PMDD as a Veterinary Surgeon and Business Owner

Photograph by the lovely Victoria Elsmore

There's something both humbling and liberating about sharing a story you've kept quiet for years. Not because of shame, exactly, but because you're still piecing it together yourself. This is one of those stories.

If you've been following my work for a while, you'll know I've been pretty open about my journey with the imposter phenomenon in veterinary practice. I've shared extensively about the therapy, the group coaching programmes, and the profound shifts that came from learning to be kinder to myself and remember my value beyond my job title.

Those tools and experiences genuinely changed my life. In fact, they gave me the career pivot that I never saw coming, eventually training as a coach myself, completing a Masters Degree in Emotional Wellbeing and now having a CMI Level 7 qualification in Somatic and Trauma-Informed Coaching & Leadership. My career has been a wild ride that I genuinely find purpose in, even if I never saw it coming.

But there was something else happening beneath the surface. Something I couldn't quite name for a long time. A pattern that repeated itself with clockwork precision, yet somehow remained invisible to me for years.

The more conversations I have about this within the profession, the more I realise that this needs to be spoken about further.

This is my story of living with and learning to navigate PMDD - Premenstrual Dysphoric Disorder.

I've also shared an incredible, free resource at the end too.

The Early Years: Missing the Signs

Me and my dog Jet, back in 2008

Looking back to my university days in my early twenties, I don't have strong memories of being particularly affected by my menstrual cycle.

Honestly? I felt a bit smug about it.

While other people talked about period pain and planning their lives around their cycles, mine seemed unremarkable. I was on epilepsy medication at the time, which may have had some counteracting effects, but I genuinely didn't give it much thought.

I remember feeling rather fortunate, if I'm honest. No cramps, no drama, no fuss.

What I didn't know then was that this wouldn't last forever. And that when things did shift, they'd do so in ways I'd never see coming.

The Pattern Emerges: A Week That Didn't Make Sense

I loved working in practice, most of the time...

Fast forward a few years into practice. I was working for a boss who had become a good friend. We'd worked together for years, did things outside of work together, and I genuinely valued our relationship. I felt confident in my role - most of the time.

But then there was this week.

During this particular week, which seemed to roll around with mysterious regularity, everything changed. I'd go from being a fairly outwardly confident veterinary surgeon who was happy to handle whatever came my way, to feeling very small, very incapable, very insecure, and deeply not good enough.

Now, I'd be lying if I said that tone of "not good enough" hadn't hummed in the background throughout much of my career - I've shared that story before. But during this week? It wasn't humming. It was shouting. At full volume. And I couldn't step past it.

For example: I'd suddenly decide that my boss didn't appreciate me, and I'd be convinced of this. I'd genuinely feel unappreciated and would start making quite a song and dance about it - I'd send messages, I'd get upset. Then, the following week, I'd look back and think, "Why on earth did I make such a fuss? She's a good boss. She does appreciate me. I can see that now." The shame and regretwas real afterwards.

The really troubling part? I did things I'm not proud of but I'd feel a genuine pull to do. I felt like a different person during my pre-menstrual week.

There were days when I'd technically finish work but would leave my keys on my desk and just... walk out. I'd go for a walk around the village, telling myself stories: "Nobody's going to notice I've gone. Nobody cares. Nobody will spot it." Of course, the reality was that everyone was busy, and no one was tracking my whereabouts because they trusted me. But in those moments, I was testing something. Looking for proof of a narrative I'd convinced myself was true during that week.

A few days later, I'd feel deeply ashamed of how I'd acted. In between, my period would arrive - not that I spotted this at the time.

Then the cycle would repeat. Three weeks of building myself back up. One week of inexplicable emotional turbulence. Repeat.

When the Tools Stopped Working (Sort Of)

Life was better, mostly.

After I went through therapy and a transformational group coaching programme for those background imposter worries and anxiety, things genuinely got better overall. I had tools now and remembered my value (most of the time!). I knew how to check in with myself, to question whether my thoughts were true, to be more compassionate with my inner dialogue and my emotions. I wasn't the negative voice in my head. I was valuable, I mattered.

I had connected to who I was outside of work - taking part in Crossfit, Tough Mudders and genuinely embracing being a human beyond my job title. I couldn't believe the difference, and I enjoyed work again too.

For a while, those difficult weeks became much less prominent. I still noticed the odd trickier day or week, but I could step back and ask myself, "Is this actually true? What do I need right now? What's really going on here? Is that really something you'd choose to say?" And let's be honest, having the odd bad day is very human, right?

But here's what I still couldn't see at that point: the cyclical nature of it all.

And then, a couple of years later, I started running my own business(es) and locuming. With that came new levels of stress, new responsibilities, new pressures. And suddenly, those weeks started becoming more amplified again.

This time, I began to notice there was a fairly regular pattern to when I'd feel this way. But honestly? It was my partner who spotted it before I did, and I'm forever grateful for that.

We'd find ourselves having the same conversation every month: "I just don't know what I'm good at anymore. I don't feel like I'm making any impact. I think I need to quit all my businesses and run away and live in the woods."

I felt as though the tools I had didn't make a difference in those days, weirdly.

And then, the next week, I'd love it all again.

"You know," he said gently one day, "we have this exact conversation every month. And then the following week, you're happy again."

As much as part of me probably didn't want to admit it, he was right.

That's when I became much more conscious of the timing of this, and started to research further.

The Weekend I Couldn't Stop Crying

There was one particular weekend in 2019ish - a family getaway - that became a turning point for me. I couldn't stop crying the entire time. Only my partner knew. I wore sunglasses pretty much the whole weekend, trying to hold it together. I couldn't settle, I kept walking and pacing and didn't know what to do. I'll be honest, it was scary. Was I having some sort of breakdown? I didn't know what was going on.

I felt so unlike myself. As someone who considers herself quite self-aware, who has tools, who works in this space professionally, I was completely bewildered. There was no logical or rational reason for feeling this way. Nothing had changed in my life, I didn't even really have thoughts around this emotion and anxiety. Yet I felt terrified, distraught, and probably looked like a rabbit in the headlights.

Looking back, I drank more that weekend than I usually would any other month - relatives quite liberal with their gin measures and dutifully accepting. I know now that alcohol has quite a significant effect on me during that phase of my cycle. But at the time, I just felt lost and confused.

My period came, and within a day or so I was back to myself.

That was the point when I reached out to my GP.

Putting the Pieces Together

By this time, I'd already been suspicious about the cyclical nature of what I was experiencing. I'd been on forums, read about PMDD on places like IAPMD, and understood that tracking was important. So I started doing it - crudely at first, with pen and paper and a basic app - but consistently.

(In the resource we share below, there are proper tracking tools as part of the resource kit!)

The pattern was undeniable. These symptoms existed only during that one week before my period. The rest of the month? I was absolutely fine.

My GP suggested an SSRI medication for my signs, but I was hesitant. Given my history with epilepsy and the warnings around seizures on those medications*, I decided to hold off and research more about PMDD first. You know there's always a pet who succumbs to every side effect of any medication they're given? Yeah, that's me in human form. I had also tried to explain I was fine three weeks of the month, but felt I didn't get far with my conversation and wasn't sure the GP I spoke to had heard of PMDD before. I researched further and found resources to share with them.

*Not advice for anyone else, speak to your medical professionals, of course! Lots of people find SSRIs very helpful for all or part of their cycle.

Then, in 2020/2021, I saw a consultant gynaecologist for an incidental finding on a different MRI scan. During a follow up scan, she suspected I might also have endometriosis. When I brought up my other symptoms, we had a proper discussion, and she diagnosed me with PMDD.

It made sense. It all finally made sense. I had someone who listened to me and gave me some hope.

I also started to notice a clear link between particularly stressful seasons of life and worse symptoms in my PMDD weeks.

The pieces were coming together, but I was also aware that every hormonal birth control I'd ever tried had come with significant side effects. Coils, pills - they'd all given me this horrible sense of impending doom, amongst other things. So I was understandably apprehensive about hormonal treatments, which I know have worked wonderfully for many people with PMDD. Again, real testament to different things working for different people; your treatment stack will likely be different to mine, if this is you too.

My gynaecologist was understanding. "There will be ways around it," she assured me. Thank goodness, I thought.

Learning to Navigate

I started with supplements initially under the guidance of the gynecologist: Vitamin B6, magnesium, omega-3s. I also made some dietary changes, see further on. We stayed in touch and she continued to reassure me there would be other options too. I began working my life around my cycle more consciously. And honestly? The changes made a difference. Really doubling down on my stress management made an even bigger difference.

A couple of years later, after my dad died in 2021, I saw a psychiatrist. I booked this myself proactively, gratefully using a private health insurance that I'd wisely taken out in my 20s. Grief had intensified things in ways I couldn't quite untangle, and I needed help with the questions that kept circling my mind. Was this complex PTSD from growing up with an alcoholic parent and now I was dealing with the grief of that too? Could I be neurodivergent? What I'd always thought of as "adorable personality quirks" - always starting new projects, sometimes taking on too much, having a brain that could work incredibly quickly for short burst - had become paralysing during grief and my PMDD weeks were extra rough too. I was willing to do whatever I needed to do to support myself, but I needed guidance.

With what I'd learned in my Masters Degree, I knew the complexity and impact of early life and childhood on human beings. I also knew that neurodivergence often runs in families, and I had spotted patterns reflecting back. I wanted to know if these were brain-based differences I needed to learn to navigate and lean into, or if I had more trauma to address and process, or both. I wanted a professional opinion, as the Tiktok algorithm gradually sought to persuade me I had ADHD, and I knew there could be more to it.

The psychiatrist was excellent and really helpful. We talked for a long period of time about various areas of my life and my experiences.

The psychiatrist confirmed: I met the diagnostic criteria for PMDD (and later on diagnosed me with ADHD too - that's a story for another time). It also turns out the neurodivergent individuals tend to experience PMDD more often too, Dr Helena mentions that in the resources below too.

So I never had a formal diagnosis during my time as a full-time employee in veterinary practice, but I did have one when I was locuming. And if I'm honest, I didn't navigate it as well as I could have; I just didn't know. I probably didn't communicate it properly. There was still shame there. Still misunderstanding, even within myself. This is why at Vet Empowered we wanted to provide some more resources, and exactly why we brought Dr. Helena Tucker in to run a session (and there will be further ones too).

What I did do was try to be gentler with myself. I learned to recognise when my inner critic was just being louder than usual, and that I didn't have to believe everything it said. I reminded myself that this would pass and each month I gathered more evidence that it always would. I doubled down on self-care in the evenings, especially after busy shifts. I worked hard to remember that asking for help didn't make me less capable. I gently started to hold the duality of how it could be true that I was a great vet, and could still have this week of things feeling a little harder. I paused a little more and would create 5minutes throughout the day a bit more frequently.

What Would Have Helped in Practice

Looking back, there are things that would have made a real difference and involved the whole team:

Where possible, not scheduling bigger surgeries during that week, or having back up to discuss my boss potentially doing those if the week was particularly hard. Maybe being on appointments/consults instead, and having more breaks in those weeks too; even a few extra five minute breathers would have made me easier to work with too. I didn't need the whole rota to have an overhaul.

Having a team I trusted enough to say, "This week is harder for me. Could you help hold me accountable to taking breaks?" Or "Please bear with me if this takes a bit longer." I think a supportive team in general who understood what I was experiencing without pity would have been helpful, and having ways to communicate that. My previous teams have been wonderful, by the way, I just never had words to explain my experiences. At my core, I just didn't want them to think less of me or my skills, and to help me be a little gentler with myself.

Thinking of future me - preparing nice meals or having good ready meals available, because during that week, I defaulted to eating whatever was easiest, and I knew it made me feel worse (they didn't have the McDonalds app and a points system back then, I probably would have made billionaire status... eeek). No shade on the odd takeaway, but for me, it didn't help me feel better.

Booking my locum shifts around my cycle where possible was helpful, or on reflection potentially finding practices that were happy to have me for half days sometimes if that's what I needed.

The biggest thing I've learned? The weeks that were much worse almost always coincided with periods of higher stress levels. For example, if I'd had a bit of a wild month, that week was tougher.

Dr. Helena Tucker talks about this brilliantly in the webinar we co-created at Vet Empowered (linked below) - during the luteal phase of the cycle, our stress bucket is actually quite a lot smaller.

This really meant that stress management wasn't a 'nice to have', it was imperative for me; and that included before that week too.

Navigating as a Business Owner

Now, as a business owner and working totally for myself, I feel like I've found something that works for me. On paper, I'm not sure I'd even meet the criteria for a PMDD diagnosis anymore because it's not impacting me to nearly the same extent.

But I'm under no illusion about why that is. It's because I've made significant changes in my life.

I've also had to come to terms with the fact that I have a family history that includes suspected postpartum psychosis and others who probably had PMDD too; we are a hormone sensitive line it seems. This isn't a personal fault. It's not something I can "resilience my way out of." It's something I need to work with, to manage my life and workload around. My brain literally reacts to hormonal changes in a biochemical way, it isn't a deficiency in my capability or skillset.

Here's what actually helps me now. This isn't an instruction list, please do your own research:

• Recognising my patterns. If I start deciding I want to run away from everything and that I'm not good at anything, I can usually spot that my hormones are speaking. Those decisions can be put off for a week and revisited. If they're particularly loud, I need to double down on nervous system regulation and connection.

• Lifestyle changes. I barely drink alcohol, I can't say I'm 100% tea-total as I have the odd glass of fizz at a wedding, but I markedly cut my intake (which in all honesty, wasn't much to start with). I also eat a relatively low-inflammation diet, cutting out gluten, reducing dairy and highly processed foods. This was a suggestion from my gynecologist, and whilst I'm not perfect, I do my best and it has definitely made a difference for me. I stay hydrated as much as I can too.

• Movement. My body needs to move to process stress and complete the stress cycle, but it looks different at various points in the cycle.

• EMDR therapy. Processing past challenges - not just talking about them or intellectualising them, but actually processing them - made a huge difference to my baseline stress and nervous system activation. It's not for the faint-hearted, but I'm grateful I did it. Having so much knowledge of theory, I could give a very eloquent explanation of experiences, but doing this helped me experience and process.

• Deeper self-compassion work. This is ongoing and foundational to everything else. Acceptance and compassion for myself in these times has been a gamechanger, but it has taken practice.

• Booking work around my cycle. My cycles don't always read the calendar - sometimes they're a couple of days off - but I try to leave gaps in my diary. There will always be last-minute things that come up, and I want to accommodate those without sacrificing myself. I talk a bit more about this below.

• Doubling down on active rest. I have to plan ahead and book it in. For example, conferences wipe me out, I need to book downtime after and not rely on the overly optimistic version of my forecast energy levels. I book activities that are relaxing that I have to show up to and it's harder to bail out on: sound baths, yoga classes, walks with friends, massages (I often ask for vouchers for Christmas and birthdays).

• Systemising everything. I can step back if needed, and things keep rolling. My business is no longer dependent on my hormones and capacity. So I'll make it easy to hand tasks over and set up automations around anything I have to do more than twice.

• Supplements: I still take omega-3s, magnesium, B6 and NAC - amongst other things - but of course do your own research and speak with your own medical professionals.

• Keeping options in my back pocket. I have no stigma around SSRIs or medications like Yaz. I know everyone responds differently, and I'm grateful to have options. I don't take them, nor any ADHD medications right now, but I know they're there.

• Researching and advocating. One of my strengths is that I will research the heck out of things. I'll advocate for myself. I'll find a way. I've tried many different approaches, spoken to many different people, and seen various consultants. Having private healthcare helped with some of this, and I'm aware that's a privilege. We need people on our side, and I found that sometimes I had to be that person.

• Building a toolkit of what actually helps. This has been invaluable. When I'm in the depths of it, my brain wants me to lie in bed and scroll through social media. But I've built up evidence of what actually makes a difference: getting outside for a walk, light stretching, a hot bath, 5mins of breathwork, watching something comforting on TV consciously, reading a book. I have them on a menu, and I communicate them to those who I love that are close to me too. Do I usually want to do any of those things in the moment? Absolutely not. But I do them anyway because I know they help and I have so much evidence of that now. And yeah, sometimes I find myself in a scroll hole.

Reframing the Difficult Week

I've also learned to reframe this time - not in a toxic positivity way, but in a way that acknowledges its purpose. Dr. Helena Tucker talks about the different seasons of the menstrual cycle in the free resource linked below, and I've found myself naturally working with that.

I had to do this, as over time I was noticing I came to resent this week. I could gain so much momentum for three weeks of the month, and this one seemed to grind things to a halt. I had more discomfort about this week and what it meant, than accepting and living it. So, I started to view it differently. I once joked "I'd have taken over the world by now if it wasn't for my hormones!"

For me, this week has become a time to bunker down, set boundaries and do more solitary work. I don't schedule loads of meetings if I can help it. I set boundaries well. I book things like sound baths. I treat myself to a nice breakfast sometimes. I move my body gently - maybe not a massive long run or HIIT workout, but definitely walks and stretches.

Interestingly, I often still support others through coaching during this week, I don't move my clients around often but I'm mindful in booking and my capacity. There's something about creating space for someone else and not focusing on how I'm feeling for a short period of time that can be quite helpful. Sometimes I do my best coaching at this time.. I'll regulate myself before sessions and really spend time on this, but I won't do six or seven in one day, maybe one or two. I'll still give talks too, but that's generally the only thing I'll do that day. From the outside, I'm not convinced anyone would know where I'm at.

I make it a time of care, not shame.

And sometimes I'm humbled because there'll be a month where it feels harder than usual. During those times, I might reduce my workload and afterwards I'm curious about what changed.

What I Want You to Know

If you're reading this and recognising yourself in parts of my story, please know this: you're not broken. You're not weak. You're not less capable because of this.

PMDD is real. It's a recognised condition that affects between 5-8% of people who menstruate. And it can have a profound impact on your work, relationships, and sense of self.

But here's the hopeful part: understanding it changes everything. Once you can see the pattern, you can start working with it instead of against it. You can build strategies that actually help. You can communicate your needs more clearly. You can make adjustments that honour both your capabilities and your limits. You can find the medications, supplements and support systems that help you as an individual.

I'm sharing this story not because I have it all figured out - I don't, I'm always still learning. There are still difficult months. There are still moments when I need a bit more help. But I'm sharing it because staying silent about these experiences only perpetuates the idea that we should be able to power through everything, that we should be consistent all the time, that fluctuation is somehow failure. It's not.

As veterinary professionals, we're deeply familiar with hormone cycles in our patients. We understand seasonal breeding, oestrous cycles, and hormonal influences on behaviour. Yet somehow, we struggle to extend that same understanding and compassion to ourselves.

If you're experiencing something similar, please reach out to your GP. Track your symptoms. Do your research. And know that asking for support is not a weakness - it's wisdom.

We co-created a really helpful resource at Vet Empowered with Dr. Helena Tucker, HPCP Clinical Psychologist, that dives deeper into understanding PMS (Pre-menstrual syndrome), PMDD and PME (pre-menstrual exacerbation) and practical strategies for navigating it, plus tonnes of resources. It's free to access if you want to learn more. She's a specialist in this area, and also navigates PMDD herself.

Sign up here: https://vetempowered.thrivecart.com/pms-and-pmdd-vetmed

Your cycle doesn't make you less professional. Your challenges don't make you less capable. Your honesty about both makes you remarkably human.

And that's exactly what the veterinary profession needs more of.

Disclaimer: This post shares my personal experience and is not medical advice. If you're experiencing similar symptoms, please consult your GP or healthcare professional.

Need support? Vetlife Helpline is available 24/7 for veterinary professionals: 0303 040 2551 | www.vetlife.org.uk

You're not alone, and help is available.