Ep. 189: Low Dose Naltrexone for PMS, Endo, PCOS, and more with Restorative Reproductive Medicine CNM Ashley Jensen

Have you heard of LDN or Low Dose Naltrexone? It's gaining popularity after several studies revealed its support for reproductive health issues like PMS, PMDD, endometriosis, and infertility. Today's episode with NaProTechnology trained nurse midwife, Ashley Jensen, discusses what it is, why it's effective, how it works, and whether you should ask your doctor about it for your own use. She also discusses common side effects, other benefits outside of the reproductive realm, and other options you can try before LDN or other medications. 

This episode discusses: 

• what LDN is
• how LDN works and what makes it effective 
• who it may benefit the most 
• what conditions it affects (reproductive and other) 
• possible side effects and considerations
• alternatives to LDN use

NOTE: This episode is appropriate for all audiences, but does reference PTSD.

GUEST BIO: Ashley J. Jensen, CNM is a certified nurse-midwife who specializes in restorative reproductive medicine to support women experiencing infertility, recurrent miscarriage, and a wide range of women’s health concerns, without the use of artificial hormones. She has advanced training in NaProTechnology, FEMM, and Chart Neo, and is passionate about providing holistic, root-cause-based care for conditions such as polycystic ovarian syndrome (PCOS), endometriosis, premenstrual syndrome (PMS), natural family planning, and menopause. Ashley is currently part of the women’s health team at the University of Utah. To learn more or view her profile, visit https://healthcare.utah.edu/find-a-doctor/ashley-jensen.

HELPFUL LINKS:

Ep. 117: Client Story - Ashley (Overcoming PMDD)

Ep. 10: Endometriosis 101

Dr. Phil Boyle talking about PMS and LDN on YouTube

Transcript

Caitlin Estes (00:26)
Welcome back to the Woven Well podcast. Today we're going to talk about somewhat of a secret weapon in the reproductive health and fertility world, and that is low dose naltrexone. Have you ever heard of it? If not, you are not alone. Over the last decade or so, there's been some interesting uses of it, specifically some off-label uses that have become a game changer for women dealing with PMS, endometriosis, autoimmune issues, all sorts of things.

But who is it for? How could it benefit them? How should it be used? These are really important questions. And so I invited Ashley Jensen to talk us through it. Ashley is very experienced in its use as she's been a Creighton model system nurse midwife trained in NAPR technology, FEM, neo fertility, and she is serving women and couples through the University of Utah and has been for many years. So Ashley, welcome to the show.

Ashley Jensen, CNM (01:24)
Thanks, Caitlin. It's a pleasure to be here. And I definitely geek and nerd out about this stuff all the time. So yeah, thanks.

Caitlin Estes (01:32)
Absolutely. I was just telling somebody before recording this that I dream about this stuff all the time. So it's on my mind even when I go to sleep. Well, will you tell us a little bit about yourself and the work that you do?

Ashley Jensen, CNM (01:40)
I get that.

Yeah, I've been working for about six years and all I do is restorative reproductive medicine. I'm assuming your listeners know what that is. And that's all I do. So even though I'm nurse, wife, ⁓ I don't deliver. So I'm basically a nurse practitioner. And this is all I do. And I eat it, breathe it, drink it, know, I live it. I live it too. So

Ashley Jensen, CNM (02:04)
But I love it and I do some of the infertility work, but I would say by and large I'm doing more GYN stuff now than infertility. Kind of just naturally switched to that over the last couple of years as patients have just sought me out and do a lot of PCOS, PMDD, which we'll talk about that with LDN, very helpful for that. But yeah, so this is my life, so happy to be here.

Caitlin Estes (02:26)
Yeah.

And that's very helpful to to hear that you're working in gynecology specifically because maybe sometimes we do put a little more emphasis on the infertility side of things because there's so much that we can offer those struggling with infertility, but this applies to everyone. Any woman can benefit from this restorative reproductive medicine. Doesn't matter if they're single or trying to conceive or trying to avoid pregnancy.

Ashley Jensen, CNM (02:40)
Mm-hmm.

Mm-hmm.

Totally.

Caitlin Estes (02:55)
if anyone dealing with these reproductive health issues can benefit from it. So let's talk about low dose naltrexone. What is it? How does it work? Let's get into it.

Ashley Jensen, CNM (03:08)
Yeah, yeah. So naltrexone originally was made as FDA approved for opioid withdrawal. So you'll definitely get some looks for people that when they only know the FDA intended purpose for it. but

when used in a low dose form, so it's about 10 % strength of the standard FDA approved dosage of 4.5 milligrams. It works in an entirely different way. You still don't wanna be on opioids when you're on it, but it has a lot different mechanism of action. So it's used a lot accepted pretty...

pretty widely in the functional medicine world. So I would say most functional medicine providers are going to be pretty familiar with it. Our naturopathic providers, there's actually some books out there called like the LDN book and the LDN book two, where they talk about its use in a lot of those autoimmune conditions. So things like multiple sclerosis, multiple sclerosis, ⁓ Hashimoto's, lupus, Crohn's, fibromyalgia, things like that. ⁓ As far as functional meds acceptance of it,

thoughts about using it in the GYN world is not as broad. So they don't necessarily readily think about it for some of the conditions we'll talk about today. But it does help modulate your immune system, which is why it's used in the autoimmune world. And the way I usually explain it to people for a lot of the conditions that we use it for is that one thing that we know it does is increase your beta endorphin levels. And the way it does that, it's typically used at night.

⁓ You have endorphin increase at night. We have endorphin typically like pretty steady, but it will cause a temporary suppression of the beta endorphin level. And in the morning will cause a subsequent rise and then it'll actually cause your body to make a higher amount than what it would have been making before. patients that benefit from it are like, yeah, that's a good fit. Typically they have that ⁓ noticeable improvement in wellbeing ⁓ from those endorphin levels.

like I mentioned, the immune modulator can help decrease ⁓ inflammatory cytokines chemical messengers that are promoting inflammation, keeping the immune system in check. So from the immune side, that's why it's very, very more broadly used or known for its use in the inflammatory side of things.

I actually learned while I was researching for this that I can actually help ⁓ with PCOS on the insulin side of things, which I didn't know. So that was new information for me. Yeah.

Caitlin Estes (05:40)
I think that's a newer use. I've only had one or two clients who've used it for insulin resistance. And so when they first told me about it, was like, ⁓ tell me more. And I've been looking into it since. But yeah, this low dose has a lot to do with reducing inflammation. And I appreciate you specifying how it works with increasing the beta endorphins. And I can imagine how that could make you feel better and could reduce inflammation. How can it help women with gynecological issues though?

Ashley Jensen, CNM (06:14)
Yeah, so would say like ⁓ one of my biggest, like the red flag, I don't know, maybe a green flag, like I think you'd be a good fit for this. When patients I'm doing their history, especially on a new intake, things that I think, hey, you'd be a great candidate for trying naltrexone ⁓ would be PMDD in general. So premenstrual dyspore disorders, that extreme PMS automatically, I mean, I've had just really, really good success with that. Those patients do typically end up on higher doses than the standard low dose 4.5. Most of my patients in that PMDD category do much better around like six to 10. I have one gal, she's been on 10 for a long time, doing really, really well, which we can talk about her, she's one of my favorite patients. ⁓ And then pretty much anytime like PMS, if they say they have anger or rage, this is actually a pretty like, widely accepted in the napro world. That's one of the things Dr. Hilger's trained with napro is that rage piece, that anger rage piece. And so I've been pretty in tune to that. So when I am going over the PMS list for patients, like, okay, do you have irritability or do you have anger? Okay, is that anger? Would you say that you have like mom rage or if they're a mom or like just rage where you're just like, I just can't control myself. If they say yes, they're more on the anger side than the irritability side. And I'm like, I think this would be a really good fit. And it really does help with that symptom.

Other things that I've, you know, on the GYN side would be like interstitial cystitis, which is, I would say any age can have it. I've had young patients, I've had older patients, perimenopausal patients, post-menopausal patients. So it's not defined to any age, but interstitial cystitis is basically when a woman thinks she has a UTI constantly, but keeps getting it checked and it's not. So you just have this like kind of vague bladder urinary pain. ⁓

And then I see this a lot be kind of almost cyclical in nature where they're experiencing this like only around their period, only around ovulation. Sometimes we think it may be linked to that endometriosis piece a bit, but I've had patients respond really well where that symptom just entirely goes away when they're on LDN, which is really helpful. ⁓

Long COVID long haul COVID has really benefited from it, especially that like chronic fatigue piece of the long haul COVID has been has been really great. Endometriosis has been awesome. ⁓

So there's a lot of different things, but I say those are like my big like, hey, like I think you'd be a good choice. I'm gonna recommend this to you now versus later. There's other things on the fertility side that I'm like, hey, well, we could give this a try. It might help your fertility and maybe it might not help symptom wise. which was I think for me was the case, but I didn't really notice anything really changing about it, but I got pregnant. It was great.

⁓ But other patients do really notice like huge improvements ⁓ in some of those side effects and those bothersome things.

Caitlin Estes (09:05)
So are there particular, you know, you were talking about in the infertility side of it as well, are there particular candidates that are dealing with infertility, like certain things that it can improve, or is it just sort of a general overall if somebody's struggling with infertility?

Ashley Jensen, CNM (09:22)
Yeah, no, there still definitely is markers. ⁓ particularly like Hashimoto's, if a patient has Hashimoto's, thyroiditis, with those elevated antibodies, it's very helpful for reducing those antibody, that antibody load, which we know is helpful ⁓ because of its benefit on that inflammatory, ⁓ helping on the immune modulation side of things. It's really helpful on that.

With endometriosis, we do know that, ⁓ like I said, from that work that was done through Pope Paul VI Institute and Dr. Hilgers's work, we do know that statistically, women with endometriosis and PMS have statistically significant reduced levels of beta endorphins, which this is the endorphin specifically that LDN is helping with.

Like I would say like, this would be my example. Like I had endometriosis, I had surgery for endometriosis. I went on LDN. I really could not say that I noticed anything positively beneficial, like symptom wise. But like based on those studies, I likely had reduced beta endorphin levels. So we know that if we put a patient with those reduced beta endorphins on LDN, it's going to increase those endorphin levels, which we think are going to be helpful in.

⁓ You know, just your overall body function. And then on the inflammatory side, we do think that endometriosis is a kind of inflammatory, you know, I would say it's still not well understood. ⁓ The term I kind of use with patients is that you kind of with endometriosis get this unhappy pelvis. ⁓ So, okay, there's not anatomical obstructions, but there's something that's making your pelvis be like, yeah, we don't want to make a pregnancy here. So I'll help on the unhappy pelvis and kind of just calm things down and hopefully allow for that conception and implantation.

Caitlin Estes (11:20)
Yeah and I think the commonality between almost everything that you're talking about is inflammation and you can talk to a lot of medical professionals out there and they will tell you that inflammation in many ways is a threat to overall health. Now obviously our bodies need inflammation, we can use inflammation to our benefit, there are certain ways that is absolutely essential. But when it's overdone or in areas that it's not necessarily supposed to be, that's a lot of times when we also notice those autoimmune issues where certain parts of the body are ⁓ responding negatively to the healthy normal function. So Hashimoto's is the body rejecting a thyroid function that is natural and healthy. And so we get that response. Now, the interesting one to me is the PMDD because now we can treat PMS through supporting the post-peak or luteal phase progesterone production and in my experience that usually takes care of PMS symptoms if they're long or severe but then there's PMDD which is more that brain-body connection and so it's like the brain is misfiring or responding in a way that it's not intended to to the drop in progesterone and estrogen right before the period and so I find it really interesting that LDN is a great fit for that because it makes sense you know supporting the beta endorphins is going to help the brain not misfire but understand like hey this is normal this is okay this is healthy

Ashley Jensen, CNM (13:04)
Mm-hmm.

Caitlin Estes (13:04)
And I've actually had a good number of clients over the years who had PMS, got that treated, felt so much better. And there are a lot of lifestyle things and dietary things that you can do to help your progesterone levels as well. But there was still that missing piece, but they didn't want to go on an SSRI for whatever reason. Like they just didn't want to do that. And so to have an option like LDN that works totally differently, I think is a really great avenue for a lot of people Listeners by the way if this is helpful information if you find this interesting or helpful If you want to pass it along to someone else then what I want you to do is take five seconds to leave a review It makes such a difference to listeners getting episodes like these out to other ladies who are looking for more resources and Your quick review can help us to do that

So Ashley when we're thinking about results to expect, maybe even timelines, like what have you seen in your patients over the years?

Ashley Jensen, CNM (14:08)
Yeah, typically we tell people it takes at least six weeks to get to kind of that effective, you can actually judge this is what it's going to be for you. It is something you take every day. So thinking about that PMS, PMDD, you're not just taking it during your premenstrual phase, and then you can say, okay, how do I feel? We usually ask, do you feel better, worse or the same? If you feel worse, that's probably not a good fit for you. And that is the case that it is not the magic bullet for everyone. I'd like it to be, but some patients just don't tolerate it. I've, you know, it's generally tolerated well. The most common side effects that people explain or experience would be vivid dreams. And

The category that I would say is not a good candidate typically for this are patients with PTSD trauma. I've had several of them that have had really severe PTSD nightmares as a result of it. I've had some of them like, hey, let's maybe try doing it in the morning. They've done a little bit better. We know that the mechanism of action isn't gonna be quite as good in the morning, but I I'm like, hey, we could give it a try.

but, ⁓ typically, you know, those vivid dreams, usually not too bad. Usually if it's a good effect for you, it's a medication that's going to help you. That usually goes away. Most patients say they'll sleep better. ⁓ it can feel kind of like jittery or wired initially. I rarely hear that. Headaches have been moderately common and then nausea can happen. ⁓ but typically that one, if you just increase your dose, we usually increase slowly over time.

If you're just slowly increasing, you got some nausea, just increase it a little more slowly and your body usually gets used to it. And then we usually get to that 4.5 and then at the end of six weeks of being on 4.5 and we'd say, hey, better, worse or the same. If you're worse, shouldn't be on it. If you're better, great, let's stay on that for now. If it's about the same, then let's try increasing and we increase by 1.5 increments, They'll get to some dose where they'll be like, I felt better at the last dose. Let's go back to that.

And so that's where it kind of, figure out where their sweet spot is. And then maybe they're good there for a while. And then after, you know, three to six months, like, I think I need an increase. And the nice thing about it, if you do compound it as you can make those adjustments yourself, which is really nice.

Caitlin Estes (16:14)
Hmm. Well, and I know we're running short on time, but I'm curious, are there things that you can do while you're taking LDN to try to improve the beta endorphins, like so that you don't have to be on this medication long term?

Ashley Jensen, CNM (16:28)
That's a good question. ⁓ I would say it depends on what we're looking at, what we're treating. PMS, for example, PMDD is a different beast, like you mentioned. But PMS typically is like low progesterone. Well, if you have low progesterone, it's probably because you don't have a great ovulation. Well, if you don't have a great ovulation, there's probably a reason. Is it metabolic insulin resistance? Is it thyroid that you need balanced? Is it? ⁓

Caitlin Estes (16:30)
Yeah, it's okay if you don't know.

Ashley Jensen, CNM (16:56)
you know, vitamin D that you need more of and those things that are going to help facilitate better ovulation, therefore are going to facilitate better progesterone levels. So I think there's always that like look back and, know, we're always in in restorative reproductive medicine trying to get to that root cause. And so I think that sometimes it is a little bit of a bandaid like, hey, let's be on it for now, but let's try to like fix these underlying things. Like I said, PMDD seems to be a little bit different thing. And so I think that it's a little bit harder to adjust with that, but yeah.

Caitlin Estes (17:23)
Yeah, and that's a good point too, that you're going to be treated in that holistic manner. You're looking at the whole person, the whole body, and so it could be that as those other things are getting treated, then you could experience ⁓ no longer needing the LDN as time goes on too, which is of course important. So thank you so much for being on the show, Ashley and sharing with us.

Ashley Jensen, CNM (17:43)
Right.

Yeah, of course, that went by really fast.

Caitlin Estes (17:48)
Listeners,

many times in the midst of reproductive health issues, we can feel like we are on our own as women to get them addressed. Issues that often go unnoticed deserve to be investigated, diagnosed, and treated. LDN may be a part of that journey for you, but it's obviously not for everyone.

So if you'd like to learn more about LDN, look for research on its use in restorative reproductive medicine. As always, thanks for listening as we continue to explore together what it means to be woven well.