Blog: Managing PMDD and PME in the veterinary workplace

Emma Sadler qualified as a Registered Veterinary Nurse (RVN) in 2012. From there, her career has progressed through senior nurse, head nurse and clinical supervisor roles, where she has coached and supported student nurses.

Emma is hugely passionate about workplace wellbeing and trained as a CVS wellbeing trainer, delivering mental health first aid training across CVS veterinary practices. Her passion for wellbeing feeds into her current leadership style in her work as an RVN and Wellbeing Champion, within which she aims to create a psychologically safe and supportive work environment. After navigating two maternity leave career breaks and personal life challenges, Emma has developed a growing interest in women's health. She believes it is vital that we create a working culture that truly supports and recognises the physical and mental health needs of women in veterinary practice.  

Studies show that 90% of women experience some symptoms of premenstrual syndrome (PMS) during the luteal phase of their menstrual cycle, the phase of the menstrual cycle before a woman's period arrives. This can include mild emotional mood changes, irritability, nausea, and lethargy.

Each woman's experience of the luteal phase is unique, with studies showing that underlying stress, depression, or anxiety can exacerbate premenstrual symptoms. The worsening of any pre-existing mental health conditions during the luteal phase is called premenstrual exacerbation (PME).

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS, leading to symptoms such as: 

• Brain fog 

• Anger 

• Anxiety  

• Depression and feelings of hopelessness 

• Suicidal feelings 

PMDD can significantly impact work, relationships and self-esteem due to the intensity of symptoms. It is also associated with significantly elevated risks of suicidal ideation, self-harm and suicide attempts. Statistics show that women with PMDD are seven times more likely to attempt suicide.

Due to the severity of these symptoms, living with PMDD is considered a disability under the Equality Act 2010. It is also recognised in DSM-5 and ICD-11 as a mental health condition.

The key difference between PME and PMDD is that PME symptoms are continuous but are less intense after a period, whereas PMDD symptoms stop once the period begins.

A woman is more at risk of developing PME or PMDD during a significant life event or having been exposed to a traumatic experience. Although it can appear at any age. 

How it started 

I first noticed PME symptoms five months after my mum unexpectedly died. My baby was just 12 weeks at the time of her death, and nothing can prepare you for the tragic loss of your mother while nursing a newborn baby. Early motherhood alongside grief is its own beast.

With menstruation returning alongside exclusively breast feeding, my body was riding a rollercoaster of hormonal fluctuations while depleted from the effects of grief. Grief can have a wide range of physical and emotional impacts. For me, it manifested mainly as fear and intense sadness. I constantly feared something imminently happening to me including death or serious illness. My body was constantly on the look out for danger, leading to anxiety.

Thankfully, at the time, I was receiving support from the NHS perinatal team who sign posted me to a post-natal spiritual care interfaith minister (former yoga teacher and doula). They offered me the emotional space to process my grief alongside my bitter-sweet post-natal journey which validated my feelings.

Support from spiritual care encouraged me to listen to my body and journal around the time of my period. This allowed me to notice that symptoms of my anxiety and grief were more intense before my period but then eased off after my period - a key indicator that I was experiencing PME.

Exacerbated anxiety symptoms during my luteal phase included, overwhelm, panic attacks, sleep disturbances (including night terrors), intense sadness, low self-worth/ esteem, intrusive thoughts of harm happening to me or my children, feelings of hopelessness, and fearing death.

Returning to work 

My daily PME symptoms impacted my return to work in numerous ways. These included: 

• Overall lower threshold of the emotional demands and stress levels in veterinary practice 

• Brain fog, causing difficulties when calculating drug doses 

• Euthanasia's triggering grief response 

• Dizzy spells during back-to-back nurse consultations 

• Noise sensitivity in a busy prep room 

• Anxiety with aggressive dogs and fearing attacks 

• Being more sensitive to blood and traumatic injuries 

• Low self-worth/confidence in my working ability 

Coping in practice 

I'm extremely grateful for my supportive management team who helped me return to work after a difficult maternity leave. They encouraged me to be more open about PME symptoms and allowed flexible working alongside workplace adjustments to help alleviate symptoms.

Adjustments included: 

• Change in working hours  

• Taking short breaks when feeling overwhelmed  

• Bringing down noise levels where possible   

• Allowing appropriate time away for appointments including for doctors and therapy  

• Extending nurse clinic appointments 

• Nurse shadowing days if feeling less confident  

• Avoiding aggressive dogs where possible or using extra safety measures 

PMDD leads to a significant economic and personal burden with 40% of woman with PMDD more likely to miss work due to symptoms.

Although I’m not officially diagnosed with PMDD, my symptoms and experiences still qualify for reasonable adjustments and workplace flexibility.

How workplaces can help 

Having a manager who understands and is willing to offer their support is key to functioning with these conditions and workplaces can help remove stigma by creating an open, understanding culture around women's menstrual health. 

This could include educating all staff on women's wellbeing and encouraging woman's health awareness days.  Examples of relevant women's health awareness events include: 

• Endometriosis Awareness Month - March  

• PMDD Awareness Month - April 

• Maternal Mental Health Week – May 

• Breast Cancer Awareness Month – October 

• Baby Loss Awareness Week - October 

• World Menopause Awareness Day – October 

Workplaces can get further support via: 

• CIPD menstruation at work  

• CIPD menstruation and menstrual health at work: guide for people professionals 

• ACAS guidance on managing the menopause 

• RCVS 'Let’s talk adjustments' guide and resources 

• RCVS Mind Matters ‘Managing mental health in the workplace’ CPD course on the RCVS Academy 

It is important to note that there is legislation in place to protect those with disabilities. The Equality Act (2010) covers England, Scotland and Wales /Cymru, and the Disability Discrimination Act (1995) covers Northern Ireland. For more information, please see the 'Let’s talk adjustments' resources above.

Developing personal coping strategies 

From a personal perspective, spiritual care support helped bring in practical techniques that I could use daily to ease PME and overall anxiety. I use these techniques at work if I start to feel overwhelmed, including:  

• Grounding methods  

• Relaxation techniques 

• Breathing techniques 

• Somatic body work, for example emotional freedom tapping. I enjoy performing tasks mindfully (such a suturing which I find therapeutic!) and taking breaths in between clients and patients. Vetlife has a fantastic resource online how to practice mindfulness in busy veterinary life.  

Support from spiritual care has had significant, positive impact on my womanhood. At 34 years old, I was only just finding out the benefits of honouring my menstrual cycle and self-care during my periods has now become an ultimate necessity when navigating PME/PMDD symptoms. I now work with my cycle rather than against it and self-manage workload by arranging any presentations or practicing Schedule 3 surgery after my period when I’m more confident, less anxious and less self-critical.

I'm still learning how to manage PME/PMDD symptoms to support my overall wellbeing at work as, frustratingly, they can be quite unpredictable – one week you feel able to manage certain situations, and the next you don’t. I'm now more able to welcome PME symptoms with self-compassion and care.

Final reflections 

• Unlike PMDD, you cannot be formally diagnosed with PME as a condition, but recognising PME symptoms has an important role to play in getting the right support and treatment for any underlying mental health conditions. When discussing symptoms of potential PME/PMDD with a medical professional, it’s important keep a day-to-day diary tracking your symptoms. This will help avoid misdiagnosis and support a correct treatment plan.  

• Being aware of your menstrual cycle and symptoms can help diagnose other underlying issues - I believe if I wasn't encouraged to look at my symptoms around my menstrual cycle I wouldn't have received my recent complex trauma diagnosis (for which I had trauma focused cognitive behavioural therapy). 

• The NHS recognises that the spiritual needs of an individual plays an important part in recovery. You don't need spiritual faith to access and benefit from this service.  

• I urge women who notice menstrual related mood changes to seek support in work. The veterinary industry is heavily influenced by women, and it is vital that we are encouraged to be open and honest about our menstrual health. It's time to address the needs of women to avoid burnout and create a supportive future for the next generation of female veterinary professionals.   

References 

Tucker, H. (2025). Hormones and women’s mental health in veterinary practice: Understanding and managing PMS and PMDD. Vet Empowered. Available at: https://vetempowered.thrivecart.com/pms-and-pmdd-vetmed/?mc_cid=51c86f152a&mc_eid=aec81e9ec5

First, M. B., Gaebel, W., Maj, M., Stein, D. J., Kogan, C. S., Saunders, J. B., Poznyak, V. B., Gureje, O., Lewis-Fernández, R., Maercker, A., Brewin, C. R., Cloitre, M., Claudino, A., Pike, K. M., Baird, G., Skuse, D., Krueger, R. B., Briken, P., Burke, J. D., Lochman, J. E., … Reed, G. M. (2021). An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World psychiatry : official journal of the World Psychiatric Association (WPA), 20(1), 34–51. https://doi.org/10.1002/wps.20825

IAPMD - Facts & Figures. International Association for Premenstrual Disorders. Available at: https://www.iapmd.org/facts-figures

IAPMD- What is PMDD. Available at https://www.iapmd.org/pmdd#:~:text=PMDD%20Symptoms,birth%2C%20miscarriaage%2C%20menopause)

Mind - Getting a premenstrual dysphoric disorder (PMDD) diagnosis (2024). Available at: https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/getting-a-pmdd-diagnosis/

The PMDD project- A guide to understanding PMDD- What is PMDD? (N.D.). Available at: https://thepmddproject.org/wp-content/uploads/2025/01/What-is-PMDD-Digital-03-1.pdf