you'd like to continue learning beyond the podcast, my book, The Power of Hormones is available now and I've included a link to buy in the episode show notes.  [01:16:24][44.5]
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Dr Louise Newson: [01:16:27] I find it quite weird to think that we all know that our ovaries make estrogen, progesterone, testosterone, but other organs in our body make, like our brain makes them as well. So there's two things that I feel very perplexed about. One is that if women have their womb removed, with their ovaries, they're told they don't need progesterone. So that feels a bit weird because if they've had their ovaries removed, why are we just prioritising estrogen instead of estrogen, progesterone, testosterone. But the other thing is why, when we know that the hormones are made in the brain as well, we know the people with PMDD, the changing hormone levels can trigger the symptoms. Why do people think just removing the ovaries is going to be the treatment and going to cure those people because you've still got hormonal changes in your brain.  [01:17:21][54.3]
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Anna Salinas: [01:17:22] Right, yeah.  [01:17:23][0.7]
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Dr Louise Newson: [01:17:25] Do you see what I mean? You can't take your brain out, so why decide that your ovaries are the problem? [01:17:29][3.3]
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Anna Salinas: [01:17:29] And don't you have them in the adrenal glands also?  [01:17:30][1.4]
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Dr Louise Newson: [01:17:31] And your adrenal glands and other areas of the body too. Your muscles make hormones, so it feels almost a bit too simplistic.  [01:17:38][6.9]
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Anna Salinas: [01:17:39] Absolutely. Yeah, I can see that now. I didn't see it four or five years ago, but now I can definitely see that now. And also with progesterone thinking that it's only protective for the lining of the womb and you only need it if you've got a uterus, take the uterus out and you don't need it. Well, surely progesterone is doing more than that in the body. I mean, logic. I don't know. I'm not a medic.  [01:18:00][21.4]
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Dr Louise Newson: [01:18:02] You don't need to be a medic.  [01:18:02][0.2]
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Anna Salinas: [01:18:02] Yeah. Exactly. But is it not obvious that it is going to be doing more than just protecting the lining of the womb? [01:18:06][4.3]
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Dr Louise Newson: [01:18:06] So we have, every single cell in our body responds to progesterone and progestorone actually makes the other hormones. It makes testosterone, it makes estradiol, it also makes cortisol and cortisone. So it's a really important hormone and we've known this for decades. Since hormones were discovered they realised progesterone was really important but somehow it's always thought about for the womb and I did ask at a conference recently, actually, it was an international conference and I just stood up and asked somebody who had given a talk about surgical menopause in young women and said of course if you have their womb removed you only need to give them estrogen so I said oh, I was just wondering where this has come from and I'm not sure why because I, my understanding is that progesterone is in the ovaries too and she looked at me and she said that's because that's what the guidelines say, next question please and she just completely dismissed me and I thought hang on you have to be a bit inquisitive you have to ask those questions.  [01:19:03][56.7]
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Anna Salinas: [01:19:05] Absolutely.  [01:19:05][0.0]
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Dr Louise Newson: [01:19:05] But the other thing is, and I've been doing a lot on my sort of social media and just talking about language, because progesterone is either the hormone we make ourselves or the hormone that you're being prescribed now is the same molecular structure we're replacing like with like, but a lot of people, including doctors and often women, also, talk about progesterone when it's not progesterone. So they'll talk about the coil that contains progesterone, the progesterone-only pill, the progesterone implant. All of these contain synthetic progestogens, which are chemicals that they've made that are similar, but they're different to progesterone. They have a different molecular structure. They have completely different actions in the body. And for many women, they actually block the progesterone receptor. And once it's blocking the receptor, you can't get any normal progesterone in the body. So people sometimes feel worse. So I don't know if that's ever happened to you, if you've ever had anything synthetic in your body? [01:20:04][58.6]
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Anna Salinas: [01:20:04] Well, yeah, I have. In 2020, I was having some abnormal bleeding, saw my GP, ended up seeing a gynaecologist, a male gynaicologist. And I ended up having a hysteroscopy and some fibroids removed. And he recommended to me to have the Mirena coil fitted while I was in theatre.  [01:20:25][20.7]
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Dr Louise Newson: [01:20:26] Right.  [01:20:26][0.0]
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Anna Salinas: [01:20:27] I spoke to him about my mental health. I spoke to him about PMDD. He was very, very dismissive.  [01:20:36][8.9]
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Dr Louise Newson: [01:20:36] What, of the PMDD?  [01:20:36][0.0]
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Anna Salinas: [01:20:36] Well, of all of it, and any correlation between hormones and mental health, he was very, very dismissive. And at that point, I hadn't been diagnosed with PMDD yet, but I knew I had it. And again, it was just another doctor, another medic that was just dismissive of me again. And I didn't know any better, so I followed his advice and I had the Mirena coil fitted in November of 2020. Within six weeks, I'd taken an overdose, completely unexpected to me and everyone around me, was in a coma for three days in hospital and then had another psychiatric admission. And it was my body's response to synthetic progesterone.  [01:21:23][47.6]
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Dr Louise Newson: [01:21:24] Did you have the coil taken out?  [01:21:25][1.0]
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Anna Salinas: [01:21:25] Yes, as soon as I possibly could, I got the coil out.  [01:21:28][2.9]
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Dr Louise Newson: [01:21:28] And how quickly did you respond?  [01:21:30][1.3]
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Anna Salinas: [01:21:31] Within a few weeks. It was slightly tricky because it was COVID times and the psychiatric hospital didn't want to let me out to go to the GP to have the coil out. So it took slightly longer than it should have done. But got there in the end and I was much better without the coil.  [01:21:46][15.8]
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Dr Louise Newson: [01:21:47] It's really interesting, there is definitely a cohort of people who really respond to adversely to Mirena and when I was first taught about Mirena coils when they came out, I was always taught that they don't go into the rest of the body, they only work in the womb and in medicine often once we get taught something we don't challenge or think about it. I don't know if it's a problem, the way that I work is quite different and because I've always worked as a part-time doctor and a part-time medical writer. If you're writing about something, you have to understand it. So I've always sort of challenged things. So when I learned that, I was thinking, well, hang on. We know the womb is really vascular. There's lots of blood vessels in the womb, of course there is, because when people have their periods, there's lots of bleeding. So if you've got something that's in the womb, and we know it only works supposedly on the lining of the womb, well, the lining the womb has a blood supply that connects to the body. So surely some of it gets out and for a lot of women, the amount that gets out is very low, and it's not enough to have any negative effect. But there are women, and especially women with PMDD, who are very sensitive to progesterone, changing levels and probably don't have quite enough progesterone in their body, if it's blocked, even with a small amount of a synthetic progestogen, especially in the brain, it can have the effects it's had on you.  [01:23:10][83.0]
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Anna Salinas: [01:23:10] That's what happened to me. It was absolutely horrendous. Really, really, really horrendous.  [01:23:16][5.3]
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Dr Louise Newson: [01:23:15] And did the psychiatrist believe that it could be related to the Mirena coil?  [01:23:19][3.6]
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Anna Salinas: [01:23:20] No, I worked out the other day with my husband that between 2011 and 2021, so in the ten years period before I got diagnosed with PMDD, we worked it out the other day that I've seen over ten psychiatrists, over 20 GP appointments, and two, well, one gynaecologist by then and one later. And nobody, none of those people, I've been under the crisis team multiple times, inpatient psychiatrist, outpatient psychiatrist. Completely dismissed, utterly and totally.  [01:23:53][32.9]
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Dr Louise Newson: [01:23:54] But it feels worse because it's not like no-one thought about it because you told them. So it's like doubly bad, isn't it, because it is not like you didn't know or think there was a hormonal problem and then no one asked the questions. You've been telling them, but they've made you feel like you were making it up.  [01:24:12][18.6]
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Anna Salinas: [01:24:14] Yes. [01:24:14][0.0]
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Dr Louise Newson: [01:24:14] I mean, you've been completely gaslit, haven't you?  [01:24:15][1.5]
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Anna Salinas: [01:24:15] Yeah. Yeah. [01:24:17][1.7]
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Dr Louise Newson: [01:24:19]  You must feel so angry and sad at the same time, don't you? [01:24:19][0.0]
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Anna Salinas: [01:24:22]  I think I've perhaps been through that. And now I'm more curious. I'm more curious when I think back to think what would have happened if in 2011 when I saw that first GP, if I'd got the right diagnosis then, what would my story have been?  [01:24:39][16.8]
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Dr Louise Newson: [01:24:39] Well, we know, don't we.  [01:24:40][0.7]
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Anna Salinas: [01:24:40] And I'm curious, because I think it would be very different to what it is, what it has been. But now I hope. I hope for the future with all the work that you do, I've got a 20-year-old daughter and I desperately hope that things are different for her.  [01:24:53][13.7]
Dr Louise Newson: [01:24:55] And that's why I'm so grateful that you've come on the podcast because learning from stories and joining the dots is really important and having people to advocate for others. I was talking to my daughter the other day, my oldest daughter has PMDD and she's 23 and my husband's quite intuitive and one day he just said to me I'm going to go and see Jess in London and I said well she's not got a migraine because we often go down when she has bad migraines. He said no something's not right, I'm going down. And she told us recently she'd counted the number of tablets that she'd got because she wanted to end her life. And it was on a day before her periods, because she, like you, it was 'only', in inverted commas, three days a month. But she said, I mean, I was just dreading every month those days coming, and it was becoming unbearable on top of my migraines. You know, if my husband hadn't been there, obviously things would have been very different for us in so many ways. But what I find so good and bad is that she's on treatment, she's on natural hormones and the progesterone especially has made the biggest difference for her. So her future is already very different. But she was 20, 21, and that was happening. How many other 20,21 year olds don't have access to safe, natural bioidentical hormones, which are, just to add, safer than any of the other medications that you've been prescribed over the last however many years.  [01:26:23][88.5]
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Anna Salinas: [01:26:24] I know. Massively safer, no side effects.  [01:26:28][4.3]
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Dr Louise Newson: [01:26:29] It's quite something, isn't it? So you coming on today sharing your story is going to anger people which I think is good because when people are angry change is going to happen and we've known about PMDD for decades. It's been known and recorded since the 1950s that it's related to a hormonal change so why the psychiatrists think that it can't be a hormonal condition beggars belief. So there's so much more that we need to do but people are talking and learning and that's really important. So before I end, just three take home tips. So if someone's listening and either they've got PMDD, their daughter, their friend, their work colleague's got it, they might not have had the extreme story you've had, but they might have been given some antidepressants that aren't helping. What things do you think they could do to advocate for safe natural hormone treatments to be given to them?  [01:27:30][60.9]
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Anna Salinas: [01:27:31] I think one massive thing is to keep a diary, a really detailed diary, even on the days when you're feeling well.  [01:27:39][7.5]
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Dr Louise Newson: [01:27:39] Yes, that's so important.  [01:27:40][0.7]
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Anna Salinas: [01:27:40] So every day to write a diary, not just when you feel awful. That's definitely a big thing I would say that's very helpful. Read your book.  [01:27:51][11.3]
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Dr Louise Newson: [01:27:52] Thank you.  [01:27:52][0.5]
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Anna Salinas: [01:27:54] I think it would be a great thing to do to educate yourself as much as you possibly possibly can and then try and get family and friends on board to help you advocate for yourself, so you don't do what I did, which is where I stopped advocating for myself because I'd kind of given up, so I didn't see a point in it anymore and people were using it against me, whereas I think if you can get some family and close friends on board to help advocate for you as well.  [01:28:22][28.4]
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Dr Louise Newson: [01:28:23] Absolutely. And sharing that knowledge with everybody. So share this podcast with as many people as possible, not just for those people who might be suffering with PMDD. Because it affects at least one in 20 women, probably more. So everyone's going to know someone who's probably suffering without any help, support and hormone treatment. So thank you so much for coming on I've really enjoyed, maybe is the wrong word, but it's been great having you here today.  [01:28:52][28.6]
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Anna Salinas: [01:28:53] Thank you for having me.  [01:28:53][0.7]
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Dr Louise Newson: [01:28:56] So just a quick one. It would be really great if you could follow or subscribe to this podcast. This will really help me reach more people with evidence-based information about hormones and their future health, and also means you never miss a future episode. Thank you.  [01:28:56][0.0]