By: Ellie Kight
Editor’s Note: During the FACTS elective for medical students, Ellie Kight interviewed Dr. Kate Heimann, a family physician and FACTS preceptor who integrates fertility awareness-based methods (FABMs) into her practice. The interview focused on diagnosis and management of premenstrual syndrome (PMS) from the perspective of a practicing physician. If you are an FABM-trained medical professional or fertility educator interested in teaching the next generation of medical professionals about these methods and their role in restorative reproductive medicine, please apply to be a preceptor here.
Introduction
Premenstrual syndrome (PMS) is a common but often misunderstood condition affecting a significant percentage of the female population. Studies show about 80% of women experience at least one symptom of PMS and approximately 12% meet the full criteria for the condition. [1] Nevertheless, PMS remains an under-recognized diagnosis that can significantly disrupt daily life, affecting women’s physical and emotional health.
Dr. Heimann’s Journey to Fertility Awareness
Dr. Heimann is a Board-certified family medicine physician. She attended medical school in California and currently works in Northeast Indiana. She is passionate about school athletic programs, adolescent/pediatric medicine, and women’s health.
Her interest in fertility awareness and natural family planning methods was sparked while exploring alternatives to conventional hormone-based treatments. She explained, “I wanted to find more natural, non-contraceptive options for family planning and to address menstrual pathology.” She was searching for options beyond the standard contraceptive delivery methods like oral contraceptive pills (OCPs) or intrauterine devices (IUD).
Dr. Heimann’s journey into FABMs began during residency, where she was first introduced to NaProTechnology. She later completed additional training in Fertility Education and Medical Management (FEMM). She incorporates FABMs to support women with family planning and to diagnose and treat medical conditions, including PMS. When asked why she was interested in PMS specifically, she said, “So many women have it to varying degrees. I draw attention to the fact that this isn’t how life is supposed to be; if we can address whatever is causing (PMS symptoms), whether it’s estrogen or progesterone or thyroid or endocrine imbalance, women don’t have to suffer.”
She incorporates FABMs to support women with family planning and to diagnose and treat medical conditions, including PMS … “So many women have it to varying degrees. I draw attention to the fact that this isn’t how life is supposed to be; if we can address whatever is causing (it), … women don’t have to suffer.”
Using FABMs to Diagnose PMS
PMS manifests in a combination of affective and somatic symptoms. Affective symptoms include mood swings, anxiety, irritability, and social withdrawal, while somatic symptoms include bloating, breast tenderness, headaches, and joint pain. [1] Dr. Heimann emphasizes the importance of tracking symptoms: “We use tools like ‘symptom diaries’ over at least two menstrual cycles, which help us identify patterns and address hormonal imbalances.” The Marquette Model, in particular, helps identify fluctuations in estrogen and LH levels, which she uses to provide personalized and targeted interventions such as bioidentical hormone therapy or supplementation.
Dr. Heimann also encourages patients to use phone applications (apps) to track their menstruation, changes in discharge or cervical fluid color/consistency, and daily symptoms. These apps can track timing of menstruation, intercourse, discharge appearance, abnormal bleeding, and stressors or emotional shifts, if necessary. She believes these apps are especially suited for her younger population of women. Although apps may be a terrific tool to facilitate tracking of the female cycle, women should still learn how to observe and interpret their cycle biomarkers by working with a trained instructor.
Lifestyle Modifications and Management
Dr. Heimann emphasizes the importance of lifestyle modifications in managing PMS. “Diet and exercise play a significant role in regulating hormones and reducing PMS symptoms.” She reports that weight loss, physical activity, and a healthy sleep regimen can improve adrenal and thyroid function, which in turn support hormonal balance. Dr. Heimann commonly recommends dietary changes such as reduced carbohydrate intake to decrease inflammation and possible insulin resistance, which can influence the hypothalamic-pituitary-adrenal axis. “For some patients,” she added, “gluten intolerance can exacerbate inflammation and, thus, PMS symptoms.” Vitamin D, vitamin B6, and inositol are commonly recommended, but Dr. Heimann cautions that they should be considered as part of a comprehensive treatment plan rather than stand-alone solutions.
“Diet and exercise play a significant role in regulating hormones and reducing PMS symptoms.” She reports that weight loss, physical activity, and a healthy sleep regimen can improve adrenal and thyroid function, which in turn support hormonal balance.”
A common misunderstanding is that oral contraceptive pills are an effective treatment for PMS. While OCPs may help treat the underlying physiology of PMS, such as abnormal hormonal imbalance, Dr. Heimann emphasized OCPs do not effectively address the cause of the symptoms. She prefers using the Marquette Model or obtaining a basic hormone panel to assess progesterone, estrogen, and other biomarkers to design a targeted treatment approach. She recommends obtaining labs for at least two cycles to achieve a holistic view of the patient’s patterns before implementing a treatment plan, which may include prescribing hormones that were deficient at that specific point in the cycle, usually in the luteal phase before menstruation. Dr. Heimann believes this is a more successful approach because it is unique to each patient and identifies and treats the specific hormone imbalances causing PMS symptoms.
Misconceptions about PMS and FABMs
Addressing misconceptions about PMS is a major challenge as many patients believe it is “just something they have to live with.” Dr. Heimann wants to “challenge that belief and help women understand that PMS is not inevitable or something they need to endure.” By using FABMs to track symptoms and identify underlying hormonal imbalances, she empowers patients to take control of their health and explore treatment options that align with their unique needs.
Despite the many benefits of FABMs, Dr. Heimann acknowledges some challenges in their implementation. “Adolescents, in particular, may struggle to remember to track their symptoms consistently.” To overcome this barrier, she recommends that they use phone applications to make tracking more accessible and easier to integrate into daily life. Syncing on these apps with younger patients with supportive family members can encourage consistent tracking and provide emotional support.
Guidance for Medical Professionals
Dr. Heimann’s advice to medical professionals, particularly medical students and residents, is to embrace FABMs to better understand and treat women’s health conditions. She recommends starting with a solid understanding through a course like those offered via FACTS CME and exploring charting methods such as FEMM. “Beyond conception and family planning, these models offer a diagnostic approach to menstrual health and pathologies.” She also encourages the use of apps to enhance patient engagement and streamline charting practices, noting that some of these apps allow physician syncing as well.
“Dr. Heimann’s advice to medical professionals, particularly medical students and residents, is to embrace FABMs to better understand and treat women’s health conditions … starting with a solid understanding through a course like those offered via FACTS CME.”
A New Approach
As a medical student who was largely unexposed to FABMs in the pre-clinical years, I appreciate the personalized approach to a common diagnosis. I hope to incorporate individualized charting, lifestyle modifications, and targeted hormone therapies to offer holistic management of PMS and improve overall reproductive health.
Editor’s Note: Follow the links below to learn more about PMS, benefits of charting for PMS and other conditions, and fertility apps.
- Diving Deeper into Premenstrual Dysphoric Disorder: The Benefits of Charting
- Fertility Apps for Holistic Health Tracking: A Research Review
- The Relationship Between Stress and PMS: A Research Review
- Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Review
References
[1] Hofmeister S, Bodden S. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 2016;94(3):236-240.
ABOUT THE AUTHOR
Ellie Kight
Ellie Kight is a third-year medical student at Marian University Wood College of Osteopathic Medicine in Indianapolis, IN. She completed her undergraduate education at American University in Washington, DC. While still a third-year medical student, she is considering applying to general surgery residency programs. Ellie enrolled in the FACTS elective to learn more about natural family planning and its approach to fertility and women’s health with the goal of empowering women to take control of their health and wellbeing.
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