Google “menstrual madness” and you will find the malady I have been struggling with for the majority of my life: Premenstrual Dysphoric Disorder.
PMDD is a severe health condition tied to the menstrual cycle. Symptoms appear like clockwork in the luteal phase — the roughly two weeks after ovulation and before menstruation — and often include debilitating sadness, anger, anxiety, cognitive fog, and suicidal ideation. Then, with menstruation, comes blessed relief: for about two weeks in the follicular phase, life is symptom‑free, until ovulation restarts the cycle. PMDD affects one in twenty menstruating women and girls.
I have a PhD and have taught at leading research universities. I am the author of numerous articles and op-eds as well as a peer reviewed book. I am a mother of two wonderful boys, and my marriage is strong and long – this March we will celebrate our fifteenth anniversary. Despite the picture-perfect presentation, my life has been a cycle of pain and impairment. I have lost twelve to fourteen days to PMDD every single month for twenty-six years.
Two hundred years ago, the “cure” for menstrual madness (as well as neurasthenia, nymphomania, masturbation and all cases of “insanity”) was an ovariotomy — the surgical removal of both ovaries. Today, despite leaps in our understanding of human physiology, female hormonal conditions like PMDD remain understudied and misunderstood. While we no longer call it menstrual madness, women with PMDD are forced into the same 19th century cure as a result. Until recently, I was one of them.
I was twelve when I got my period and started skipping school. I’d forge a sick note from my parents and walk a mile to my house to retreat into the musty, copper carpeted sanctuary of the cellar where I’d spend hours on the couch watching Nick at Night and the movie Empire Records.
It wasn’t until age fifteen that I connected my mood to hormones. I was fighting with my parents — the blow-up type of fight that borders on violence – and my mother chased me down to the basement. I fled to the unfinished part with the washing machine, ancient water boiler and a small door leading to the outside. She confronted me and I picked up a bottle of bleach and threw it. The jug careened through the air and hit the water heater, spraying bleach and sparks everywhere. I collapsed onto the crumbling cement floor and cried. I confessed that I had secretly begun taking hormonal birth control and having sex. My parents took me off birth control and to a psychiatrist who prescribed Prozac.
Therapy and medication did little to quell the cyclical tempest. Throughout high school and college, I cried, hid, and buried the pain beneath alcohol and drugs. When asked what the matter was, I had a well-worn, and what I thought was accurate, response: Bad PMS. I didn’t know it, but it was the conflation of PMS with my real condition, PMDD, that was the very reason my condition remained shrouded in obscurity for so long.
Genesis
In the 1930s, the American physician Robert Frank observed that a subset of his patients would become tense, irritable, tearful, and prone to “foolish and ill considered actions” shortly before menstruation. He called the phenomenon “premenstrual tension.” In the 1950s, British endocrinologist Katharina Dalton rebranded the condition “Premenstrual Syndrome” and broadened the list of associated symptoms, which she said could affect a woman’s academic performance, her social behavior, and her ability to function.
But it was not until the 1980s that PMS entered into the cultural lexicon with two sensational trials of women in Britain who killed their partners in fits of rage. With Dalton as an expert witness, the courts accepted the plea of diminished responsibility due to PMS and the women avoided prison sentences. The stories gained international coverage as a warning of how the menstrual cycle could turn otherwise placid women into violent beasts. Dalton’s interviews amplified the message, and the idea of the premenstrual woman as emotionally unstable, dangerous, or simply incapable of normal self-command was reified in popular culture. The trope of the “hormonal” women was born. Scholars would later argue that this trope arrived at a politically consequential moment, amid a backlash against the gains of the women’s movement, providing a new biological vocabulary for an old claim: that women’s bodies rendered them irrational and ontologically unsuitable for public life.
Yet the very normative excesses of PMS also created a diagnostic problem. “PMS” was so broad and elastic that it could encompass everything from bloating and food cravings to depression, rage, and profound functional impairment. Psychiatrists therefore began considering whether a much narrower and more severe version of PMS should be formally recognized in the Diagnostic and Statistical Manual of Mental Disorders. In the run-up to the 1987 revision of the DSM-III-R, a committee proposed Late Luteal Phase Dysphoric Disorder (LLPDD).
This was a major decision. The DSM was not simply another medical textbook: its classifications govern clinical practice, insurance reimbursement, professional training, research, and legal proceedings. Inclusion could transform an amorphous and frequently trivialized complaint into a condition that physicians were expected to recognize and researchers could systematically investigate.
The proposal was met with petitioning, op-eds, and boardroom fights by clinicians who argued there was little evidence supporting a distinct psychiatric disorder. Feminist opponents saw the category as a “gendered artifact”: and feared that such a diagnosis could be deployed against women in employment disputes, child-custody proceedings, or other settings in which female competence was suspect by default. They argued that by putting the condition in the DSM, its authors were pathologizing female biology, rendering the menstrual cycle itself a malady requiring psychological treatment.
This continued to be the position of some feminist clinicians and scholars in 1994, when LLPDD was renamed Premenstrual Dysphoric Disorder and put in Appendix B of the DSM. Nearly a decade later, some remained unconvinced PMDD was anything other than a cultural construct. “Women [should be] encouraged to consider the culture-bound nature of PMS and PMDD and ask themselves whether some of the premenstrual changes should be considered symptoms at all,” wrote psychologists Joan Chrisler and Paula Caplan in 2002. While they did not doubt changes occurred, coping with them was matter of will and mindset:
Women’s coping might be enhanced if they thought of their premenstrual experiences as “changes” rather than “symptoms”…If instead of thinking of themselves as “overreacting,” they thought of themselves as “sensitive”; if instead of thinking “I am depressed and about to cry,” they thought “water retention makes my tear ducts feel full.”
They were wrong. PMDD was real and I couldn’t rationalize or reframe my way out of what my body was doing to me. Nor could talk therapy or psychiatric drugs help me overcome the overwhelming emotions PMDD catalyzed. But the feminists of the 1980s were also right. By putting it in the DSM, PMDD was categorized as a mental disorder and was subjected to the attendant social stigma. And there was another implication, one that those who doubted the existence of PMDD never contemplated. By treating PMDD as a mental disorder, the system deprioritized examination of its biological, physiological — hormonal — underpinnings.
In 2013, thirty years after its first recognition, PMMD finally entered the main text of the DSM. For an individual to be diagnosed with PMDD, her mood has to be tracked over two cycles. She must exhibit at least 5 of 11 symptoms (at least 1 mood related) to qualify and these symptoms must seriously impact her life. The condition was added to the International Classification of Diseases in 2019. Yet many clinicians still do not know PMDD exists.
In 2026 the psychiatrist Helena Tucker interviewed 252 women with PMDD. They were asked to share what it was like living with the disorder. While having vastly different life experiences and while coming from vastly different backgrounds, the women’s answers converged on a number of themes. One was unpredictability and loss of control. A woman’s mood and the very way she sees the world shifts in an instant and at unpredictable times. She lives in perpetual apprehension of the pregnant sky about to break.
Another theme was systemic failure. Because clinicians are not educated about PMDD and because it rests at the intersection of gynecology, endocrinology and psychiatry, patients are left cycling through providers and ping ponging between specialties searching for a diagnosis. Thus it takes a woman an average of twelve years to put a name to her suffering. Once an accurate diagnosis is secured, so begins the search for an effective treatment. A medicine that helps one person does nothing for another. Women with PMDD are walking through life in an information netherland, where theories abound but no one knows precisely what’s going on and how to stop it.
I’ve had many of these experiences. But some of the defining features of my PMDD elude this list. Like the hound Cerberus with his three heads, these subconscious responses to my condition prevented me from moving forward with my life.
My Cerberus: Stigma, Denial, and Forgetting
I told no one about my PMDD because I internalized the stigma that surrounds it. I could have told my colleagues about PMDD, but that would have required talking about periods and menstruation was dirty and embarrassing. I could have told my coworker why I didn’t go to the conference, but that would have meant admitting I was a slave to my hormones: unstable; unreliable. I was deeply ashamed of what I believed was a mental illness and that I couldn’t, by a force of will, overcome it. In short, disclosure of my handicap — and it was a handicap — was not a risk I wanted to take.
This shame fed into and was buttressed by another factor: denial. For my entire working life, I did not admit to myself how incapacitating my condition was. I continued to believe that I was on equal terms with my non-PMDD professional counterparts and I blamed myself when I did not rise to the common standards.
And then there is the forgetting. I don’t remember the devastating sadness and marathon days of sleeping. I don’t remember the inflection points in my marriage that, if my husband were another man, would have meant the end of it. Each month, I would forget how bad it was. Each month the pain had the sharpness and surprise of being punched in the stomach for the first time.
The memories that do emerge are ephemeral. I remember in the vaguest way, losing my first job out of college; a blowout fight with my husband at the airport; a car crash; road rage that almost turned into a fist fight; binging on Ambien to sleep through the sadness. When I comb through my journal, there are hundreds of references to PMDD yet curiously little detail about the events surrounding it. “Think of PMDD as thousands of little traumas,” my therapist told me recently as I tried to plumb my mind for anecdotes for this essay. “Your brain is protecting itself from the excruciating pain of the moment.”
One of the few entries that detail an incident of PMDD at length is from 2020:
…and then the crying, now hysterical, came on full force. I sat in the driver’s seat yelling and pounding my fists on the steering wheel. How many times have I been in this place? Parked in some parking lot, hand on the steering wheel trying to push back against the feelings. Desperate to be normal. Desperate to put all the pain and struggle in the past. To be done. To have finally found a cure. A cure. The cure.
“The cure” I was alluding to was not medicine: it was the title of a short story I wrote in high school. The story is about a young woman who decides to get surgery to cure an unnamed condition. It follows the woman as she lies on the examining table in a thin hospital frock, her feet in stirrups, as she insists that her reluctant doctor perform the procedure, and then at the dinner table as she weathers the disdain of her family when they learn what she has done. Even as a teenager, ignorant of what PMDD was or what toll it would take on my life, my subconscious knew that the only way to stop the ruthless cycle would be the knife.
But I was not ready. I held out hope for a psychological, pharmacological solution. I had tried at least ten different drugs to treat my PMDD up to that point, and all either exacerbated it (like the birth control did when I was fifteen) or did nothing.
Enough
“The reason these drugs don’t work,” my new psychiatrist told me, “is because you don’t have PMDD. You have Bipolar 2.” It was 2020. I was thirty-six. I knew I didn’t have bipolar — I didn’t have the manic highs, only the depressive lows — but I was desperate. The antipsychotics she gave me, at high levels, offered relief. But at a price.
When I took it at night, it constricted my throat and nasal passages making it impossible to swallow. It left me so groggy in the morning I could not safely drive my kids to school. I started having problems with memory and word retrieval. I remember panicking in the shower because I could not remember the word for apple. I knew what an apple was. I could picture it. But I could not remember the name. At the grocery store, I struggled to remember the last digits of my husband’s phone number attached to our savings card. I was teaching at Georgetown University, and I struggled to put together a coherent syllabus and speak to the class extemporaneously. I spent a year organizing an international conference, and I could not give the opening remarks because I could not pronounce the words. I became convinced I had early onset Alzheimer’s. It was terrifying. It was only when I lost my job that I put two and two together.
My husband and I had had enough. I’d exhausted all options. I resigned myself to “the cure” that I had resisted for so many years. It was 2025, but I was a prisoner of the logic of menstrual madness of the 19th century: If hormones are the problem, take out their source: the ovaries.
Deadly Consequences
When you have Premenstrual Dysphoric Disorder the last days before your period are excruciating. Every month I’d fantasize about slitting my wrists and letting the pain spill out. Yet my ideations of self-harm were nothing compared to the one in three women with PMDD who attempt suicide. Because there’s no national surveillance or adequate data, we don’t know how many of those women succeed. But I have talked to too many mothers of the women who have.
Christina Bohn was a thoracic ICU nurse. She was a valedictorian. She loved to sing and play tennis. She came home one day from senior year in college and told her mother she felt terrible. She battled an unknown enemy until the end of her life.
Christina was put on thirteen different kinds of medicines. She attempted to take her life eleven times. After each of these heart wrenching close calls, no one thought to ask about her menstrual cycle. “The menstrual cycle is incredibly important. They check your temperature, pulse, respiration, and blood pressure. The menstrual cycle is the 5th vital sign,” said Marybeth Bohn, Christina’s mother.
Corydon Hammond was one of the first clinicians to point out the centrality of the menstrual cycle at the annual meeting of the American Psychological Association and later in a journal article. This was not about best practices, he argued. This was a matter of morality. “We can no longer ethically test women psychologically without asking them if their symptoms may vary with their menstrual cycle, ” wrote Hammond in 1984. Yet four decades later, prescribing psychiatrists in America continue to do just that.
Even with the salve of time, mothers like Marybeth still blame themselves. “Why= didn’t I think about her period?” One woman who lost her daughter, Mary, to suicide in 2024 told me over the phone one day. “Why did she decide to quit on me?” “She did not quit on you.” I told her as her breathing became ragged. “She was under the influence of PMDD and the world looks very very different.” Like my wrists throbbing with the need to be cut, her daughter’s mind was consumed by the need to put an end to the pain. “You feel helpless, ” said Marybeth when I told her about my conversation with Mary’s mother, “competing with that liar and thief. This hijacker takes over their mind.”
Marybeth recounts a time when Christina was hospitalized for a suicide attempt. The next morning she was released from the hospital, the doctors having assessed her stable enough to return home. Christina was unable to explain what happened. She had gotten her period.
“It’s completely disorienting,” my husband told me as we walked the dog one morning. “One minute you’d be crying uncontrollably, talking about wanting to die and then the next you’d have your period and be happy, chirpy, flirty, and full of ambition. And the worst part is you barely remembered it. But I did. Every single time.”
Still reeling from the bipolar misdiagnosis and what it cost me, my husband and I went to the hospital to meet with the surgeon. The doctor agreed to perform the surgery but insisted I go on the GnRH agonist Lupron for at least 3 months. The medicine, which is administered by syringe each month and which is used to treat hormone based cancer, stops the functioning of your ovaries and puts you into immediate menopause which is what would happen post surgery. It worked. For the first time in my adult life I knew what it was like to have a normal month. It was transformative.
Ten months later the surgeon called to tell me I needed to come in to have the operation. The medication has not been indicated for use over a year — we don’t know if it’s safe and health insurance may not continue to cover it because it is not a recognized treatment for PMDD, she told me. I sat down and put my head between my legs to stop the nausea. Then I got angry: there has to be another way. I started digging into the medical literature and was astounded by what I found: very little.
While a huge amount is still unknown, most researchers agree that PMDD is an abnormal brain sensitivity to the normal shifts in reproductive hormones in the menstrual cycle. One such hormone is progesterone. After ovulation, progesterone rises. The body converts some progesterone into allopregnanolone (ALLO) which affects systems involved in stress, anxiety, sleep, and mood. For most people, ALLO has a calming effect. It interacts with GABA-A receptors, which help quiet or slow activity in the brain. In people with PMDD, however, ordinary rises and falls in progesterone and ALLO may have the opposite effect. Rather than feeling calmer, a person may feel more anxious, irritable, depressed, emotionally raw, or overwhelmed. Researchers are still trying to understand why this happens, whether it occurs in all people with PMDD, and exactly which brain pathways are involved.
Estrogen, particularly estradiol, may also play a role. Estradiol changes throughout the menstrual cycle and affects parts of the brain involved in mood, attention, stress, and emotional reactions. Some researchers think that certain people with PMDD may be especially sensitive to those shifts.
Serotonin is another factor. Serotonin is a brain chemical involved in mood, sleep, appetite, and emotional processing. Estrogen and progesterone can influence serotonin-related systems in several ways. Some studies suggest that people with PMDD may respond differently to changes in serotonin signaling. For example, experimental lowering of tryptophan — a nutrient the body uses to make serotonin — has worsened symptoms in some people with PMDD. Researchers have also explored possible differences in serotonin receptors, transporters, and enzymes that help break down serotonin.
There are many “may,” “might,” and “researchers think” statements here for a reason. Most biological studies have included small numbers of participants, used different methods and definitions, or produced findings that have not yet been repeated in larger groups. There are crucial unanswered questions key to unlocking this puzzle: Why do some people develop these sensitivities? Why do symptoms vary so much from one person to another? And, most important for me and all women with PMDD, how do you cure it?
That so many of these questions remain unanswered is not merely a consequence of the historical neglect of PMDD. This lack reflects a biomedical system that for decades — for millenia! — failed to study female biology. The last century of clinical science has seen women routinely underrepresented. In the modern era, scientists disproportionately relied on male animals and cells because ovarian hormone fluctuations were assumed to introduce unwanted variability or “noise.” It was not until 1993 that NIH-funded clinical research was required to include women, and not until 2016 that NIH formally required researchers to consider sex as a biological variable in animal and human studies. Research specifically relevant to women’s health received only 7.9 percent of NIH grant funding in 2023, despite women comprising roughly half the population. Only about 0.1 to 0.2 percent of total NIH funding in 2015 went to gynecologic research. The result is a medical evidence base built disproportionately around male biology, leaving fundamental questions about how estrogen and progesterone, their cyclical fluctuations, and their interactions with the brain shape women’s health remarkably underexplored.
The relief from the cyclical demon of PMDD through chemical menopause gave me the clarity and time to interrogate the fears fuelling my resistance to removing my ovaries. Fear is often driven by ignorance. But in this case, the more knowledge I gained about my ovaries the more fearful I became. The ovaries play a crucial role in the female body beyond reproduction. Through the production of estrogen, progesterone, testosterone, inhibin, and other signaling molecules, they influence the brain, bones, cardiovascular system, connective tissue, metabolism, and immune function. Estrogen, for example, helps preserve bone density and regulates collagen production and connective-tissue turnover; its loss at menopause is associated with reductions in skin collagen, elasticity, and bone mass.
The effects of losing ovarian function are particularly apparent in women who undergo surgical menopause at a young age. Women who had an ovary removed before natural menopause have a 46 percent higher risk of cognitive impairment or dementia, according to one study, and a 31 percent higher rate of all-cause mortality according to another. Ovarian hormones also interact extensively with the immune system and new research is uncovering a complex two-way relationship between ovarian function, immune cells, inflammation, and aging. New technology has allowed scientists to examine the ovaries at unprecedented resolution, revealing previously unrecognized cellular subtypes, developmental pathways, and regional organization within the organ.
Through my research, I concluded that my impulse to avoid surgery was, for me, the right one. But saving my ovaries meant I had to return to the hell of PMDD. I refused to do that also.
My husband and I decided to consult another surgeon. I am glad I did. I left the new surgeon’s office with a cheshire cat-like smile and a heady, gitty feeling. She told me I did not need to remove my ovaries and that she would continue to prescribe Lupron or another drug off label for the next 8 years until natural menopause.
Yet ovarian suppression brought with it new pain. Despite the Hormone Replacement Therapy, I developed arthritis in my neck and was no longer able to do my favorite exercise routines or take my daily jog. After 13 months, I decided to stop chemical menopause. It has been two months off Lupron as of this writing, and I am still waiting for my ovaries to “wake up” and for the hell of PMDD to return.
At the end of the day, ovarian suppression, like ovary removal, is a crude answer to a complex biological question that we would be well equipped to answer given requisite money and political will.
I cannot believe that women with PMDD would willingly choose to have their healthy ovaries removed if another cure was available. But because there is no cure, and for many, no effective treatment (including Lupron, which some cannot tolerate) too many women have had to take this route. One of them is JoLynn. The defining feature of PMDD for JoLynn, a mother of three, was the overwhelming sadness. She would get through the days by locking herself in her room and taking sleep medications. One day, in the depths of her luteal phase, she attempted to take her own life. Her husband found her in time.
JoLynn knew that she would eventually try to take her life again if something did not change. So, after decades of failed treatments, she decided to remove her ovaries. She went to one doctor, and then another, and another. She went through 17 providers until one of them said yes. The doctor’s responses went like this: You are so beautiful and young, what if you want to have more kids? What does your husband say? You are so beautiful and young, you don’t want surgery, it will make you old. You are so beautiful and young, early menopause will shave 5 years off your life. “You don’t understand,” JoLynn would plead with them, “without surgery there won’t be another five years. I won’t survive the year.”
Finally, she found a doctor who would perform the procedure. It changed her life. She went back to school and became a social worker with the mission of creating a place where women can go when they are in the throes of PMDD — a place that is not an emergency room or a psychiatric hospital. She also joined me and Marybeth in founding the PMDD Policy Council, where I serve as president.
The PMDD Policy Council was formed on a simple premise: PMDD is too lethal, too prevalent, and too serious to be ignored. We have gathered hundreds of women, clinicians, and partners and friends in a movement to change the status quo through public policy at the state and federal level. Our work focuses on the four deficits that have created so much pain for so many: lack of public awareness, lack of clinician education, lack of clinical research, and lack of national data collection.
I know that the Council is not a cure for my PMDD. It is not an ovariotomy. But it is my way of making meaning out of my menstrual madness and helping others as well.