Treating Mood Disorders Associated with PMS and Perimenopause
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1 Treating Mood Disorders Associated with PMS and Perimenopause Anna M. Cabeca, DO, FACOG, ABAARM HRT Symposium Savannah GA July 14-16, All Rights Reserved. 1
2 Disclosure Anna M. Cabeca, DO, FACOG, ABAARM, practices at Cabeca Health. Conflict of interest was resolved through peer review of slide content. Professional Education Services Group staff have no financial interest or relationships to disclose All Rights Reserved. 2
3 Disclosure This continuing education activity is managed and accredited by Professional Education Services Group. Neither PESG nor any accrediting organization supports or endorses any product or service mentioned in this activity All Rights Reserved. 3
4 Educational Grant Support This continuing education activity is supported by an educational grant from PCCA All Rights Reserved. 4
5 Learning Objectives At the conclusion of this activity, the participant will be able to: Discuss how hormonal changes and imbalances effect mood, neurotransmitters, and sexual health. Discuss use of bio-identical hormones and integrative therapies to treat symptoms. Discuss how nutritional deficiencies interfere with hormone actions and various treatment options that can be used All Rights Reserved. 5
6 Inflammation & Hormone Imbalance At time of menopause a woman s average life expectancy is 32.7 years 1:2 Osteoporotic Fracture 1:3 Coronary Heart Disease 1:5 Stroke or Alzheimer's 1:8 Breast Cancer Kung HC, Hoyert DL, Xu J, Murphy SL. Deaths: final data for Natl Vital Stat Rep 2008;56: All Rights Reserved. 6
7 PMS PMS results from interaction of cyclic changes in ovarian steroids Central neurotransmitters (serotonin, γ- endorphin, GABA), and the Autonomic nervous system All Rights Reserved. 7
8 Premenstrual Syndrome (PMS) Definition of PMS: The cyclic appearance of one or more of a large constellation of symptoms (200) Lifestyle or work is affected Followed by a period of time entirely free of symptoms. The most frequently encountered symptoms include the following: abdominal bloating, anxiety, breast tenderness, crying spells, depression, fatigue, irritability, thirst and appetite changes, and variable degrees of edema of the extremities Occurring within the last 7 10 days of the cycle Speroff L. Clinical Gynecologic Endocrinology and Infertility 7 th ed 2005 pg All Rights Reserved. 8
9 Premenstrual Syndrome (PMS) 30% in severity in symptoms in 5 days prior to menses compared with the 5 days following menses 90% women experience at some time in life 40-50% problems related to their cycle 2-10% impacts work or lifestyle 10% abnormal thyroid function Lougue CM, 1986, Schmidt PJ, et al. Thyroid function in PMS Cohen LS, The Harvard Study of Moods and Cycles, All Rights Reserved. 9
10 Premenstrual Dysphoric Disorder (PMDD) Definition of PMDD (DSM IV Criteria): Confirm a pattern of symptoms Present in the last week of the luteal phase Remitting after the onset of menses Interfere with her normal activities or relationships The symptoms are not an exacerbation of another psychiatric disorder All Rights Reserved. 10
11 According to the US Bureau of the Census, women aged years, who are in their late and post reproductive years, will constitute 26% of the female population in the USA by All Rights Reserved. 11
12 Z.R. 36 y.o. 1/2008 Cc: PMS, moodiness, breast tenderness, having difficulty organizing tasks, memory loss, decreased libido PM/Shx: neg, G4P4004; WDWN, 5 11, 155 lbs., fcb b/l, areolar and vaginal mucosal palor All Rights Reserved. 12
13 Z.R. 36 y.o 1/ All Rights Reserved. 13
14 Z.R. 36 y.o 1/ All Rights Reserved. 14
15 Z.R. 36 y.o. 2/ All Rights Reserved. 15
16 Stages of Energy Extraction From Food Food Pyruvate Lactate In a very healthy state, the body operates in a similar fashion to a finely tuned vehicle. Pure air and food in: Pure carbon dioxide, water, and urea out. Malate Fumarate Succinate Citrate cis-aconitate Isocitrate a-ketoglutarate The following flowchart is not unlike the cellular engine of the body. Food macronutrients serve as the raw fuel transitioned into carbohydrate, fat, and protein energy resources that the cell uses to build ATP. In a sub-optimal state, the engine of the body may not run quite so cleanly. Kinks in metabolic pathways can lead to accumulations of various biochemical intermediates. Several of these GLYCOLYTIC and CO 2 + H 2 O + Urea KREB S CYCLE intermediates (in red) will show up on an Organix Test when the cell metabolism isn t (shaded areas) running smoothly. = step requiring vitamin cofactor All Rights Reserved. 16
17 Z.R. 36 y.o. 2/ All Rights Reserved. 17
18 Z.R. Therapeutic life style changes Dietary recommendations/detox program Progesterone cream 60 mg/ml ½ ml on cycle day DHEA 25 mg/d Daily vitamin packs (multivitamin with minerals, MCHC calcium, Omega 3 360/240 mg EPA/DHA), Carnitine 500mg, Magnesium Glycinate, Zinc 50 mg, Glycine, NAC, Vitamin C 1000 mg, Vit E (mixed tocotrienols) 400IU, Iodide 25mg per day All Rights Reserved. 18
19 The Perimenopausal Transition (PMT) Average age of onset = 46 y Age of onset for 95% of women = y Average duration = 5 y Duration for 95% of women = 2 8 y < 10% abruptly cease menses When FSH >20 IU/L, and LH >30 IU/L, pregnancy unlikely Speroff L Clinical Gyneocologic Endocrinology and Infertility 7 th ed All Rights Reserved. 19
20 Estrogens E2 receptors are present in the amygdala and hippocampus, which influence mood and behavior Genazzani AR, Lucchesi A, Stomati M, et al. Effects of sex steroid hormones on the neuroendocrine system. Eur J Cotracept Reprod Health Care. 997; 2: #serotonergic receptors in the brain & production of serotonin Kugaya A, Epperson CN, Zoghbi S, et al. Increase in prefrontal cortex serotonin 2A receptors following estrogen treatment in postmenopausal women. Am J Psychiatry. 203;160: Modulates activity of the noradrenergic system and diminishes the number and sensitivity of dopamine receptors Garlow S, et al. The neurochemistry of mood disorders: clinical studies. In:Neurobiology of Mental Illness, All Rights Reserved. 20
TREATING MOOD DISORDERS ASSOCIATED WITH PMS AND PERIMENOPAUSE
TREATING MOOD DISORDERS ASSOCIATED WITH PMS AND PERIMENOPAUSE Anna M. Cabeca, DO, FACOG, ABAARM HRT Symposium Las Vegas, Nevada February 16-18, 2017 Disclosure 2 Anna M. Cabeca, DO, FACOG, ABAARM, practices
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