Understanding patterns of premenstrual distress
In this episode of The Choice Space, Dr Lee David speaks with Dr Sally Doust about premenstrual distress, including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). The conversation explores how hormonal changes across the menstrual cycle can affect mood, energy and emotional wellbeing – and why recognising patterns can help people make more sense of their experiences.
Many people notice shifts in how they feel across the month, yet these patterns are not always easy to identify or talk about. This discussion brings together medical insight and everyday experience to explore how understanding the menstrual cycle can open up more compassionate ways of responding to these changes.
Hormones and the changing rhythm of the cycle
One of the key themes in the conversation is the idea that the menstrual cycle is a constantly changing hormonal environment. Levels of oestrogen and progesterone rise and fall across the month, influencing both the body and the brain.
Many people find that the first half of the cycle – when oestrogen rises – can feel more energised and mentally clear. After ovulation, the hormonal environment shifts again. Mood, energy and emotional sensitivity can change as progesterone rises and oestrogen falls.
This reflects the simple reality that the body is never static. Hormones interact with neurotransmitters such as serotonin, dopamine and GABA, which are involved in mood, motivation and calm. For some people these changes are barely noticeable. For others they can feel much more significant.
Recognising that the “normal” state of the menstrual cycle involves ongoing change can help bring a different perspective to these experiences.
When premenstrual symptoms become more disruptive
Many people experience some premenstrual symptoms at times during their cycle. These may include irritability, tiredness, low mood, sleep changes or physical discomfort such as headaches or bloating.
Premenstrual syndrome (PMS) describes a cluster of symptoms that occur during the premenstrual phase and ease once the period begins. The key feature is timing – symptoms appear at a similar point in the cycle and then lift.
What often stands out in clinical practice is that the emotional effects can feel the most difficult. People may describe increased anxiety, overwhelm or a sense that everyday challenges suddenly feel harder to manage.
Understanding this cyclical pattern can help shift the interpretation of these experiences. Rather than seeing them as a sign that something is fundamentally wrong, they may reflect a predictable biological rhythm interacting with the pressures of everyday life.
Recognising the impact of PMDD
Premenstrual dysphoric disorder (PMDD) sits at the more severe end of the spectrum. The emotional effects can be much more intense and disruptive.
People with PMDD often describe severe mood swings, anxiety, intense sadness or a sense of feeling unlike themselves during the premenstrual phase. These symptoms can affect relationships, work and daily functioning before lifting again once the cycle moves forward.
A recurring theme in the conversation is how often these experiences go unrecognised. Some people receive other diagnoses such as anxiety or depression before the cyclical nature of their symptoms becomes clear.
Naming the pattern can be deeply validating. It can help people understand that what they have been experiencing has a biological component rather than reflecting a personal failing or lack of resilience.
The value of noticing patterns
One of the simplest ideas discussed in the episode is the value of paying attention to patterns across the cycle.
Many people only notice the connection between mood and the menstrual cycle in hindsight – for example when a difficult week suddenly makes sense once their period begins. This moment of recognition can shift how the experience is understood.
Tracking patterns over time can bring a clearer sense of rhythm. Some people begin to notice particular days or phases when energy is higher, concentration feels easier or emotions feel closer to the surface.
This kind of awareness does not remove the physical changes happening in the body. Instead it can create more space for understanding, helping people relate to these shifts with less self-criticism and more curiosity.
The role of compassion and self-understanding
Another important theme in the conversation is how easily people can become self-critical when mood or energy changes.
Many women describe questioning themselves during premenstrual phases – wondering why they feel less patient, more emotional or more overwhelmed than usual. Cultural messages about hormones can sometimes add to this sense of judgement.
A more compassionate perspective recognises that hormonal fluctuations are a normal part of physiology. Instead of framing these changes as a personal weakness, they can be understood as part of the body’s natural rhythm.
Some people also notice that the heightened sensitivity that appears during the premenstrual phase can bring moments of clarity or insight. Emotions may feel closer to the surface, sometimes highlighting needs or tensions that are easy to overlook during busier phases of the month.
Everyday factors that can shape hormonal wellbeing
The episode also reflects on the wider factors that can influence how people experience their cycle.
Lifestyle factors such as sleep, nutrition, physical activity and alcohol use all interact with hormonal regulation. These elements rarely operate in isolation – they form part of the broader environment in which the body functions.
One example discussed in the conversation is the idea of the “30 – 30 – 30” approach to nutrition – around 30 grams of protein per meal, 30 grams of fibre per day and around 30 different plant foods across a week.
The principle behind this approach is not rigid dietary rules. Instead it reflects the idea that small, steady shifts in everyday habits can support the body’s overall regulation.
This perspective connects hormonal health with the wider context of wellbeing rather than treating symptoms in isolation.
Choice Space takeaways – small, workable reflections
- Notice patterns in mood or energy across the month with curiosity rather than judgement
- Allow space for changing rhythms of energy, concentration and emotion
- Share experiences with trusted people who can offer understanding and support
- Reflect on the ways daily habits – such as sleep, movement or nutrition – influence wellbeing
- Consider how recognising patterns can open up more compassionate choices
Closing reflection
Understanding premenstrual patterns can shift the way many people interpret their experiences. Rather than seeing mood changes as something mysterious or personal, they can be understood as part of the body’s natural rhythms. This perspective can create space for more compassion, curiosity and thoughtful choices in everyday life.
About the guest
Dr Sally Doust is a GP with a specialist interest in women’s health and medical educator. She works in the NHS, in private practice, and at Brighton and Sussex Medical School. In her GP work she found many women had adverse experiences of healthcare because of gender biases and lack of research into women’s health – this inspired her to specialise in this area and remains the key purpose of her career. She holds diplomas in obstetrics and gynaecology (DRCOG) and sexual and reproductive healthcare (DFSRH). She is a member of the Primary Care Women’s Health Society and the British Menopause Society. For the past two years she’s been a delegate for the United Nations Commission on the Status of Women.
You can connect with Sally on LinkedIn.
Resources and links
- PMS information and guidelines – https://www.pms.org.uk
- Primary Care Women’s Health Society – https://www.pcwhs.co.uk
- NAPS PMS guidelines
