A generic pill to treat PMS (Ep. 51)

I like to think that I make medical decisions based on science.  However, science only advances when we try things that are new and unproven.  If the last few years has illustrated anything, it is that science is never settled.
This podcast is like that - you won't find this referenced anywhere, and it's likely that your Ob/Gyn or PCP will look at you (and me) like we're crazy for bringing this up.
There is anecdotal evidence that you can treat the symptoms of PMS with a generic medication that's on the WHO's list of "essential medications" and can be had for pennies.
Take a listen and decide for yourself!

Brain Swelling "study"
CSF Increase during menstrual cycle

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Welcome to another episode of the Trillium Show. This episode is going to be different from some of the other ones that we've done. Usually when we are talking about scientific procedures. We're talking about data, and I like to try and teach and talk about things that have science behind them.
Just as a disclaimer, this podcast isn't going to be one of those episodes. This is going to be one of those shows that a mentor of mine, Dr. Robert McClellan, would say, kind of with a smirk on his face, the plural of anecdote isn't data, and that was something that was drilled into our heads during general surgery training is that just because something happens once or twice doesn't mean that there is science behind it to prove that it's valid.
But at the same time, in plastic surgery, a lot of what we do doesn't have good science behind it. And we're trying to fix that, but, so much of what we do is subjective, that you really can't have a lot of data behind some of the things that we do day in and day out. This is one of those things that was just kind of too cool not to talk about.
And what I'm talking about is the treatment of premenstrual dysphoric disorder, PMDD, more commonly known to the lay public as PMS, with a blood pressure medicine. And this is something that until about a year ago I had never heard of until one of our nurse anesthetists who had been in practice for a long time Started talking about it.
She said, Well, you know, I've never PMS since I was in nurse anesthesia school because an anesthesiologist had given me this trick and it works like a charm. And as we were talking, she kind of talked through this. The trick, the secret is the use of a generic low dose blood pressure medication called hydrochlorothiazide. It's been out forever. It's very safe, and she has been taking this a couple of days before her menstrual cycle starts, probably for 30 years. I was initially very skeptical. I did some research.
There is. Absolutely no data out there suggesting that this is a real thing. But at the same time, my wife and I talked about it and she tried it. It worked for her. And so we decided to test a small dose on our 14 year old and it worked for her. So I have, you know, an N of, of three, three of three of people that I know in my life who have tried this.
Before your menstrual cycle, your body retains fluid. What a low dose thiazide diuretic does is it is going to cause you to get rid of some of that fluid and prevent some of the swelling and bloating that can happen in your body. The theory is, that it's swelling within your brain, specifically your frontal cortex where kind of behavior and emotion is controlled. That causes some of the irritability and the behavioral emotional problems that accompany some women's menstrual cycles.
And it makes a lot of logical sense. Again, there's no science behind it. The only thing that I was really able to find when I was looking on the internet is that there are a couple of very small studies. One which came out in 2016 and I'm actually surprised it was even published. It was a study of one woman, who underwent a series of brain scans around the time of her menstrual cycle and showed that her brain actually swelled.
In the days leading up to a menstrual cycle, and then after her cycle was over, it returned to its baseline volume. And that kind of lends some credence to this theory that the thiazide diuretic is going to prevent some of that swelling. The other study I was able to find was a study out of the 1980s, where some radiologists did MR studies looking at cerebral spinal fluid volume.
around the time of menstruation. And what they found was in premenopausal women, the volume of cerebrospinal fluid, so the fluid that sits around your brain and spinal cord that kind of acts as a cushion, goes up by about 10 milliliters during Your menstrual cycle and then returns to baseline afterwards where it doesn't do that in either men or in post-menopausal women.
So both of those things taken together kind of lends some credence to this thiazide as a treatment for brain edema or swelling, and that it may cause some improvement in premenstrual dysphoric disorder. So again, as Dr. Mack would say, the plural of anecdote isn't data. This is something that is, not mainstream, but in my very small experience has seemed to work. So it's something to talk to your gynecologist about, something to talk to your family practitioner about.
I think we were using 15 milligrams for my wife seems to work really well. There is really you only take it once. It's a single dose right when you start to feel a little bit irritable, and really has been, an eye opening little experiment.
So talk to your physician about it. Please don't call me. I'm not going to prescribe your I'm not going to prescribe blood pressure medication for premenstrual dysphoric disorder. that's kind of well outside my wheelhouse, but, I wanted to bring this up and throw that out there because it is something that I think Could very much impact a lot of, women's health and well being, ,certainly around the time of your menstrual cycle.
Thanks for listening. This is string way outside the realm of typical plastic surgery, but, it was interesting and I thought I wanted to share it with everybody to let you know. Shoot me an email if you need to. I'm sure I'm going to get some hate mail for this: [e-mail] or shoot me DM on Instagram.
Thanks. And we'll see you the next show.