PMDD vs PMS: Hormonal Influence on Cognitive Function | Ep. 589

Episode 589

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Friday Podcast, episode number 589.
In today’s episode, we are digging into PMDD. I am sharing a research study that
looked at food, cognitive performance, appetite, how that changes for women with PMDD
compared to women without PMDD. And we are going to look at the study findings.
They measured hormone levels, what the implications are. And we’re going to talk a
little bit about the strengths and weaknesses of their approach. So without further
ado, let’s go ahead and jump into today’s episode with a focus on PMDD.
The title of today’s study changes in mood, cognitive performance, and appetite in
the late luteal and follicular phases of the menstrual cycle in women with and
without PMDD. This study was published in Hormones and behavior.
And I wanted to talk about it today because I feel like it really does highlight
some of the differences between the way that the psychological psychiatric community
look at an issue like PMDD versus how you might look at PMDD if you track your
menstrual cycles and are looking at the menstrual cycle as a really important factor
in it. What I find to be most interesting about this study, as we will dive into,
is that they essentially dismiss the hormonal implications of this.
And that’s, that’s really fascinating to me because by definition, how they define
PMDD and how they define PMS. So I’ll actually, I’ll actually give you a bit of a
quote for what they talk about. So, PMDD is characterized primarily by a cluster of
mood symptoms, especially depression, tension, anxiety, irritability, and fatigue, with
five or more symptoms present during the luteal phase. So when they’re defining PMDD,
they’re looking at a specific period of time. One of the things they’re looking for
is they’re looking for the appearance of these symptoms during the five to seven
days preceding the menstrual period. So they’re saying these symptoms are specifically
happening during that week before her period, and then they disappear in the
follicular phase once the period is over. So if you think about this just logically
for a moment, if these symptoms are simply appearing at that specific time of the
cycle every time she is in that phase of the cycle, then logically you would think,
“Well, there must be a hormone component.” But as we’ll discuss, the researchers
largely dismiss that component. We’ll talk about why and what the implications are of
that. So that kind of gives you a preview of what we’re going to be talking about
today. So in this, I guess I should say But from my perspective,
based on looking at the research around PMDD, I mean, PMDD, I often refer to as
PMS’s cousin or something like that. It’s a really exacerbated version of PMS.
And when we look at just the overall, I talked about this in the fifth vital sign.
So 90 % of women report some level of
some shifts in mood and energy during that time leading up to your period. But
Molamina would refer to shifts that are manageable and that don’t disrupt your daily
life and comparing that to PMS or PMDD. So kind of looking at the mild version of
this versus the moderate to severe situation that women are reporting.
And when we cross over into the line of PMDD specifically. PMDD is typically
identified when the symptoms are debilitating. So we’ve now crossed from mild
manageable symptoms, even moderate symptoms that are inconvenient to full on
disruptive. You can’t get to work. It’s debilitating. And for a few days out of
every cycle, you basically can’t function, potentially can’t go to work. So that
would be the distinction between PMS and PMDD and what I find interesting is that
if you Learn about PMDD and if you’re kind of reading information about it if you
see articles about it if you if people are talking about it online Or however,
you’re getting your information about PMDD You would almost think that it’s a
completely separate and different condition to PMS However, it is essentially like the
worst version of it if you really think about it because it just goes from
manageable, mild, to moderate, obviously disruptive, and convenient to debilitating.
So if you think of it on the spectrum, PMDD is on the edge of that spectrum where
it’s starting to cause a significant issue in your life. And so in this study,
what makes it, I suppose, unique and what they really looked at, what they were
trying to do, is they were trying to look at some of the symptoms that women
commonly report with PMDD in more of a systematic way. So they were looking at,
as you mentioned, mood changes, changes in cognitive function. So memory recall tasks
and even balance, things like that, as well as as food cravings. They were looking
at these specific symptoms and they were kind of spot -testing during different phases
of the menstrual cycle and having these women complete questionnaires that were
standardized testing questionnaires so that they can have a much better and more
standardized understanding of how their cognition and mood and all of these different
aspects were changing. They tract hormones.
And this is the part that I want to focus on as well, because what they did to
be clear is they had these women, and I would say that they weren’t necessarily
tracking their cycles, not the way that we would understand tracking their cycles.
They were identifying ovulation with LH testing, which is very common for research
studies that are looking at the menstrual cycle and shifts and changes in the
menstrual cycle. And on this podcast, we’ve talked extensively about some of the
potential limitations for LH testing, specifically LH testing,
when we experience the LH surge, the surge and luteinizing hormone,
it is typically a precursor to ovulation. So once that LH surge takes place,
ovulation is typically happening 36 hours -ish after that takes place.
So LH by itself does not confirm that ovulation has taken place, but it is
correlated with ovulation. So it’s not to say it’s not useful, but if we’re looking
to confirm ovulation, that’s not necessarily confirming the specific date that
happened. It’s a precursor that they’re looking at. And so how they measured estrogen
and progesterone, which was really astounding to me, is that they would identify
which phase of the cycle the woman was in, and they would do a salivary test once.
So once in the pre -ovulatory phase, they did a salivary test in the morning, and
they would identify the estradiol level that one day, and then once in the post
-ovulatory phase. So literally like once a spot test one day,
one time, and then they base their study results on that. So that is astounding to
me because when we look at the menstrual cycle, even if you start to understand the
hormone cycle and how that works, as a woman is approaching ovulation and she’s in
that follicular phase, the follicular phase by definition is when the follicle is
developing. And the estrogen output is not just the same. It’s not the same every
hour of the day. So if you did multiple salivary tests throughout the day, you
would see a bit of a change throughout the day. But throughout the cycle, there’s a
significant change because as the follicle develops and grows, as a woman gets closer
to ovulation, the estrogen levels significantly change and peak before that LH surge
takes place. And we don’t produce significant progesterone until after ovulation,
but the progesterone level is very different, and it fluctuates throughout the post
-ovulatory phase. So after a woman ovulates, the progesterone levels start to rise
significantly, and they tend to peak mid -ludial. So they tend to peak about seven
days after ovulation, and then they start to fall. And this is what I find very
interesting about this study. So if you’re working with a practitioner who has been
trained to actually look at the menstrual cycle as a vital sign and has been
trained to do spot testing throughout the cycle to determine the pattern of
progesterone throughout the luteal phase. So if we’re dealing with a woman that has
PMS or PMDD, and like I said, logically you’re thinking, “Okay, so this is literally
defined by this woman having significant changes in her mood, in her cognition,
in her appetite, specifically during the week before her period.” And we know that
there are women who don’t experience those symptoms or women who experience those
symptoms to a greater degree. So the period of time in question would be the seven
days leading up to menstruation. So logically, I mean, I would love to design a
study. I mean, I know I have bias, I know I have a certain, but at the end of
the day, if we’re looking at this specific period of time, the seven days leading
up to ovulation, or sorry, leading up to menstruation, wouldn’t it make logical sense
to not just test the progesterone one random day in the entire luteal phase?
Wouldn’t it make sense to have full systematic tracking of the menstrual cycle where
we actually have this woman charting. And yes, we can do the LH test, but why
don’t we also test mucus? Why don’t we also test BBT and actually be able to have
a few different markers to confirm. You could even do the progesterone test, right,
on specific days. Progesterone is a great way to confirm ovulation happened because
we’re not producing significant progesterone until after ovulation. So there’s lots of
ways that we could do this in a more scientific manner to get a closer, more
accurate assessment of the day of ovulation. And then what would happen if we tested
the progesterone, not just like I’m telling you, I’m stuck on this, like I’m
astounded that they literally tested it once. So what would happen if they tested
the progesterone every three days, or if they did those spot tests of hormone of
hormone levels. They did it three days after ovulation, six days after ovulation,
nine days after ovulation. What if they spot -tested it, and actually for each woman,
they had a curve of progesterone that we could actually put on a graph for the
entire luteal phase so that we could actually see the difference in progesterone
levels during the period of time in question, which is the five to seven days
leading up to their menstrual period. So you can see where I’m going with this.
So these researchers, like I said, I can’t let it go. I’m sorry, I just keep
bringing it up. They tested progesterone once.
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And so when we look at what they found, if we look at the study results, so when
they tested for mood, cognition, changes in appetite, they did find that women with
PMDD, So again, they’re on the end of that spectrum. They have the maximum, you
know, most debilitating symptoms in this specific phase of their cycle. They showed
clear and consistent changes across mood, memory, and appetite in the luteal phase.
So they had significantly higher depression and anxiety scores. They had more negative
mood ratings. And those ratings were more negative compared to their own scores in
the follicular phase. So in this study, they actually looked at the women and had
them do these kind of spot surveys at different points in their own cycles. So they
were able to compare the data to other times of their cycles. So compared to their
own follicular phase, it was significantly worse. But then, of course, they also had
a control group, women who did not have PMDD. So compared to the women without
PMDD, there was a significant difference in these symptoms, again, and I stress,
during that week before their menstrual period. And so what they said here,
cognitively, if we look at kind of the overall findings, the performance dropped,
especially on delayed word and number recall tasks. So they had these women doing
these different tasks, these standardized tests, And they would have them if they
could recall maybe a certain number list or if they could recall certain tasks.
Their cognition was noticeably significantly off, especially for the women who had the
more severe symptoms, PMDD. And then when it came to appetite, they didn’t only
crave more high fat foods, but they actually consumed about 100 more calories at
lunchtime, primarily from fat and protein. So in this study, what they did is they
would have these women come into the clinic and they would give them lunch and they
didn’t tell them that they were tracking anything related to the food. They would
just say, “You can eat whatever you want.” So they didn’t tell them you had to eat
all of it or anything like that. They would just give them the lunch and then they
would weigh it before and after so they could determine about what they ate and
that’s how they measured the food consumption. So they did find that there were
these significant differences. And so I would say what the study did well is that,
I mean, although they, I think one of the things that they did well was they did
use the standardized tests to determine the changes in cognition mood. They tested
the food intake very specifically because they measured what they were eating. So
they did control for a lot of it. And for what it’s worth, I mean, they did make
an effort to get the data from the correct phase of the cycle. But as I’ve already
mentioned, I feel like given the fact that these symptoms are specific to a specific
phase of the cycle, I don’t feel like they went far enough to really gather the
data and make the conclusions that they used. In terms of the hormone findings
specifically, the researchers actually found and they stated in their study that there
was no significant difference between the estradiol levels and the progesterone levels
of either group. So this is what I have been alluding to and I just want to hang
out here for a moment. So what they did, again, is that they tested the hormone
levels once. So out of all of the, they said here that all of the women in the
study had ovulatory menstrual cycles that range from 23 to 33 days. And when
examining hormone levels as a function of group and phase, estradiol levels were not
significantly different in the luteal phase compared to the follicular phase in the
PMDD and control group. Regarding progesterone, there was a main effect of phase.
And what they’re saying is that progesterone levels were higher in the luteal phase
than the follicular phase. But beyond the shift, obviously, and that’s because we
don’t produce significant progesterone until after ovulation. But beyond that, they
were saying that both groups were the same. And so it’s like, okay, conversation’s
over. we don’t have to continue to talk about this. There’s no effective hormones.
The researchers go on to suggest that, although we can clearly see that this is a
repetitive thing that is happening for these women, and that these symptoms are
worsening at a very specific point in the cycle over and over again. They’re having
menstrual cycle after menstrual cycle. They’re experiencing a significant increase in
symptoms during the five to seven days leading up to their period, they’re saying,
but we spot tested at once and there was no real difference between subjects. So
therefore it’s not hormonal. And so we need to look at other alternatives. So what
the researchers suggest for women with PMDD is SSRIs.
So they are suggesting psychiatric medication. They’re saying that the psychiatric
medication works. We’ve seen studies that show that it works. And they also dismiss
the potential for even progesterone replacement therapy because they’re saying that
it’s not hormonal. And they’re saying, well, maybe it’s since the hormones were the
same, then maybe it’s just that women with PMDD are more sensitive to hormones. And
that’s why they’re responding differently. So like I said, when I hang out here,
because as I already laid out, you cannot get an actual scientific,
legit comparison of hormones in a cycle when we know that hormones fluctuate,
we know that there’s a rise and fall. And when we look at research that has
actually looked more deeply at that rise and fall of hormone levels, we can see
that women who have PMS and PMDD symptoms are more likely to have an atypical
progesterone pattern in that luteal phase. So when we actually don’t just like check
one random day in the luteal, but when we do a systematic series of hormone
testing, you can actually see that women who have increased PMS symptoms in that
phase of the cycle, instead of having a kind of rise and a peak mid luteal,
you can see that potentially, and then a gradual drop in hormones over that second
half, right. So in a healthy normal cycle where a woman would have very minimal PMS
symptoms, you would see a gradual dip. And the interesting thing when you have women
charting their cycles is that when you have somebody tracking their temperature and
tracking their mucus, you also get this kind of direct view of what’s happening
hormonally. And so it’s not uncommon for women who are having more significant PMS
symptoms to show different changes in their charts during the luteal phase.
Whether that’s we see temperatures dropping or erratic temperatures, whether we see
the luteal phase actually itself being shorter. And so for the record, in this
particular study, they didn’t measure specifically the length of the follicular or
luteal phases. They measured the total cycle length. They estimated the day of
ovulation with the LH testing, and they did a spot test, but they did not identify
the specific length of those phases. So we don’t know if the women in the study
who had PMDD, if the length of their luteal phase was any different than the
control group. We don’t know if there was any significant difference. We don’t know
if there was any spotting premenstrually or any of the other symptoms that tend to
be correlated with low progesterone. So certainly I would say that the way that they
did the study, it’s just the, how can I say it? The way that they did the study
is potentially just the laziest, least scientific way to truly evaluate if this is a
problem. Again, it’s so interesting to me when you don’t look at these issues that
are happening cyclically that clearly have a menstrual cycle component. When you don’t
look at it from the lens of the menstrual cycle and you don’t think that the fact
that it is a condition defined by happening at a specific time of the cycle, you
don’t think to really investigate that phase. If this is the phase that it’s
happening in, then why aren’t we making an effort to actually look at that phase,
so compare the hormone levels of that specific period of time in the control group
to the women who are having PMDD. Like, obviously, this isn’t just a thing that
every single woman experiences. So if there are women who are having these severe
symptoms to the point that they can’t go to work and it’s super debilitating, then
why aren’t we looking at it more deeply and actually looking at the cycle as a
vital sign, because clearly it’s giving giving us information. So I’m going to jump
off of that because I could go on for the rest of the day. But this is a huge
problem because then what happens is this study, their conclusion is that there’s not
really a hormonal issue. Although we can see that it’s happening at a certain point
in the cycle, we tested the hormones and it’s totally fine. There’s no hormonal
component whatsoever. They just drop it as if they’ve actually investigated it, right?
But they didn’t. They didn’t fully investigate it. So then what you have is them
concluding that really the only solution for women is to go on psychiatric
medication. This is a psychiatric problem. It’s just coincidental that it happens to
be going on at this part of the cycle consistently. And even though that’s part of
the definition, we just need to get them on psychiatric meds. So clearly the
implications of this line of thinking and this level of research and just this bias
of bias towards psychiatric medication for conditions that are clearly related to the
menstrual cycle, and also even just the lack of understanding. I don’t think these
researchers were malicious. I think that they actually fell at the time that they
were following very sound methodological standards, right? Because they did use the LH
testing to confirm ovulation. So Isn’t that just so simple? And of course, it didn’t
occur to them to actually test more than what, like they thought, okay, well, we’ll
just test for that progesterone one time on one day. And that’s gonna give us the
full insight of what’s going on. So, yeah, so the implications of this are clear.
I think that women are still experiencing these symptoms, but because we’re not
looking at the menstrual cycle as a vital sign, We’re not really investigating it to
the level that it needs to be investigated at. And so this is one of the
challenges when you’re having conversations, potentially even with professionals, and
you’re wanting to know more about the menstrual cycle, you’re wanting to dig deeper
into your symptoms, you’re wanting to find out, well, this is happening with my
cycle, I’ve been charting, there must be something going on here. This is potentially
one of the reasons why these concerns or sometimes whether it’s that they’re just
not addressed or that they’re not taken seriously, because we have literal peer
-reviewed published studies that would say that it’s not really a hormonal issue. Even
though when you look at the study and how they did it, there’s clear issues with
it. Like you can’t make a conclusion based on this study, I would say. I would say
firmly, you can’t make an actual conclusion. You would have to actually do a proper
study where we’re looking at that phase more specifically before you can rule out
that there’s a hormone component. And so I suppose this is a reminder, this is
certainly one of the reasons why I do this research series. I do it because it
gives me an opportunity to talk specifically about specific papers, to go in, to
talk about their findings, and discuss why sometimes we’re seeing these types of
findings. So I think with research, it’s always important to remember that this field
of research is not infallible. The researchers have biases. They also have gaps in
knowledge. We all have biases. We all have gaps in knowledge. So if I was doing a
research study, I would have to outline to the best of my ability what my biases
are. And that’s why you need to have a peer review process. Because if there’s gaps
in my knowledge, you need to have peers and experts to be able to say, “Okay, but
you didn’t look at this part. You didn’t look at this part.” But this is my point.
There’s no one study that’s going to prove everything for the end of time. We have
to continue to build on research, and that is built into research in many ways,
because when you’re looking at the study, they are reviewing other similar studies
that have been done. They’re outlining what those studies did well, what potentially
could have been improved. And whenever research is put out, these researchers are
attempting to make it better. So they’re saying, okay, the previous researchers, they
didn’t really measure the actual food, they didn’t weigh it. So while they were
finding differences in appetite, we’re going to improve on their design, and we’re
going to try to make sure that we get a better view of that so we can be more
sure of our results. And in that same way, I would say with this study, they did
a lot well, but the next step would be to actually look more thoroughly and
specifically at the luteal phase. And I do have a comment about that because what
happens if we do that study and we see that there is a clear difference in the
hormonal composition of women with PMDD versus PMS? What happens, PMDD is extremely
common, PMS is extremely common, and the standard of care at this point,
obviously, is to put these women on psychiatric medication. So if we actually have a
study that shows that this is not necessarily an imbalance of serotonin or all of
the psychiatric approach to mental health, and there is a significant difference in
hormone levels, what happens then? Because, for example, bioidentical progesterone,
that’s not something that can necessarily be patented. That’s not necessarily something
that you can make a medication for. So the way our system is designed is that
these companies are trying to make a profit. And in order to make a profit, they
need to create something that they can patent. so they can’t just sell the
bioidenticals because everybody can sell that. They have to create a slight variation
on that, a different molecular structure that they can specifically patent so that
they can make profit. This is one of the issues. Again, when looking at research,
I think it’s really important for us not to look at research as this Beale and
Endall objective science only situation. Science is involved,
but who’s funding the studies and what would be the benefit of the industry who’s
making profit off of this specific approach and having women use psychiatric
medication for this, something that can be patented, right? Something that they can
earn a profit on. What would be the benefit of showing that those approaches could
potentially provide equal or even less promising results than simply improving
lifestyle factors to boost progesterone or potentially administering bioidentical
progesterone in the specific phase of the cycle.
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with the top five evidence -based supplements to support egg development, mitochondrial
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your complimentary copy today. That’s fertilityfriday .com /egquality. Now let’s go ahead
and jump back into today’s episode.
So, I would say that we’re not always, the research, the way it’s designed, isn’t
always giving a fair shot. Again, the researchers are already biased towards this
approach and against the hormonal approach. And then in this study in particular,
they actually talk a little bit about, well, some studies have looked at the
potential of replacing progesterone replacement, but they haven’t really shown shown
much promise. One of the things that I will continue to talk about, the limitations
of research related to menstrual cycle, things are happening at certain times of the
menstrual cycle or identifying certain functions, like ovulation and things like that.
When you look at the study design, the studies are being designed by individuals who
are not knowledgeable around fertility awareness methods and body literacy and even
just the menstrual cycle in general. So when you’re looking at the way that they’re
designing the studies, they’re not thinking about the menstrual cycle like we are
thinking about the menstrual cycle. So even if they are administering progesterone, if
they are not having these women track their cycles, confirm ovulation, not just do
an LH test, but actually confirm ovulation. If they’re not consistently doing that,
if they’re basing their tests on the 28 -day myth and having these women take
progesterone on day 21 or have them take progesterone on day 14 or whatever they’re
doing, then when their study shows that this method isn’t effective or isn’t helping
or whatever, that’s why we have to really look at these studies with a keen eye.
So when you see a research paper and they’re saying, well, there’s no hormonal
component, and they’re saying, well, the previous studies on progesterone haven’t been
effective. So therefore, it’s not a hormonal issue. And really, we need to just give
them psychiatric medication. We have to actually dissect what that means so that
we’re not just taking that at face value. ‘Cause I just picked this study apart
with regards to their conclusion that there’s no hormonal component. They cannot
conclude that based on how they did this research, but they did and it’s published
and it’s out there. And so you can have professionals that say, “Well, there’s no
hormonal component. “This has been studied.” So we really have to be very critical
of these research studies. We really have to be able to review them, look at them
with a critical eye. We can’t just take what they’re saying for face value because
at this stage of this point in time that we are in, the menstrual cycle is not
being looked at as a vital sign. It is not being looked at, especially in the
psychiatric world. It is not being looked at as a specific factor. And they’re
certainly not studying it in a hot, according to what we talked about here. They’re
not studying it in a scientific way. So naturally I wanted to release this episode
after last week’s episode with Dr. Katie Marwick. I mean,
the conversation that we had was so fascinating. She was the author of the paper,
“The menstrual cycle and overlooked sign in psychiatry.” And so I feel like this
paper plus her interview highlights this really huge hole and gap in the field of
psychiatry. Now, I certainly do not specialize in psychiatry and I obviously have
limited knowledge in that field, but the implications of this are very significant.
The implications of this and also beyond the implication of the potential contribution
of hormones, hormone replacement therapy to this conversation, the lack of knowledge
and expertise, even just the lack of understanding and how that filters into how
these studies are designed and the approach that it’s taken, kind of the assumption
that there’s no hormonal input. So they’re kind of giving it lip service even when
they’re designing the studies because they don’t really anticipate seeing any
significant contributing factor.
on your education. You spent years in school and compared to the average person,
your knowledge just leaps and bounds about physiology, about hormone health,
reproduction, whatever it is. Yet, when we come to the menstrual cycle and we come
to the things that we talk about on this podcast, we come to the concept of
fertility awareness. We come to the concept of tracking mucus and temperature and
understanding how the hormonal shifts impact the cycle and how the broader impacts of
those fluctuations and changes impact overall health. This is an area where most
health professionals have zero education, if not less. And so there’s a significant
overconfidence in just all things menstrual cycles. So that’s reflected in the
research as well. So I was excited to share today’s episode and just share this
take on it. I hope that for those of you who’ve wondered why this is missing from
these different areas of health, these different areas of medicine, science, hopefully
this shed some light on it and also highlights a really key aspect of potentially
moving forward. We have to be critical of the research. So we’ve gone to a point
where we really rely on evidence -based, like evidence -based strategies. we rely
heavily on the scientific evidence. And obviously, that’s a big part of my work. And
I think it’s extremely important to be able to rely on the evidence. But with that
said, we can’t just take every paper that’s published to assume that everything was
done. That’s just perfect. And researchers have no bias. And there’s no influences
potentially in terms of who’s funding it or which industry benefits from different
findings of different papers and potentially which industries want to make sure to
maintain that status quo so that their finances don’t change, that there’s industries
that rely on women not understanding this information. Their whole industry relies on
it because if we really saw how ineffective their treatments were, that the whole
house the cards would come crumbling down and women would demand alternate treatments,
right? So we have to look at all of these things critically and really think about,
okay, so what are the implications really here? Is their conclusion legit?
Can they even be saying that? So I’ll leave you with those thoughts and I’ll be
posting and sharing about this on social media when it comes out. So you can find
me at Fertility Friday. I’d love to hear what your thoughts are on this episode. So
feel free to message us over there, DM us over there. And I’d love to hear what
your thoughts are on this topic because like I said, I almost couldn’t believe it.
Like when I read the paper and I saw that they literally tested this once and made
these broad sweeping conclusions about it. I read it multiple times. I read it over
and I was like, wait a minute, wait a minute, they only tested it once. like what?
Like one time in the whole cycle, what’s going on? What excuse me? So I was really
just like amazed that this is where we’re at. And I really hope that future study
designs are looking at this more critically. So if you are wanting to learn more
about this particular study, head over to fertilityfriday .com /589.
So that’s where you’ll find the show notes, you’ll find the summary, you’ll also
find the link to the study that we talked about, so fertilityfriday .com /589. If you
enjoyed today’s episode and you can think of someone who would appreciate it, if
you’re wanting to share it with somebody, hey, if you’re working with a psychiatrist
or a psychologist and you are experiencing severe PMDD, feel free to share it along.
This is one of the ways that the podcast has grown over the years, and so I
certainly appreciate all of you who’ve been sharing the podcast. If you enjoy the
podcast, then I would encourage you to leave a rating and review on Apple Podcasts.
That also really helps listeners to know what the podcast is about when they’re
searching for a new podcast. They’ve just found it. Of course, what do we do? We
go straight to the review. So if you’ve been enjoying the podcast, I would invite
you to leave a review there. I try to look at all of the reviews every so often.
So if you leave a review, I will definitely see it. So with that said, enjoy the
rest of your week weekend whenever you’re tuning into the show. And of course, as
always, until next time, be well and happy charting. If you’re loving the podcast
and you’re ready to apply fertility awareness strategies in your women’s health
practice, then I know you’ll love our Fertility Awareness Mastery Mentorship. It’s a
nine month immersive experience that will completely transform the way you work with
clients, allowing you to not only teach fertility awareness, but to use the menstrual
cycle as a vital sign and diagnostic tool in your women’s health practice. Our next
class starts in January, 2026, so there’s still time to reserve your spot. There’s
no other program like this offered anywhere. Transform your practice in nine months.
Head over to fertilityfriday .com /vamlive to apply now. That’s fertilityfriday .com
/famlive.