Your PMDD Tough Day Toolbox with Victoria Schoeffel
Learn how the Belle app is so much more than a symptom tracker and how it can help you to not only get some relief from PMDD in the short term, but also build resistance over time.
-
Victoria Schoeffel is the CEO and Co-founder at Belle Health. Victoria was inspired to " change the status quo in female health" after identifying a gap in support for premenstrual dysphoric disorder. While she was at the University of Cambridge, Victoria and her co-founder and Belle Health CTO, Rafael Schaider, combined her personal experience living with PMDD, and her degrees in psychology and medicine, with Rafael's engineering background to help people living with PMDD get tailored, evidence-based and proven guidance to help manage the luteal phase. In this conversation, Victoria shares her own personal experiences with PMDD and how she came across a study of internet based cognitive behavioral therapy that became the starting point, or the inspiration, for the Belle Health app.
I have tried the app for myself and there's so much good stuff in there. I love the SOS feature that helps you quickly find the right tool by selecting the symptom that's bothering you in the moment. There's also a self-paced course that goes deeper into these strategies and exercises. You can generate a symptom report to take to your doctor if you're trying to get a diagnosis. And Belle Health is now coming out with a Belle Smart Ring, which is going to use your physiological data to give you better and more specific recommendations tailored to your individual needs, and I'm really excited for that to come out.
So please enjoy my chat with Victoria Schoeffel. -
Title: Your PMDD Tough Day Toolbox with Victoria Schoeffel
Episode number: 28
Date: 01.20.26
Speakers: Diane DeJesus, RD, IBCLC (host) · Victoria Schoeffel, Belle Health (guest)
EXCERPT (00:00)
Victoria: We have a lot of different techniques inside the app for mindfulness, meditations, breathing exercises. My personal favorite is actually attention training technique that I hadn't heard of beforehand, because that probably helps, helps a lot with my comorbid ADHD and like, yeah, makes for me like a, a huge difference.
Victoria: And in the app, what it allows you is that you can build up habits, learn those different techniques, integrate them in your life, but also use them in like specific situations when you might not be feeling good. So what we do is that we recommend specific techniques based on certain symptoms. So a user can choose like a symptom, and based on that, we'd say like, ah, this technique seems to be matching that. Try this.
INTRO (00:46)
Diane: If you want to learn how you can live better with PMDD, this podcast was created for you. This is Mindfulness for PMDD with Diane. I'm Diane and I'm a registered dietitian and lactation consultant. I'm also a mom, a PMDD warrior, and a trauma-informed mindfulness teacher, and this is where I discuss topics related to PMDD through the lens of mindfulness and meditation, and where I share all about how mindfulness has gotten me to a place of greater peace and acceptance with my PMDD. I also chat with people who have helped and inspired me along the way so they can share their wisdom with you too. So let's get started.
SAFETY NOTE / DISCLAIMER (01:38)
This podcast is not a substitute for psychological therapy or medical advice. Please take care when listening to this podcast, as some may find certain words or subjects triggering or difficult to hear. Take only what serves you and leave the rest behind.
WHY A PMDD APP CAN BE MORE THAN A SYMPTOM TRACKER (01:54)
Diane: Okay. I was thrilled when I discovered the Belle app, which is an app designed for people with PMDD to not only track their symptoms, but also get evidence-based tools tailored to help with those specific symptoms. And the thing that got me so excited was that among the cognitive behavioral therapy tools in the app were a lot of what I recognized as mindfulness exercises. So here was this app that was making mindfulness accessible to people with PMDD.
Diane: My guest today is Victoria Schoeffel, who is the CEO and co-founder at Belle Health. Victoria was inspired to change the status quo in female health after identifying a gap in support for premenstrual dysphoric disorder. While she was at the University of Cambridge, Victoria and her co-founder and Belle Health CTO, Rafael Schaider, combined her personal experience living with PMDD and her degrees in psychology and medicine with Rafael's engineering background to help people living with PMDD get tailored, evidence-based and proven guidance to help manage the luteal phase.
Diane: In this conversation, Victoria shares her own personal experiences with PMDD and how she came across a study of internet-based cognitive behavioral therapy that became the starting point, or the inspiration, for the Belle Health app. So listen to our chat to learn how the Belle app is so much more than a symptom tracker and how it can help you to not only get some relief in the short term, but also build resilience over time.
Diane: I have tried the app for myself and there's so much good stuff in there. I love the SOS feature that helps you quickly find the right tool by selecting the symptom that's bothering you in the moment. There's also a self-paced course that goes deeper into these strategies and exercises. You can generate a symptom report to take to your doctor if you're trying to get a diagnosis. And Belle Health is now coming out with a Belle Smart Ring, which is going to use your physiological data, as like the wearer of the ring; so it'll take information like your heart rate, for example, to give you better and more specific recommendations tailored to your individual needs. And I'm really excited for that to come out.
Diane: So please enjoy my chat with Victoria Schoeffel.
WHEN YOUR LUTEAL PHASE HAS ITS OWN PATTERN (05:05)
Diane: Hi, Victoria. Thank you so much for joining me. Welcome.
Victoria: Hi. Thank you so much for having me.
Diane: I appreciate that you have, you're joining in from Munich, you told me, and so it's 8:00 PM there and it's 1:00 PM where I am. So I really appreciate you making the time.
Victoria: No, for sure. Like as a really kind of not having a good work-life balance right now. So would still be here otherwise anyways.
Diane: Okay. So I had mentioned to you that, you know, before we jump in, one of the things I love to do on this podcast is just kind of state, like where I am in my cycle and what I'm experiencing, and if I have a guest who also experiences this PMDD, I like to include them. And you said you'd be up for that. So I can start.
Diane: I am day 16 today and I felt the luteal phase kick in yesterday. Like I woke up tired and I normally don't, unless it's the luteal phase. I woke up tired and irritable, and today I feel like my strength is down, my appetite is up. I, I deal with dysautonomia, so I'm feeling that more today, like more dizziness and yeah, I'm feeling it. It's like clearly here. The luteal phase is here.
Victoria: I feel you. I definitely feel you. Also day 16, so we also just feeling like the luteal phase starts. And kind of like really a bit anxious, to be honest, of like, okay, now kind of starts again, of just celebrating the time that was so good and like, knowing that it'll not stay like that already. Not being able to sleep as well yesterday night anymore, and knowing, okay, like it's probably just getting worse.
Victoria: I also, for myself, notice that often like a, a pattern that it gets worse at the beginning of the luteal phase, then it gets a little bit better again for me, and then it gets way worse again. And I kind of like correlate that to the, to, to the changes in progesterone in the end.
Diane: Yes.
Victoria: So I'm kind of like really anxious right now for this particular phase, and I'm hoping, okay, like maybe then I kind of adjust to like this phase again, but... But yeah, feel you very, very much.
Diane: I am so glad that you shared that. 'Cause I experience a very similar thing. It kind of ramps up, but then it settles down a little bit. I think sort of toward the, like, let's say we're looking at the last two weeks before my period, right? It's like that first week of my luteal phase. It'll start off bad and then it'll get better for a few days and then it really kicks in, let's say in, in the last like week or so before the period.
Victoria: I'm totally experiencing the same thing and I've been thinking about it quite a lot of like, it makes sense when comparing that to the hormonal graph. But then also sometimes I've been kind of reasoning of like, okay, maybe my brain adjusts to like, okay, this, this is my new normal. Then it gets like a little bit better in coping and then it gets like worse again somehow because it's getting too much.
Victoria: So I've been like having those theories which just explain of why am I feeling like that. But I think that's also one of the areas about PMDD, which more research is needed of like: where does it kick in? Like what are the differences in different types? Do most people experience it like that? Or are there different patterns of like when that actually occurs? And yeah, that's something I would be very, very excited about just seeing in the future.
Diane: Oh, okay. This is so good. We're getting, it's getting juicy already. All right, so before we get ahead of ourselves, 'cause we are going to talk about you, you do have a PMDD app and there's a lot of research that's going on behind that app and I'm so excited to talk about that. But let's back up a little bit 'cause I wanna know, first, if you could tell us a little bit about, you know, yourself and your experience with PMDD.
DISCOVERING PMDD AFTER MEDICAL TRAINING DIDN’T NAME IT (08:56)
Victoria: Yeah. Well, where to start? I think like the main thing to know about me is that I'm a massive nerd, so I love to study and did that quite a lot. So I have multiple degrees in philosophy, psychology, and medicine actually before getting into like this whole project right now. And that really defines me quite a bit, that I just love to, to, to learn and like create things. And that brought me also really like, into, like, into the PMDD space, I think from my intellectual perspective, because there's just so much to explore, so much not known, and so much new things to add about PMDD.
Victoria: To be honest, it's been like, it's a, it's a really like a journey I think that like many others go through as well. I very clearly remember first actually learning about PMS when I was probably 21. I think it might be like a bit unique that I hadn't heard about that beforehand, which might be related to coming from Germany and there may be even less of a conversation even about PMS existing.
Victoria: I learned about it when I was living in the U.S. for a while and studying there. And I realized that in the end that something exists about the menstrual cycle impacting it, when I realized that I had always really, really bad conflicts with my ex-boyfriend back then. And at some point I was able to, to see that pattern of that, I was just not able to emotionally cope. I still think that like he was wrong in the end, not about it, but that there was like just this difference of like how well I could adjust, how well I could deal with it.
Victoria: And from that point onwards, it kind of like, I got like more and more and learned more per se, but in a very, very slow, slow way without really realizing the full impact of it. And I then went on to study medicine after that. And yeah, relatively at the end of my degree still, I had never heard about PMDD at that point. Not mentioned a single time in any of my curriculum. I also checked everything that I had and just PMDD doesn't exist in like that universe thing.
Victoria: But at some point there, like I had this moment where I was preparing for a presentation and I was just freaking out. I was feeling so, so, so bad. I could just not focus. I was anxious. I was, I was just not feeling like myself. And then on the next day I got my period and all of a sudden I had this light bulb moment of like, oh, I'm feeling great. Like I'm actually in pain. I do have strong period pain, but I'm like, my mind felt like clear all of a sudden. So there's like just not this fog in front of me. Like something that makes everything just look dark and gray in many ways.
Victoria: And on that day I actually Googled like it again deeper and I was like, come on, like I'm studying medicine. Like I've been going to my gynecologist actually back in Germany always. And she told me, oh, get monk's pepper, because that's the, like you can try hormonal contraception in Germany for PMS or you can try like monk's pepper. And I couldn't really try hormonal contraception back then because of like another medical problem.
Diane: Yeah.
Victoria: So monk's pepper is actually, it's just like a supplement, like for that.
Diane: What is that? Okay. A supplement.
Victoria: Yeah, actually I think in English it's like they use also monk's pepper, but I think it's Vitex agnus-castus. In Germany, they always use that word and then I translate it, probably always wrong. And I was like, okay. Like I've tried that. I cannot really do something. And then with this, like it always getting better. At some point I was like, okay, like I guess I just gotta live with that.
Victoria: But then getting again, like into the, like the bad phase. And on that day I was like, no, but like this is impossible. Like I'm studying medicine myself, like I'm supposed to actually know what to do and I'm not supposed to just accept that I cannot do anything about that.
Diane: Right.
Victoria: So actually started to, to sit down and I went down a really, really deep rabbit hole that probably lasted on my whole follicular phase, like in at that point, of like reading just every paper about that. And also learned for the first time about PMDD. It was also not that hard to read every paper because there's not even that much research, which is quite sad to say, but it's actually exactly, exactly that. And that's actually where like everything really started. First time I learned about PMDD and where like all the, the ideas of changing something, this space started for me.
Diane: Yes. Wow. Okay. And so by this time, when you are finally discovering what PMDD is, and you're reading the available research out there, which is not, which was not much and still is not much, right? Where, where were you at in your, in your studies at that time, or where were you at, you know, in your life at that time?
Victoria: Pretty much the end actually. So I was pretty much at the end. I had like, I think it was like in February, two years, two and a half years ago now, like around that time. And I was already, yeah, like thinking about like where to go, like afterwards, because I was more like into the direction that I wanted to change something more fundamental about the medical system. So not necessarily practice medicine myself, but to change something about the structure.
Victoria: Like the whole journey that I had taken intellectually before was always like this more on a theoretical side to like maybe create something that can actually impact way more people. And that was also like that moment of learning about PMDD was even the, the start of like the, the company, the, the app in the end.
Victoria: I think like from that day on, I was bothering my, back then, like, boyfriend, partner, now husband, about this. Okay. Like we gotta do something about this. This is like, it's impossible that nothing exists. It's like impossible that nobody is talking about this because it affects me in such a deep way. And I knew that already for like a longer time before like, that, that day. And it's even something I brought up when we started dating on the first time.
Victoria: And looking back, I, I'm really, really sure that I had it since I'm, since I got my first period in the end. But on that day, the thing that really changed was that I was not accepting it anymore. I was not accepting that that's just the way that it needs to be. And I was like, okay, but I cannot just blame the world outside of how it is in the end. It's up to me to change something as well. So, that's when every day I was like, no, we gotta do something about it. And we started to, to, to discuss, like, I was going deep into the literature, seeing like, what can we do?
Diane: Yes. So it sounds like you really in that moment, or in those moments that you were just learning what PMDD was, you were already being inspired to do something about this, it sounds like. Yeah?
Victoria: Yeah. To be honest, I think for me it was like very, very fluid. I think also something that was quite different for me, from what I've experienced and heard from many others, is because I didn't even know about PMS, PMS never had a negative association for me. It's just, it could be also be really, really strong PMS. It's just like this experience that I had, of being really affected in a negative way. That was like the first description of it. And then understanding deeper those differences helped a lot.
Victoria: But I, I think I skipped that part where it was like, oh, like somebody would see that as something that's not strong or that's like not worth doing something for. I just knew in the actual medical system, they would not really have resources. And to be honest, I don't blame the doctors in the end because if you don't have it in your medical education, how are you supposed to do something? Like, I didn't learn anything. I know that my colleagues and friends that I studied with, I'm the one that brings it up and say like, hey, like, you gotta know like about this, people, right? You gotta recognize this.
Victoria: But then like, look at the medical reality. In most countries you have very, very little time to actually provide any type of treatment. You don't have the time to like dive as deep, and then if it's not mentioned a single time, there's so much to learn when you study medicine. It seems then like something like on top of it and you don't realize actually how, how much it affects actually so many individuals around the world and to what degree.
Diane: Yes, yes. And also, I mean, even, even now, 2024, it's still a relatively recent diagnosis, isn't it, in terms of being officially recognized, let's say in, in the ICD or whatever. That was not very long ago. Right?
Victoria: Yeah, actually the ICD, they're, they're just rolling out, no, or they just rolled out the ICD-11 and there, PMDD is actually inside. Funnily enough, as I mentioned, I'm from Germany, and Germany, they use the ICD, but it's not translated officially yet, so they still use the ICD-10 and not ICD-11. And that's somehow, it's a huge project for, to translate this and to have it approved. So it's something where, I've heard it's probably still going to take three years or something like that. And until then, PMDD actually does not exist as official diagnosis in Germany.
Diane: Oh my gosh.
Victoria: Right. In Germany.
Diane: Right. Oh my gosh. And so, see, even then it's like, right, so depending where you are, it may be an, a recognized diagnosis. It may not. Even once something's a recognized diagnosis though, then it needs time to roll out within the medical community, you know. And so in the meanwhile, like you said, there's real people having real experiences and really struggling, and it feels like there just isn't enough knowledge and enough support.
Victoria: Yeah. Yeah.
BUILDING BELLE FROM PERSONAL EXPERIENCE AND RESEARCH (18:09)
Diane: So you mentioned, is it when you mentioned your, your co-founder, is that Rafael?
Victoria: Yes.
Diane: So you mentioned how you kind of started this together, yeah?
Victoria: Yeah.
Diane: So how did you and Rafael come to create an app for PMDD; how did you guys decide that that was the path you were going to take to do something with PMDD?
Victoria: Actually, I think I was very, very persistent about it. So it was actually still like in that phase of like even realizing the term PMDD at that moment, not necessarily experience, but this term of PMDD. And within those like two weeks of deciding, okay, I wanna change something about this, I want to make like a, a difference, I was going through the literature and I came across a paper from researchers that had developed an internet-based cognitive behavioral therapy for PMDD, and those researchers were also based in, were, they were based in Germany.
Victoria: I was actually at that point I was studying in Cambridge, in the UK. So I was still living in the UK back then, and I was reading their paper and it was very, very interesting because their, the therapy program, had quite good effectiveness. Also for myself, certain treatment modalities were just out of question. I could just not go down that route.
Victoria: So, when I was reading like those results, I was like, that's super, super, super interesting. At the same time, I was aware, in different ways already, that in Germany there was like this system that was quite new at that point. So two years ago it had just launched, where apps, when they are medically certified and when you have research studies that can prove that this app is a medically effective treatment for certain health condition, that they can be reimbursed by the public health insurances.
Victoria: In Germany, most people are actually like insured by public health insurance, around 90%, and even private health insurances then go into like reimbursing them. What it means is that actually people can get access to your treatment and also to information via an app. Their health insurance will just cover the costs and whether they get access to it or not, it's just based on the individual doctor's decision on whether they have that health condition.
Victoria: And that seemed such an interesting system for especially something like PMDD because even most doctors don't have the time, the knowledge, the resources to, to go down that route to explain all the things that you can do, like all the different treatment options, and also consider like cognitive behavioral therapy because treatment places and therapy places are just not as available. And that seemed like a very, very interesting system to me on the one hand.
Victoria: And then on the other hand, I read this paper by the researchers. And when seeing that I actually contacted them. So I wrote them an email and I was like, I read like your paper, would you like to have to, to have a chat about it? And got in touch, had some conversations about it. We all agreed that PMDD is something that we gotta do something about.
Victoria: And at the same time, what they were saying is like, we're right now in the university context, we're researchers. So we do research, but our role in this is not to actually make sure that it's available afterwards. Because to make sure that you have like an app or a digital therapy program in a system, there are a lot of different steps involved, a lot of costs.
Diane: Right.
Victoria: You need to like, keep up, and researchers cannot do that. It's like a very, very different project. And they said it's like, it's really sad because, when we ran this first study that they did, that was also all based in Germany, there were like women from all over Germany coming, and they're still writing them up to that date. They still wrote them up to that date of like, can they still participate in that program? Can they have access to that program? Because they saw, right, this is about that. And they were just like, yeah, we can't, like, we can't because you do the research and then there are things you created that end up in your drawer.
Victoria: And we had then like this continuing conversation and we were like, okay, like my, my husband comes from the technical side, so Raf comes from the technical side. I was like on the medical psychological side and we were like, well, we can do that. So we sat down and we're like, okay, how can we actually make this happen so that we create an app for this? That it can actually be available to people. And that's really the whole start of the app.
Victoria: And that started within this research context. So we like kind of then continued, got like our, recruited a PhD student via the university, would run like a new clinical study.
Diane: Okay.
Victoria: We got like into the whole development of the app with also this focus on the therapy program. It's included in the app. Considering all the things that you need to do to make sure that the data protection is good, that it can be medically effective, that it's like safe. It's like a lot of extra things to consider for like those types of systems. And setups are actually like two clinical studies. Like, we're now running the first one for checking, okay, is this program, that also the researchers developed before, is like an app-adapted version of this program, actually a medically effective support treatment for reducing symptoms and improving quality of life?
Diane: And, and that is a question that's being studied right now in the current clinical study?
Victoria: Exactly.
Diane: Okay. I wanna go back for a second 'cause I don't wanna leave out Rafael. You mentioned that Rafael has a tech background?
Victoria: Yeah, he studied engineering and worked in also, like previously, as like an engineer already at like another startup. And also like in Cambridge when, when I came up and yeah, I convinced him to quit. So he joins my efforts to make like a, a difference to, to this whole area.
Diane: Yeah. So did you, did you guys meet in Cambridge?
Victoria: Yes, but we were also already like dating like at that point, like before. So we are dating, living together. He's been like through many PMDD cycles with me already.
Diane: Yes.
Victoria: He already, he already felt the pain from the, from the other side. I think from, that exists too, from like some, from a loved one, from like a partner's perspective, that PMDD is, when you're in a relationship, it's not something that only you experience, but you experience as a couple.
Diane: Absolutely.
Victoria: It's like a different, for sure, like a very different experience and different struggles, some of that. But I think that probably helped in convincing him of like the importance of this.
Diane: Yes. Okay. So you came across some people who were already researching internet-based cognitive behavioral therapy for PMDD, and that was sort of the beginning of this creating an app, using that knowledge, that information. And you currently now have your own study going on to really look at the effectiveness of what you have built and are building in your app, right?
Victoria: Yeah.
WHY PMDD TRACKING NEEDS TO BE BUILT FOR PMDD (25:03)
Diane: I wanna talk about what I found interesting when I went ahead and signed up for the app and also what, you know, the person listening would experience in the app and, and like what that experience is for the user. And what they can look forward to.
Diane: So for me, the reason I was so excited to chat with you about this app is because, you know, I, I came across your app, I think on Instagram. I'm scrolling and it was giving me, I think like, I don't know, I don't know what you call 'em, sponsored posts or something every now and then. And I thought, oh, it must be a symptom tracker. It must be a symptom tracker for PMDD. Right. Kind of just making assumptions and then maybe I saw something else and I was like, oh, it feels like there's a little more to this. I'm not sure.
Diane: And what I loved was when I actually got to go in there and look around, I was like, there's so much. There's so much. There's just so much. It's robust. You can track symptoms, but also what I loved was there was so much for me, what I loved was there was so much like, that seemed like mindfulness and then you've got the CBT. There's just, so for me it felt so robust and like so many different things you can do within the app.
Diane: And you're not just saying here, track your symptoms or here we're gonna toss you some like notifications about like some, I don't know, some little task you could do today to try to feel better. It's actually really, really, really deep and there's so much that a person can do in there, in the app. So can you talk about like what that experience is or what you're trying to create for the user going into the app and what you can do in there and how it works.
Victoria: Yeah, sure. Like, first of all, also like I'm, I'm so happy to hear that you're enjoying, enjoying it because like it's really, we build it in the end for that purpose of making a difference to people. And yeah, the app is for sure, it's, it's actually quite massive already. It's way too, maybe we also need some to make some things even a little bit simpler and like polish still things, but like it's way more than a PMDD tracker.
Victoria: So I would really divide it into like two categories of it. One part is that you can track symptoms for PMDD and we built that part also really with PMDD in mind. So we talk to a lot of different doctors that are actually also treating actually PMDD, not that many of those, but there are like some that are specialized, and talk with them of, okay, like how would you actually need symptom tracking data so that you could use this to diagnose PMDD.
Diane: Oh, okay.
Victoria: We looked into research for that and for example, one thing that in research is actually commonly used, the Daily Record of Severity of Problems, which actually where you need to track your symptoms on a scale from one to six or zero to five. And that's really, really important because for PMDD you actually need to see that difference.
Victoria: And if you have our, our symptom tracker where you're just tracking with emoji, your doctors will tell you, like, yeah, sorry, like, can you please go back and like track this again on a piece of paper, because actually we need the data more accurately. So we saw this problem on the diagnosis side and we're like, okay, like this is something we can build into like the tracker.
Victoria: And at the same time, we, we built then like the tracker to consider like PMDD, but PMDD experiences can be very, very varied. There are a lot of comorbidities, which means that actually you basically need to track, be able to track whatever you want. So that's the next step, is that like there, what we built in is that you can yourself add in any symptom that you want and compare that really with your menstrual cycle and see, like in the data analysis of like, how does it, how do your symptoms actually differ between your follicular phase and your luteal phase? What are maybe the symptoms that are most prevalent for you? What is like most bothersome? Is there something that you should focus on?
Victoria: So that's really like on the tracking side. There's also, I'd say on that side, a lot of things that we still want to work on of like this, having the possibility, I know, like a deeper understanding of one's own data to see what are triggers, tracking medications, tracking sleep, nutrition, like how does everything interact and how can you then work with recommendation.
Victoria: Yeah, so that's really what this, understanding part, diagnostic part, that kind of comes together for the individual user, but then also how can it be used in a medical way to potentially provide faster diagnosis. Even as a first step, how can we include doctors in that part?
Victoria: So that's this side of it where, I am, I sometimes get like very, a little bit angry when people say like, more like in the, it's usually men in the startup space of, ah, like you're building a, a period tracker. I'm like, no, we're not building a period tracker. It is not, no, it's not period tracker. It does include a period tracker. It does have a symptom tracker, but it's actually really a tracker for PMDD and PME, properly, so that you can understand how do actually other health conditions also vary with the menstrual cycle. What is maybe PME and what is maybe PMDD? And where can you actually make like a difference?
Victoria: So that's that one aspect of it. And it's hard. An app will not solve everything. Like just to face it, right?
Diane: Right.
Victoria: Just the way if somebody says, ah, you're promising me that, like an app is going to like, undo my, like, my PMDD will be gone, and then I'm just fine. It's like, no, it's not going to do that. It's all that it can do is to provide support to make it easier, accessible, and also like to help you integrate positive lifestyle habits long-term in your life where there is good evidence that it actually helps. And all of those in the app are based on CBT, some also DBT techniques, that have been developed specifically for PMDD and also where we already had that previous research study that our research collaboration had done on that type of content.
Diane: I love that. It sounds like, well, firstly, I love that everything starts back with the research. So you mentioned, you know, only putting in certain tools that you felt you had enough scientific evidence for. But then it's taking all the information that you as the user are adding in about your symptoms and your experience, and kind of trying to guide you toward the tools that may help you find some relief or some benefit, and then guiding you through that.
Diane: So as, as opposed to having everything really, kind of segmented and separated in your life, right? I'm tracking my symptoms over here. Oh, someone said this might help me. Okay, now I have to go figure out how to do that thing. Or, you know, learn how to, whatever it is, do this technique or go find a way to meditate. It's kind of all, all kept together within the app, which I love so much.
Victoria: Yeah, that's definitely really the goal. And there's like, there are a lot of like small parts here and there of things that you can do where like if you spend more time on the app or there, some of them are even really hidden where we need to, where we need to bring them a little bit more obviously out because there are a lot of different like features that kind of come together to create, it's really thought through from the beginning to the end about somebody who has PMDD. Like how can we support somebody who has PMDD?
Victoria: And that's also the next things that we're going to build, are we going to include to like add into that? Like what could make that better and how can we make it the most customizable so that it actually can reflect the experience of also different, different people with PMDD, right? It's like, very, very different.
Victoria: And I guess like one thing about that is normally when you build an app as an early-stage startup, like what happens is people tell you, ah, you gotta launch early, you gotta just put it out. Like, even if it's like still quite bad, just put it out.
Diane: Right.
Victoria: They call it a minimal viable product. And for us, this is a little bit different because we started with this research study. We started with this German model where we built our huge, extensive system. And this system is something that's tested in a clinical study. There's like a lot of extra features about data protection side that are not even discussed like in any other system. Or for example, accessibility of color, accessibility, like other accessibility features that are really [unintelligible] if you think about it from a medical perspective.
Victoria: And we built this whole system with also users included and user testing. But it had to be all within the system that you first build it, then you do like clinical study on it, and then afterwards you actually just get to marketing. So it's a very, very different system. It makes it also very hard as a company because you actually for a long time, like also just not, not having like any, any income to like to, to really support that system.
Victoria: But what happened with that for us is that when we launched our international app, and, and an English app as well, after users had asked us to have it also available in English, this was already a huge system. This is like not the first iteration. We had already so many different releases. So probably the, the first app version was out in February 2023. The actual app was released in, no, in the end of June 2024. And between that, we've been working a lot and very hard on it. And not only, not only my husband and I, but like by now also like a, a team to make that happen. So it's, it's quite comprehensive already, so it will not solve everything for sure, but I feel quite confident to say it's for sure, like, the most comprehensive app for PMDD that is right now on the market.
Diane: Yes.
WHEN YOU NEED THE RIGHT TOOL IN THE MOMENT (34:19)
Diane: Who do you, who do you like, envision using, and I'm, obviously you've already tested it in, in so many ways and with so many users. So I guess who, like, how do you envision people using the app? Who do you envision using it? Because it sounds like you can even use it if you're like trying to confirm that you have PMDD, right? And you wanna like track and, and show your doctor your symptoms. But, but it sounds like it can be used in so many different ways or, so, I'm wondering kind of like what, who's coming to your app or who are you, like tr, you know, how do you envision people using it?
Victoria: Yeah, I think there are like kind of three groups that we, we see that are in that space. The first group is really maybe still like in the, in the phase of trying to get an official diagnosis. And for that, you do need to track. What you can do then with the app is to track it in the way that you do need to track it. If you have also in the end, if you want to have official diagnosis, the best to go to a doctor who really knows what they're talking about in that area and that use the systems that are recommended for that. So that would be in the end, the Daily Record of Severity of Problems for a diagnosis.
Diane: Mm-hmm.
Victoria: And you can do that inside the app and then you can export your data in a way that it's like very easily readable for a doctor so that they can just take like a look at like the data, see the patterns inside it, and then thereby do a diagnosis.
Victoria: So that's the first group. And I think that group is also a little bit mixed in with people that we've been talking with that want to see that for themselves of like, how does it change? Like how do my symptoms change? How do they improve? Is there like anything that worsens them? And how does that maybe like, correlate with other factors in my life?
Victoria: I think then there's a second group that really comes like more for like their, or where, where maybe like the stronger reason -- they tend to track as well -- but like where the stronger reason is really those, the content, like the exercises, the CBT techniques, there to have like that, like in that place on things that are actually specifically also information that relates to PMDD. So not something that's just in general, a meditation, but that's something that really relates to this.
Diane: Yeah.
Victoria: And also to, to have like this easy access to know, based on a symptom, what can I maybe do so that I actually don't need to think, because in that moment when I might be having a PMDD crisis, I can't think. That's like the whole point about it. So I actually really need some quick support and some way to, to calm down, calm myself, maybe like down. That's, I'd say like a little bit, like a second use case. And it's for sure like our, our overlap.
Victoria: And then I think like a third one that we see like a little bit and that we want to also like, that we'll be working on, on, on extending features for that is actually, I think a lot of people have like our mixed version of PMDD, which might be more PME, but who knows anything about right now because there's even less literature available about PME.
Diane: Yes.
Victoria: What we see when we look like from, from data also, from like our study that we've been seeing, a lot of people who think that they have just a pure PMDD, they have a more of a PME. So that means symptoms that worsen before the period, but they're also symptoms already there otherwise. And makes a lot of sense because there's like a whole mix up that a lot of other health conditions also worsen with the menstrual cycle.
Diane: Yes.
Victoria: Have changed the menstrual cycle. So migraines are known for menstrual migraines. Epilepsy. There's a form that only occurs before menstrual cycle. ADHD, depression, the bipolar changes. So like, there's like a lot, even like actually insulin resistance and everybody and people who have diabetes change. So extend those variations and to understand what is like maybe something that is really like pure PMDD symptom and often you cannot really differentiate that well. Or something where it's this impact of the menstrual cycle. How do like different factors influence that? What are maybe triggers? What can I try to do then? Because this is like a trigger for me and it will not be the same for everybody.
Victoria: So for somebody might be more nutrition, it can make a difference. For somebody else, it really means that they should maybe like, try like antidepressants, but it's not, it's not the same for, for everybody. So there the use case that we will probably be working the most on -- so it's like not the only one, we still have also like a lot of different features coming up for, for different parts of that -- but the use case we probably work the most on is for considering what impact does your, all those psychological and physiological biomarkers, have on your health and how it changes with the menstrual cycle, which is then expressed in this, what PMDD actually, actually is.
Diane: Yes.
Victoria: So better tracking, better data interpretation. We also have like a really exciting project for that coming up with like another research collaboration that I, I don't think I can talk about this yet. But that's really like, I think a third use case where there comes just even more complexity than like a very clean symptom pattern of PMDD.
Diane: Right. That's so fascinating. You made a really, really excellent, excellent point about PME. And for anyone who may be listening who doesn't, hasn't heard of PME, that's premenstrual exacerbation of some other condition. And so what's happening is you already have those symptoms throughout the cycle and then the luteal phase comes along and worsens some or all of those symptoms of that other condition.
Diane: And so yeah, it sounds like whether you're looking to just understand your own PMDD and your own symptoms, just to have a better grasp of what you're dealing with and how to help yourself and support yourself, or you're looking to understand how your PMDD and your experience is maybe also tied in with some other conditions or some other things going on, it sounds like the app just really is a great way of all in one place, getting a really good view of what exactly is going on in your experience: how are all these things connected and what is, what is it that for you is helping or maybe not helping? 'Cause everybody's experience is so unique.
MAKING PMDD SUPPORT MORE ACCESSIBLE (40:41)
Diane: I noticed some other things when I was poking around on, I think your website. Man, you have so much going on. I noticed that you have a program for employers, and I don't know if maybe this is only in Germany or in other places, but where like employers can offer the app to employees?
Victoria: Yeah, so this is something that's still very, very early stage, but yeah, we, we started in this research context and also thinking really about how can we make this something viable? Because in the end, having an app, I'm learning that more every day, it's like very, very expensive for creating it, but not only that, even to keep like the data stored safely. So it's like the end, you need some way to like make this happen.
Diane: Right.
Victoria: In the end, I come from a country where health care is very accessible. It's accessible for everyone. Like everybody needs to have a health insurance. It's insured and that's like a value that's also very deeply entrenched in, in me, with, with that background. And then so having studied also a system where healthcare is just something that you should have a right to. What we provide is like really between that intersection of already providing healthcare because it doesn't exist in the actual medical system.
Diane: Right.
Victoria: Like, it's quite, it's like something where I personally believe that everybody should be, have access to it, independent of their economic buying power, independent on whether they can afford it. That's very, very hard because we can carry the whole cost. Like we are like at some point we need in some way, at least like to operate even, that we can finance it in some way. And that's like where we're thinking like also about health insurances, employers. And we are at the very start actually for employers at the program. We're in some early stage conversations.
Victoria: Because we believe that should actually be accessible and that might be like a root where that's... can be provided and where that exists also for many other health conditions. PMDD is a health condition as any other, so it should be actually covered by health insurances. It should be covered by employee benefit programs.
Diane: Right.
Victoria: And what we're really working towards.
Diane: Okay.
Victoria: So if it's anybody listening who can also give us like any introduction. That's always super, super helpful to get into the conversations and to start really that part to make sure that it's not only available for some people, but it's available for everybody.
Diane: Yeah. Yeah. So working to get that into, it sounds like, like employee assistance programs and things like that.
Victoria: Yeah, exactly.
Diane: There was one, there was one other thing I saw, and by the way, I'm mindful of the time and I know it's getting late there for you. There was, there was one other thing I wanted to ask you about that I saw either in the app or on your website. And then I also just want you to just, you know, tell me what I've not asked. But there was like a, there's like a course or courses within the app. Can you talk about that?
Victoria: Yeah. So basically the course that you see available there that's like our extra therapy course that we developed together with the researchers that is also tested in the clinical study right now. While that is in the clinical study and before it is actually a part of health insurance programs, we cannot make it completely available within the app.
Diane: Mm-hmm. Okay.
Victoria: That's something that we were told, do not do that because otherwise, like no health insurance was ever going to cover this. So, and then several people asked us, can you make that like, available, like in any form already? Like the whole part. What it is, it's actually our 12-week program. It's quite intense, to be honest. So it's if you see somewhere else online a 12-week program advertised, it's not, not that, it's definitely not that.
Diane: Okay.
Victoria: It's really like a 12-week program to look at PMDD from every angle to work on like space on cognitive behavioral therapy. To work on restructuring your thought processes. Stress management is a part, nutritional changes, exercise, and also like certain behavioral patterns that might make actually PMDD even worse.
Diane: Mm-hmm.
Victoria: And that all from our psychological perspective developed together with actually Professor Weise and Professor Kleinstaeuber who, who are the researchers that are already mentioned before in the PMDD course. And then that's like something that we also hope to make like more available and more accessible within the app. And right now it's like really just like the, the starting point that we already show that this part exists. And we are quite excited when more people can actually access this.
Diane: So the researchers behind the course were the original researchers behind... Is that the research that you discovered? The internet-based CBT for PMDD?
Victoria: Exactly.
Diane: Oh, wow. Very cool. Okay. And so when, when that is more available, is that something that's like a self-guided thing, like someone does themself through the app?
Victoria: Yeah. You basically, you have a lot of activities and, and modules of that you need to go through. And you first learn, you start in the first week to learn more. Those modules are called psychoeducation, to learn about the condition, to learn about causes in different perspective, but also reflect always everything back to yourself, and goes on reflect treatments. And then goes really into like our psychological treatment of different parts of PMDD.
Victoria: So for example, what are common thoughts that you're experiencing during PMDD and how can you restructure those thought processes to be less problematic? Because it's very, very common that people experience very problematic thoughts when they're in a luteal phase. And, what this app course really teaches you -- some also the techniques that are available for, like in the general app, they do the same -- but what the app course, in a way, way deeper way is it guides you through very structured to take the time aside. So to take even like two, three to four hours per week minimum to actually do it in a, in a good way to go through it and to work very, very specifically on the things that you're experiencing and how from with psychological coping strategies, you can reform those experiences. And with that also have, yeah, like lessen your symptoms, like be able to better cope.
Victoria: Which kind of comes back to this point that I, that I mentioned earlier of like an app will not be able to, to cure like every type of PMDD symptoms. Never. Like that's just not, it's still, there's still like a very, like, there's like a biological basis to it. But there are also, when you think about the causes of PMDD, there are biological factors that impact the development of PMDD. But there are also certain psychological and social factors that can worsen PMDD or that can also just cause that somebody's experiencing it. And then what coping skills can do is they can allow you to better deal with those experiences and the changes that you experience during PMDD.
Diane: Right.
Victoria: And that's what really the course in a very, very intense way, guides you through to make like changes, that can help you to, to deal better with your symptoms.
Diane: Yeah. And it sounds like that's really what the app is about too, is about really understanding, developing the tools and skills and the understanding of your PMDD to learn how to manage and cope better and, you know, how to like use that knowledge to help yourself.
Diane: The app is called the Belle Health App. Can you get it just wherever you would get your, your apps?
Victoria: Actually there you can get it in their App Store and in the store. So it's available on all platforms and it's available everywhere except in Germany. Because in Germany you can only get it right now via a research study. The reason for that is that if we would have the app also available in Germany, it could just confound the results because then people could just go and use the app that is available.
Diane: Sure.
Victoria: And would not need to, because like our research study is a randomized controlled trial, which means there will be people who get the app at a certain stage, and then there will be people who only get that after a certain amount of time has passed to check, ah, is the app actually helpful or is it just that there may be results because people are participating in that study? The only exception, so if you're based in Germany then go to our website, sign up for like our second clinical trial. That's going to, to start at the end of the year. But everywhere else it's available in the normal app stores.
Diane: Okay. So I asked you a whole lot of questions about all the question, you know, all the, the things that I was curious about, but I'm sure there are things that I didn't cover. So is there, you know, what is it that you want people to know overall just about, about you and the Belle Health app?
Victoria: Yeah, I guess what I would want people to know is that we really care about it. Like we are not, we are not doing this for some reason of just having like another period tracker or like for this like having something available and saying like, ah, we are selling something for people with PMDD who are already suffering a lot. And then there's just something else out there and it's really not the point about it.
Victoria: It's not. This, like we've already dedicated, I think now two and a half years of like every free minute on that. Every cent that we have into this project because we really want to make a difference and we are probably not going to do everything perfect. So if there's anything that anybody sees where they want to give us feedback or help us improve in something, we appreciate that a lot. And also if you just, anybody wants to have like a chat about how we can really make a difference in this area. You have a lot of ideas and a lot of actually really, really, really exciting things coming up of how we want to integrate stuff. And like, I'm, I'm so excited when I can actually share all of this, but yeah, if just like anybody who wants to, to unite and to really make like a difference in this area to like... my vision is that in, in 20 years, we're going to look back and we'll be like crazy that we haven't treated PMDD. Like, crazy.
Diane: Yeah.
Victoria: That medicine, we, that was not a part. Crazy that we, in the end, we treated also women and men in medicine, so, like biological women, like that sense the same. Because that experience of hormone changes and different phase of the menstrual cycle are just fundamentally different. So anybody who also is working towards that goal wants to make a difference in any type of way, please reach out. I'm always really, really excited to have those conversations. And you'll see more of us around.
Diane: Perfect. Where can, where can people find you or how can they reach out?
Victoria: Actually if you go to our website, so Bellehealth.co, you'll find my email. It's also victoria@Bellehealth.co. So you can just reach out, write an email, write us via any channel that you see from us online. And sometimes like I, when I'm like in a really bad PMDD phase, I might miss it, but otherwise you always get, like, get back as soon as we see.
Diane: Amazing. And I will be in touch with you to get, you know, whatever links that you want to share in the show notes. We'll definitely do that in the show notes and put more information about the app in there.
Diane: Thank you so much again for, for making the time to chat with me all the way from Munich. It's now nine o'clock there, I guess, at night. So I really appreciate it and I'm so excited about what you guys are working on.
Victoria: Thank you so much also for like all your work of spreading awareness. It means a lot and with, if all of us are working together to make a difference, it will change this, the status quo.
Diane: Yes, yes. I love that. Thank you, Victoria.
Victoria: Thank you.
OUTRO (51:52)
Diane: Thank you so much for listening. If you liked the show, please subscribe wherever you get your podcasts. For links to everything mentioned in this episode, you can check out the show notes and you can find me, Diane DeJesus, on Instagram @mindfulnessforPMDD. Now I invite you to pause, take a breath, and look around.
