This episode is bought to you by Quell — to help support rebuilding healthy skin from the outside-in + inside-out!
Take $10 off your next order! Use promo code QUELL10 at check out — Get started HERE!
– – –
Do you feel like you have PMS “on steroids”? Every month feels like an exaggerated PMS experience coupled potentially with what some call the “period flu”. These often debilitating symptoms point toward what is Premenstrual Dysphoric Disorder.
Premenstrual Dysphoric Disorder (PMDD) impacts 5-8% of women whose symptoms are often blown off by conventional doctors, leaving them to feel like there’s nothing to be done other than suffer every month.
As you know from previous episodes, there is a strong link between hormonal imbalances, mood, brain function, skin health and more. Since many listeners struggle with histamine intolerance, you should know that there can be a link between Premenstual Dysphoric Disorder PMDD symptoms and histamine intolerance.
For some, the PMDD – histamine connection can create an extremely disregulated state, especially for those women who are neurodivergent.
To talk through Premenstrual Dysphoric Disorder (PMDD) (and share her suggestions of PMDD treatment and natural remedy options), I’m joined by Dr. Jolene Brighten!
Dr. Brighten is an internationally renowned hormone expert, nutrition scientist, and founder of Dr. Brighten Essentials, a supplement company creating science-backed solutions for women’s health. Board-certified in naturopathic endocrinology, a certified menopause specialist, and a sexual health counselor, Dr. Brighten is the bestselling author of Beyond the Pill and Is This Normal, empowering women to optimize their hormones and enhance sexual wellness. A passionate advocate for uncovering the root causes of hormonal imbalances, Dr. Brighten inspires women worldwide to reclaim their vitality through her clinical expertise, speaking engagements, and educational platforms.
Let’s dive in!
Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android
In This Episode:
- How estrogen directly influences histamine levels
- The role of mast cells in histamine intolerance and chronic inflammation
- What is premenstrual dysphoric disorder (PMDD)?
- How histamine intolerance can disrupt progesterone levels
- The surprising way gut bacteria impact estrogen detoxification
- How common environmental toxins (like BPA) can fuel PMDD symptoms + histamine issues
- The link between PMDD, histamine, and neurodivergent women (especially ADHD & autism)
- What causes the “period flu”? (and other PMDD symptoms)
- Key lab tests for understanding premenstrual dysphoric disorder (PMDD)
- Dr. Brighten’s natural Premenstrual Dysphoric Disorder remedies to ease debilitating PMDD symptoms (as well as more conventional PMDD treatment options)
- How to advocate for yourself when your doctor dismisses your symptoms
Quotes
“Histamine can also potentiate more estrogen in the system, so they're going to work together.”
“With PMDD, it seems the moment you pass ovulation, you enter into this heightened state of emotions and physical symptoms.”
Links
Find Dr. Brighten online | Instagram | YouTube | Tiktok | Threads
GET Dr. Brighten’s books → Beyond the Pill and Is This Normal?
Healthy Skin Show ep.286: Is This Normal? (Rashes “Down There” + Hormones Edition)
Premenstrual Dysphoric Disorder (StatPearls)
Histamine and PMDD: The Hidden Link Worsening Your Symptoms
Evidence-based treatment of Premenstrual Dysphoric Disorder: a concise review
382: What Is Premenstrual Dysphoric Disorder + How Awful Hormonal PMDD Symptoms Are Linked To Histamine Intolerance w/ Dr. Jolene Brighten {FULL TRANSCRIPT}
Jennifer Fugo (00:00)
Dr. Brighten, I am so excited not only to have you back on the show, but this is the first in-person, ever, episode that I've done with a guest. When it's usually me, it is in person, but you're the first time where we've actually gotten to talk together. So welcome back.
Dr. Jolene Brighten (00:15)
I'm so excited, I’m like so giddy right now that I'm like, I get to be the first in-person.
Jennifer Fugo (00:20)
I know, it's exciting, and especially too, because I love the topic you suggested today, which is this whole other part of histamine intolerance, and histamine issues in women's health issues, that I didn't even consider. And the whole histamine piece is really fascinating to me. A lot of people struggle with histamine issues, but they don't realize that there's this interesting, weird interplay between histamine and estrogen. So I think that would be a good place to kind of kick things off. Can you talk a little bit about why, when we have issues with estrogen, or maybe, I know we've got a lot to unpack here, but how did these two kind of come together, in a way, so that we can set the stage for all of the other things we're going to talk about?
Dr. Jolene Brighten (01:07)
Sure. Well, I think it's first important for people to understand that estrogen is present your entire flow of the menstrual cycle. So from day one to day 20, 30, whatever your cycle's like, estrogen is always there, whereas progesterone, that's predominantly only going to happen following ovulation, the luteal phase. So it's important to understand this because as we talk about when symptoms come up, you can have an understanding of, like, why it might feel like it's all the time. So with estrogen, what's so interesting is that it interacts with the immune system. We know this, right? It's part of the hypothesis of why women have more autoimmune disease. But our mast cells, which are the cells that are responsible for releasing histamine, actually have receptors for estrogen. So estrogen can stimulate them to release histamine.
Histamine can also potentiate more estrogen in the system, so they're going to work together. But the other thing that's interesting is we have this enzyme, DAO, that helps clear our histamine. So we need histamine, it's a good thing. And the body knows that too much of a good thing is never a good thing, so it has a mechanism for clearing it. However, when we see states where estrogen is high or it's unchallenged by progesterone, what some people call estrogen dominance, the research will call hyperestrogenism. So too much estrogen going on, or it's out of balance with progesterone, it can actually downregulate this enzyme. So now you've got estrogen saying release histamine and also don't clear it from the system.
Jennifer Fugo (02:42)
So with that being said, is it more an issue where you're adding estrogen into the body or is it possible where, for example, if we look at a stool test, and some bacteria that are gram-negative have beta-glucuronidase, and so it's creating this like hijacked estrogen detox system where we can't get estrogen out. So does it matter whether it's this outside estrogen coming in or something that we just can't remove ourselves and clear out of the system?
Dr. Jolene Brighten (03:17)
Yeah, so this is a great question because there's several ways that estrogen can be affecting your histamine pathways. So one is we can have poor liver detoxification, And then what you talked about, beta-glucuronidase. That enzyme can, so everybody understands, your liver packages up estrogen, says move it out, get it released, and that enzyme’s like, I don't care what you just did liver, we're going to reactivate it, put it back into circulation. So when we have gut dysbiosis that can contribute. There are rare conditions where you can make too much estrogen, and then there are not-so-rare conditions, like being under stress, where you don't make enough progesterone to oppose estrogen.
But to your point about the exogenous estrogen, xenoestrogens, environmental toxins known as endocrine disruptors, are known to also interface with the histamine pathways and be able to stimulate it in the same way. In fact, there have been animal studies, we need more human trials on this, but I mean, who wants to be, I'm not signing up for this. I don't really want to be in a trial where it's like, let's just load you up with a bunch of xenoestrogens, so these environmental toxins, and let's just see what happens. What we know from the animal studies is it can potentiate allergic reactions. So histamine is involved in allergic reactions. So it is worth considering what are you putting in your mouth, what are you putting on your skin, what are you breathing, what is around in your environment.
Jennifer Fugo (04:38)
And that's those receipts too, right?
Dr. Jolene Brighten (04:40)
BPA is found in, not all receipts, but if it's slick, it's got BPA on it as well. And there have been studies that show that if you're touching those BPA-laden receipts over and over, so like you and me, we go to the grocery, we touch it one time, not the end of the world. Our liver, our gut, our kidneys, our lungs, these are wonderful organs that can eliminate environmental toxins. So when we come into contact with these things in small amounts, we're supporting our body, we can move them out. The real concern becomes for the cashier who is touching them day in and day out. And that's a situation where I tell people, get some gloves, wear gloves while you're doing that, that way you're reducing that. Waitresses is another place where people get exposed.
And what's interesting is that there has been a question in the research, is it actually worse if you touch those receipts and you're washing your hands often, because are you disrupting the barrier and actually absorbing more? So sometimes people are like, just wash your hands a lot. And it's like, well that could potentially make things worse if you're over-drying your hands, which a lot of soaps do.
Jennifer Fugo (05:48)
That's true. So what it sounds like, at least to me, is that if we have too much estrogen, this can be a problem. If we have too much of these xenoestrogens, no matter where they come from, whether it's the receipts or it could be from, I would assume skin care products and all sorts of chemicals in our environment also play a role in this. That can be a factor. And so with that, you brought up this whole concept of PMDD, which is not something, like I've never personally experienced it. PMS, yeah, I totally get it. But PMDD, at least the way I think about it, is this is like PMS on steroids essentially. But I can't say for sure that's what it is. So can you define for us what is premenstrual dysphoric disorder (PMDD), and I guess let's start there, and who exactly is most prone to end up with this condition and what are some PMDD symptoms?
Dr. Jolene Brighten (06:44)
Yeah, so PMDD, I think your explanation is perfect. It's like if you've ever had PMS, now I want you to amp it up times like 1 million, and that is PMDD.
Dr. Jolene Brighten (07:45)
So with PMDD, women will experience this for a much longer period of time. So PMS is typically like three to five days before your period. With PMDD symptoms, it seems the moment you pass ovulation, you enter into this heightened state of emotions and physical symptoms. So it's not just an emotional state, although emotions can be so extreme that there's suicidal ideation, there is significant clinical depression going on, and it's only happening half of the month. Once you get your period, things go away. And a lot of people, they recognize breast tenderness, achy joints, not feeling well overall. Some women with PMDD will report things that feel like the period flu, which is something that you don't have to have PMDD to have, however, it points strongly to histamine and prostaglandin issues going on. So with PMDD, to get this diagnosis, these symptoms have to be present most of the year, and you have to have a combination of emotional and physical PMDD symptoms going on.
Now, to your question of who primarily gets this, that has been something that the research has tried to figure out for a long time. And it was actually through serving autistic women and women with ADHD that we found that the majority of women that have autism in these surveys are reporting PMDD. So we see over 90% correlation of being autistic and having PMDD. And when it comes to ADHD, roughly half of the women with ADHD reported experiencing PMDD.
Jennifer Fugo (09:21)
Wow. That is a fairly sizable portion of people. Okay, so many questions. First of all, what is the period flu?
Dr. Jolene Brighten (09:30)
I actually wrote about this in Is This Normal? because I get this question so much, but people don't necessarily call it the period flu. People would say, I get sick every single month. Okay, tell me more about that. Oh, I'm like, achy, I have fever, chills, I have headaches, I'm having trouble sleeping. They're getting in bed and they're feeling like, okay, I'm coming down with something. Do you actually have a fever? Mm-mm. Any swollen lymph nodes? No. No signs of an actual infection, and it's happening cyclically. So that's the period flu.
We've got two mechanisms that are the working hypothesis of what's going on. So number one is prostaglandins. If you ever get really bad period pain and you get period poops, you have elevated prostaglandins. Pro tip, get your omega-3 fatty acids up. So prostaglandins are made from omega fatty acids. More omega-6 in your diet, like the standard American diet, the worse they are, and they’re worse as in they're very potent. So they're going to cause your uterus to contract, and they don't care what muscle they're making contracts, which is how your bowels contract. It's also why I tell people, anyone who's had a baby has had potent prostaglandins going on, because that's how we get a baby out. And it's also, whenever I talk to people about this, anyone who ever says, oh, I didn't poop when I had a baby, had a really good nurse that lied to them, because absolutely that happens, because prostaglandins don't care. They don't care who's contracting. But these are also inflammatory. So if you have very painful periods, you are experiencing period poops, that is pointing towards prostaglandins. Magnesium and omega-3s are two first-line things that we bring in that can help alleviate those.
So we also see this happens with patients who have endometriosis, and endometriosis patients also tend to have elevated histamine and have histamine issues as well. So that brings us to histamine. That's the other thing that can be going on. And so as we talked about, estrogen can be up. Or, more commonly, you are stressed, you are not eating well, you're not sleeping enough, really anything. It's like, kind of the lame thing about being a woman is any stressor coming in can downregulate your progesterone production because your body will always choose that you survive over procreation. And that's what progesterone is really about. So in that situation, we can have that estrogen unchallenged. Now we are seeing the histamine mechanism that I talked about before.
And this tends to get worse as you get into perimenopause, because initially in perimenopause, progesterone starts to decline, estrogen is left unchecked, and then estrogen starts going up one month, down one month, up one month, down one month. I mean, I wish it was perfectly predictable, you don't know what you're gonna get in the roller coaster. And it isn't until the late stage of perimenopause, where you're in that 12-month stretch to hitting that no-estrogen zone of menopause, that things start to get better.
Jennifer Fugo (12:33)
So when talking about what is premenstrual dysphoric disorder, is this something that is easily diagnosable and that gets readily diagnosed, or is this something where women are told, oh, you just have really bad PMS, sorry, take some more Advil, like what happens? Because I feel like this is something that I only started to hear about more recently.
Dr. Jolene Brighten (12:56)
Yes. So no, it's not easily diagnosed, you have to keep a symptom journal because, like I said, it has to be present most of the year. And so you have to keep a symptom journal and you have to meet the criteria. It's a very extreme condition, so they don't want to just diagnose everybody with it. It's the same as ADHD and autism, like you're going through a gauntlet to get those diagnoses because they don't want to just hand them out. Contrary to popular belief, because people are like, these days everybody has PMDD or autism. No, it's not like that, and it's actually really hard to get the diagnosis. So they're not getting diagnosed, and then when they finally are, they're often only given hormonal birth control.
Now the problem with that is that there's another aspect of PMDD, of progesterone issues. So how progesterone is metabolized may interact differently. So either you don't get to allopregnanolone, which is the stimulating GABA, chill out, calm, be relaxed, happening in your brain, stimulating that GABA receptor, or your receptors are not receiving it, they're not functioning right. Now the interesting thing about that is that we see this happens a lot in neurodivergent women as well. So what causes PMDD? We don't know. We have these working hypotheses, and that's what we go through in a patient history, and we address it accordingly.
Dr. Jolene Brighten (14:24)
However, some women, so we know progestin, I want everyone to understand there is absolutely no progesterone in any form of hormonal birth control. So if you ever take hormonal birth control, let's say you take the minipill, that's progestin. And you're like, that made me feel crazy, I felt awful. You're not alone, a lot of women report having adverse mood symptoms. At this point, we have no causation research, we can only say it's correlation. And we see that some women, when they have PMDD and they're given the pill, things get a lot worse. Their doctor doesn't have anything else to give them. The next step is, let's get you on some psych meds, let's get you, and it just becomes one medication after another. And we really have to be looking at what is going on for this individual. If you have suicidal ideation and SSRIs are saving your life, I have no qualms with that, we may very well need to utilize that.
However, if we also have histamine issues going on, you were just on the Dr. Brighten show talking all about this, so people definitely listen to Jen's expertise on that. But if we have histamine issues going on, we can see that you're having skin issues. When it comes to histamine, it's a neurotransmitter. It's also interacting with acetylcholine, which is how we learn, our memory, and dopamine, how we stay motivated, how we feel rewarded, how we want to keep back going and doing the stuff that's good for us, right, like exercise. Well, when you look at neurodivergent women, they already have issues with dopamine and acetylcholine. So you add that histamine into the mix, and now we can have not only mood issues going on, because too much histamine on the brain makes some people feel ragey, but you can also see other issues where they start struggling in life, especially in the weeks leading up to their period.
Jennifer Fugo (16:07)
Is it possible that someone could have had PMDD, I'm just trying to think of different scenarios here. And you had, so as part of it, you're saying, okay, there's a lot of times these pretty intense mood issues, you could be severely anxious, there could be depression, all sorts of things, that you were, maybe five years ago, started on an SSRI and different psych meds to try to manage that component of what's coming up. And so you were kind of put in that box, but you still have these issues. So could that maybe make a diagnosis of PMDD down the road harder if somebody does, because they're just like, oh, yeah, you have this thing, but it's not connected to that?
Dr. Jolene Brighten (16:49)
Yeah. What you brought up is a real problem we have in women's medicine, is once the label is slapped on you, nobody looks past that. So whether that be depression, PMDD, there are lots of patients that I've had who got the diagnosis of PMDD, yet when I discuss with them what's going on, they're struggling the entire month, it's just amplified. And as it turns out, they're actually neurodivergent, like they actually have ADHD. So they need accommodations through the entire month, and then during the luteal phase of their cycle, then we have to look at what do we need to do differently to support you. Sometimes those are things that are natural, sometimes it is just using an SSRI during that period of time, sometimes it's using antihistamines. So doing something like Claritin, 10 milligrams twice a day, and people do that for like three days out of their cycle. They're like, I don't get period flu, my mood is so much better, my ADHD medications actually work. So, anybody listening, if you're like, why do my ADHD medications not work half the month? Because they don't work half the month. It's not you, it's your hormones.
Jennifer Fugo (17:53)
That's interesting. Wow. Oh, my goodness. Okay, so if you're listening to this and you have, like you said, it's a really amped up PMS experience with these really intense, and obviously there's a range, but intense, kind of emotional, mental pieces to what's happening to you that seem to shift, ebb and flow. Is this something where you could go to a regular OBGYN and be like, I think I have this? Is there a likelihood that they're going to go, oh, you're just googling too much?
Dr. Jolene Brighten (18:29)
I mean, that's, raise your hand if you've ever been to a doctor and you've had that experience. I mean, right? All of us.
Jennifer Fugo (18:36)
Any number, right.
Dr. Jolene Brighten (18:37)
Meet a woman who hasn't, and then let's all get her doctor's referral. Because it is so, so common. This is why, so in my book, Is this Normal?, I put checklists in there of things you need to be tracking. So for all of these women's health conditions that tend to be, women are gaslit about, I was like, we're putting checklists in there so that you know what to track and you know what your doctor should be doing to work that up. So if you go to your doctor and you say, I've been tracking this for six months, here's the mood symptoms I have, here are the physical symptoms I have, here is how it affects the quality of life. So if it's making you unable to go to school, go to work, that's going to get your doctor's attention. So, I can't do my activities of daily living. Don't bring up exercise because it's too often that women are just considered lazy, not trying enough, and you just need to eat right and exercise. But more things of like, I mean, let's face it, in the United States, they want to know how productive you're being. And if you can't be productive, then that becomes a red flag because now you're not going to be able to feed yourself, to house yourself. So those become big concerns. So that's what I would recommend is tracking those things.
If you present that data to, generally, the average OGBYN, they should be able to identify that. If they say to you, I just think this is bad PMS, say to them, well, is PMDD in your differential? Like your categories, basically your list of things this might be, what have you done to rule this in and rule this out? Why is it that you don't suspect this? And if you feel like you're not getting anywhere with them, then what you need to say is, I need all of this documented in my chart that I requested that you evaluate me for PMDD and your reason for refusal, I will be requesting my chart notes and getting a second opinion. It's unfortunate we have to do this with providers, but often when they know that another provider is going to be looking over their work, they're more apt to make sure that they do the workup they should have done.
Jennifer Fugo (20:39)
And I always tell clients too, when I'm coaching them on how to talk to a doctor, be respectful, and you don't have to say, you know, the tone.
Dr. Jolene Brighten (20:47)
But listen, if you’ve got PMDD, I'm gonna say, it is gonna be very hard for you to be respectful. I'm with you 100% because doctors are people, and people have nervous systems that if you attack, they go into fight, flight, freeze. And I wish they would fawn more, because that's the one where they people please. That's not always necessarily the case, but they can just shut down from the conversation. It's not even voluntary, it's just a normal human reaction. But it is something that I would say is very difficult, that if you have PMDD and you go in several days before your period, you're probably going to lose your mind on your doctor. But also it's like this double-edged sword, right? Because if you go in when things are going well, they're going to be like, the person I see in front of me is fine.
Jennifer Fugo (21:32)
Yeah, you look fine. Everything looks good.
Dr. Jolene Brighten (21:33)
You cannot look at somebody and know if they have PMDD. So that's really important for people to know.
Jennifer Fugo (21:37)
And that's why you're saying the documentation is so important for trying to get PMDD treatment, that you could show over the course of multiple months this is what happens, this is the onset. I even encourage clients to do, like, say on a scale from 1 to 10, 1 being a non-existent issue, 10 being the worst it's ever been, rate your symptoms. Because you might say, oh, I'm feeling depressed, or I'm getting really anxious, and they might be like, well, what does that mean? And you could say on a scale from 1 to 10, it's a 10. Like out of the whole month, this is a 10, and I cannot sleep, I can't get to work, I'm actually missing work. And you can get really clear with them, like you said, on quality of life issues.
So it sounds like the symptom tracker is probably more important here and the most helpful. But are there any labs or testing that someone might consider for PMDD treatment? Or if they're going to go kind of the functional route to deal with this, is there anything that might be worthwhile looking into?
Dr. Jolene Brighten (22:35)
So your symptoms are going to guide a lot of your PMDD treatment. I think it's really important for women to understand that you always need a provider who's considering your symptoms. Especially once you get to perimenopause. No, we can't test your hormones, and when we say hormones, we're talking about ovarian hormones, because they fluctuate so wildly from cycle to cycle, we can't really tell you what's going on based on the labs. We need your data of living in your body. That is so, so important.
When it comes to PMDD treatment, we certainly want to be looking at what factors could be contributing. So as you talked about, like beta-glucuronidase, like if we're doing a stool culture, can we understand if we have got dysbiosis? As we know, the gut can also be pumping us full of histamine as well, so do we have something contributing on that level? We can look at estrogen metabolism, we can look at estrogen levels in the luteal phase and compare it to progesterone and see where things are at. We always test progesterone ideally five to seven days after ovulation. Doctors will say day 19 to 21 of your cycle, that's assuming you ovulate on day 14, which very few people do. So it is helpful to check, like doing LH test strips, which you will just pee on a stick every day at like 2 pm, and when you get a spike that's indicative of ovulation happening in the next 24 hours, then we can base the lab off of that.
Dr. Jolene Brighten (23:56)
But if you know my cycle always comes like every 30 days, we can count back seven days and say, okay, this is about when progesterone is going to spike. Why this is important of catching it is because I've had far too many patients, it's probably happened to your listeners as well, who are told they have no progesterone. I'm like, when did they test? Oh, I was on the third day of my period. I'm like, well you shouldn't have any progesterone because you didn't ovulate, you're menstruating. So we have to catch it and get the right time.
We can also look at inflammatory markers. So if we have a high CRP, we've got a lot of inflammation going on. So this can happen in PMDD, this can happen, as we've already talked about, in ADHD and autism, there's a lot of immune dysregulation that can happen in neurodivergent people. So we can start looking at inflammatory markers. If you have inflammation, that can disrupt neurotransmitters as well. So if you have inflammation, microglial cells are getting activated in the brain, we can feel depressed. We know. So if anybody's ever had a cold or flu and they're like, I'm cranky, I'm sad, I just want to hibernate like a bear. Yeah, that's mama nature saying you’ve got something that we don't want to spread, so we're going to make all these interleukins, these cytokines in your brain, tell you quarantine, get away from people, stop socializing, so we protect the community. It's pretty brilliant, if you ask me. So we can start to look at those pieces.
Dr. Jolene Brighten (25:23)
But PMDD is not a diagnosis that's based on labs. Same with like ADHD, autism, these are not lab based diagnoses. However, there are so many labs that we can look at to really understand what's going on. So vitamin D is another example, if that's too low, we often see immune system dysregulation, we also start to see estrogen problems can develop. So we can look at a lot of different factors based on the individual. But when it comes to the diagnosis, there's no one thing that we can use in terms of labs.
Jennifer Fugo (25:56)
Can I ask too, what if you have fibroids, would that potentially play a role in PMDD? Or are those two totally separate things?
Dr. Jolene Brighten (26:04)
So they're separate things as far as the research is concerned right now. Like, you never know. We are so bad at funding women's medicine. I've got more question marks about women's health and the treatments that we do than I actually have answers when I look at the scientific literature. This is why the patient's lived experience should always be considered in the framework of doing labs, and of what we currently know in medicine.
With fibroids, those can be, they're hormonally driven, so there certainly can be excess estrogen going on. Some also can be potentiated by progesterone. We'll see some people develop fibroids during pregnancy. So with that, if we've got this pro-estrogen state, then we can start seeing that there's going to be issues with histamine as well. And I want people to understand, it's not just always a histamine issue, but as the research is evolving, we're starting to understand more and more about this interplay between hormones and neurotransmitters, and how those are having an impact on our mood and our body.
Jennifer Fugo (27:07)
It's so fascinating because, it's interesting, you and I, we grew up with this body that has continued to change. You feel like you get to know it, and you get to like, what, 11 or 12, 13, and all of a sudden you have this massive shift.
Dr. Jolene Brighten (27:23)
Total stranger in your own body.
Jennifer Fugo (27:25)
Right. And then you get, and some poor girls have a really rough time, you know. I didn't feel like I did, but then went on the pill, was on it for 10 years, and then I was like, oh my gosh, this is what PMS is like. I did not know. This is awful.
So for anybody struggling with PMDD and what is premenstrual dysphoric disorder, can you share from your experience as a physician and working with women struggling with this, and also the stories that you've heard, do you feel like they should really feel trapped in this diagnosis? Like, is there hope that they can do things to make it better beyond, I mean, yes, medication, it sounds like, but are there other premenstrual dysphoric disorder remedies like diet or any supplements or anything like that, that might also be supportive of having more runway, feeling more like yourself, and just not being so susceptible to all of these imbalances? Because it's really, we talked a lot about quality of life and man, quality of life is everything. If you don't have that and you're just suffering, nobody's going to give you a cookie for that.
Dr. Jolene Brighten (28:34)
No cookies, no handouts for that. You can still eat cookies if you have PMDD, by the way. In fact, I would encourage you eating chocolate in your luteal phase. No, I mean, so what happens in our luteal phase is that, I talked about too much estrogen, but if estrogen also is too low, then serotonin and dopamine follow. So this is why ADHD can be more of a struggle where mood symptoms, some people feel kind of bluesy when they're in that phase of their cycle, because estrogen really kind of just is like, let me just lead you down if it's going down. And so eating carbohydrates, so if you crave carbs, that's a lot of times about serotonin. Chocolate can help with your mood and your neurotransmitters. Plus, if it's dark chocolate, you're getting polyphenols, we love that.
So, firstly, I do want people to know that you shouldn't feel trapped in this diagnosis. You should have someone that you can partner with who can support you through this. I actually, I had horrifically painful, heavy periods. I was put on the pill, 29 years of menstruating before I got my endometriosis diagnosis. And I did suffer with PMDD, only later to find out that, oh, I'm actually neurodivergent, so that's actually what was going on this entire time. So I think it's about one, listening to your lived experience and unraveling the layers. You know, a lot of people use the onion analogy of like, peeling it back, peeling it back. And sometimes, I know people are, they feel very opposed to SSRIs. I think that's a big one. People are like, I don't want to get on it because often doctors don't give you a way off.
But with PMDD, for example, you might start on an SSRI, and that's just the outer layer, that you are managing this two weeks out of the month, so that you have six months out of the year that you're getting back to yourself, while you then work on the diet and the lifestyle pieces and peel that back even further. That doesn't mean you have to be on it forever. But again, if you're severely depressed or you're finding that you have suicidal ideation, then having big guns intervention, so to speak, maybe not the best analogy, but you know, this bigger level of intervention, that's important to keep you around.
Dr. Jolene Brighten (30:45)
I think that so often in the wellness and the functional medicine space, it's like the gold standard is like, let's get to the root cause and let's just address that. And we forget that if you're not also managing symptoms, that person can't change their diet. Like when you're so depressed and you're just in your bed and you can't even be brought to like get into the shower, why are you going to go to the kitchen and cook anything? Like you're not going to be motivated to do that. So I just want to say that piece, because there's lots of women's health conditions where people will tell you you can treat it completely naturally. And that's true for them, but that doesn't mean it's true for you.
So when it comes to nutrition, lifestyle, like, absolutely, things that we can be doing. So on our episode together, you talked all about the histamine foods. I'm really about bringing in nettles. I lived in the Pacific northwest for like 12 years, so you forage your own nettles, with gloves because they will sting you. But you know, having nettle tea coming in. As we talked about, eating apples, these things that are high in quercetin, they're going to help stabilize that mast cell with the histamine. I already talked about magnesium, getting like 300 milligrams of magnesium glycinate in particular, because the glycinate, little molecule that's attached there, will help with the sleep and help you get to sleep. It can help with the prostaglandins, it can help with inflammation, we know it supports brain health. Omega-3 fatty acids, we talked about those, diet first, supplement second. And then I would also say looking at vitamin B6. Now, vitamin B6 more is not better, you can end up with paresthesias.
Jennifer Fugo (32:17)
That's true.
Dr. Jolene Brighten (32:18)
And the research shows us that you're going to be taking a high dose for a long period of time when that happens. However, when you're talking to people who are neurodivergent, they often have lots of little genes that aren't quite like everybody else. And so you might take 50 milligrams and have a problem. So this is why I usually say, like, starting 25, 20 milligrams, if you're going to take that. That can help with estrogen, and it can also help with histamine. I'm always a fan of the two-for-ones.
Then we can look at things like, how are we supporting our progesterone levels? Now, there is a theory that your own progesterone can be problematic. I actually don't see that as much, and when we actually start optimizing progesterone levels in the majority of people, things get better. Stress reduction, getting enough vitamin C, hanging out with people you actually like, okay, community helps, but you have to actually like them. And if you are neurodivergent and you're like, I can only hang out with one person, not like, a group of people, that's what you want to do. You want to honor that. I always say, people who make you feel like glitter, like people you leave and you're like, I'm sparkly and I'm happy. And it doesn't have to be that way all the time, relationships have dynamics, okay, but, like, the majority of the time, you don't feel completely drained from that.
That can help your progesterone as well, as can things like chaste tree berry or Vitex, so bringing that in as a supplement. I make a supplement called Balance Women's Hormone Support, and it's meant to help optimize estrogen and progesterone throughout the cycle, with an emphasis on what's happening in the liver as well, so it has sulforaphane in it. If you're like, I don't want to take pills, get broccoli sprouts, broccoli sprouts are going to be your winner. It's going to help with processing your estrogen, but it's also going to support your liver in doing its detox.
Dr. Jolene Brighten (34:00)
And that's what we want to look at nutritionally as well. Supporting liver detox, getting enough fiber, at least 25 grams. There's a lot of people out there that are like, women need to get 30, 35, 40. If you're in perimenopause or menopause, perhaps, yes. If you're still cycling, if we push too much fiber, we could actually start dropping estrogen, and as I said, we can have a problem with our serotonin and our dopamine if we do that. So we want to get at least 25 grams. And if you get more and you feel fine, yes. But I don't think you need to go and aim for, like, more fiber is better. And just for everybody listening, because I don't want you to be the farty girl, you know, in class, or the person who can't poop, if you aren't eating enough fiber, you start with 5 grams a day. After a week go another 5 grams, now you're 10 grams a day. Work your way up. Because people will hear stuff like this and they're like, 25 grams, thanks, Dr. Brighten, done. And then I get a message and they're like, I haven't pooped in three days. I'm like, okay, too much, too fast.
Jennifer Fugo (34:59)
And don't start with inulin. That is not the one to start with.
Dr. Jolene Brighten (35:03)
Yeah, you start simple with things like, I like psyllium husk. As I have told you, I like to make yogurt, I use raw oats with my yogurt, I do a little bit of psyllium husk. A little bit because there is heavy metal contamination in psyllium husk, like most of our foods. But that's just to say that you don't want to hit, like, two tablespoons every day. You don't need that much. So getting a little bit of psyllium husk, chia seeds, fresh ground flax seeds, if you're seed cycling, you can bring them in that way, add some raspberries, you're already checking your fiber box for the day.
Jennifer Fugo (35:37)
And I love how, when you make salads, because we're in person, everyone, I mean, this is so great because we actually get to hang out and have conversations like this and eat together. But I love that you do carrot on top of a salad, but it's so thin. It's not like, you know, the bags from the grocery store of the big, chunky things of carrot that are like, oh, this is dried out, and it's not that great. That actually is really nice. You just shave the carrot and add some carrot on top, yeah?
Dr. Jolene Brighten (36:08)
Yeah, which helps with estrogen metabolism as well. And I do that because I have to mix things up for my toddler to keep things interesting, but also, like, you ever try to get a chopped carrot on your fork when you're three, it's very difficult. But, you know, little things like that that you can start adding in. So like when you have a salad, you can start adding in different vegetables, so thinking about like, maybe you do some asparagus on there, you can even add fruit like strawberries into the mix. I said vitamin C is a good thing, bell peppers, strawberries, you know, do some little bits of lemon in there. And you're getting your vitamin C up, that's going to help both the adrenal glands and the ovaries function at their best.
Dr. Jolene Brighten (36:50)
And so the last thing I'll say that I think is super overlooked in women's health is minding your mitochondria, as Dr. Terry Wahls had said. Most people hear about how your heart and your brain are so concentrated with mitochondria, but your ovaries are actually packed with mitochondria. We're talking about hundreds of thousands of mitochondria, like the egg egging on the egg, right? Like cheering on that follicle to ovulate. If you're not caring for your mitochondria by eating phytonutrients, by avoiding things that can be harmful, so like we talked about, environmental toxins, unnecessary antibiotics, time and a place for those. But also doing the stressors that aren't the normal everyday stressors, like ending your showers in cold, or if you want to go step for further, cold plunge, doing saunas, things like that, you can actually have a tremendous impact on your ovarian health.
Jennifer Fugo (37:46)
I love that. I love that there's so much that we can do, right? There might not be a cure, but we can do so much to make massive improvements to live a fuller, richer, healthier life. And sometimes one journey might look a little different than somebody else's, and that is okay. Where can everybody find you?
Dr. Jolene Brighten (38:11)
Oh, yeah, you can find me at drbrighten.com, that's D-R-B-R-I G-H-T-E-N.com, I'm all over social media @drjolenebrighten, like the Dolly Parton song. And then you can also find me on The Dr. Brighten Show, which you are on. We actually have two episodes coming out with you, so people should definitely follow. If they love you, then you're really gonna love everything she shared.
Jennifer Fugo (38:33)
Well, thank you so much for coming back. I deeply appreciate you being the first official in-person interview, and I always look forward to having you back again.
Dr. Jolene Brighten (38:44)
Fantastic. Well, thanks so much for having me, and I'm so excited to be able to be here supporting your audience.
