PMDD Antihistamines: Why They May Help — and Why Histamine Isn't the Whole Story

0:00So good, so good, so good. New summer arrivals are at Nordstrom Rack stores now. Get ready to save big with up to 60 % off brands like Rag & Bone, Levi's, Adidas, and Free People. Join the Nordi Club to unlock exclusive discounts, shop new arrivals first, and more. Plus, buy online and pick up at your favorite rack store for free. Great brands, great prices. That's why you rack. This episode is brought to you by Google Chrome. You think you know a browser, but Gemini and Chrome? That's new. It can help you with practically anything on the web, like restoring a vintage motorcycle from a 50-page restoration block, or finally break down that long article you've had open for weeks.

0:42Gemini and Chrome is here for it. Ready to make anything online make sense? There's no place like Chrome. Check responses set up required, compatibility and availability varies 18+. It sure seems like everyone and their mother is talking about antihistamines like Allegra and even Pepsid for PMDD right now. And I asked you what you wanted to know and your questions were very clear. So here are the questions I'm going to be answering in this episode. Can you explain the whole PMDD? Could be a histamine response thing. What are your thoughts on the Allegra, Pepsid thing that's been circulating? Is there any natural relief?

1:18and how do I tell if I have PMDD and not PMS. So today on the Dr. Brighton Show, and hi, by the way, this is your host, Dr. Jolene Brighton, and we're gonna get into all of this. But before we do, I wanna make sure that you don't miss out on this because if you're struggling with PMDD, I don't want you stuck guessing. I am a PMDD girly myself, and it's no coincidence that I also have endometriosis, ADHD, and autism. Now, for a limited time, when you pre-order my book, ADHD in women, you're going to get access to my live PMDD workshop that's happening June 10th. In that training, I'm going to help you identify your PMDD pattern, understand how ADHD, histamine, and hormones are interacting in your body, and we're going to map out what to do in each phase of your cycle.

2:09But I'm also going to walk you through supplement strategies, what to talk to your doctor about, including dosages, and I'll be answering your questions live. Now, if that sounds good to you, go to drbrighton.com slash PMDD. Grab a copy of ADHD and Women where I have an entire chapter on PMDD just for you. And then you'll also get access to the June 10th workshop. Okay, so I'm actually gonna start with the question I've been asking and that is, if PMDD affects millions of women, why in the hell are there only nine active NIH-funded studies going on right now? Now, PMDD, premenstrual dysphoric disorder, that's anticipated to affect anywhere from 3 % to 8 % of menstruating women.

2:51Some research says it's as high as 10%. And since medicine is absolutely awful and not gaslighting women and believing them, that 10 % may even be an underestimate. And while someone will definitely comment, 3%, that's not a lot of women. No, that's millions of women. That's actually a lot of women. And so despite that, we've got limited research, limited treatment options, and a lot of women are being dismissed. So what happens when medicine doesn't give clear answers? Women start experimenting because PMDD, and we're going to talk about the symptoms in this episode. We're going to talk about how to tell if it's PMS or PMDD.

3:28But I want you to understand that PMDD is so severe, the self-harm rate is so high that women are literally doing anything they can to remain on this planet with us. And I think anyone out there looking at you, mainstream media, judging women and saying, oh, they're using antihistamines, these dumb women just following a TikTok trend. Like you should slow your roll because what we're not talking about is why the hell don't we have more research studies going on? Why is it so underfunded? And why do we act like women's lives are so expendable? Women are literally doing anything they can to stay with us.

4:00And I think we need to pause and we need to listen. Now, the antihistamine conversation is not new. hi, I have endometriosis, PMDD. We've been talking about this for years now. And I think the first time I saw people on social media, it was like five years ago. When you started trying it, it started working. And that's exactly how something like antihistamine suddenly became a trend. But here's the thing. Trends don't come out of nowhere. If it wasn't working, no one would be talking about it. So there's a biological reason this works for some people. And that now brings me to your question, which is, can you explain the whole PMDD could be a histamine response thing?

4:42Okay, so here's the truth. Yes, histamine can be involved in PMDD. I write about histamine all throughout ADHD and women because it is acting as a neurotransmitter, but histamine alone is not the whole story. Now, if histamine had nothing to do with PMDD, antihistamines wouldn't help anyone. And we're going to talk about antihistamines and the Pepsid H2 blocker in this episode as well. So stick around for that. Now, histamine is part of your immune system, but it's also playing a role in inflammation in the brain, neuroinflammation, brain signaling, our mood, it can disrupt our sleep at night, and estrogen increases histamine release.

5:24So during certain times of your cycle, especially when your brain is already more sensitive, histamine can be amplifying your anxiety, your irritability. We see the perimenopause rage that can come with that and even perimenopause, sleep disorders, insomnia, brain fog, that can be part of the PMDD picture. Now, in your cyclical years, this is hitting you like 7, 10, maybe 14 days out of every month. Put it in perspective, y 'all. That is six months out of every year. And we got nine research studies active right now, actively being funded by the NIH? I don't think so. That is lame. If you are in perimenopause and you have PMDD, this can become a lot more unstable and unpredictable, and the rage can be amplified.

6:09Now, you add on top of that having ADHD or autism, which is commonly associated with emotional dysregulation, and ADHD and autistic brains have a propensity towards throwing histamine, having histamine issues. We see a lot of MCAS being involved in this, which is mast cell activation syndrome. We see histamine intolerance, but there's also this underlying neuroinflammation that's already happening when you have a neurodevelopmental condition. And when you have a neurodevelopmental condition, you are also more hormonally sensitive. And so the same shifts that another brain experiences, the normal hormone shifts throughout our cycle, You know, as it turns out in the research, it's actually not that bad if you're neurotypical.

6:53But if you are neurodivergent in that camp, things swing wildly. And we see that roughly around 50 % of those with ADHD in one survey, they reported having concomitant PMDD. And over 90 % of those who are autistic report having concomitant ADHD. So there's something going on here. And it is very much related to the full body experience, which is being a neurodevelopmental condition. And that I know is a reframe for a lot of people because ADHD is always like, that's a brain condition. That's a psychiatric condition. Hate to break it to you. It's a full body condition, which is why in my book, I was like, we got to go through all the systems here.

7:33Now, the other thing I will mention is endometriosis. So endometriosis, those lesions tend to be rich in mast cells. And I like to joke that if you like look at them wrong, they just degranulate and they dump histamine. And so we see women with endometriosis reporting more symptoms of PMDD. We do not have research at this time to say, oh, endometriosis, PMDD, they go to big other like besties or anything like that. But we do understand, if you just listen to women, that women with endometriosis experience more PMDD-like symptoms. And all of this, the ADHD, the PMDD, the endometriosis, comes down to inflammation, immune signaling, and definitely those histamine pathways.

8:14So when someone takes antihistamine and then they feel better, that is because histamine is involved. But it's not the full picture of PMDD. And I want you to understand that. We're also going to go through some warnings here of why that is not a good idea as a long-term treatment. Now, another question you asked me was, what are my thoughts on the Allegra-Pepcid thing that's been circulating? So Allegra, that is an antihistamine. Pepsid is an H2 blocker. The antihistamine is working on the H1 system. I'm going to break that down a little bit more. But what I want to share with you is that when I was going through infertility treatments, it was my fertility doctor who recommended doing a combination of H1 and H2 blockers.

8:58And the reason why they recommended that is because of the history of adenomyosis and endometriosis. There can be higher levels of histamine. Histamine is inflammatory. It can affect how implantation happens. And what I noticed with that is that, yes, my symptoms of endometriosis, they did mildly improve. It wasn't a complete game changer for me, but it was also something as well that when I went through my miscarriage, which was a second trimester miscarriage about a year ago, and I went through grief, as one does, I was in a really dark place. but then months later cyclically what started to move in was that dark cloud that I remember of PMDD and I realized my old friend was back and I was man I had managed PMDD very well through my life and then following the the the pregnancy loss there's a very inflammatory state to be in not to mention where my mood my mental health was and I was like I got to get relief ASAP and I used the combination.

10:04I used Claritin and H2 blocker, Pepsid. And taking both of those gave me relief, but I didn't stay with that long-term. I am not on antihistamines now, and we're going to be talking, this is going to be a two-part episode, but we're going to be talking about more layers. And in the workshop, I'm going to take you through things of ways to approach PMDDs that you're not beholden to antihistamines. Antihistamines are not a root cause approach. They can be a life-saving approach for some people, but I got a lot more to say on this. So firstly, a lot of people will get relief with just using the antihistamine, the H1 blocker.

10:41So histamine is like a signal that your immune system sends, but your body has different receptors for that signal. And H1 receptors are what most people think of with allergies. So that's what most people think of when they think about histamine. They think about the itching, the hives, maybe the stuffy nose, the watery eyes, the swelling that can happen. If you're really histamine sensitive, maybe you drink wine, you have flushing. And for some people, they have a more wired and reactive feeling. So that's the H1 receptor. The H2 receptors are found heavily in your stomach and they are responsible for your stomach acid production.

11:24Already, if you understand that, you understand why this is not going to be a long-term solution. And if you don't, don't worry, we're going to get there. But the H2, it also exists in immune cells and blood vessels. So Allegra, that's going to block the H1 receptors. So remember the itchy, the swelling, the watery eyes. Pepsid blocks the H2, which is involved in digestion, but also some of the immune cells as well. And that means using both can reduce histamine signaling by affecting multiple pathways, not just one. And that's why some people try an antihistamine and they're like, that's not enough.

12:01I have to add PEPCIT because they have to hit both pathways. But here is something so key that I need you to understand. And that is blocking histamine receptors is not the same as fixing why your body is releasing histamine in the first place or not clearing it. So antihistamines, those are symptom control. They're not root cause. It's like putting on noise-canceling headphones while a fire alarm is going off. But maybe that's not even a fair analogy because in a lot of ways, it does help. You do feel better, right? So if I put on noise-canceling headphones and there's an alarm, I feel better, but the alarm is still there.

12:40So we can always use things to help you get symptom relief while we work on the root cause of things. But I don't want anyone hearing this and being like, antihistamines for life. Now, before you go and grab whatever you have at home, I want to talk to you about something really important because not all antihistamines are created equal. And if you are reaching for Benadryl, that's a first-generation antihistamine, and I never recommend this, okay? Because Benadryl crosses into the brain, and it has anticholinergic effects. That means it interferes with acetylcholine. Acetylcholine is a neurotransmitter that's involved in your memory and your cognition.

13:26My perimenopausal women, my ADHD women, I need you listen up. You have acetylcholine problems. You don't want to compound that by adding in Benadryl. So long-term frequent use of medications like Benadryl, those have been associated with an increased risk of cognitive decline and even dementia. So Benadryl, we ain't reaching for that, okay? You want to talk to your doctor about alternatives to that. Now, I just want to be clear that like because I just said this, that doesn't mean if you one time took Benadryl that it's dangerous or that an occasional use, like you're like, I got stung by a bee.

14:02I needed it. Like, that doesn't like seal the deal that you're going to get dementia. It is regular, consistent. And how are women with PMDD using it? Cycle after cycle after cycle, sometimes for two weeks at a time. That's six months out of the year. That is not something that any doctor who understands the research would recommend. Now, second generation antihistamines, Allegra, Zyrtec, Claritin, Those have a different profile, but even those, we still need to zoom out and we need to look at the bigger picture because the reality is there is no study for PMDD and antihistamines. We need that research.

14:39There's clearly a mechanism here, but we don't know the long-term impact if you are using that three to six months out of the year. Now, the other question I think is really important and goes along with this is, is there any natural relief? Yes, but it also has to be targeted. So if histamine is part of your PMDD story, then vitamin C, that can support histamine breakdown, DAO enzyme, that's the enzyme that exists to break down your histamine, that can also help. But I also want to talk about saffron here and specifically afron. Now, if you know the Radiant Mind story of this formulation I created, it's because of my struggles with PMDD and what I knew what was coming down the pipeline for me in menopause because I did Lupron and I got a little like preview, like a movie clip roll of like how hellish that was going to be for me.

15:30And I was like, ah, absolutely not. So that's why I designed this formulation. Now, why this particular form of saffron matters is that it has been studied in PMDD. There was a randomized control trial where PMDD women, they were assigned to saffron, fluoxetine, or placebo, and during the luteal phase for two menstrual cycles, that's what they took. One thing I hear from women all the time is that they're struggling with symptoms like hot flashes, sleep disruptions, and brain fog, but aren't sure where to turn to for help. Menopause is inevitable, but suffering through it isn't. That's why I want to tell you about Alloy.

16:09Alloy is a digital health platform that connects you with a menopause-specialized doctor who can create a personalized treatment plan tailored to your needs, all from the comfort of your home. Join the 95 % of women who tried Alloy and saw relief in the first two weeks. Head to myalloy.com and use the code DRBRYTEND. that's myalloy.com m-y-a-l-l-o-y.com and the code drbrighton d-r-b-r-i-g-h-t-e-n share your symptoms and you'll get a fully customized treatment plan and unlimited messaging with your doctor plus you'll get twenty dollars off your first order today that's m-y-a-l-l-o-y.com code drbrighton Eczema is unpredictable, but you can flare less with Epglyss, a once-monthly treatment for moderate to severe eczema.

17:11After an initial four-month or longer dosing phase, about 4 in 10 people taking Epglyss achieved itch relief and clear or almost clear skin at 16 weeks. And most of those people maintain skin that's still more clear at one year with monthly dosing. EbGliss, Librikizumab, LBKZ, a 250 milligram per two milliliter injection is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema. Also called atopic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies.

17:40EbGliss can be used with or without topical corticosteroids. Don't use if you're allergic to EbGliss. Allergic reactions can occur that can be severe. Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with EpGliss. Before starting EpGliss, tell your doctor if you have a parasitic infection. Ask your doctor about EpGliss and visit epgliss.lily.com or call 1-800-LILY-RX or 1-800-545-5979. Saffron Group used 15 milligrams twice daily. So it's 30 milligrams in a day. Both saffron and fluoxetine reduced PMDD symptoms compared to placebo.

18:14So when I mentioned Radiant Mind, which you all know I take, it's not just take something for your mood. I'm saying there is evidence that saffron may support mood, irritability, emotional symptoms. It helps with libido. It helps with sleep. It helps with hot flashes. But that doesn't mean that saffron is a replacement for medications, okay? Supplements are designed to support your natural physiology. They're not designed to treat disease. And I think that's just a really important caveat because I would never want someone to be like, SSRIs are saving my life. but Dr. Brighton talked about saffron.

18:50So I'm going to jump off that and use saffron instead. That's a conversation to have with your prescriber. Now, there's a lot of things that can help with PMDD. And I'm going to go through them in the workshop with dosages because I know you can ask clarifying questions. And I feel like that's a more responsible way to do it. So I can help you have a productive conversation with your provider. But the reality is, is throwing the kitchen sink at PMDD and just hoping for the best, that doesn't always work. And so we have to talk about like the exact things. And this is a two-part episode. In part two, I'm going to also talk a lot more about SSRIs and birth control.

19:25But in this episode, I wanted to make it more in the theme of histamine since that is what's circulating and I've gotten so many questions about it. Now to answer the question, like, is it PMDD or is it PMS? Like, how do I tell if I have PMDD and not PMS. So if you don't know which one you're dealing with, you certainly can't treat it correctly. Because in PMS, we often need more progesterone. In PMDD, the level of progesterone, that's not necessarily going to get as positive an effect as it does with PMS. Now, PMDD is defined by a very specific pattern. Those symptoms show up in the luteal phase, that is after ovulation, and then within starting your period, they go away.

20:07So they improve shortly after starting your period. Premenstrual exacerbation, that is when you have depression that is consistent, but then it gets worse before your period. That's different from PMDD. PMDD is very luteal phase specific, as is PMS. But with PMDD, you also need at least five symptoms, and at least one must be mood-related. So that's going to be things like irritability, anxiety, depression. So a lot of mood symptoms are going on with PMDD. You can also have really severe mood swings. Like one minute you're so happy and the next minute you're crying. But the biggest distinction between PMS and PMDD is that PMDD impairs your ability to function.

20:56It's not just feeling off. It's not just feeling like, oh, I'm a little bit sad, a little bit weepy when that one commercial comes on, PMDD is a, I don't recognize myself. I can't function the way I normally do. A dark cloud has moved in. The way I have always described it, it feels like to me is I can see how great my life is on the other side, but there is a window between me and my life and I cannot reach through. I cannot touch it. I cannot feel it. I cannot be grateful for it or get to it. I'm stuck. I'm stuck on this other side and it sucks. It's the worst. So in addition to the mood symptoms, we also see lack of concentration.

21:38That can be difficult when you have concomitant ADHD going on to differentiate it, but you have these severe, severe impeding your life level of mood symptoms. There can also be physical symptoms. So joint pain, muscle aches, you may have fatigue, You may have increased cravings. You may have symptoms that look a lot like disordered eating. You can have severe fatigue despite sleeping and then also wanting to sleep all the time. So track your symptoms because there's a lot of symptoms that fit into PMDD's umbrella. Track your symptoms and then make sure that you're following them throughout your cycle for at least two months to take them to your doctor.

22:24So that brings me to the question of how do I get a doctor to listen? Now, I will say there is no test to confirm PMDD. There's no blood work. There's no hormone test. There's nothing like that. And most women aren't getting dismissed because their symptoms aren't real. They're getting dismissed because the pattern isn't clear and it hasn't signaled to the doctor that like this is a pattern or your doctor may not believe in PMDD. That's real. Okay. I wrote all about it in my book about how PMDD was pharma initiated so that pharma could sell us one particular drug for this and get it FDA approved.

23:00That's all real. But because of that, that's made some doctors believe that PMDD is not real. Although as someone who lived it and experienced it before it was even recognized, before it was even a diagnosis, before it was an ICD-10 code or DSM criteria condition, like I had it. It's real. So I want you to know just because like pharma was like, hey, we can make some money off of this condition doesn't mean the condition is not real. So the biggest advice I would give you is that if you need to get diagnosed with PMDD, you're like, I have this. I need to get a diagnosis. I need to get help. You got to track your symptoms and you do it alongside your cycle and you have to do it for at least two cycles and you're tracking everything.

23:39What's your mood doing? How's it impacting work? How's it impacting your relationships? How's it impacting school? How is it impacting your physical capacity? Can you even work out? Are you sleeping 12 hours a day? When you bring that pattern, that should change the conversation. And if it doesn't, then that provider, they weren't really ever going to help you anyways. And that sucks. And I hate to say that. Sometimes it's like, oh, I can say like, go see another provider. But is it really that easy? Is it really that easy in women's medicine? It's not. So how do you find a provider? Start getting into forums.

24:12Start getting into chat groups like they have them on Reddit. Ask in the comments, certainly on my Instagram post, on this YouTube video. If you have a provider who's great, drop their name and their location. You never know whose life you're going to save. But just by sharing, like this doctor will listen to you. Now, when it comes to antihistamines and Pepsid, women are typically using these for half of the month or five days before they expect their symptoms to hit. So they are tracking their symptoms and then they're like, okay, five days before I'm going to start the antihistamines and possibly the Pepsid.

24:49Now I talked about some of the problems with the antihistamines, but what I want to note about Pepsid is that it is very real that if we are lowering your stomach acid, that can affect your digestion, that can affect gut motility, so that could set you up possibly for infections. Your stomach acid is a barrier for things that are coming in and it can also lead to nutrient deficiency. You're not able to liberate minerals. You're not able to liberate B12 as easily. And so being on Pepsi long-term isn't an answer for PMDD. And that may be frustrating to you because you're like, but this is actually working.

25:27You got to talk to your doctor. So I'm a doctor. I'm not your doctor. You can't listen to this episode or women on social media and then be like, okay, I'm just going to take anahistamines and Pepsi for the rest of my life. That is playing with fire. We just don't have the data to say that is safe. And like I said, histamine is only one part of the picture. In episode two, we're going to go even deeper on this. But what I want you to understand is that these medications, while they can be helpful, they're not without side effects. So while women are following just the standard dose on the package because these are over the counter and they're using those and they're reporting success.

26:04and I believe these women. I have also experienced it with these antihistamines. We've got to ask the question, why? Why are you struggling with all this histamine? Did we miss endometriosis or adenomyosis? Could that be going on? Do you have gut dysbiosis? So the gut we're going to talk about in episode two can be playing a role here. Is it a situation where your mast cells are really unstable? We need to stabilize them. Is it a situation where you're not clearing estrogen effectively and estrogen is stimulating those mast cells to release histamine and then histamine is stimulating your ovaries to make more estrogen.

26:40We have to go deeper and ask why. Because while the compensation with an antihistamine may work in the short term, I have had people come to me who are like, I started the antihistamine thing and I was on it for years and then it stopped working and things got worse. Well, we were using a band-aid approach rather than getting to the root cause. And I am not against a band-aid approach, okay? I am a big fan. Like, right? If we are thinking about self-harm, if we may injure ourselves, like, I don't think it's a bad idea. Whether that is antihistamine, the go-to, which is SSRI, maybe birth control actually works for you.