--- title: PMS and stress url: https://menovivre.ae/case-studies/pms-mood-swings-progesterone-cortisol/ published: 2026-11-04T07:29:17+00:00 modified: 2026-11-04T09:13:14+00:00 author: Abhishek post_type: page word_count: 2118 reading_time_minutes: 11 --- # PMS and stress PMS and stress # Finding calm before her period again: a case study of PMS mood swings and stress She came to us in her early 40s, overwhelmed, tearful and tired, with mood swings that were worst before her period and two years of family stress behind her. About three months into her plan, she told us the premenstrual mood swings had almost completely settled. Care led by Dr Nirusha Kumaran, Physician, Hormone Health, Functional and Longevity Medicine Reviewed by [To be confirmed by the clinic] Published To be added on publication Last updated To be added on publication ## 01How she was feeling when she came to us If your mood shifts in the week before your period, and lately for longer, her story may sound familiar. In her early 40s, she came to us for a [functional medicine](/our-services/functional-medicine-women-dubai/) and hormone review after several years of worsening symptoms, at their hardest over the previous six to twelve months. Mood swings troubled her most, followed by overwhelm and crying, anxiety, brain fog, feeling less able to cope with stress, tiredness and losing her motivation. About three years earlier it had started as typical premenstrual symptoms that eased once her period arrived. Now they lasted longer and hit harder. Small things could leave her overwhelmed and in tears, and both work and home life were feeling the strain. Her digestion suffered when she was stressed, and her periods had become shorter. Behind it all were two years of family illness, loss and caregiving. She was already doing a lot right. She exercised, ate mostly whole foods and slept well, and she had tried iron tablets and an iron infusion with little change to her iron stores. ## 02What her tests showed Her results came back about a month later, from [hormone and cortisol tests](/our-services/menopause-blood-hormone-tests-dubai/) timed to her cycle. They did not point to perimenopause, so we looked elsewhere. Her blood sugar (HbA1c 5.4%, down from 5.7% at an earlier test), cholesterol and inflammation markers were all in good shape. Three things stood out. Her [morning cortisol](/conditions-we-treat/cortisol-adrenal-health-dubai/) was at the top end of the laboratory range. One reading is never a diagnosis, but it fitted two years of strain. In the second half of her cycle, her progesterone was low compared with her oestrogen. And her iron stores were still below where we would like them, with a low alkaline phosphatase hinting that she might be short of zinc. A genetic report helped us choose her supplements, for example a methylated B-complex in place of standard folic acid. Gene results like these are not a diagnosis. They gave us one more clue as to why her symptoms peaked before her period while her hormone levels sat within range. Her key results Marker Results review Follow-up What it tells us Morning cortisol Top end of the range Lower A snapshot, read alongside the stress she had been under Progesterone, second half of the cycle (nmol/L) Low compared with oestrogen 56.25 Measured while she was using the cream DHEA In range, lower than in past years In range Stayed within range HbA1c (%) 5.4, down from 5.7 Next panel Already improving with changes she had made Ferritin (iron stores) Below our target Next panel Why iron stayed in her plan ## 03PMS or PMDD? How the difference was weighed Premenstrual syndrome (PMS) brings mood and physical symptoms in the days before a period that ease once it starts. Premenstrual dysphoric disorder (PMDD) is a more severe form, diagnosed against set criteria. Her symptoms began as typical PMS and had lately spread across more of her cycle. Keeping a symptom diary for two cycles is the clearest way to tell these apart. For her, the timing of her symptoms mattered more than the label, and her plan was shaped around it, with the stress she had been carrying in mind. **Why not HRT?** Hormone replacement therapy treats the symptoms of [perimenopause](/conditions-we-treat/perimenopause-symptoms-dubai/) and menopause. Her tests did not point to perimenopause and her periods were continuing, so oestrogen was not what she needed. The focus was the second half of her cycle, where her symptoms were and where her progesterone was low. ## 04The plan we made together Her plan had five strands: supporting progesterone in the second half of her cycle, calming her stress response, nutrition for mood and energy, helping her body clear hormones, and absorbing minerals well. Dr Nirusha prescribed a pharmacy-prepared progesterone cream for the evenings from day 12 to day 26 of her cycle, matched to when her symptoms were worst. Other recognised options for PMS are covered in the questions below. Evenings became a time to wind down, with magnesium and a supplement blend aimed at cortisol regulation, quieter activities and less time on screens. She took iron daily, away from tea and coffee, along with a trace-mineral complex with zinc, a methylated B-complex with choline, and glutathione two or three times a week. Her days were built around one morning coffee, morning light, regular meals with enough protein and fibre, daily movement and a steady sleep routine, with a walk or slow breathing when anxiety rose. A stool test was suggested to look at her gut health. ## 05How she was feeling three months on At her follow-up, 11 to 12 weeks into the plan, she had kept to it well after a small change to her morning coffee early on. The low mood that used to come just before sleep had eased within about a week of starting her bedtime routine. Work was still busy, but it no longer felt overwhelming, and her energy and clarity had improved. Most importantly to her, the premenstrual mood swings and emotional lows had almost completely settled. Once or twice she felt the old feelings creeping back, and they passed quickly with a walk or a distraction. Some cramps and a dip in energy around her period remained, milder than the mood symptoms had been. In one cycle her period came early, possibly because the amount of cream varied as the bottle ran low. She stopped the cream for that cycle, and we asked her to keep to the prescribed amount and to get in touch if she had another early period, heavy bleeding, spotting or any return of her symptoms. Her morning cortisol was lower at this review, and her progesterone in the second half of her cycle was 56.25 nmol/L. How she felt at her follow-up, as she described it What troubled her At her follow-up Mood swingsAlmost completely settled Overwhelm and cryingOne or two moments that passed quickly Brain fogClearer thinking Coping with stressWork no longer overwhelming TirednessMore energy MotivationEnergy to spare after work The days before her periodMood almost settled; some cramps and tiredness remain ### Her measured results Progesterone at her follow-up; HbA1c from an earlier test to her results review, after changes she had already made. Progesterone, second half of her cycle Low→56.25nmol/L Measured while using the cream HbA1c 5.7→5.4% Improving before her plan began ## 06What comes next for her Her progesterone continues at the same dose, and a broccoli-derived supplement was added to support how her body processes oestrogen. The rest of her routine carries on. She eats mostly whole foods, adjusted around her training and her cycle, with support from our [functional nutrition](/our-services/functional-nutrition-menopause-dubai/) team using her genetic report and a food diary. A full blood panel is planned next, including her iron stores, so we can check how they are responding. ### What her story shows - Hormone levels within the normal range do not always tell the whole story. Her symptoms followed the second half of her cycle, and that timing shaped her plan more than any single number. - One cortisol reading is a snapshot. Hers was at the top of the range after two years of strain and lower at her follow-up, and we read it alongside what she was living through. - Progesterone cream is one approach to PMS among several. Lifestyle changes, talking therapy (CBT), the combined pill and some antidepressants are the options UK guidance lists, and the right choice depends on the woman. Her plan had several parts working together, so no single step can take the credit, and every woman’s body responds in its own way. The figures come from her own records, and the general points follow NHS and NICE guidance. ## At a glance About her Early 40s, still having periods, with symptoms building over several years How she felt Mood swings, overwhelm and tears, anxiety, brain fog, tiredness and low motivation, all worse before her period What we found Not perimenopause. Morning cortisol at the top of the range, progesterone low compared with oestrogen in the second half of her cycle, and iron stores lower than we would like Her plan Progesterone cream in the second half of her cycle, a calming bedtime routine, iron, minerals and B vitamins, and food changes How she is now Premenstrual mood swings almost completely settled; more energy and clearer thinking; work no longer overwhelming Time with us About three and a half months, three visits ### Visits - **First visit**Her story, her priorities and tests timed to her cycle - **Results, about a month later**Not perimenopause; her plan begins - **Follow-up, 11 to 12 weeks into the plan**Feeling much better; repeat tests; plan continued - **Next**Full blood panel, including her iron ![Dr Nirusha Kumaran, physician in hormone health, functional and longevity medicine](https://menovivre.ae/wp-content/uploads/2026/11/Nirusha-Menovivre.png) Care led by ## Dr Nirusha Kumaran Physician, Hormone Health, Functional and Longevity Medicine Dr Nirusha is a UK-trained physician in functional and longevity medicine, with advanced training in hormone therapies and nutrigenomics. A member of the British Menopause Society and the British College of Functional Medicine, she cares for women with thyroid conditions such as Hashimoto’s alongside their menopause care. [Read her profile](/about-us/our-team/functional-longevity-hormone-specialist-dubai/) or find her on [LinkedIn](https://www.linkedin.com/in/dr-nirusha-kumaran/). ### Questions about this case Q: Why are my PMS mood swings getting worse in my early 40s? A: There can be a few reasons. Perimenopause can begin in the early 40s and make hormone levels swing, and some women become more sensitive to the normal hormone changes before a period. Stress, low iron and poor sleep can add to it. For her, the tests did not point to perimenopause, and two years of family illness, loss and caregiving, along with low iron stores, were part of the picture. Q: Does progesterone help PMS mood swings, and what are the alternatives? A: For her, progesterone cream was one part of a wider plan with a bedtime routine, iron and food changes, and together they helped her mood swings almost completely settle. It is not the only route. Lifestyle changes, cognitive behavioural therapy (CBT), the combined pill and some antidepressants (SSRIs) are recognised options for PMS, and a consultation is the place to talk through which suits you. Q: Why do I feel low just before I fall asleep, and what helps? A: She slept well, but a low mood used to settle in just before sleep. It eased within about a week of a calmer bedtime routine with magnesium and a supplement blend aimed at cortisol, quieter evenings and less time on screens. Small changes to your evenings are a gentle place to start, and your doctor can help you look at what else might be behind it. Q: Where can I get help for PMS or PMDD in Dubai? A: At Menovivre, Dr Nirusha and our team care for women with PMS, PMDD, perimenopause and menopause, with blood and hormone tests timed to your cycle, nutrition support and a plan made for you. If you can, bring a diary of your symptoms from the last two cycles to your first consultation. It helps us tell PMS, PMDD and perimenopause apart. ## If this sounds like you If the days before your period have become harder to get through, a first consultation with Dr Nirusha is a chance to talk through how you have been feeling, test what needs testing, such as your iron and cycle-timed hormones, and build a plan around you. [Request an appointment](/contact-us/) ## Related - [All case studies](#) - [Case study 01: getting her energy back after ovarian surgery](#) - [What is oestrogen dominance?](#) - [Normal blood tests but still feel unwell?](#) This case study is published with the patient’s written consent. Her name, age and dates have been changed or removed to protect her identity, and no photographs of her appear on this page. This page describes one woman’s care under the supervision of a DHA-licensed physician at Menovivre Clinic. It is general information, not medical advice, and it does not replace a consultation. Every treatment described here has risks as well as benefits, which were discussed with her before it started. There is no guarantee that the result will be the same, as it might vary from one individual to another. Please speak to a doctor about your own situation.