PMDD and the Long History of Dismissing Women’s Pain

Once a month, in what I now know is called the luteal phase, my world feels like it’s being shattered, a Jenga tower where the bricks are being removed without my knowledge. It’s disorienting, depressive, and full of anxiety. Then, my period comes, and I feel slightly like myself again. On the last day of my period, I’m almost back to normal. But for two weeks of the month—so half of my entire life—my hormones suddenly unbalance me. Up until a couple of years ago, I didn’t know that what was happening to me was PMDD.

The difference between PMS vs PMDD

PMDD, otherwise known as premenstrual dysphoric disorder, is a severe form of premenstrual syndrome (PMS) that causes significant emotional and physical distress, impacting daily life in profound ways. It’s not just moodiness or mild bloating. It’s characterized by a range of intense and often debilitating symptoms: fatigue, depression, tearfulness, weight gain, bloating, suicidal ideation, muscle pain, rejection sensitivity, and anxiety. These typically begin a week or two before menstruation and then fade a few days after it starts. Unlike PMS, PMDD symptoms can feel all-consuming, making it hard to function in everyday life.

Sometimes, as I’ve personally experienced, medical professionals will use a different term; they might call it an endocrine disorder instead of PMDD. The language changes depending on who you speak to. I still don’t have a formal diagnosis, but I have been diagnosed with PCOS (polycystic ovary syndrome), and my symptoms align closely with what’s described as PMDD. Whether it’s referred to as an endocrine disorder or PMDD feels like semantics when you’re the one experiencing it, but the lack of clarity and agreement in the medical world can make getting help feel like another uphill battle.

What the PMDD research is saying

PMDD was only officially recognized relatively recently. In 2013, the American Psychological Association (APA) added it to the DSM-5, classifying it as a psychiatric disorder. It took until 2019 for the World Health Organization to acknowledge it too, by including it in ICD-11 and categorizing it as a disorder of the reproductive system. For something that impacts such a large percentage of women, it’s alarming how long it took for these institutions to catch up. This is not surprising, though, as women have been historically excluded from clinical trials due to deeply rooted medical misogyny. Men, even today, are considered the ‘norm’, whilst conditions affecting majority women are often under explored. Researchers historically dismissed women’s biology as too variable and inconvenient, and shockingly before 1993, women were rarely included in clinical trials.

Research estimates that PMDD affects somewhere between 3% to 8% of women of reproductive age. That might seem like a small number, but consider what that looks like in real-world terms – millions of people suffering every month. And even those numbers may be an undercount. PMDD is hard to diagnose due to limited research, minimal awareness even among medical professionals, and because it lacks a definitive biomarker, there’s no clear test for it. Women are often told it’s “just PMS,” or worse, that it’s all in their heads.

Writer Beth McColl, who suffers from PMDD, describes the experience with painful honesty. In her Substack newsletter, she writes, “PMDD is a bastard of a thing, and every person I’ve ever met who suffers with it has to perform their own set of superhuman feats every month just to live. As my own mood spirals downwards yet again, I’m doing my best to keep that in mind and resist the impulse to turn on myself.”

She continues: “For a handful of days, I will rock and cry and rail against the world and doubt every decision I’ve ever made. It will be very hard. But then it will be slightly less hard, and then even less hard than that, and then I will be up above the surface of things, breathing the air and feeling okay, then alright, then good, then happy. This is not enough, not really, not for a whole life, but for now I hold onto it with all I have.”

Her words resonate deeply because they echo what so many of us experience but don’t always have the vocabulary - or the medical validation - to name. PMDD is not just about bad moods or difficult periods. It’s about the complete derailment of your life, your relationships, your work, and your sense of self, over and over again.

The correlation between PMDD and mental health

Recent research backs this up. A study led by Dr. Sophie Hodgetts at Durham University looked at over 400 individuals and found that PMDD sufferers reported a significantly lower quality of life and lower satisfaction in their relationships. Among those surveyed, more than half (216 participants) reported having PMDD. These individuals also reported reduced feelings of intimacy, trust, and passion in their relationships. In other words, PMDD doesn’t just impact the person who has it; it ripples outward, affecting their partners, families, and social circles.

This sentiment is something I’ve seen echoed again and again online. One woman named Katie, speaking candidly on camera, says: “Almost every person I’ve worked with with PMDD, once a month when they get their symptoms, they contemplate breaking up with their partner. Once a month, they think about completely burning their life down and starting over.” The video struck a chord; more than 157,000 people liked it.

Because PMDD is still largely misunderstood and the research remains limited, understanding the symptoms from the outside can be difficult. That’s why the lived experiences of people with PMDD - shared through social media, blogs, or personal essays—are so important. These online communities offer a kind of lifeline, a reminder that we’re not alone in our experience, even when it can feel utterly isolating.

People like me shouldn’t have to endure the rug being pulled from under us every month because of our menstrual cycle, with no support or explanation, and be expected to ‘just get on with it.’ Women’s pain has a long history of being dismissed. PMDD is just the latest chapter in that story. But by sharing our stories and pushing for recognition, diagnosis, and better treatment, we can begin to change that narrative.