PMS – You are really not crazy!

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PMS is a Hormonal Imbalance that Causes Emotional Symptoms.

Last week one of my pellet patients asked me to see her daughter, even though I don’t see young women anymore since I began BioBalance Health for people over 40.  I asked her why she couldn’t see her gynecologist and she told me that she was told that she had PMS and that was a condition that was treated by a psychiatrist!  I have treated PMS successfully by replacing one hormone that is missing, Progesterone, two weeks a month, the same two weeks that women experience the symptoms of PMS.  I agreed to see her although I wish my fellow gynecologists would learn how easily this can be treated and not make young women feel like they are crazy, because they aren’t!

NOTE: Before I give you the impression that I treat PMS currently at BioBalance® Health, I want to clear that up: I only treat PMS in my younger cycling patients (36yo. to menopause) who take testosterone pellets for other symptoms.  My recommendation for finding a doctor who treats PMS in your area is to contact a local compounding pharmacy and ask the pharmacist which GYNs treat PMS, or contact one of the large compounding pharmacies, eg. College Pharmacy in Colorado Springs, or Belmar Pharmacy in Colorado as well to find a doctor in your area who can treat you.  There are many good compounding pharmacies who have pharmacists who can tell you which doctors prescribe progesterone for PMS.

What is PMS?

PMS symptoms are only present 2 weeks a month, the 2 weeks before menstruation. This condition causes patients to feel different, not like themselves in the ways listed below, and also caused menstrual changes in the menstrual periods that follow the PMS symptoms.

The Emotional and physical Symptoms of PMS:  All occur monthly, for 14 days

  • Depression
  • Anxiety
  • Anger and irritability
  • Bloating,
  • Migraine headaches,
  • Water weight gain,
  • Pelvic pain
  • Fatigue
  • Insomnia


The Menstrual Symptoms associated with PMS:

The GYN Symptoms that can occur secondary to PMS (poor progesterone production) include:

1)irregular periods, spotting for a week before the period starts

2) heavy bleeding, sometimes uncontrollable bleeding,

3) infertility,

4) multiple miscarriages

5) lack of ovulation, and lack of periods for months at a time like with PCO Polycystic ovaries

My History Treating PMS (skip if you already know this)

I have been a gynecologist in private practice in St. Louis County since 1985 when I graduated from my OBGYN residency at Mercy Hospital. My training gave me an excellent knowledge of GYN Surgery and Obstetrics, but a very minimal understanding of the hormonal cycles of women, including Premenstrual Tension (PMS). Since the 1980s when PMS was recognized as a condition of women, OBGYNs have been taught that PMS is a psychiatric disease that must be treated with psychiatric medicines, primarily anti-depressants. Most OBGYNs today still believe that women who have PMS are “crazy”, and either give them an antidepressant which rarely work to treat the symptoms or refer their PMS patients to a psychiatrist.  In my case, I do not do either because PMS is a hormonal imbalance that causes emotional symptoms, and because psychiatric diseases are not cyclic every 28 days lasting 2 weeks, followed by 2 weeks of normalcy.

The Cause of PMS

Since 1988 I have studied the cause of PMS and with the help of a very intelligent compounding pharmacist, Pete Hueseman, I found the answer to the cause and treatment for PMS.  I began to treat PMS hormonally and now have successfully treated hundreds of PMS patients with bio-identical Progesterone.  It is a simple answer. PMS is caused by a deficiency of the hormone Progesterone during the two weeks after ovulation, from around days 14-28!  This is not a complicated diagnostic discovery, and the treatment should be obvious to all doctors who treat young, fertile women. More about that in a minute…

From 1980- the present there has been no effective treatment for PMS approved by the FDA         (just ineffective anti-depressants) because it is still  categorized as a psychiatric disease.   When I took my second American Board of OBGYN test in 1999, a question on my test was: “Is PMS a Psychiatric Disease that should be treated with antidepressants?”  And the correct answer according to the American College of OBGYN was that that statement was TRUE, they believed and still do in 2024 that PMS is a psychiatric disease!  In 1999 I had been treating PMS successfully with bio-identical compounded progesterone for over a decade with bioidentical progesterone in non-oral form (suppositories, vaginal tablets, vaginal cream, and transdermal creams), given only during the second half of the menstrual cycle, from ovulation until the onset of the period.

To understand PMS you have to understand how the three sex hormones work during a woman’s 28 day cycle.  We count the days of a cycle starting at the first day of bleeding, which is day 1.  While we have a period our estradiol, progesterone and testosterone are all at their lowest level in the blood, but by the end of our period estradiol (estrogen) and testosterone start being produced by the ovary. They increase and both peak at ovulation, usually day 14, giving a woman a viable egg and a surge in her sex drive to motivate her to have sex and fertilize the egg. On day 14 the egg is released from the ovary and the corpus luteum (where the egg came from on the ovary) starts secreting progesterone.  This hormone increases and plateaus during the next 14 days, while estradiol and testosterone level out.  The day before bleeding, when the egg is not fertilized, all three hormones drop precipitously and that causes the uterine lining that was growing under the control of estrogen, to shed and bleed.

PMS occurs during the second half of the menstrual cycle when the developing egg is not ovulated or is immature and ovulated but is not “ripe” enough to stimulate a decent progesterone blood level.  In the case of PCO, many eggs develop but are trapped and don’t ovulate at all so no progesterone is produced.  In all these cases, women with PMS are symptomatic both in the symptoms above and the menstrual abnormalities listed earlier.

All of the physiologic changes that take place in the PMS patient indicate an inability to conceive, or to conceive but have multiple miscarriages.

The Treatment for PMS:

The Treatment is bio-identical Progesterone, but the FDA didn’t have a form of bioidentical Progesterone that worked until the last 10 years, when Prometrium was produced. Prometrium is an oral pill containing natural progesterone in peanut oil.  This works well for some women, but not for others. For those women we prescribe bio-identical compounded progesterone in sublingual, vaginal, transdermal and BLA Progesterone oral forms.

The most important fact about diagnosing PMS is to remember that the symptoms of PMS only occur 2 weeks a “menstrual” month (28 days of the cycle).  The most important fact about treatment is that PMS should be treated with Progesterone the second two weeks of the menstrual cycle at bedtime.

Now my patients ask me to treat their daughters who are cycling and whose OBGYN follow the guidelines of ACOG blindly even if the suggested treatment (anti-depressants don’t work or make them worse).  I can only hope that the method of treating PMS as a hormone deficiency, instead of a psychiatric disease, will be accepted by American College of Gynecology and that you can find doctors you can be treated by, by finding a compounding pharmacy who will refer you.

Compounding pharmacies in St. Louis: Neels’s Pharmacy, and Medical Arts Pharmacy (ask for Brock) in Clayton MO, Jennifer’s Pharmacy in Clayton, MO.

Phone number

(314) 849-3123

Medical Arts Clayton Pharmacy › compounding


(314) 862-7400

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author. • (314) 993-0963. Please subscribe to our YouTube channel and please check “ Like “. Follow us on Facebook and Instagram at BioBalanceHealth.


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