In this episode of The Choice Space, Dr Lee David speaks with Dr Sally Doust, GP and women’s health specialist, 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, sleep and emotional sensitivity – and why these patterns are often overlooked or misunderstood.

They discuss the wider context of women’s health inequalities, including the lack of research and the ways this can affect recognition and treatment. Sally explains how changes in oestrogen and progesterone interact with the brain and body, and why premenstrual symptoms can look very different from one person to another.

The episode also looks at how to tell when symptoms may be cyclical, why tracking patterns can be so helpful and how recognition itself can reduce self-blame. There is thoughtful discussion of PMDD, including the severity of symptoms some women experience and the importance of feeling believed and supported.

Lee and Sally also explore practical support, from cycle tracking and self-compassion to lifestyle changes, supplements and medical treatment options. This is a grounded conversation about understanding patterns, widening choice and responding with more care and clarity.

Key moments
00:37 Introduction
02:48 Women’s health inequalities
04:27 Hormones across the cycle
08:52 Hormones and the brain
11:16 What PMS can look like
14:22 Cyclical patterns and timing
16:42 Choice Pause – changing mood and energy
25:35 Understanding PMDD
31:35 Supportive choices for PMS
35:29 Treatment options
41:52 Cycle tracking takeaway
42:50 The 30 – 30 – 30 approach

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.

Here is a link to the NAPS PMS guidelines

About the host

Dr Lee David is a GP, CBT therapist and author specialising in mental health and wellbeing. Lee has written many books on CBT, mindfulness and teen wellbeing, and speaks regularly at conferences and in the media. Away from work she enjoys running, hiking, singing in a choir and spending time outdoors with her family. You can find Lee through her website and on Instagram, TikTok (@dr.lee.david), Facebook and LinkedIn. You can find more about her books, wellbeing courses and therapy here: https://linktr.ee/dr.lee.david