PMDD Awareness with Dawn

Speaker 1: 0:10

Hey guys, welcome back to the Preview Alliance podcast. This is Sarah, and today I have a special guest. You guys know how passionate we are about talking all things mental health, and our topic today is something I think a lot of women are going to resonate. It's a little different than our typical when we talk about pregnancy and postpartum, but you guys will get it, and I want to welcome my guest, dr Dawn, and I'm going to say this wrong Dawn, boonder, boonder, boonder. Okay, and Dawn, welcome, we're just going to call you Dawn for this, so I'm not going to murder your last name every single time. But welcome, and please share with us the incredible way that we got connected because of what you're doing.

Speaker 2: 0:51

I completed my residency and then went into practice for eight years as a generalist, which means that I provided OB care and gynecologic care to women, and then, about eight years after I started in my practice, I then decided to go back to fellowship in reproductive behavioral health, and so I am at fellowship currently. I am being trained by and work with Dr Smith, who has been on the podcast before, and that is how I was connected with you.

Speaker 1: 1:31

That's so great. And so for the audience, who's maybe not done the medical journey before you guys don't really? You know, it's kind of new when you hear physician. So this woman went through college, medical school residency, she practiced and then she's chosen to go back to school to a pretty intensive fellowship. So this is a huge deal that you have a passion about this to learn to be better for your patients. So for me, from all the other women, thank you, and I just want to say that is like a rock star quality. So, guys, we are so excited that Dawn's with us. Now tell us just a little bit about you personally. Are you a mom? How has this come into play?

Speaker 2: 2:09

Yes, so I am married. I am a mom of four. I have a 23-year-old son. I have a 12, almost 13-year-old daughter, an 8-year-old daughter and a 2-year-old daughter. Okay, so you're in the trenches with us, plus on the other side of freedom a little bit, so you have the full spectrum, yep, but I think as a parent, you never truly get to the other side of freedom. They're always there, you're always learning together, no matter how old they are. It's just different phases of life.

Speaker 1: 2:43

I love that. Okay, perfect. And one thing that we have not touched on that I'm so excited we're going to touch on today is PMDD. And our audience is going to go okay, what is that? So let's hit it. What would you, when we hear this PMDD and I think of it as how I explain it, you correct me, is right before our period, think of it as how I explain it and you correct me, is right before our period, that feeling that hits us. You think of PMS, but PMDD to me is that next level of kind of depression symptoms, the body symptoms. I used to think, literally life was ending a little bit Like I was really dramatic before for me and my now husband. I'm like, are we going to break up? Because he's the worst person ever during that time. It was really, all joking aside, scary.

Speaker 2: 3:32

Yes, yes. So PMDD is premenstrual dysphoric disorder. You are correct in saying that it's like PMS or premenstrual syndrome that is significantly worse. And so when we look, there's a lot of different diagnoses that can come with mood changes associated with hormones. And so I think it's a good idea to start there at what are the different diagnoses and what are we looking for as a provider that cares for women and their mental health as it relates to hormone changes.

Speaker 2: 4:03

So if we look at women and we ask them, do you have symptoms that change around the time of your cycle, right before you get your period? Do you have physical symptoms? Do you have emotional symptoms? Do you have behavioral symptoms? And so when we say physical symptoms, like, do you feel bloating, do you feel breast tenderness, do you feel nauseous, do you feel really fatigued, when we say emotional or psychological changes, do you feel depression, do you feel irritability, do you feel angry, do you feel anxiety, do you feel the need to withdraw socially, or do you feel like others are rejecting you? That's another one to this heightened sense of rejection. And then behavioral, to do you feel more forgetful or other changes from that standpoint.

Speaker 2: 4:45

So when we talk to women about do you have changes before your period at any various time in your life, up to 90% of women will say like, oh, I've noticed that before, but just whether or not it actually gets to the point where it's significant for PMS or PMDD or PME which is something else I'm going to talk about briefly that has to do with how many symptoms you're feeling, how much they're actually bothering you in your daily life and interfering with activities, and so PMS you can consider it to be more of the mild changes, but that doesn't necessarily mean that it's not significant for you. You may only have one or two things you're noticing, but they may still be bothersome to you. Pmdd is the only one of the things we're talking about today. That actually is part of the DSM-5 criteria, and so that means it has a very set standard of what you need to make that diagnosis.

Speaker 2: 5:40

The other ones we're talking about is not specifically listed in the DSM, which is the book we use for making diagnoses, but they are very real and affect women in their daily lives. Pme is premenstrual exacerbation, and that is when you have an underlying mood disorder and so you have anxiety or depression at baseline depression at baseline and then the week before you get your period it gets significantly worse, which is different from PMDD, which is where during the first half of your cycle you have very, very minimal mood symptoms at all, and then right before your period they're very heightened, whereas in PME you have some baseline mood symptoms all month, but then they really ramp up during the time that your hormones are shifting, right before you get your period. And so those are kind of the three main areas that I talk to women about, or the three different diagnoses I talk to women about, and which diagnoses they have really falls or is really determined by what symptoms they're having, to what severity, how much it's interfering with their daily lives.

Speaker 1: 6:46

Look, okay, I never knew about the exasperation one and I think a good question to start this off is I think women are getting periods earlier and earlier, right, and the lack of education about our period and our hormones and what's expected versus not is a problem. And it's very similar to perinatal mood anxiety disorders, right, which our audience is familiar with depression, anxiety and rage and PTSD and OCD. So now we're talking about, say, these moms who are trying to get pregnant right, and that's heightened and that's a lot, and they're going. Okay, Dawn, I think I'm falling in one of these categories and if we even compare it to like baby blues versus postpartum depression right, Baby blues go away you can kind of reason, rationalize Okay, I cried because I spilt that, right, and that's a little silly.

Speaker 1: 7:37

But like I'm having hormones versus depression, I'm hopeless, I'm not bonding with my baby. Why did I ever do this? So if we take kind of that approach to explain it because I'm sure our audience is going ding, ding, ding, this could be me how can you help them start having this conversation with their physician?

Speaker 2: 7:55

Absolutely. So I think first asking, bringing it up and saying I think that I'm having some mood changes before I get my period, a week before I get my period, and seeing how their physician responds is one way. If their physician is a gynecologist or mental health practitioner or psychiatrist, then hopefully they will respond and say, okay, yes, like, let's go, let's talk about this. That is also kind of within the realm of reproductive mental health, our specialists who specialize just in this. So if their provider does not feel comfortable with this, asking, hey, can I get a referral, or do you know of somebody who does specialize in this? Another thing that can be helpful is when I see a woman who has changes in their mood before they get their cycle and they're questioning, hey, what could this be? What is happening? What I tell them is I have a few approaches that I take with them. But I say, like, how much does it matter to you that you know the exact diagnosis of what you do or don't have, because we can treat different symptoms in different ways. How bothersome is it to you and do you want to know exactly which one it is? Is it PMDD, is it PME? Because really, diagnostically, the way that we determine.

Speaker 2: 9:10

What you have is to have you keep a calendar for at least two months of your symptoms, and I prefer not to do just a really easy. I'm just going to write down two words each day. This is a pretty intense. There's different screening tools that we use that I have women monitor each day, like, do you have feelings of hopelessness, are you noticing bloating? And they rate it. And they do that each day for two months and they also mark the day they have their periods. And then I can look at your calendar and say, hey, if you meet the criteria, you don't, based upon the things that you're responding. And so I think, approaching your physician and asking, hey, what do you know about this? I think this could be happening for me and seeing if they feel comfortable with it or if they would rather refer you out. The second thing is, too, is see if you can get a tool to on your own and kind of mark so that you can see, hey, is this truly happening during these times of my cycle or is this happening all month?

Speaker 2: 10:04

and I'm just noticing it's getting a little bit worse before my cycle and that's when it really is interfering with my interactions with others and with job and school and work and things can be helpful, but the hard thing about doing it on your own without having a provider help you is it can be tricky to actually understand your cycles and understand when are they coming, what is actually happening with them, what are my hormones during each phase, and so that's the one thing that can be tricky about doing these forms before you go in is actually knowing what's happening with your cycle that you're trying to record.

Speaker 1: 10:37

I find most women are suffering in silence almost because no one's opened up the conversation or were maybe led to believe women are just supposed to suffer during our periods or pre-period.

Speaker 2: 10:48

I think a lot of women do keep this to themselves or they feel like something must be wrong. But if everybody else is dealing with it, then it must just be me. I think is what a lot of women think, and so they don't really say anything. Or unfortunately, in our society we have such a stigma around mental health in general that they don't want to admit that maybe I do need help with something or maybe this is a problem for me, and so they just don't say anything until it gets to the point where it's interacting so significantly with their daily activities that they have to reach out.

Speaker 1: 11:19

I remember back even in high school, you know you were saying being withdrawn, remembering right before my period, like I just wanted to withdraw alone and not like deal with people and the irritability. Do you think if someone is experiencing these symptoms, do you think it's generally they've experienced it since they've started their period, or do you think it gets worse with age, or is it kind of individually focused? It's like you know. Did I suffer from this? Probably. I think I got my period when I was 12.

Speaker 2: 11:48

I think it's some of both. So we tend to diagnose women in their late twenties, early thirties, like that's when they start coming and asking for help Retrospectively. When we diagnose women, some of them will say yeah, I've noticed this ever since I got my period, so it happened pretty early on. But some women don't notice it till later. It is once. Once you do have PMDD, it is considered more of a chronic type of condition where it can get better. There are things you can do to help. But it's really common for women when they stop doing treatment that they notice the symptoms come back again, because what's happening is they're having the same mood shifts and their body is responding to those mood shifts and so once they stop being in treatment like, their body will respond again. So, just like any other chronic condition if you have high blood pressure or if you have diabetes, if you're on medications for it or your treatment for it, once you stop doing that treatment it will come back. Same thing with other chronic conditions. Yes, there are things you can do to help your symptoms and if you're doing those things to help, they tend to help your symptoms, Just like if you have high blood pressure and your physician says hey, let's eat certain diet and lose weight and do things that will help your blood pressure goes down. Well, if you stop doing that and you gain the weight back and you start eating your other diet like it can come back again and so the same type of thing.

Speaker 2: 13:08

It's something that a lot of women will say well, can you give me something?

Speaker 2: 13:11

And it will like fix it right now and then I don't have to deal with it the rest of my life. Unfortunately, that probably isn't the way that it's going to work for you Now. It can at times seem worse or at times seem better, and for a month, a month may change how severe that it is, but it is something that we want to work with you on. How can you manage this? Because we know that during the course of your lifetime if we were to add up all of your reproductive cycles and that week beforehand it's about 3.8 years of your life close to four years of your life is in this like leak of emotional change and turmoil for some women, and so we know it's a significant amount of your life when added together, and so we don't want to just say like, oh, you have to deal with this. But you know, it's something that we kind of have to work towards finding solutions that work for you, so that it's not interfering with that so that it's not interfering with that.

Speaker 1: 14:09

I mean, whoa, that fact right, like that's a lot of our life that we're suffering, wow, yeah, now let's turn it. You've mentioned it. What can women do? So, let's say, the wait list to see a you or a Claire is long, and in some states we don't have you guys. So what can we do if we're going? Okay, yep, all right, I'm resonating. Is there things I can do in my daily life before and then we'll go to the next level what could a physician and this patient do together for the level of treatment? So we'll start what the patient can do and what would be the approach from a physician.

Speaker 2: 14:42

Yeah, Yep, and I do want to say we are getting more data, we're getting more research, but really this is an area that research is rather lacking, Like we don't have robust data or not as much as I wish that we had to say like this is definitely it. So I'm hoping five years from now, 10 years from now, 15 years from now, when our daughters are older, we'll say, like great, we have these better tools. So what I'm providing right now is what we have now or what I know now. Right, Some of the things that are some lifestyle modifications that some studies have shown may be helpful. They're not robust, but these are good things to do anyway. So limiting caffeine and salt and alcohol, especially during that time right before your period when it tends to increase, those might help. Improving your sleep quality can make a big difference. Exercising so, again, all things that kind of help to in general improve mood and improve your physical well-being as well, seem to be helpful.

Speaker 2: 15:46

Now, again, great data. We don't have robust randomized controlled trials that show this. But is there risks to doing these things? Really, the risk is pretty low and it's good for you physically anyway, so those are good places to start. There are also some nutritional supplements that show may be helpful as well. So doing calcium during that luteal phase of the cycle, so 1200 milligrams of calcium. Doing vitamin B6 between 50 and 100 milligrams during that luteal phase, magnesium, vitamin E don't have quite as much data on those, but those are potentially things that may be helpful. So sometimes doing even if you look at like a daily women's vitamin C does it have these things in it?

Speaker 2: 16:29

Maybe helpful therapy in general, I think everybody should be in therapy. Therapy is wonderful. I don't care what you are or are not diagnosed with. We all interact with the world based on our past experiences, and nobody's perception of the world is actually completely accurate, and so therapy can help us navigate in ways that we have formed the world or we interact with the world. That maybe is we could do better at.

Speaker 2: 16:56

But cognitive behavioral therapy can be helpful in when okay, I know that this time of the month is happening when I feel the need to withdraw. What are things I can do when I feel that I'm being rejected? Like how can I help myself to see that this is not a reality? Or this is my thinking that has caused me to feel this way. You had mentioned that with when you were dating your current husband, right, like when you have that time of the month, you're like man, am I doing stuff? It's kind of like that have that time of the month, you're like man, am I doing stuff? It's kind of like that's that feeling of rejection and like this person doesn't want to be with me and he probably would say like no, there was no I one week out of every month. I did not think that you were not the one for me, right, yeah, and so it's doing therapy to help identify that.

Speaker 2: 17:36

And some women actually feel a lot better just knowing and being able to own what's happening, because if you don't understand what's happening, you just kind of feel like you're doing well and then all of a sudden, there's a week comes along that doesn't make sense, unlike your once your period actually starts and you have a physical sign like okay, this is what's happening. Like it's, especially for women who may not have as regular of cycles, where they can't mark it on the calendar, like it can be really hard to say, hey, what is what is going on. Here's my little plug for gynecology as well. If your cycles are really that irregular to you, please see somebody, because that could be happening Right. But part of it is starting to track as well.

Speaker 2: 18:22

It can be helpful for some women, just so that they can look at their calendar and say like, all right, like I know that this is when they feel really ragey, they can look at their calendar and say this makes sense. This is a week I know it's this week I maybe need to start working on some of my activity. You know some of my looking inward, and when I'm getting really snappy with my kids, I have to remind myself like it's this week.

Speaker 1: 18:50

It's not that this is the reality of things. This is what's happening with my hormones right now. No, I mean name entertainment. We say that all the time, right, because you do. You're just like am I crazy? Like what's why? Especially if my depression diagnosis says pardon.

Speaker 1: 19:00

Once I knew like hey, this is a name to it. I was like it's not a me thing and I think that took a lot of shame and guilt off of me. And I think the same thing applies here. And I remember, like I do not have periods anymore thanks to a hysterectomy from my littlest guy. He secured that, that we were done. But I remember I would get my period and I'd go, oh, I'm not crazy. Like that thought would literally come in my head and I would be like, oh, wow, I'm not turning into this person I didn't recognize.

Speaker 1: 19:32

So I think, is there a way? So what I think gets messy is so our audience is they're trying to become moms, right, or they're moms. And I think when you're mixing in trying to get pregnant on top of this, that's a hard right. Infertility is a hard road to walk. And then, if you are experiencing that, what are you seeing in those type of patients versus what are you seeing about the patients who are moms? Right, we got little kids like us. We got two-year-olds running around and you are suffering with this, right, and it's kind of hard to say, well, is this a postpartum depression or is this because of my cycle? Right, like I think it gets so messy. So what can you speak to? Just a little about those two different patients.

Speaker 2: 20:16

So let's first go to the postpartum moms and what they're noticing because they how would they like is this postpartum depression? Is this PMDD? What is happening here? I think a lot of that comes down to what's happening the rest of the month. So if you have postpartum depression, then probably what's happening when your cycles come back is an exacerbation of what's going on, because the rest of your month you're still having those symptoms.

Speaker 2: 20:43

Now we do have women who will get their postpartum depression controlled. They'll be doing very well. They'll stop breastfeeding, their cycles will come back and they'll say, whoa, what just happened? What is this? And sometimes we do see that after women have babies, where beforehand maybe they had better sleep quality, maybe before you had kids you exercise regularly because you had more time right, like maybe you didn't drink coffee every morning to help you get out of bed. And so now your other lifestyle things, your lack of sleep, your dietary changes, all of these things are contributing. And then when your cycles start coming back, you notice it either for the first time ever or you notice it more than you ever did before.

Speaker 2: 21:27

And so we do have women that we'll see in our clinic that will say like, oh, I actually think that you have PMDD or, yes, you have postpartum depression.

Speaker 2: 21:36

We're treating it Now that you stop breastfeeding or you're far enough postpartum where your cycles have come back. You're seeing this exacerbation right beforehand, with the exception of some of the treatment options and this is kind of nuance that we talked about in our clinic at the end of the day, it doesn't really, from my standpoint, make a difference if you have PMDD or PME, like you're suffering either way, like we need to treat that. The biggest thing that matters is which treatment options are available to you. I'm not going to recommend something that you're going to do one week of the month if you're actually struggling all month but barely holding it together, and then that one last week you're doing poorly, whereas if it's only one week of the month, we may have a few things that we can do treatment wise that are just during that week, and so that's really the only time it makes a huge difference to me, because I can identify with you that like this is not going well. We need to help you feel better, no matter which letters I happen to hand you.

Speaker 1: 22:31

Yeah, yeah, no, that makes total sense. And I think moms it's so blurry because A, they don't, they don't know about these topics, right. Like no one's really trying to talk to them about depression, anxiety during pregnancy, then in postpartum or PMDD, right? So like these concepts are new. So it's so gray and blurry to be in, like how do I feel and why do I feel that? But I think it hits back to what you say track, like tracking and writing down, and we were big fans of voice journaling or just journaling of like here's how I felt today. What can we tie it to? You could evenaling of like here's how I felt today. What can we tie it to? You could even go into like baby cried all night. I slept no hours last night. This is how I felt today, Right, but it is one of those things where we are the highest you know highest rate, I believe, of mental health crisis, especially in moms and women, is now, and the conversations that we're having should be the conversations that they're having with their OBs and gynecologists and PCPs.

Speaker 1: 23:29

But it is lack of knowledge right From, I think, a lot of people. It's not just on the moms. I think residencies could do better, Fellowships could do better. There should be more of a conversation that women do not have to suffer. Like you said, you don't really care what the diagnosis is. You want that patient to be better and that's what I hope the message is we're getting across today is you do not have to suffer. There is Dawn's in this world that you know. There's information that we can provide now to the mom who's trying to get pregnant. And she was like okay, Dawn, I'm trying to get pregnant, and that last week, before I can take that test to see if my period comes or not I don't know if it's me getting my head, Cause I I've been there. I got my head Right and I was just like every little physical thing, I was just like, oh my God, is it happening? Was that implantation? And then the withdrawal, all that stuff. So I'm like, well, how do we tell that? Like that's to me. I struggled with that.

Speaker 3: 24:29

What would you say to me?

Speaker 1: 24:29

Yeah, I would say I'm going to get in therapy, Sarah, which I am, and I should have been back there. You know, I really should have.

Speaker 2: 24:35

This is actually a really good point, though. Anybody who is suffering with infertility and this is not just it took us two or three months to get pregnant Anybody who's suffering with infertility I really do strongly encourage that you do therapy, because the emotional rollercoaster you go on whether or not you have PMS or PMDD is so intense Every month. You are so hopeful and excited and optimistic and fearful, and then you get your period and it's like your world crashes down, and it's so hard for you as an individual, it's so hard for your partner and it's so hard for you as a couple, because how you support one another through all of that, and so, if you have infertility, I really do encourage you to have therapy, just because it can help so much with that right along the way. Now, when we talk to women who are trying to get pregnant, they might say you know I was doing fine and then this happened, or like I started trying to get pregnant. What's going on? I would say well, there's a few things. First, sometimes women are on hormones to stop them from getting pregnant, which is birth control right, and so they're on birth control. They stop the birth control to try to achieve pregnancy. Well, birth control actually is one of the things that we can do to help with PMDD symptoms. So potentially we were helping mask some of those symptoms and now we're taking that away, in addition to adding in this other emotional roller coaster. So I think you could potentially have two things going on at once.

Speaker 2: 26:07

If you are having infertility and we're giving you fertility medications, that is a whole different level of hormones that we need to be addressing too. So that may not be PMS or PMDD, but really just the heightened hormones that we're giving you throughout. But as you're trying to get pregnant, I would say the really the way that we would know what it is that's going on is by tracking to see how are you feeling. Are you anxious all month Because you know as soon as you get your period, here we go again, we're starting again. So your anxiety is really high than the last week. It gets a little bit higher. Well, that's probably you're just very anxious at baseline, but are you actually feeling rather calm? This is just your fourth or fifth month of trying. You're not having as much of sure. You get disappointed, but it's not like you're waiting for that positive test to come back, but you're noticing these symptoms then yes maybe it is PMDD or PMS, in which case, then, let's talk about what do we want to do.

Speaker 2: 27:03

you know that you're going to want to be pregnant, so if it is only that week before you get your cycle, during the pregnancy itself, you probably will actually be okay. So what do we want to do to try to help treat you? We aren't going to want to do a hormonal thing that'll stop you from getting pregnant. That's not going to help. Like which treatment would you feel comfortable with, knowing that you're going to get pregnant? And so it's just working through individual treatment plans.

Speaker 2: 27:29

In medicine, we call this shared decision making. So we sit down, we talk and we say this is what we have, the benefits, pros and cons of each. And then this is you know, when we look at the risks and we weigh those with the benefits, what do you, as the patient, feel most comfortable with? And the thing is that we can change our plan. So if you do that for a month or two and you say, no, this is not, I'm still not doing well, and we're still not pregnant, at that point, okay, what else do we want to do instead? What can we try?

Speaker 1: 27:55

next, I think what's, if you know? So let's talk about the baseline, that I've always had anxiety, or I've always had depression, dawn, and so we're getting into, you know, the whole topic of medication during pregnancy and postpartum. So it kind of leeways into it, right. And so you as an OB, now going on with the fellowship and the extra knowledge. So women, they're worried, right, we're all kind of, I think, trying very early. You know, don't eat deli meat, don't eat a hot dog. You know, like certainly don't take, like't take that shoved down our faces. And now we know that is a risk versus risk, not a harm versus benefit. If mom is mentally not okay, baby's not okay, she's physically not okay. So just for a second, speak to that a little bit, because I can hear our listeners going okay, but I want to get pregnant, or what's if I really am needing this medicine and now I'm pregnant? That kind of happens. We all start getting a little uncomfortable, right.

Speaker 2: 28:53

Yes, yeah, and so what I would say, if you let's use anxiety, if you said I have baseline anxiety and it's there all the time and my anxiety is worsening right before I get my cycles, but my baseline anxiety is over there or is always there, then I would say, well, let's look at first how significant is your baseline anxiety. So if your anxiety is just mild and it maybe interferes sometimes, but for the most part, like you notice it, it doesn't interfere all the time. You're really noticing it right before you get your cycle but otherwise feel like you're handling it well, then maybe therapy and exercise and mindfulness techniques really is the best solution for you. If your anxiety is rather significant at baseline and you know every time you have to go to the grocery store to get groceries, you have to sit in the car and give yourself a pep talk before you can get out to go into the store and you hate being around in crowds and you groceries. You have to sit in the car and give yourself a pep talk before you can get out to go into the store and you hate being around in crowds and you find that you have to call into school or work or whatever activities because you just get so anxious, then we probably should start talking about what other things can we do as well to help you with your symptoms.

Speaker 2: 30:03

And so it really comes down to how severe are your symptoms Are they mild, moderate, severe? And then how much are they interacting with your daily activities? As far as where should we start? And also, how have you responded to things in the past? If you came and said you know, this is how my symptoms are, I've been in therapy for three years and they're just not getting controlled, like really, we probably should be trying other things to help you with this. If you say you went to therapy once and it didn't seem to make any difference, I'm going to tell you I don't think that that's actually therapy, because you only did it once, you don't take a blood pressure medicine one time in the next week, check your blood pressure and say it didn't work.

Speaker 1: 30:41

That's a big point and we stress that with our pre-reliance patients and then with our listeners of saying therapy is a process Like you're not going to be able to in one hour. Let it all out and explain to this therapist your childhood trauma, what your husband said to upset you yesterday and what's going on at work. In one hour it just ain't going to happen, you know. So it's like we always say take time, it's a relationship. So I love that. That. You mentioned that.

Speaker 1: 31:05

I think one thing moms are challenged with when it comes to mental health. How would so, how would you advise a patient like Dawn Okay, my husband doesn't get it, my family doesn't get it, I am suffering with PMDD. How do I tell them? Like, how would you say to like, explain it, like it's real right? You know like we've had to have these conversations when it comes to postpartum depression anxiety it's real, it's a medical condition, like it. When it comes to postpartum depression anxiety it's real, it's a medical condition, like it's treatable. So, like, what do you say to that moms? Like, let me explain it to them, cause they're telling me oh, you just get really crazy around this week. Or, you know, we always know when our period's coming. Those, you know, those horrible gaslighting comments that we've heard our whole life.

Speaker 2: 31:41

Yeah, so I with my patients. I will invite them to bring their partner to their next visit with them so that we can talk about it together, because sometimes it is easier to have a conversation where, as a patient, it can be difficult to put words into what you're feeling and it's hard to explain biologically what's happening inside of you if you didn't go to medical school and get that degree so you can listen to me talk about what's happening with your hormones and what's happening with your mood and say, yes, I get it. And then when you go home, you try to explain that to somebody else who didn't go to medical school and they ask you a question and you say, well, I don't, I don't know, and it's not really fair for you to have to be able to answer all of those questions for him, because you did not train for years to understand what your hormones are doing, because you did not train for years to understand what your hormones are doing. So I will tell women if they want to bring their partner to one of their sessions. They are more than welcome to do that and we can go together through what's happening to help them to understand what they're feeling. And sometimes, too. The charts can be helpful from that standpoint too, because when we're reviewing the charts together, it is an actual objective piece of information of like oh, look like this is really going okay, and then these are a lot higher, and so sometimes that can be helpful, I think, just to have another viewpoint explained into your significant other. Thankfully now there are some support groups and things like that too for PMDD that there wasn't before, and so sometimes letting them look through some of those things can be helpful as well.

Speaker 2: 33:15

If you have a supportive partner who says, like I get some things going on, I like I don't know how to help you with it, though, like, tell me how to help you with it. I think it's having a conversation of like every month may not look the same. It'd be great if every month looked exactly the same. So then you knew, like on cycle day 24, I'm going to get angry. On cycle day 25, I'm going to cry and I'm like but that's not the way that it works and so, understanding, it's not always going to be the same. These are the symptoms that I have noticed.

Speaker 2: 33:45

But then if you have symptoms you've noticed and your partner is supportive and says, okay, I understand and I can understand that you feel a sense of rejection then maybe they can I do like the love languages and things like that.

Speaker 2: 33:59

I think we respond differently, so maybe they can be more intentional during that time to show you whatever your love language is to help you with that. If it is that you feel exhausted, okay, maybe then that week they know that they can help with putting the kids to bed so that you can get to bed on time, so you actually get that sleep that you need. If you find that doing dietary adjustments during that month really helps you, then maybe they're not going to bring home two large pizzas and a container of beer for supper one night because that's not going to help with your mood stuff at all. Like, as long as they can understand what it is that we're working towards and what helps, then hopefully, as a supportive partner, they can get on board with. Okay, this is during this week we're going to do these things to try to support you, because we know that this is that this will end in five days.

Speaker 1: 34:50

I love that and I wish I would have known that. And you know, honestly, it's like everybody I feel like has shared Google calendars. You know a little bit couples do and it's, I mean, it wouldn't be a bad thing. And if I still have my period, I would probably try to highlight that week. So Bill would know, be prepared, you know, a little bit like help me through this right. We've never had that conversation. It was always just like I think he probably hope, prayed and hid in the corner a little bit to survive it with me and then we returned.

Speaker 1: 35:15

So to listeners, please take this advice and like you could share this podcast episode with them and be like I've never heard someone talk about it this way. Listen to this, take some key points. But, dawn, I want to ask you what we ask all our guests. Since you're a mom of four, you have a full range to give us some information here. What is one thing and this we've heard every answer in the book, so there's no right or wrong that you wish you knew about motherhood before you were a mom.

Speaker 2: 35:45

I think I thought about this because there's like there's so many things I'm like, oh, these are good. But really I think every mom needs to know you are enough. So it does not matter how much money you do or don't make, how much time you're able to spend at home versus at work, like how your world looks, like you are enough to your child. They will never think that you are perfect. They will always have complaints about how you are doing things, but at the end of the day, like you are their mom and you are important to them and you are the one that was meant to be there for them and you are enough the way that you are.

Speaker 1: 36:29

Love that and I don't think moms hear that enough, recognize that enough. So I hope that's for our listeners Everybody who's a mom, just hear Dawn's words and just, even if you have to look into yourself in the mirror which we all do some days and say I am enough, I can't do this today, I will continue. So, dawn, I would love to have you back at some point and we can. Um, I'd love to have more conversations about this and other topics, because I think you are just really forging a path for moms and women who are suffering unnecessarily, and I just think it's awesome. And again, you're a rock star, so I really appreciate your time.

Speaker 2: 37:08

Thank you so much. It was wonderful talking with you today.

Speaker 1: 37:11

Okay, guys, turn into this next week and follow us on Instagram and download and share this episode. Thank you, guys.

Speaker 3: 37:20

Maternal mental health is as important as physical health. The Preview Alliance podcast was created for and by moms dealing with postpartum depression and all its variables, like anxiety, anger and even apathy. Hosted by CEO founder Sarah Parkhurst and licensed clinical social worker Whitney Gay, each episode focuses on specific issues relevant to pregnancy and postpartum. Join us and hear how other moms have overcome mental health challenges, as well as access tips and suggestions on dealing with your own challenges as moms. You can also browse our podcast library and listen to previous episodes at any time. Please know you're not alone on this journey. We're here to help.