The Sirona Health Podcast: PMDD, Hormones & Mental Health

A landmark study using this exact medication was one of the first to prove PMDD is genuinely hormonal, not psychological. In this episode, Dr Georgina Standen explains GnRH agonists and antagonists — medication that switches off ovulation entirely — how they're used for treatment-resistant PMDD, and why the research on long-term ovarian suppression from other conditions tells us so much about using them safely.

In this episode:

• How GnRH agonists and antagonists actually work — and why the same tool used to treat severe PMDD is also the tool that first proved it's real
• Real response rates for treatment-resistant PMDD — and an honest look at the roughly 30% who don't respond even to this
• Why endometriosis and fibroid research does so much of the heavy lifting behind how these medications are used for PMDD
• Why "add-back" hormone therapy isn't optional — and what the research on primary ovarian insufficiency tells us about the real, long-term stakes of getting this wrong
• Who this treatment genuinely suits, and why it's not a first-line option

The Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health, a specialist women's health practice. Further information: sironahealth.co.uk 

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.

Not every woman can take the combined pill — and not everything that's commonly prescribed for PMDD actually has the evidence behind it. In this episode, Dr Georgina Standen goes beyond the combined pill into transdermal oestrogen, progesterone taken alone, and Slynd — and is honest about which of these genuinely has trial evidence, and which is more contested than it might appear.

In this episode:

• Transdermal oestrogen plus a progestogen — the lesser-known option with real trial evidence behind it, and why it isn't for everyone
• Why this approach can be a particularly good fit for PMDD that worsens in perimenopause, and why it can continue well past age 50 in a way the pill can't
• Progesterone taken alone — a genuine, ongoing disagreement in the field, and an honest look at what the trial evidence actually shows
• Slynd, the progestin-only option — why it's theoretically promising but still unproven for PMDD specifically
• A specific combination worth knowing about for perimenopausal women also dealing with menstrual migraines

The Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health, a specialist women's health practice. Further information: sironahealth.co.uk 

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.

Three pills. Three progestins. Three very different reasons a woman ends up on one and not another. In this episode, Dr Georgina Standen properly unpacks "the pill" for PMDD — what actually separates one formulation from the next, which one has the real evidence behind it, and why the way you take it can matter as much as which one you choose.

In this episode:

• What "the pill" actually means — and why the progestin, not the oestrogen, is where most of the real differences live
• The evidence for drospirenone specifically — and the honest admission that it still only works for around half of women
• Why the traditional 21-day, 7-day-break pattern can actively work against you with PMDD, and what running pills continuously changes
• What actually happens to your bleeding on the pill — and the myths circulating online that put women off a treatment that could help
• Zoely, and why swapping in a natural oestrogen might matter for some women

The Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health, a specialist women's health practice. Further information: sironahealth.co.uk 

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.

Walking into a room and forgetting why. Losing a word mid-sentence. Reading the same paragraph three times. In this episode, Dr Georgina Standen properly unpacks brain fog — what it actually is, what's driving it, and answers the question sitting underneath almost every conversation about it: does this mean something worse is coming?

In this episode:

• What brain fog actually clusters around — and why part of it looks more like an attention problem than a memory problem
• The honest answer to "is this dementia" — and the reasoning behind it, not just reassurance
• The evidence for a real, causal hormonal mechanism, from studies where memory dipped and recovered as oestrogen was removed and restored
• The three "amplifiers" that actually drive brain fog day to day — hot flushes, sleep, and mood — and why treating those is often where real improvement comes from
• Where HRT does and doesn't fit, and why the evidence on dementia prevention specifically is still genuinely unresolved

The Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health, a specialist women's health practice. Further information: sironahealth.co.uk 

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.

Why do so many women feel like their mental health suddenly changes in their forties and fifties, often without any obvious trigger? In this episode, Dr Georgina Standen applies everything this series has built so far — hormone sensitivity, DASH-MC, reproductive depression — to perimenopause specifically, and explains why this transition is so often missed, dismissed, or misdiagnosed.

In this episode:

• The clinical pattern that shows up again and again: a history of PMS, PMDD, postnatal depression or a rocky relationship with the pill, now resurfacing in a new form
• Why perimenopause isn't simply hormonal decline, but volatility — and why that's what actually destabilises a sensitive brain
• The real numbers: a 30% rise in major depressive disorder, a doubling of bipolar incidence, and higher anxiety rates during perimenopause specifically
• "Diagnostic overshadowing" — why menopausal symptoms so often get treated as a purely psychological problem
• Why sleep is so often the hidden driver behind anxiety at this life stage
• Why standard HRT isn't a universal fix, and what a properly personalised approach actually looks like

The Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health, a specialist women's health practice. Further information: sironahealth.co.uk 

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.

If two women have identical hormone levels but completely different experiences of their cycle, what's actually different between them? In this episode, Dr Georgina Standen goes back a step further than hormones themselves, into the genetics and cell biology behind why some brains are wired to be more hormone-sensitive than others.

In this episode:

• The classic hormone-suppression study that proved PMDD isn't about hormone levels at all
• What twin studies tell us about how much of PMDD is inherited
• The specific genes researchers keep finding — ESR1, a serotonin receptor gene, and GABRB2
• The cellular research showing PMDD cells respond differently to hormones at a genetic level, right down to a mismatch between gene instructions and the protein actually produced
• Why understanding the mechanism explains why treatment isn't one-size-fits-all

The Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health, a specialist women's health practice. Further information: sironahealth.co.uk 

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.

What does a brain scan actually show us about PMDD — and does the same evidence tell us anything about what happens after menopause? In this episode, Dr Georgina Standen walks through the neuroimaging research, from how PMDD brains respond differently to hormones, to what a major new study reveals about the postmenopausal brain.

In this episode:

• Why gonadal hormones appear necessary for the prefrontal cortex to function normally — and what that means for mood and concentration
• How the emotional brain, particularly the amygdala, responds differently across the menstrual cycle
• What's measurably different in the brains of women with PMDD compared to women without it — and why it correlates with symptom severity
• A landmark study of almost 125,000 women (11,000 with brain scans) on menopause, grey matter volume, and dementia risk
• Why HRT didn't reduce these grey matter changes — and why the evidence on HRT and dementia risk is genuinely conflicting, not just unclear

The Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health, a specialist women's health practice. Further information: sironahealth.co.uk 

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.

Had PMDD in your twenties, postnatal depression after having children, and now feel unlike yourself in perimenopause? These aren't separate problems. In this episode, Dr Georgina Standen explains reproductive depression — the idea that one underlying trait can show up again and again at every major hormonal transition in a woman's life.

In this episode:

• Why PMDD, postnatal depression, contraceptive-related mood changes, and perimenopausal depression are so often treated as unrelated — and why that's a mistake
• The biological reason this pattern recurs: what puberty, pregnancy, contraception and perimenopause actually have in common
• Why this reframe matters for prediction — how a PMDD history can flag risk for postnatal depression, and why that's worth knowing before pregnancy, not after
• Why treatments that worked for you at one life stage are often a sensible starting point at another
• What this concept isn't — and why it doesn't erase the other real factors at play at each life stage

The Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health, a specialist women's health practice. Further information: sironahealth.co.uk 

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.

Tried to identify with PMDD, but your worst week doesn't line up with the "classic" post-ovulation pattern? You're not alone — and you're not imagining it. In this episode, Dr Georgina Standen introduces DASH-MC, emerging research showing there isn't just one pattern of hormone sensitivity, but at least three.

In this episode:

• Why PMDD has traditionally been described as one condition — and why so many women don't recognise themselves in that description
• Type 1: the classic post-ovulation progesterone and allopregnanolone pattern
• Type 2: the lesser-known pattern driven by falling oestrogen around your period — often showing up as low mood, brain fog and fatigue rather than irritability
• Type 3: the surprising pattern linked to the oestrogen surge around ovulation — impulsivity, risk-taking and difficulty controlling urges
• Why this matters for ADHD specifically, and for choosing the right treatment

The Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health, a specialist women's health practice. Further information: sironahealth.co.uk 

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.

If your hormone tests keep coming back "normal" but you still feel awful — this episode explains why. Dr Georgina Standen breaks down the real science behind PMS and PMDD: it's not about how much oestrogen or progesterone you have, it's about how your brain responds to it.

In this episode:

• Why women with PMS and PMDD usually have completely normal hormone levels — and why that's not a dead end
• The lab research showing PMDD cells respond differently to the same hormone exposure, right down to gene expression
• Why SSRIs can work within days for PMDD, when standard depression treatment takes weeks
• The traditional progesterone-and-GABA explanation — how allopregnanolone should calm the brain, and why it doesn't always
• Why hormonal contraception can be so unpredictable for PMDD specifically, and why more isn't always better
• How stress, sleep, and alcohol can amplify an already-sensitive system

The Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health, a specialist women's health practice. Further information: sironahealth.co.uk 

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.