Alisa Asano - Naturopath, 285 Little Collins Street Level 1, Melbourne (2025)

16/02/2024

The pill prevents ovulation, so in theory it should work for PMDD. But it often doesn't unfortunately.

There are a few reasons this could be.

Higher estrogen states could be why women can react to the pill.

Or it could be that there is a sensitivity to hormones in general.

It could also be a drug side effect of the pill - inflammation, the impact on methylation, and multiple nutrient deficiencies the pill will cause.

It could be all of the above.

The same goes for HRT.

If you are taking estrogen for perimenopause, it may be helpful for the low states of estrogen, but not for the high states, where we are essentially just adding to already high estrogen.

Treatment considerations for these possibilities include estrogen detox, supplementing isoflavones, nervous system support, supporting methylation and restoring deficiencies.

For the women who respond positively to the pill (very few), it may be that hormones are low. A clue for this is that you feel best on your period, when hormones are at their baseline.

It is possible to compliment a good response to the pill by addressing the side effects and bridging the gap. There are many things we can do here.

What has been your experience on the pill?

09/02/2024

There is no agreed cause of PMDD.

But it is widely acknowledged to be a multi-factorial, individual condition.

(Active research is increasing).

There are so many variations in presentations, symptoms, test results and circumstances we see with PMDD.

There are also many variations in response to SSRI's and OCP. Reflecting how different the causes can be.

We know it's a body reaction to changing hormones. Knowing this means we do have some control.

Things to consider when exploring physiological causes:

◇Elevated estrogen and it's impact on mood and dopamine
◇Low estrogen and its impact on serotonin and executive functioning
◇Progesterone deficiency and its impact on GABA and anxiety
◇PCOS and lack of ovulation
◇Histamine status
◇Response to SSRI's - positive or negative
◇Response to OCP or HRT - positive or negative
◇Estrogen metabolism SNPs
◇Nutrient deficiencies that can impact hormones and neurotransmitters

Almost all of the physiological causes require blood testing. We want to guess as little as possible.

Unfortunately it can be challenging to find a provider who will get on board with testing everything necessary. I hope this changes.

Advocate as much as you can. Working with a qualified naturopath will also help you access the necessary testing.

Feel free to share your experiences with common treatments. And as always, my DMs are always open

03/02/2024

There are many variations of PMDD, whether that be the classic late luteal, or predominantly physical, or progestin induced, or non-ovulatory. And more.

This is partly what makes treatment so challenging. There is no gold standard treatment, and no single cause.

The most distressing part of PMDD regardless of the variation or type, are the psychological symptoms. I would presume 100% of my clients agree with this.

We know that one of the main causes of PMDD is an altered sensitivity to normal hormone fluctuations that influence the function of the central nervous system.

This involves a disruption to GABA receptor flexibility, and more activity in the amygdala (stress activation), as well as cortisol dysregulation.

Estrogen is heavily tied into serotonin, and there is likely less activity of serotonin in the luteal phase.

Histamine is also a very interesting molecule that works heavily in the CNS and is strongly tied in with GABA and estrogen.

In light of all this, we can address these areas and work towards mild cycles. Even symptom free.

Everything needs to be explored for a thorough assessment and accurate treatment for the individual.

My DMs are always open if you have questions 💜

I have assessment consultations available from March. DM to book, or check the link in my bio for bookings.

30/01/2024

If you are going to start taking better care of your mind and body, you're going to need to prioritize your diet and lifestyle to effectively treat PMDD.

I know this may not be a primary treatment strategy that many want to hear 🥴

Diet and lifestyle take the most amount of physical and mental effort. The human brain wants the easier route.

But the reality is, diet and lifestyle do impact PMDD symptoms without a doubt in my mind.

And within that treatment umbrella there are various things that may need changing in order to feel a positive change.

ALSO to add to the difficulty, in our symptom window, diet and lifestyle change are some of the hardest things to execute, for obvious reasons.

We have to make change realistic and manageable, and build on that.

Here are some gentle recommendations that may help support you (experiment):

◇Start any change in your follicular phase, or the window you feel well, never in your symptom window

◇Delegate some of your mental load where you can, so you have room to make change

◇Choose 1 change at a time, this is important

◇Halve your caffeine, alcohol and sugar intake (but probably not all at once!)

◇Commit to one thing daily that will reduce systemic inflammation - 1 hour more sleep, 2 cups veg, 15 min light exposure, 20 minute walk after a meal

◇Start a good quality magnesium at the right dose

There are numerous diet and lifestyle strategies that can make a big difference, depending on your circumstances.

If you need some help, my DMs are always open for discussion.

If you require tailored treatment, I have consultations available from March. DM if you would like to join the cancellation list, or book a free discovery call.

💜

15/01/2024

The fundamentals of PMDD treatment.

1. It is a biochemical reaction, not a behavioural choice
2. Methylation status matters
3. Is there a true hormone imbalance
4. Neuroinflammation
5. Cortisol dysfunction
6. Life stages such as perimenopause
7. There is overlap with ADHD
8. Diet and lifestyle impact symptoms 100%
9. Herbs and supplements do work 100%
10. Blood sugar stability

PMDD responds best to an individualized treatment plan involving a complex of factors. But it can be hard to navigate alone.

If you need some help, my DMs are always open ❤

22/12/2023

Dear all,
The year has come to an end. It hasn't always been easy for many of us. We have celebrated many highs, and grew stronger through the lows.

Thank you to all of my clients for working with me and sharing your health journey. It has been a pleasure and privilege to support you; you truly inspire me personally and professionally in this often complex and painful space of women's mental health, and of course PMDD.

I am very grateful.

Please enjoy a beautiful and peaceful festive season. My hope is that you give yourself permission to take a break, do what makes you happy, and never give up on yourself and the future you want.

I will personally be enjoying slow time, good food, connection with the people I love, nature, and less phone time.

I look forward to seeing you in the new year.

I will be back in practice on January 2nd, with a few spots remaining in January for new clients.

All love 💗
Alisa

27/11/2023

One of the essential assessments needed to treat PMDD and ADHD at the root cause is your methylation status.

I am increasingly convinced that methylation issues are a common missing piece in the PMDD and ADHD (in women/afab) puzzle.

If you have been treatment resistant and 'tried everything', I would highly encourage you to check your methylation markers (hcy, B12, WBH, folate ++).

Methylation is involved in the compounds that affect both conditions way down in this pathway; dopamine, serotonin, noradrenalin, histamine and estrogen.

A simple B12 deficiency can impact methylation; it's not just about MTHFR.

There are many factors that can impact and influence these conditions; everything needs to be explored for sustained management of symptoms (which can be put into remission).

--‐----------------------------------------------------------------------
I am fully booked for the year. If you would like a free 15-minute call to get you started in the meantime, my booking link is in the bio.

17/11/2023

Is your period the only time your feel well in your cycle?

It could suggest that you are reacting to hormones at all times in your cycle except when they are at baseline - on your period.

Clinically, it may indicate that you feel better at a lower hormone profile, and have a sensitivity to estrogen and progesterone.

If this is the case, it may be worth working on detox pathways to optimize hormone metabolism, while working on reducing the brain sensitivity to hormones.

This might mean addressing histamine, inflammation and GABA imbalances.

Would love to hear in the comments if anyone is only experiencing respite during their period?

My Dm's are always open if you need some guidance.
.........................................
I am fully booked for the year but still have some free 15 minute calls available, and new clients availabilities from Jan-Feb. Link in bio for times available.

13/11/2023

This is one example of a symptom pattern. It's not the classic 7 days before your period pattern.

There are a few variations of typical symptom patterns, and many individual variations within these.

PMDD is still quite controversial and lacking in good quality evidence, but we know it exists.

We also know that there is usually not one single cause, but a few factors that can work together to create your set of symptoms.

Understanding your underlying causes and symptom pattern will determine your treatment plan, and journey to mild and even symptom free cycles.

There is so much we can do ❤

Be your own scientist, collect data and record your symptoms for 2+ cycles.

This is why treatment needs to be tailored and adjusted for best possible outcomes.

If you need some help, my DM's are always open.

⬇️
I only have Dec 13th and 15th appointment's remaining for new clients this year, otherwise I have some free calls remaining to get you started.

DM to book, or click the link in my bio to see availabilities worldwide.

29/10/2023

It's not just about a low histamine diet.

One of the many pathways highly relevant to explore for PMDD and PMS is histamine excess or intolerance.

If we find that an OTC anti-histamine improves your symptom window, then it is worth trialing a low histamine lifestyle while we work on why your histamine might be a problem.

It is impossible to be histamine free; we all need some histamine. The key is to have it act appropriately as needed.

Inflammation and gut issues are almost always a key driver in histamine issues, and can be a reflection of an impaired methylation cycle and MTHFR SNPs. Excess estrogen will also have an impact on histamine, as will mast cell activation syndrome.

Stress and elevated stress hormones can also increase histamine

Natural treatments for histamine regulation include P5P, quercetin, bromelain, zinc, curcumin, SAMe, B12, folate, dairy free, cortisol management, and diet strategy.

It is also worth testing whole blood histamine with someone who understands the range to interpret your numbers.

If you have any questions or need some guidance, my DMs are always open.

24/10/2023

Test not guess. There is so much we can get out of testing.

My clients know how much I rely on blood tests to get better results.

There is no blood test to diagnose PMDD, but there is so much we can test to determine your treatment pathway.

As I always say, there are various factors and root causes to the development and perpetuation of PMDD.

This is why testing is non-negotiable.

As a naturopath, reference ranges are some of the most important factors to consider when interpreting test results. They will be different to the standard range.

My recommendations for blood tests for PMDD management:

Peak luteal s*x hormones (has to include Prolactin)
B12 + folate
Homocysteine
Whole blood histamine
Iron studies
Thyroid panel
Glucose (+ insulin)
Vitamin D
CRP
GI-MAP (best for treatment resistant depression and anxiety)

It can be stressful to get these through a GP (as many of you know). It's the systems fault, and not always fair to expect the GP to test something without a clear rationale.

However I do always encourage clients to advocate for their healthcare as much as possible.

For those based in Australia, we can bypass the GP and arrange a direct referral to the lab for recommended tests (this is out of pocket).

I typically get what we can through the GP, and get the rest done directly to make it as cost effective as possible.

If you have any questions, DMs are always open. Always a pleasure to connect.

13/10/2023

I am convinced that methylation is an essential area to address for PMDD (and ADHD!), especially if you have reacted to medications.

Following on from my previous post, methylation can be a key treatment area for many with PMDD, and ADHD.

It's a pathway that is essential in the regulation of key chemicals involved in mood and hormones - highly relevant for PMDD.

Signs & symptoms that this pathway may be compromised and underlying your PMDD (and ADHD):

Positive for MTHFR SNPS
Elevated homocysteine
Low B12 + folate
High histamine symptoms
Flat, unmotivated mood
Sugar cravings
Puffiness and inflammation
Severe mood swings
Elevated estrogen

If this is you, I would always staet with a methylation and hormone assessment to minimise the guess work.

Methylation is a complicated treatment area, and not black and white. Careful dosing of specific nutrients is vital to minimise possible reactions.

If you need some help to get started, my DM's are open, and initial assessments available from mid-november.

02/10/2023

There is no single treatment for PMDD and/or ADHD.

Unfortunately there is no 1 answer, and modern medicine does not have much to offer.

If your goal is to achieve an optimal quality of life, treatment will involve more that one approach.

The most beneficial treatment for these conditions encompasses a combined therapeutic collection of smart nutrition, strategic herbs and supplements and realistic lifestyle change.

This journey towards healing and lifestyle balance is unique for every individual.

Both PMDD and ADHD are long-term conditions that require ongoing management, and have varying underlying causes.

By targeting specific biochemical pathways that impact chemicals including dopamine, serotonin, GABA, and histamine, we can reduce symptoms of both PMDD and ADHD, and make other therapies such as counselling and medications work better.

There is overlap and common denominators here.

It extremely difficult to navigate these conditions alone - and you are not alone ❤

Dm's on this account are always open if you need somewhere to start.

25/09/2023

I have come across many clients who have been using the wrong treatment for their underlying imbalances, which of course, results in disappointing outcomes.

This can be really damaging to how we think about ourselves and relationship to our body. Most of my clients already feel broken.

There are various root causes and factors that contribute to the development and maintenance of PMDD.

It's not always just about progesterone metabolites.

In order to achieve mild and even symptom free cycles, you need to address the underlying factors.

This is different for everyone, and no two women will ever present with the same set of genetics, psychology, trauma, environment and biochemistry.

It is essential to target the correct pathways for better treatment outcomes.

If you are targeting hormones when you don't actually have a hormone imbalance, your results are going to be compromised.

You are probably not treatment resistant, you just haven't addressed the right underlying causes.

You will see in the slides above that I explore 5 key areas for treatment. They are not mutually exclusive, and there can be more than 1 pathway needing to be addressed.

This is where some good clinical guidance and case taking is extremely valuable in understanding your body.

If you need some help with this, my DM's are always open and I try to respond to as many questions as possible.

I am fully booked until the end of October, so I have opened some more free 15-minute calls to get you started. Booking link in bio.

15/09/2023

Vitex (chaste tree), and SSRI's are often prescribed to treat PMDD. Both have different mechanisms, and can help reduce PMDD symptoms.

Some people respond beautifully to vitex, while others experience a negative reaction.

It's important to understand your underlying drivers before establishing treatment.

If you have normal levels of progesterone, or have excess estrogen, and experience rage as part of your symptom pattern, vitex is probably not for you.

Working on supporting neurotransmitters and reducing estrogen may be a better treatment direction.

If you have experienced treatment resistance to SSRI's, elevated histamine may be an issue. High histamine can counteract the effects of serotonin.

If this is the case, we would want to test homocysteine and histamine, and work on methylation pathways.

Remember, PMDD has many root causes and biochemical considerations, and not all treatment is created equally.

These are only 2 of many important considerations to investigate.

Individual factors and testing is essential for better treatment.

Let me know if you have reacted to vitex?

My DMs are always open if you need some guidance. I also have some free calls available this month to discuss your treatment options. Link in bio

01/09/2023

Sometimes cyclic mood symptoms can be a result of hormone imbalances rather than a brain sensitivity to normal hormone changes.

This is why testing is non-negotiable when establishing an assessment and case formulation.

Treatment can be entirely different depending on the root cause.

For example, if you have healthy progesterone levels, I would not recommend herbs to promote progesterone, such as vitex. It's probably not a hormone issue.

This could make you feel worse.

If it's a hormone imbalance we would work directly on modulating hormones.

If it's a brain sensitivity, we would work on supporting neurotransmitters and the nervous system.

Sometimes we need to work on a bit of both.

Common denominators and root causes for both often include optimising methylation, addressing inflammation, and a creating healthy gut environment.

There are always various factors to consider with each individual, and many things we can do to minimise the symptom window.

No two women will ever present with the same root causes.

If you need some guidance, my DMs are always open.

I have some free calls available this month, and some new client availabilities coming up in late October. See bookings link in bio.

16/08/2023

We know that some of the same hormones and neurotransmitters play a key role in the pathology of both PMDD and ADHD.

Estrogen, serotonin, dopamine and histamine changes are some key common denominators. Methylation is a crucial pathway that helps to regulate these chemicals.

ADHD symptoms will fluctuate alongside hormone fluctuations and increase in your PMDD symptom window. Many of you will know and experience this.

If you have MTHFR variations, supporting methylation is even more important because it can leave you more vulnerable to methylation impairment and dysregulate the above hormones and neurotransmitters.

This can trigger or exacerbate symptoms.

One thing you can do to support methylation is through nutrition.

Eating greens everyday can support methylation and help compensate for MTHFR variations.

I like to get my biggest dose through a daily green smoothie, especially for folate and minerals. It's the easiest way and we can pack a lot in there.

A warning on supplementing folate, B12 and other methylation cofactors: we need to test and not guess, this is important.

My recommendations for testing: MTHFR (both SNPS), homocysteine, B12, folate, and sometimes a full methylation profile.

Estrogen can be both protective and destructive for both conditions depending on the levels, therefore also testing s*x hormones at specific times in your cycle is essential to get treatment right.

Supporting methylation can be highly valuable in treating PMDD and ADHD, but they are different conditions and require a combination of tailored strategies.

Remember, there are various root causes and not everyone will need to work on methylation, so before self diagnosing and self prescribing, please get tested and work with someone who knows how to to support methylation/MTHFR variations.

My DMs are always open.

*Please note I am booked up until October, feel free to get in touch and I can put you on my cancellation list.

04/08/2023

Working on your blood sugar is potentially one of the best strategies to reduce symptoms of both.

I often talk about addressing common denominators because it's one of the most efficient ways to treat various symptoms at the same time.

Blood sugar is one of those 🙏

Even subtle variations can impact biochemistry and influence symptoms.

Fluctuating blood sugar can negatively impact hormonal fluctuations/imbalances, cortisol, adrenalin, dopamine, and progesterone. All involved in the pathology of ADHD and PMDD to some degree.

Blood sugar regulation will also help compensate for changes in estrogen that can worsen symptoms of both too.

The thing is, stabilising blood sugar consistently is hard, because any diet change or restriction is hard and requires diligence 😩

But once we stabilise blood sugar consistently, there is a huge return on that investment; more stable mood, safety in the nervous system, balanced hormones, more energy, less cravings, weight loss, slowed aging, and a reduction in ADHD and PMDD.

And It's not just food that we need to address in order to stabilise blood sugar; sleep deficiency, mineral deficiency, stress and cortisol are all important factors to consider.

Some things I love you to start practicing as part of your daily habits for support blood sugar:

Magnesium and chromium

10 minute movement after dinner

Fat + protein (an antidote to blood sugar regulation)

1 hour meal prep on the weekend

Working towards a low sugar diet

Dash of apple cider vinegar before meals/carbs

Dietary limitations can cause distress for those with ADHD, disordered eating, and an eating disorder history, so restrictions/change should have clear rationale and be realistic.

If you need some help, my DMs are always open ❤

Alisa Asano - Naturopath

16/02/2024

09/02/2024

03/02/2024

30/01/2024

15/01/2024

22/12/2023

27/11/2023

17/11/2023

13/11/2023

29/10/2023

24/10/2023

13/10/2023

02/10/2023

25/09/2023

15/09/2023

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