PMDD with Kendall Buckley

Do you feel particularly anxious, overwhelmed, outraged, low or even crazy just before your period? 

If you’ve got a flow, you oughta know, that it’s not the same experience for everyone. 

Some of us can have mild mood symptoms, and others quite severe. 

Kendall Buckley, a queer sexologist with a Masters in PMDD, breaks it down for us. Evidence based with facts on stats - she encourages you to validate your feelings and learn about how your cycle affects you. 

Our Guest!
Kendall Buckley
https://www.kendallbuckley.com/
Instagram: https://www.instagram.com/kendall.buckley.sexologist
Article: https://www.quin.org.au/body/reproductive-health/pmdd-with-kendall-buckley-insight-from-a-queer-sexologist

Find us here!
Instragram: @fgsx_pod
Email: fgsx.pod@gmail.com

Resources here!
The PMDD Project: https://thepmddproject.org/
Jean Hailes: https://www.jeanhailes.org.au/articles/pms-and-pmdd-and-you/

We are your co-hosts, Dr Shyamini and Nurse Ellie, and this, is For Goodness Sex xx

Transcript

SPEAKER_02 0:00

Hello.

SPEAKER_07 0:01

My name is episode. We have a lot of heavy talking about mental health, depression, and suicide. So if this episode is not for you, please feel free to skip. And if you are struggling, reach out to your loved ones or your healthcare professionals. Hi, hello, and welcome. We are your co-hosts, Dr. Charmani and Nurse Ellie.

SPEAKER_02 1:24

And this is For Goodness Sex.

SPEAKER_07 1:38

Welcome back to For Goodness Sakes, everyone. Hello. Hi. Today we have another beautiful guest with us. I've been the guest so far. I know. It's so good. It's so nice. Alright, so I have with me Kendall Buckley. Kendall is a queer therapist and sexologist working closely with the queer, gender, and neurodiverse population. She provides therapy all across Australia via telehealth with a focus on non-monogamy, kink aware therapy, sex worker therapy, and PMDD, which is premenstrual dysphoric disorder. She's been a registered nurse for eight years.

SPEAKER_03 2:15

Oh yeah, eight or nine. Eight or nine? Yeah, I think it's about nine now.

SPEAKER_07 2:18

Okay, wow. And holds a master of sexology from Curtin. Kendall's special interest and expertise is in PMDD, which is great because that's what we'll be talking about today. Yeah. Wow, what an intro. I'm not done.

SPEAKER_02 2:36

Sorry.

SPEAKER_07 2:37

I go on, I go on. I have a habit of doing that. I'm so sorry.

SPEAKER_02 2:39

I was already totally taken aback by that intro. But continue.

SPEAKER_07 2:43

I'm looking forward to more. But no, she's just the person for the job because PMDD was the focus of her master's research. And she also brings personal lived experience and professional clinical experience to her clients for PMDD. I'm still going, just one more, just one more little bit. Outside of work, you can hear Kendall discussing all things, sex, relationships, and queerness on RTR FM. Are you still a regular host for All Things Queer?

SPEAKER_03 3:12

Yeah, I am. I just have had a slight little break. I was a bit clinically burnouty, actually, so I just needed to take a small break. But yeah, I'll be gone back.

SPEAKER_07 3:20

And that's so fair. We were literally just talking about burnout. We were. And now I'm done, but we're very privileged to have you here. Wow. Yes. Yay. Welcome, Kendall.

SPEAKER_01 3:30

Thanks. Thanks for having me.

SPEAKER_07 3:32

Thank you for being here. Thank you so much. How are we feeling?

SPEAKER_01 3:34

Yeah, good.

SPEAKER_07 3:37

I hear that you're bleeding.

SPEAKER_03 3:38

I'm bleeding. I am actually bleeding. Yeah. So I'm on day three of my cycle. I am actually bleeding. Yeah. Yesterday was horrendous. Had really bad pain, but today I'm good.

SPEAKER_07 3:49

Okay. So, Kendall, how would you explain PMDD to someone who was hearing about it for the first time?

SPEAKER_03 3:57

Good question. I would, in fairly lay terms, describe it if I'm being my brutal self. Please. As if someone if I promote brutality on this point. Yeah, look, if I was at a pub and I was talking to someone, I would say that it's it's like it's like PMS, but PMS on crack. Okay. Is how I would describe it. In very lay terms.

SPEAKER_04 4:22

Uh-huh.

SPEAKER_03 4:22

But clinically, I would say it's something that is PMS, but it's clinically significant to the point that it impacts your life. Yeah. Like that's kind of the key difference, I would say, between the two of them. But in in lay terms, PMS on crack. PMS on crack. Yeah.

SPEAKER_07 4:40

Yeah, yeah. No, brilliant. I've heard that, like either PMS on steroids or PMS on crack, which I like. I've heard that multiple times, and yeah, I I wanted to know how you felt about using that. Because like and although, yes, we know that it is PMS on crack, it's also significantly greater, you know? Like it it does something that would cause like an actual, as you said, like impact on your life.

SPEAKER_02 5:04

Yeah, I like how you use that word, because I think that's really important clinically. Is this person functional or dysfunctional? Um that's really important to define, yeah. Definitely. Definitely.

SPEAKER_07 5:14

Well, yeah. So other than other than that, is there other things that make PMDD like distinct from PMS?

SPEAKER_03 5:22

Um Yeah, like uh really the key difference is the marked lability with regards to emotions. And so like the primary difference between PMS and PMDD is the simple fact that it is clinically significant and that it does actually impact your life. So what impacting your life means is your relationships, your ability to go to work, your ability to study, your ability to perform in life in the things that you would deem normally that you can do, but then in the period of time that PMDD is effectively in like at play, you you can't function. Yeah. So there has to be that dysfunction and inability to operate in life, that is the key difference. 80% of the population get PMS. Like that's normal. Yeah. So, you know, having like slightly more being feeling like anxious or sleepy or just being a little bit irritable, that's fairly normal. Like that's actually what's kind of supposed to happen in that time frame. But for you to have anger, irritability, to be fighting with your partner, uh, to, you know, potentially be having thoughts of suicide, uh, to for those really big impacts to happen, that's that's not PMS.

SPEAKER_05 6:42

Yeah.

SPEAKER_03 6:42

That that's that's the five to eight percent of the population that have that clinical signific clinically significant differentiation from from simply just PMS.

SPEAKER_02 6:51

And is that clinical significance um subjective or objective, do you think?

SPEAKER_03 6:57

Uh no, it's definitely objective because uh I guess, well, the keynote.

SPEAKER_02 7:02

I know it's a tricky thing, yeah. Just thinking about that, because like I guess clinically and yeah, that's that's all totally correct. Um it's I've been thinking, you know, when people we talked a bit about this previously about um like you know, if if the periods are heavy for you, they're heavy for you, um even though we have clinical markers. And so um, do you think there's an element of what functioning looks like for every individual is different?

SPEAKER_03 7:26

Yeah, absolutely. I mean, I guess if someone was taking time off of work, or someone couldn't perform in the usual way that they would, if someone was having, say, arguments every single time with their partner, or they wanted to break up with their partner every sort of four weeks on particular particular time frames, and they actually did it, or they they made some really significant um choices that then a week later after they bled, they then regretted. Like that things that you could measure. Yeah, so that's they're the things that are the the key.

SPEAKER_02 8:05

Yeah, so I guess the feelings are subjective, but the outcomes are measurable objectives, like work and interpersonal relationships and things. Yeah, yeah, definitely.

SPEAKER_03 8:13

So that that can be subjective, yeah. It's just like pain is subjective, like one person's four might be, you know, like another person's ten. But yeah, so it it is subjective in that sense. I guess the the key difference is PMS is not in the DSM 5 or the ICD 11. So it those that neither of those things are diagnosable like disorders. Well, PMS isn't. PMDD is a diagnosable disorder that has very specific di and very clear and quite challenging actually diagnostic criteria that you need to meet in order to be diagnosed with that, which I fully support because I do not think that it's something that you should just wave around willy-nilly. Yes.

SPEAKER_07 8:59

Yeah. And as you say, like so many of the population experience PMS symptoms, and then when you look at the percentage of PMDD as like between five to eight, did you say? And probably more like undiagnosed, I imagine. Um, yeah, you do notice the significance and the difference there. Yeah, absolutely. Um okay, well, thank you for that. Um can you walk us through what's like happening in the brain during the menstrual cycle that that makes PMDD different to PMS or you know why people struggle with PMS PMDD? What's happening in the in the brain during the menstrual cycle?

SPEAKER_03 9:36

Good question. So I guess to understand what's happening within the brain, it's important to understand the different phases of the menstrual cycle. So an average cycle is 28 days. This can obviously vary for different people for different reasons. But just for the explanation of it, we'll write with 28 days. So day one is the first day of bleed, and then so that's obviously um what what am I thinking? It was like day one is the day of your bleed.

SPEAKER_02 10:05

It's the feel-good follicular phase.

SPEAKER_01 10:07

That's when you're menstruating and when you're bleeding. I was like, why can't I think of the name of that time frame?

SPEAKER_03 10:14

And then after you bleed, we're entering the follicular phase. And so when you're in the follicular phase, your estrogen is increasing, and then it peaks at ovulation, and then after that time frame, um, what essentially happens is the funky little corpus luteum lingers around, and then that's basically what keeps progesterone alive and kicking in your luteal phase, and then it increases and then shut suddenly drops. So you've got these two different hormones that are dominant in those different cycles, and then they have an impact on your neurotransmitters, specifically serotonin and dopamine. They're the two things that are sort of effectively at play. So in the luteal phase of the cycle, with progesterone being dominant, it effectively modulates at dopamine and serotonin. So people with ADHD tend to notice that their symptoms increase in that time frame.

SPEAKER_07 11:06

Yes, I want to touch on this later as well. Yeah, it's so interesting.

SPEAKER_03 11:09

And serotonin is decreased as well. So that fundamentally is what impacts at a baseline level people with PMDD. So everyone in a normal sort of like PMS cycle will, as a result of progesterone and this funky little metabolite of progesterone called allopreganolone, which I think just sounds like a busta. It does sound like a progress.

SPEAKER_07 11:42

Yeah, it does.

SPEAKER_03 11:42

So I just call it aloe.

SPEAKER_07 11:44

Okay, love. Aloe. Yeah.

SPEAKER_03 11:45

So progesterone has this funky little metabolite called aloe, and and what that fundamentally does is it it's called a PAM.

SPEAKER_07 11:53

Ooh.

SPEAKER_03 11:54

So it's a positive allosteric modulator.

SPEAKER_07 11:57

I'm thinking of Parmigiana. I was thinking of PAM shirt that I'm wearing right now. But there we go.

SPEAKER_03 12:03

So aloe positive is a positive allosteric modulator of the GABA A receptor. But basically, what that means is it goes on up to your brain and then says, hey, open up this channel and then GABA flows in. Okay. To give you an example of what another GABA is, sorry, another PAM is alcohol and benzos. True. So if you think when you drink booths or when you have a benzo, you're pretty chill and relaxed. Because it basically stimulates the exact same receptor. Okay. So that's what should happen ordinarily in that stage of your cycle.

SPEAKER_04 12:35

Okay.

SPEAKER_03 12:36

But people with PMDD have an altered response to that particular stage of the cycle.

SPEAKER_07 12:42

Because this is a common misconception where like it's not actually an imbalance of hormones, it's the the body reacting to those hormones. Is that correct?

SPEAKER_03 12:49

Yes. Yeah, exactly right. So instead of being chill and relaxed and, you know, just a little bit sedated, so to speak, which is the normal response that should happen, you're irritable and agitated, and you know, want to pull your hair out and starting fights with people, and you can't concentrate and you want to quit your job, or you're perceiving a neutral response as threat, uh paranoid in different sort of spaces. I guess the easiest way to explain is it's like being hyper-vigilant. Yeah. Because fundamentally that's sort of what my research found when I did my masters, was basically it ends up being like a trauma response stage. So you end up every single month.

SPEAKER_07 13:32

Yeah. Well, every single time. That's wild.

SPEAKER_03 13:34

Yeah, yeah. That's wild.

SPEAKER_07 13:36

And um, so like you know how sometimes with like Fernergan? Like Fernergan's meant to be like a sedative, but like then there's like small part of the population where it does the opposite effect. Like my friend gave it to her child on a flight or something, and it like she just went nuts, like you know, is like it had the opposite effect of what it intended. Is that kind of like what's happening with people with PMDD, where like this is it's meant to cause a sedative effect, but for people in PMDD it it does the opposite and makes them more agitated, irritable.

SPEAKER_03 14:05

Yeah, so the interesting thing about the response, and this is kind of where it gets quite complicated, and why educating people on what causes or sort of what is the most likely cause of PMDD is the most important thing. Because when you understand the why, then you understand why certain treatments work.

SPEAKER_07 14:25

Okay.

SPEAKER_03 14:26

And so what my research found when I was completing my dissertation was that PMDD, and this is emerging research, is also supporting this, thankfully, as well, which is great, is that it's as a result of chronic stress and trauma.

SPEAKER_04 14:40

Okay.

SPEAKER_03 14:40

And so basically when you're under a lot of stress or you're going through like a trauma, your body actually releases aloe to help you to regulate.

SPEAKER_07 14:53

At any time.

SPEAKER_03 14:54

Yeah, this happens to everyone. And so when you are going through that particular stage of your cycle, basically as a result of the way that I would explain it to people, it's a bit like if someone drinks alcohol all the time, like d they're an alcoholic, after a while, the impact or the effect of that particular sort of like the the PAM, because it is a PAM, just no longer has the same effect. So it's becomes blunted. And so what actually leads to the blunting is that chronic stress and trauma decreases a couple of other key neurotransmitters, which is all quite boring and like quite technical, but it's GABA.

SPEAKER_01 15:34

Not for us.

SPEAKER_02 15:36

This is a very highbrow production.

SPEAKER_01 15:38

Very highbrow. I can tell. I'm really feeling it.

SPEAKER_02 15:42

We're drinking wine out of mugs.

SPEAKER_01 15:44

We are. We've put a pen. Positive allisteric modulator.

SPEAKER_07 15:50

We've got a bowl of chips, so you know. Yeah. It's all happening.

SPEAKER_03 15:53

Fundamentally. Where was I?

SPEAKER_07 15:56

Um, so when someone drinks alcohol, it's blunted.

SPEAKER_03 15:59

So yeah, so basically, if you have lived a really stressful life, and this is an interesting thing, most people tend to get diagnosed usually in their 30s. Right. So if you imagine a person who has had a whole lifetime of like chronic stress and trauma, CPTSD is very common as a co-occurring uh condition that occurs. And so um, if you have been in a hyper-vigilant state for whatever reason for a really long time, your body kind of like wears out.

SPEAKER_07 16:31

Yeah.

SPEAKER_03 16:32

And so allosteric load, it's usually quite a familiar thing in relation to like, say, the heart and things like that. But basically, your body just it it gets worn out, and that's basically what happens because it's the chronic activation of the HPA axis. So basically, your body is just so stressed out and it's releasing all of this aloe, and then it goes up to your brain to calm you down, and then through all of this chronic activation, it basically stops working. But then in addition to that, chronic stress and trauma decreases GABA. And so a PAM only works when GABA's there.

SPEAKER_07 17:08

Yeah, okay.

SPEAKER_03 17:08

And if we don't have enough GABA, then the PAMs don't work. So people with PMDD are often found to alcohol doesn't work as well for them. Okay. Benzos don't work for them.

SPEAKER_06 17:17

True.

SPEAKER_03 17:18

And so myself, I can't benzos don't work on me. They just don't. And boom, I can drink and drink and drink, and it just doesn't really work. So like it's it's this.

SPEAKER_02 17:27

You mean the sedative effect? Yeah. Yeah, okay. Yeah, yeah.

SPEAKER_03 17:30

So that kind of response that typically should occur doesn't occur, and that studies have shown that as well. And so I think that that's a a key kind of difference as well, is to be like, well, if you've got this chronic stress and trauma and there's not as much GABA floating around, and then when you look at it from that perspective, that's kind of where the treatments, like the ones that work, they're the ones that become sort of clinically significant, is helping you to identify that.

SPEAKER_07 17:57

Okay, so rather than like an an adverse reaction to it, it's more just like uh a life of maybe that's been quite stressful has has yeah, has has caused some blunting.

SPEAKER_03 18:08

Yeah.

SPEAKER_07 18:09

Yeah. Wow, okay, God, it is really complex, isn't it? There's lots there.

SPEAKER_03 18:13

Yeah, and so that's why, as I was saying earlier, it's sometimes quite hard to explain. And so it's not just necessarily one silver bullet. And when you're going through that sort of cycle every month and it's really distressing, yeah. It's even trying to wrap your head around that when you've got brain fog and you can't concentrate as well. And rational thought goes out the window. Yeah, and you're just hyper-vigilant as well in those time frames. It's the the key is helping people to kind of understand that.

SPEAKER_00 18:44

So yeah.

SPEAKER_02 18:45

I also quite liked how you um you both mentioned that it isn't just the hormones, right? Because I think that's a m a common misconception, is that particularly amongst peers or other people experiencing the same symptoms, it's like, well, we all have the same hormones. Right. Why are you responding differently to me? But you've clearly identified that it's a very complex set of neurotransmitters and susceptibilities to things and chronic trauma, all this sort of stuff. So you certainly can't compare your experience to others in that way as well. And it's not just hormones.

SPEAKER_07 19:16

Exactly. Is that right? Yeah, absolutely. Yeah. And I think it helps because like there's so much shame, I think you know, surrounding it. And for like so many people are like, oh, it's just just your hormones. But it's like, yes, it it is hormone.

SPEAKER_02 19:32

Like I think it's just like I think it's just like diminishing um uh an experience that is universal for everyone who has a period, right? Like everybody has everybody menstruates who sorry, not everyone menstruates, clearly. Those who menstruate will have similar experiences to everyone around them, but like the um the way that we respond to that menstrual cycle is is very, very different. Yeah. So it's not just a simp it is like a hormonal regulation and HPI access that you mentioned, but it's just not that.

SPEAKER_07 20:04

It's like we said before, like pain or you know, like how yeah, we all experience things differently.

SPEAKER_03 20:09

Going back to the first question of how would I describe it if I was to be professional. Rather than we don't do that here. Well, it the it kind of gives it a better so I I termed it a psychoneuroendocrine disorder.

SPEAKER_07 20:22

Okay. Psychoneuroendocrine disorder.

SPEAKER_03 20:25

Sort of is a better like umbrella d descriptor of it because it's psychological, it's a neurological, and it's an endocrine, like it's all of those things. It's multi-system, yeah. So there's no one size. Yeah, one size fits all. One size? One solution.

SPEAKER_02 20:42

One cause. And so it definitely uh sorry, I'm so burnt out.

SPEAKER_07 20:48

Yeah. Um no, that's really helpful. Like, yeah, it's really helpful to break that down. So thank you. Um which and I mean you touched on this, and we're saying touch, we're just we're saying it. Um I like touching. I know you do. I know. I get we've yeah, we've spoken about the causes. Um, and I guess I you we you already sort of described this, the role of the role of a aloe. Um and I know there's you spoke about the a lot of like trauma history also linking with PMDD. Is there also like a genetic factor?

SPEAKER_03 21:22

Um look, there has been some research to indicate that yes, there are uh like some genetic implications, however like trauma can be something that's passed down. Epigenetic is right. From an epigenetic perspective. And so I think the thing to maybe factor in is that chronic stress and trauma does alter your genes. So when I was doing my research, there was you know that scene in did you ever watch It's Always Sunny in Philadelphia? Yes, but I don't think enough to you know Charlie, like when it's like really manic and excitable. There's all of these like pictures. Oh, a classic meme. Yeah, yeah. Yeah, that literally that one with all of the bits of stream that are kind of going up there and connecting everything.

SPEAKER_07 22:15

Are pretty sure he's smoking a ciggy? Yes.

SPEAKER_03 22:17

That was me doing my dissertation with like chronic stress and trauma, and I'm blinking everything. And I was like, right, so chronic stress impact you know impacts serotonin and it impacts GABA and it impacts all of these sorts of things and it impacts your genes. And that's what all of these this research is saying. But ultimately, it it the source is all of that. And so that, regardless of whether or not the genes were altered from an epigenetic perspective, or they were altered as a result of your life, environment, experiences, yeah, like they're they're all at play. But it's it's not you couldn't blame your family. But I guess if you know your mother has it, you might be more likely to have it, you know, because you could have gone through the same traumas.

SPEAKER_02 23:03

Or the epigenetics.

SPEAKER_03 23:04

Yeah. But also intergenerational trauma as well. And um, you think about gosh, like a lot of the studies that I saw interestingly were done on populations that I would say politically underwent quite a lot of trauma. And the only time that I saw younger people, um, like sort of like young teens have the disorder, um, was interestingly in elite athletes that were Russian. And so if you think about like, so the studies were done on Russian populations, but if you think about sort of um the pressures put on like internationally competing athletes from from a young age to like perform and to to train, and like that's not a happy, chill childhood. So like the the the the chronic stress element meant that then that appeared clinically sooner than was ordinary in like the ordinary population, which is usually around 30. And so interesting on the basis of all of that kind of deduced, oh, it it like when you've got that much stress, then it can appear sooner.

SPEAKER_07 24:10

So it's so interesting. Yeah. Yeah.

SPEAKER_03 24:13

Yeah.

SPEAKER_07 24:14

Yeah, that makes it really evident, doesn't it? But it's like wow, this is yeah. So it was younger younger teens in sport Russian teens, was that what you were saying?

SPEAKER_03 24:23

Yeah, so just I'm not saying it Russian teens get it.

SPEAKER_01 24:27

Sorry to everyone in Russian listening.

SPEAKER_03 24:34

Yeah, it's a dollar. And so people from lots of other different nations as well, but yeah, okay.

SPEAKER_07 24:48

Okay, so in order to diagnose PMTD, what is the criteria and what are some of the main symptoms that we've got? Well then tick tick tick.

SPEAKER_03 25:01

Yeah, kill people and quit your job and break up with people and Yeah, I used to imagine smashing people's heads up against a brick wall and it exploding and getting a lot of pleasure from it.

SPEAKER_07 25:13

Okay, wow. Yeah, yeah. And it's not just like sorry, DBA again, but it's not again, it's not just like the the few days before your period, is it? This can last for like two weeks.

SPEAKER_03 25:23

Yeah, but if someone has a longer lutil phase, it can last for all of that time frame. And for some people it even lasts for the time that they're bleeding as well. So yeah.

SPEAKER_07 25:31

And it's so much of your life. It's so much of your life. It's half of it. Gosh.

SPEAKER_03 25:34

It is half of it. Switching. Yeah. So uh you know, smashing heads up against a brick wall is not in the DSM 5. Okay, that's a shot. What let's have a little look at what is, shall we? Please. Yes, so we've got marked mood swings, affective lability, irritability, or anger, or interpersonal conflict, uh, depressed mood, and anxiety. So they're the core emotional symptoms that we need to have. And then we've got secondary to that, we've got to have loss of interest, uh, difficulty concentrating, fatigue, appetite changes, hyper, uh, or insomnia, uh, feeling overwhelmed, um, and the physical symptoms, which uh really, in the whole scheme of things, are really quite redundant in in the whole scheme of all of the other things.

SPEAKER_07 26:20

Because PMDD doesn't mean that doesn't necessarily well doesn't mean heavy, painful periods, right? I think that's a very common misconception again, that like it's it's yeah, much more to do with all these other symptoms that you're mentioning in terms of emotional as well.

SPEAKER_03 26:32

Yeah, yeah, absolutely. So th those those fundamentally the majority of those need to be there. And essentially the way that it's diagnosed is that it pretty much starts around about all these feelings and emotions and symptoms tend to start emerging after ovulation. The key difference is that they that they end at menstruation, okay, or sort of when you're entering the follicular phase. So, from a perspective of how it feels, it genuinely feels like a dark cloud. And the weirdest, craziest thing that happens is as soon as you start bleeding, it's like a relationship. No, but it's like all of those feelings are gone. What do you mean? I don't want to kill anyone. What do you mean the sounds aren't incredibly loud? And someone chewing, I don't want to smash their head up against the wall, or the checkout chick at Kohl's, or that child that's crying in the restaurant next to me, I don't want to strangle them, or someone just simply asking something of me, or anyone needing anything of me. I don't want to like be homicidal anymore.

SPEAKER_07 27:38

So the significance of when that bleed starts and that that relief, that that's what is the difference between PMDD and an actual homicidal maniac, I guess, who feels that the way all the time. Yeah. That's so interesting. And like how like difficult living, experiencing that all in one month, not like yourself, and then I can imagine, I don't know, I can't speak, but I can imagine almost be like, who was that guy? And like you remember, yeah, was it real? And you kind of forget, and then it happens again, and then you're reminded, and then you forget.

SPEAKER_03 28:12

Is that yeah, and so what's really common for a lot of people is this uh like shame cycle that occurs. And so you'll be oh gosh, I remember we years ago, and then thankfully, because of lots of tracking and learning and knowing myself, uh, in a five-year relationship, every single day, because I've been tracking for years, every single sorry, every single cycle on day 22, we would have the worst arguments. Wow consistently, as is also for consistently day 24 and 25, I would experience thoughts of suicide consistently, every single time, every single month, I knew that that was gonna happen. So, like the impact and but also the predictability of that, yes, yes, of knowing, oh, we're just on day 22 and that's why I'm being argumentative or really nitpicking.

SPEAKER_07 29:03

So, this is the importance of tracking, yeah, yeah, absolutely.

SPEAKER_03 29:06

And you know, but it also sort of reduces the impact or the power of it. So instead of like I'm you know, I I'm I'm irritable, it's like I'm noticing I'm feeling irritable. Or what day of my cycle am I on, for example? Oh, I'm actually just not going to react to that.

SPEAKER_07 29:22

It just separates you.

SPEAKER_03 29:23

Yeah, just it helps give that bit of distance, and I think just gives it less power fundamentally.

SPEAKER_07 29:29

Fully, no, that makes sense. That makes sense.

SPEAKER_03 29:32

I think it's maybe worth mentioning from a diagnostic perspective as well. The reason why it's so important is PMDD really only does affect five to eight percent of the population. And so I recently had a patient come through to me, and I pretty much for all of my patients I get them to track their cycles, regardless of why they're coming to me. The majority of people I work with are assigned female at birth. So I just get them to track because your your emotions are affected if you're cycling anyway. And so if we can map it and understand you better, which is very much what I promote, then let's just do it. This particular person we discovered that, you know, they feel anxious in their follicular phase, and then they also have, you know, these other points around when they're um ovulating as well, and they've got a history of say anxiety and depression. And so in this particular instance for this person, they wouldn't be diagnosed as having PMDD, it would be what would be classified as premenstrual exacerbation.

SPEAKER_00 30:32

Okay.

SPEAKER_03 30:33

So if from a foundational perspective you have uh pre-existing depression or anxiety, or you know, say complex PTSD or BPD or even autism, for example, but then in this luteal phase, your symptoms are exacerbated.

SPEAKER_07 30:51

Okay.

SPEAKER_03 30:51

It's not that you have PMDD, it's an exacerbation of a f like what already exists. It's just you're more heightened and sensitive in those time frames. So from a clinical perspective, treating someone with standalone PMDD is very different from treating someone that has depression and anxiety that is already existing, or autism or ADHD, or any of those things, then what you would do is just straight up PMDD. So it it changes what the diagnosis is, what the treatment is, but it's also the reason why people have been misdiagnosed. I get it. Which is really common.

SPEAKER_07 31:32

So it's so that's why it's so important to like it as you said, it's not just a civil bill, it's not just a a diagnosis. It's so important to get the whole picture over the span of, yeah, of obviously multiple cycles. Um to then, you know, is it PMS, is it like just exacerbation of that, or then is it PMDD? Because that will then affect how like anything, how you manage to treat it. Is that what you're saying? Yeah, absolutely.

SPEAKER_03 31:57

And I think making the jobs of physicians easier is is is is better for you and it's better for them.

SPEAKER_07 32:05

Okay, let's talk about it. Sorry. Yeah. Because let's do it. Because and I mean I'm guilty until I started working in sexual health, though. I admit that I would probably be the one to go to a clinician or a doctor and um not really know much about my body or what's going on, you know, until I started studying sexual health.

SPEAKER_03 32:24

Let's talk about it.

SPEAKER_07 32:25

Let's talk about it. And it's just so it's it changes the whole consult, you know, when you have someone that presents to you and is and knows their body and knows what's normal, knows what's normal, and is able to tell you because unfortunately we need specifics. Like when it comes to tracking and when it comes to bleeding or symptoms, abnormal bleeding, we need to know. And it's so helpful when because it sounds like we're being really annoying, you know, what day specifically, how much blood specifically, you know, like we but we need to know. So it's so helpful when you have someone that comes to you that does track their cycle, does know what's normal, does know what's not normal, they can just tell you like boom, boom, boom, this has been happening. It it speeds up the process, it does.

SPEAKER_03 33:08

It does absolutely yeah, and it's the difference between getting the right and the wrong medication, or you might not even need medication at all. You might take a gentler approach, you know, or let's try these options first because this sh, you know, it's clinically showing that this is the case for you, this is the research that supports that, so let's go in with the least sort of invasive or uh like impactful treatment plan, like first of all.

SPEAKER_02 33:32

I do wonder, like I certainly have patients that come to me after a period of time and they look at me really confused, like, why are you asking me all of these questions? And they say, Oh, no one's ever asked these before. And I do wonder if there's a degree of dismissal over time, um, mistrust with clinicians and things like that. And then they they come to you like, Why are you this is weird? I've never had to like literally be accosted with all these specific questions. And you're like, well, actually, it's like really important, and if you want to make the right diagnosis, um we're not magicians, so yeah.

SPEAKER_07 34:04

It does feel like we're being a bit invasive and asking all these questions if they haven't been asked before.

SPEAKER_03 34:08

Um When I finished my dissertation and my master's was 2022. Yeah. So that's totally. It is sexy. However, I'm really turned on at the time. Sorry, I've become a dissertation. Can you do the rest of my assembly? I was the o at the time, I was the only person in Australia that had researched PMDD.

SPEAKER_07 34:31

Oh my gosh.

SPEAKER_03 34:32

There was not a single person that had done it. In classic ADHD form, also, because I'm the first person in my family to go to uni and get a master's, of course, because no one had been to uni, so they didn't, of course, get a master's. And silly ADHD, you think the job's bigger than what it actually is? And I was just a bit silly, and I didn't necessarily have the most supportive person. So I thought, oh, I'm gonna do this thing because I've got the condition to I'll research it, I'll do qualitative research on this thing.

SPEAKER_01 34:56

Oh my gosh. And then it wasn't until I phoned up, I was crying, the chronic stress and trauma of the research of this thing, because I'm teaching myself these psychoneuroendocrine like systems and processes. I'm like, oh my god.

SPEAKER_07 35:08

While traumatising yourself when you're learning about the trauma.

SPEAKER_01 35:11

The systems were through the roof. It was the worst. My my person who I was with at the time really had a hard time of it. It was not fun. We ended up breaking up. I'm not surprised.

SPEAKER_03 35:22

But anyway, basically they were like, what you're doing is actually a PhD, not not a master's. It's generally a master. True, of course. Yeah, because it was it hadn't been done.

SPEAKER_07 35:32

I've been telling well, yeah, okay, good. I'm glad because I've been telling everyone that you've done your PhD in in I'm P and D, sorry. So you pretty much did.

SPEAKER_03 35:40

Yeah, but the the point I'm making of that is that was 2022.

SPEAKER_07 35:44

Yes.

SPEAKER_03 35:46

No one had done any research in Australia. So when people say to you, so that was 2022, it's 2026 now, that was four years ago. Yes, a lot of people know a lot about it now, but do you know why they know a lot about it? Social media. Yes, absolutely. That's why people know a lot about it. That's the only reason why it's a lot of people. So 2022, no one had No, but bearing in mind, it only entered the DSM 5 in 2013. So that is not, and that that's only that amount of research. And the only reason why they even researched it in the first place. No, this is the kick it for me, right? Does it know? It does. Oh, okay. A man called Eli Lilly, actually. But basically, what it is is that it's a beautiful name. Damn it. It is a beautiful name. But basically, this is one of the things that I found really interesting.

SPEAKER_02 36:37

Is it weird to be turned on by that as well?

SPEAKER_03 36:39

Eli Lilly. It is, it is close to America. It's actually very close to her. But basically, it it's because it became profitable. So they had an incentive to research it. And so the reason why all of this research began is because if you know anything about the DSM five, you don't even have to include this part, but it's actually really interesting. And so it appeared in the DSM four in the appendix.

SPEAKER_00 37:04

Okay.

SPEAKER_03 37:05

And so what happens is, you know, clinicians or physicians will be like, so we're getting these presentations of these people kind of coming through saying this stuff. And so then they just let the DS, like the APA, like know that this is kind of what's happening. And so they just flag it as something that is occurring, basically.

SPEAKER_07 37:22

We're not sure what this is, yeah.

SPEAKER_03 37:23

We're not sure what this is, but like we're actually getting these clinical presentations. Yeah, so enough of them were getting it.

SPEAKER_07 37:29

Okay.

SPEAKER_03 37:29

So it appears in the appendix of the of the DSM, and then what happens is around about that time. Fluoxetine. I was just gonna say, is it fluxetine? Was about the patent was just about to expire. Oh my god. You're kidding. What they did, do you know what they did? They had a bunch of little backdoor meetings with the FDA, and it was the first ever drug in the world ever to be approved for a condition that actually didn't exist yet in the DSM. You're kidding.

SPEAKER_07 38:01

Those lying bastards at Johnson and Johnson.

SPEAKER_01 38:06

Are you actually me?

SPEAKER_07 38:07

Oh no, no, that was just a that was a joke. It was just a joke. It was actually a quote, you know, like we'll put no more tears on the label, but it does make you cry. There's lying bastards of Johnson and Johnson. No.

SPEAKER_02 38:21

No, no, it's fine. Anyway, family guy, so it wasn't. Yeah, cool. Okay.

SPEAKER_03 38:24

Um but basically they did a bunch of research and then it got approved, and all of these people were going, well like basically produced a heap of body of research to say that it worked. And uh annoyingly, out of all of my research, annoyingly, the thing that annoyed me more than anything is that the silver bullet is actually to target serotonin. And so annoyingly, those profit-making mother truckers were right. But what they did, because American healthcare system is they packaged it, and you know how they're allowed to like market it? Yeah. So like they had all these ads, are you feeling cranky? Are you feeling this? And it's like this pink and go see your doctor about blah blah blah blah blah. And then sales went through the roof, and they made a bunch of money off of all of these women that were having all of these symptoms, and then produced all of this research, which annoyingly you know, was like actually right. However, there was also some other research that vitamin B6, because it's required for like neurotransmitter conversion, and also like calcium because of like neuronal excitability and a bunch of other different things. So it became the gold standard.

SPEAKER_07 39:40

Damn it, damn it. But there's so much more than that. But there's more kind of it, yeah.

SPEAKER_03 39:45

Yeah.

SPEAKER_07 39:45

So that is so Yeah, frustrating.

SPEAKER_03 39:49

Yeah, so I have I've it was really a thing I couldn't like I I was so annoyed by it when I was doing my dissertation.

SPEAKER_07 39:55

I really want to write about this, but I can't, so I love foxatine, you know, more than you know, it's thank God. But that is that is frustrating that and once again it came down to that, down down to marketing and profiting. Sometimes that's so frustrating.

SPEAKER_03 40:08

But then to get the FDA to say that this is the most effective treatment so that then all physicians fundamentally prescribe it so that then and then they market it towards women, making them feel crazy, which is ridiculous seeing of like considering the history with like medical sex. Yeah, it's suffer from hysteria. Yeah.

SPEAKER_07 40:27

Well, yes, I had a little timeline here that I was looking at c like of how PMDD came to be. And you you've you've mentioned it there, but firstly in the 1800s it was called Mency's Moodiness, apparently. Oh Yeah. And then 1930s they called it premenstrual tension. And then in 1953 was PMS. And then it wasn't till the late 80s, and I I this could be I could be wrong here, that they then started looking at PMS versus PMDD. What is that?

SPEAKER_03 41:01

Yeah, no, it's around about right, but I think it was in the DSM III, it was in Mara's late luteal phase disorder. So like it was sort of the last week that um the symptoms were presenting. And so that was yeah, DSM three and then DSM four with premenstrual dysphoric disorder and then and then went into the side.

SPEAKER_02 41:18

Just to clarify, the DSM is I don't think we've mentioned. No, no, no, no, that's fine. It's just the it's essentially the manual we use to diagnose psychiatric conditions. And the three, four, five is just the volumes at which they are re-evaluated existed before. So we are using a set of diagnostic criteria that is evidence-based and that keeps getting re-evaluated. So that's what we're referring to when we say DSM, just to be clear. Yeah, yeah.

SPEAKER_07 41:46

And it is important, obviously, and and we've spoken about it like obviously medic medication and having the diagnostic criteria criteria is important as well as all the other things that you have spoken about, Kendall, like you know, vitamins and supplements, which is something so interesting. And because I like love my vitamins and supplements as well, you know, and I obviously I know that you know there's not not a lot of evidence for a lot of things, but I might even if it's placebo, sometimes I might, it's doing its thing, you know, like it's doing its thing.

SPEAKER_03 42:15

There is quite a lot of evidence though to support some things, and even in um like gold standard treatment options, one of the things that was interesting when I was reviewing the data was like there's the American um treatment options, so like uh, you know, like the College of Gynecologists and things like that, and then the British. Interestingly, people from Swiss, like the Swiss um uh diagnostic, uh sorry, like treatment uh and management guidelines were the most holistic. And so they actually included like endocrinologists, psychologists, um naturopaths, um, like everyone that actually is involved in the whole process. And so their their guidelines were much less biased. Yes. And so whereas the US ones, it was like straight for SSRIs, there was no sort of mention of say potentially like vitamin B6, which is there's quite a lot of research around that to be uh like effective, um, and yeah, a bunch of other different things as well.

SPEAKER_07 43:15

So and I mean that's awesome, that's awesome. But and I guess like not that I understand why, but I imagine I know why, I guess, where like there's so many areas like nutrition, sleep, all that, and then like in and maybe Charmani, you can answer this, in like studying medicine, how much of how many hours have you studied medicine? Whatever however many years you studied medicine, how much was dedicated to like nutrition or holistic health, do you think?

SPEAKER_02 43:43

Well, holistic health different, I think as a GP very heavily focused holistic medicine. True, true. Okay, go back to the same. But I guess in yeah, in nutrition, very little. Yeah. Very, very, very little. Yeah, yeah. Um certainly not something that we cover in detail. Maybe a lecture.

SPEAKER_07 44:01

So like it's like it's no wonder these people go, okay, because you know, SSRI medication, like that's what you were trained, and that's is helpful, but like it's so important to to gather all the information.

SPEAKER_02 44:12

Yeah, and I think it's also like again with during med school, like you know, we have to learn lots of different things. But I think like as a GP, I guess as a GP, I guess um like we rely very heavily on our allied health, you know. We're we're a team still, even though we are kind of physically segregated, we're still a multidisciplinary team. So whilst I think we certainly develop basic skills in nutrition, we I certainly utilise nutritionists and dietitians a lot because they and I'll sit quite happily say that's not my area of expertise. Um so yeah, just utilising you know external sources is is really important.

SPEAKER_03 44:48

Aaron Powell I often as well educate people and I explain to them. Just be because I something I think I've I noticed quite a bit clinically and just even from working in ED and things like that, people just have very high expectations of physicians and they're like, Well, you're a doctor, you should know. Yeah.

SPEAKER_02 45:03

Which is where the line of questioning thing I was sort of bringing up before is that sometimes I ask all these questions and then they say, Well, you're the doctor, don't you know? Like I'm not a magician, bro. Like you know, my head, I'm like, I actually need the information to synthesize. And my my job is a is to problem solve with information, not to know everything. I think it's really tricky.

SPEAKER_07 45:22

Yeah, like help me to help you.

SPEAKER_02 45:23

Yeah, yeah. Help me to help you. Totally.

SPEAKER_03 45:25

And so if you go to a uh a physician, say you go to your GP and you're like, I'm feeling this kind of way. And say, for example, if they've never heard of this, or you know, medical misogyny is well researched, well known, well documented. If you think there's a condition that has only just in the last, you know, 12 or so years become very well known, there isn't a huge body of evidence to support it. And this is also what I say to people your GP will say to you, these are the treatment options. At the end of the day, if there is not enough evidence to support something, a good GP will not recommend it. However, they will say to you, look, there is emerging research of this. However, because it isn't there is not enough, because all of us, we're all registered. Yeah. We have all agreed to practice evidence based on evidence-based research, which is why the evidence, and that's why we do research, and that's why we study it. And so it's got to be rigorous and peer-reviewed because you're not just saying yes to things with yes, it can be.

SPEAKER_07 46:29

Some of us do more research than others.

SPEAKER_01 46:33

I mean, yeah. It's kind of hard.

SPEAKER_02 46:42

I certainly also say, like, instead of you know, I tend to take a more strength-based approach. I don't say, oh, there's no evidence. I say, well, that we actually don't know yet. Or we don't know because we haven't done the research. And so I think it just opens up the space a little bit for conversation. It's that I can't recommend because I don't have the evidence for it. But I'm not going to sit here and say there isn't any because we just haven't done the research rather than be dismissive, I guess.

SPEAKER_07 47:04

Well, that's the thing, though, it's so fair. Like if someone were to say that to me, that's so fair. You know, um, as you say, I think that's the key rather than being dismissive, just being honest and not being like, yeah, it's not the evidence. But yeah, that there, that's the important thing, I guess.

SPEAKER_03 47:19

I I think that kind of also just goes into just recognizing that who you go to is going to determine what you're going to be diagnosed. And bearing in mind, as we mentioned about the DSM V or just the diagnostic and statistical manual, it is still up for interpretation. And the existence of the manual is still biased. Like there was being queer used to be in there, but it's not anymore. So it is dependent on like your time. Just like your time.

SPEAKER_07 47:43

It used to be in the DSM for PM NDD. No, no, no, just in general. Yes.

SPEAKER_03 47:49

Like, oh, you're homosexual. Oh, you must be sick. And so the sweet. I was like, wait, what? I'm sick. I'm I'm gay today. I mean, I'm feeling gay today.

SPEAKER_00 48:03

Feeling a bit gay today.

SPEAKER_03 48:05

Just that buggery. Buggery in the literal sense of being.

SPEAKER_07 48:20

Okay, so yeah, this has all been so so interesting. I guess I want to just circle back again to treatment options and management options, okay, because obviously it's something that is is individualized and holistic. So we know that there are medical treatment options, yeah, that we see. So, which is what you've spoken about, which is you know, SSRIs, flu floxetine, and I believe also um like the the oral contraceptive pill. Is that also used? Yeah.

SPEAKER_03 48:51

Standalone treatment and management is gonna be a couple of different things. So we're either going to target um serotonin or we're going to target hormones.

SPEAKER_07 49:00

Okay.

SPEAKER_03 49:00

And so what we're basically going to do is we're going to either target the neurotransmitter, which is a little bit of a silver bullet, that is going to make that particular luteal phase tolerable.

SPEAKER_06 49:11

Okay.

SPEAKER_03 49:11

And so we're going to increase the available serotonin around to basically give you some padding to make that particular time frame like you can function, basically. So progesterone decreases your serotonin, so we're going to give you more serotonin.

SPEAKER_07 49:24

Makes sense.

SPEAKER_03 49:25

It does.

SPEAKER_07 49:26

Is that like an SSRI that would be prescribed every day, or do people just go on it during their luteal phase?

SPEAKER_03 49:31

The interesting thing about PMDD, which I think is really cool, is that you can literally take it as PRN. So that means as and when required. So you could either use it just in your luteal phase, you could use it just on the days that are challenging, which I actually have done and it works if I'm feeling a little bit like like ropey. Um, or you can take it all of the time. Like it's the evidence actually supports the other.

SPEAKER_07 49:51

Is that because fluxetine has a longer half-life? No.

SPEAKER_03 49:56

No, it's just because it increases the available serotonin. And so most of the research is done based on major depression.

SPEAKER_02 50:02

And so is most of the research on fluxetine or is any SSRI appropriate?

SPEAKER_03 50:07

Now actually the gold standard is sertraline. So at the end of the day, it's yeah, uh an SSRI. But if someone, say, for example, has a background of ADHD, um, an SNRI might also be effective for that particular person. So there's evidence for that as well. But an SNRI, you would need to take all of the time. You can't just take that, you know, in in the luteal face. So it's just good if someone doesn't want to take them all of the time. And because some people are quite hesitant to take SSRIs because of yeah, like um side effects and things like that, which is totally fair. So just knowing that you can just, you know, try things out and see what it's like.

SPEAKER_07 50:43

It also kind of makes sense for someone who feels like a completely different person for two for two halves of their cycle. It's like, I need it for this half, you know. I I I don't necessarily need it for this half. So it kind of makes sense for them to be like, I just need to manage this during the time it needs to be managed, I guess.

SPEAKER_03 50:59

So targeting serotonin from a neurotransmitter perspective or targeting ovulation and then controlling the hormonal. So if we're not having progesterone increase and then decrease our serotonin and dopamine, then we're not dealing with those reactions to aloe.

SPEAKER_07 51:16

So if we're not having ovulation, we're not having that. Yeah.

SPEAKER_03 51:18

So basically targeting that, then that works. So but alternatively, there's you know, other options you can start with, you know, say vitamin B6, for example, or um calcium supplementation. And so generally people will do like a staged approach to go, look, try this first, see what happens. Try these things, see what happens. And so making sure that you're going to someone that understands the condition and can trial things with you and work alongside you, that's really, really effective.

SPEAKER_07 51:45

Yeah, so it's it's almost tiered, as individualized and tiered. Let's do this and then failing that, this, and then failing that, this background. Yeah, fundamentally.

SPEAKER_03 51:53

The most important thing though is to, in addition to medication, is to uh genuinely approach it holistically. So if we go back to sort of the start, uh chronic stress and trauma is predominantly the cause. So if someone is like we're basically needing to, in a way, learn how to heal the impacts of chronic stress and trauma. Recently was reading a book on complex PTSD, and one of the ways that's really effective and evidenced by also with PMDD is exercise. So strength conditioning. The reason why that works is because when you exercise, it produces BDNF, which is brain-derived neurotropic factor, which basically helps new neural pathways to form in your brain. There's not many other things that do that. Um, and so that's why exercise is really, really important. Um, getting enough protein. So protein has tryptophan in it, tryptophan's the precursor to serotonin. Serotonin keeps your brain nice and happy. And so if you're not eating enough in that time frame because you're feeling depressed, don't think of tryptophan or or eating as something that you have to do. Literally think of it as medicine. If you're not so if you're don't really react so well to SSRIs, which I didn't, I will say to my patients, exercise and going to the gym four times a week and lifting weights and eating enough food. This isn't a lifestyle thing. It's not for you to look fabulous, it's so you can protect your brain and so you can feel better.

SPEAKER_02 53:17

This is for any mental health condition. It is, absolutely. Yeah, absolutely.

SPEAKER_03 53:21

Hundreds of things. The evidence is so strong. Yeah, so so strong. The difference in myself when I exercise four times a week.

SPEAKER_07 53:30

Does it have to be specifically strength training?

SPEAKER_03 53:33

Look, you need the muscle. Yeah, okay. You know, so like you could do Pilates and walking and things like that, but doing something that also you're you're intentionally like increasing your cortisol levels and you're teaching your body that it actually can be okay in stress.

SPEAKER_07 53:53

Right.

SPEAKER_03 53:53

And so like it increases so it's learning in very controlled conditions to teach your body that it can experience highs and lows and recover. And so when you're doing it's oftentimes the reason why, especially when you've got complex trauma, uh doing the same exercises in the same place, like you're basically like reparenting yourself and teaching yourself safety.

SPEAKER_04 54:18

Yeah.

SPEAKER_03 54:19

And so if you've got ADHD, you like to like have different exercises and things like that. Like my partner, for example, loves different exercises all the time. I'm like, no, I just want to do the same thing all the time because there's safety and predictability, and so that's what you're fundamentally teaching your brain and and your body that you can deal with these highs and lows and that you're going to be okay, as well as all of the like protective elements that exist with like endorphins and etc. etc. So the difference in myself with training four times a week compared to like not at all is astronomical.

SPEAKER_05 54:51

Yeah, okay.

SPEAKER_03 54:52

I am a totally different human being. And getting enough sleep and eating enough food, um, if you're drinking too much uh coffee, that decreases GABA, as does alcohol. So remember, many, many moons ago, I basically had to go, okay, uh it I would notice every single time I would drink alcohol without fail in my luteal phase, I would be suicidal for five days afterwards.

SPEAKER_07 55:16

Wow.

SPEAKER_03 55:17

So just stop drinking and then the suicidality went away.

SPEAKER_07 55:20

Wow.

SPEAKER_03 55:20

So like it's it's it's really, really massive.

SPEAKER_07 55:22

Yeah.

SPEAKER_03 55:22

And so they're just knowing that there are chemical like reactions that are occurring that make you feel a particular way. And this is why I always say track, track, track what you eat, if you exercise, who you see, if there's conflict. Like it I would track things like gluten, if I was horny, if I like started a fight, if I had sex, like if I was like irritable, if I wanted like everything you think it's insignificant, it doesn't matter, just write it down, and then you'll notice a pattern appear. So yeah.

SPEAKER_07 55:52

Yeah, no, that's such good advice. It's like taking it and you know, taking it back to the basics, you know, like it's just like eating well, sleeping, like exercise, it all is still s so significant.

SPEAKER_03 56:04

And managing your stress as well. Like that's the biggest thing. Like if you're in and look, I I think as we're just realizing that if you're in, say me when I was doing my masters, I I had to do it.

SPEAKER_07 56:14

Yeah.

SPEAKER_03 56:14

And so I had to take SSRIs in that particular period of time, even though for me I had this pretty crappy side effect, which was a herpes flare-up, which is just not fun. And weirdly, I was like, because obviously I was researching stuff, I was like, oh yeah, like it uh targets that particular part of your brain, and it's this awful side effect that seems to happen like for some people. So I was like, oh, I'm feeling happier, but I've got a herpes out. And I can't have sex, so that's really great. That's really, really great. But looking at it and going, okay, well, if I wanted to say do something that was going to be more stressful, knowing that I don't take SSRIs now, but if I was doing something that was like I really wanted to do, that was connected with values, and this is the thing for everyone. Yeah. If it's increased stress, then going, okay, well, you you can just dip in and out of the support when you need it.

SPEAKER_07 57:03

You need extra help. Yeah, because like yeah, it's like, how do we avoid how do we manage stress? Obviously, all the things that you said, but like ultimately there's gonna be things that bring stress, so it's nice to know that that's there.

SPEAKER_03 57:14

Yeah, I can't hone in enough though. Track, track, track, track, track, track. So then you know what works for you.

SPEAKER_07 57:19

Lovely. Okay, so I guess lastly, what does like meaningful support look like um from partners, from friends, or even from workplaces for people living with PMDD?

SPEAKER_03 57:30

That's a really good question. Um, and I would honestly say meaningful support would be having boundaries and not being codependent, genuinely. Someone that is codependent and lacks boundaries and tolerates poor behavior regardless of any mental health condition enables an individual. Someone can be feeling really crap, someone can be irritable, someone can be angry, someone can be argumentative, someone can, you know, need any of these things. However, tolerating that again and again and again isn't okay, and it's also not healthy for the relationship. So if, say, for example, someone was noticing, and the obviously this you have to be very careful about how you word these things, and I wouldn't bring these things up in the Lutil phase. But say, for example, if you kind of noticed this was happening, like being able to say, hey, listen, I've just noticed this happening in these particular time frames, and uh like I'm feeling this kind of way, and what I'd really need is X, Y, and Z, and just setting boundaries and sticking to them. And so I'm not gonna tolerate someone being angry, I'm not gonna tolerate you slamming doors, I'm not gonna tolerate doing X, Y, and Z because you know it might affect me. And also if you notice that you start to be affected by your partner being like, Do you know what? I'm noticing like when you're feeling a little bit burnt out and you notice that you start reacting, it's going, Do you know what? I'm actually needing to take care of myself and I'm needing to make sure that I'm getting support because you fundamentally can't support someone if your mental health isn't sound and you're not good. And so if you need to take space space, you take space. Yeah. However, I would always say this to people in any instance, it is not someone else's job ever to tiptoe around you and figure things out. It is your job if you're the person. Now, this isn't to go, it's your fault, because it's never anyone's fault. Trauma and all of these things, it's you know, in the DBT sort of approach of of care, uh, which is dialectal behavioral therapy, it's like you didn't choose what happened to you, but at the end of the day, you got to deal with it. And so it's not other people's jobs to kind of like tiptoe around it and figure it out. So if you need space, if you need to like go for a walk, if you need someone to like look after your kids, or you need to do whatever, you need to be able to learn how to say that. Use assertive communication, articulate and ask for your needs. If someone can't meet them, that's okay. If you're not looking after yourself, if you need to go to a doctor, if you're not tracking, there are still things that you can kind of do for yourself to sort of figure out what it is that you actually need. It's not anyone else's job to try and figure that out. So knowing what you need and then being able to ask for it fundamentally because it's otherwise it's just unfair. And and that's the impact and that's why it does affect relationships. When your loved ones, because that that's the consequence of that is that relationships break down, there's conflict, and if that's like consistently happening, it's you gotta do the work, yeah. You gotta you gotta figure out what's going on. And sometimes you can't help it, but might just me, you know, say for example, like that day 22 example I gave, we just had the rule of okay, we don't have any uh we don't talk about anything on day 22. Yeah, in the Lutil phase, uh we just don't really like have big conversations or we don't make any big decisions or and it's also boundaries with yourself as well, to be like, I'm I don't make any big decisions if I can't fully trust my brain today. That makes sense. So that's it. And so look, I think just people being understanding as well that it takes time to diagnose and figure out what works for you, but just being sort of gently firm with a lot of love and kindness about boundaries and also what you will and won't tolerate because it at the end of the day, boundaries protect, they're not to control. And so if you're noticing that the impacts are on yourself or the relationship, then that's when we need to have boundaries put in place.

SPEAKER_07 1:01:38

Yeah, that's a really good answer. Yeah, brilliant answer. Yeah, thank you so much. And yeah, I hope that because you're right, it's more understanding around PMDD as well in general. So I hope that that is what we've given you today in this episode. I know that I certainly do. I've learned so much. Thank you. Thank you so much, Kendall. Do you have anything you want to ask, Charmie? No. Anything you want to add, Kendall?

SPEAKER_03 1:02:03

Um, look, I think the only thing to add is that um suicidal ideation is something that's really common in premenstrual dysphoric disorder, and for a lot of people, suicidal ideation can be really scary and it can be something that people are very fearful of. There's a really big difference between having thoughts of suicide, which a lot of people in their lifetime experience, and actually having a plan and acting on it. Again, I just can't hone in enough. This is why it's important to track.

SPEAKER_04 1:02:34

Yeah.

SPEAKER_03 1:02:34

Because, like in my case, it consistently appeared on particular days. And from a clinical perspective, and when I'm treating people, someone might come to me and say, I'm feeling like X, Y, and Z, and then I'll go, Okay, cool, what's been happening for you at the moment? Is it something that you actually want to act on? And so just being able to go, oh, I'm feeling this kind of way, uh that's a flag that I've I'm pushed too far. Yeah, I've taken it too far instead of being like, Oh my god, I actually want it to happen, oh my god, this is the worst thing. So again, just helping you to kind of distance yourself from it and not be like so worried. The difference is, do you have a plan? That's do you intend on acting on it? That's the most important thing to kind of that that's the key difference. But if we're not looking after ourselves and then you're layering on like alcohol and all of the other things, then that just makes it more complicated. So that's just sort of the important thing to to maybe flag is that if it is something that is consistently happening on particular days, like in myself, for example, I was like, oh, that must be where my progesterone's dipping, and so I don't actually feel like this.

SPEAKER_07 1:03:41

It's not as like all encompassing or like yeah, yeah.

SPEAKER_03 1:03:45

Just the tracking is the most important thing because it decreases the limits the power that it has. Like instead of I'm feeling this, it's like, oh, I'm noticing I'm feeling this, rather than I'm actually like feeling it. So there's like that distance. Absolutely. Yeah, and I gives you control.

SPEAKER_07 1:03:59

I have a few when I was doing my research, there was a few good like tracking um websites or apps that I found that I will put in the show notes. So I'll pop that in and if you have any that you use, please feel free to send them through.

SPEAKER_03 1:04:10

I just tell people to do it on a locked note on your phone so that you don't have to censor yourself because like you could you can even tell how you respond to things. Like it might be like you're like enraged about this thing, and then you read back at it and you're like, gosh, I was so like reactive to that. Yeah, yeah. Yeah, and so you just tend to start to see it yourself because you can see a difference in how you write. So yeah, cool.

SPEAKER_07 1:04:32

Yeah, and I guess we have um acknowledging that we've touched on some heavy topics to have. Yeah, yeah. Um lovely. Well, again, thank you so much. Yeah, that's been awesome. Um, yeah, your your knowledge is yeah, amazing. It's been so helpful. We've loved having you on.

SPEAKER_03 1:04:49

Yeah. Um, maybe just one thing to add if anyone um needs uh because I give clinical consultations. So like Where can we find you? Yeah, so Kendallbuckley.com or Kendall.buckley.sexologist. Um, and yeah, so if yeah, anyone wants any help with any of those things. So I do therapy and then I just do standalone like clinical consultation as well for people. So if they're like I'm stressed and I want to understand myself better, I'll help hand feed people to understand themselves and then also when they come to yourself. It makes your job easier. So that's great.

SPEAKER_00 1:05:23

Uh team. Yes, patient included. Exactly. Exactly. Thanks so much. We'll see you next time. See you next time. Bye.

SPEAKER_02 1:05:36

For Goodness Sex is produced and edited by me, Dr. Charmani, social media and visuals by Nurse Elliott, audio assistance by Avesta Sanel. We couldn't do it without our management team, Louisa and Sarah, the Hen House Recording Studio for hosting our recording sessions and Tapari Sound Safari for our music. Don't forget to check out our show notes for all our recommendations and to send us a text with your questions, queries, stories, or feedback. We love hearing from you. Thanks for listening.