- It’s just sort of like a folklore thing, PMS," says Charlie. "It’s like, your mother had PMS, and her mother had PMS, and all these women just had to go and be quiet during the month and there was nothing really anyone could do about it."
- Charlie has premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome which can cause extreme mood swings, tiredness and, for some people, suicidal ideation.
- The 30-year-old’s condition, which affects 5-8% of people who menstruate, was initially misdiagnosed as bipolar disorder. "I guess I identified the sort of cyclical nature of the unhappiness I was feeling," Charlie says.
"The only way you can have peace with it is to be like, 'I both am and am not my hormones'," she explains. "You have to make peace with it a bit because, whether or not there are ways for you to manage it, there is no easy, quick, definite solution." - In its less severe – and more common – form, PMS affects over 90% of women and people with wombs. Despite the fact that more than 200 different symptoms have been identified for the condition, Dr Kimberly Yonkers, a professor of psychiatry, obstetrics, gynaecology and reproductive sciences at Yale University, says that some medical practitioners still don’t believe it exists at all. Studies show that prevalence rates for PMS vary from 20% to 30%, depending on the underlying diagnostic criteria.
- "There are also very well-meaning individuals who feel the diagnosis stigmatises women because of the age-old stereotypes about women and hysteria, and they would like it to not exist," says Dr Yonkers, who has been researching PMS for over two decades. "But I'm responding to our patients... I can't tell them, 'Oh, it's all a figment of your imagination,' because they're genuinely suffering."
- Since the now-outdated term premenstrual tension (PMT) was coined in 1931, medical research still hasn’t found a universally agreed cause – or a catch-all cure – for the range of symptoms women experience in the days and weeks running up to their period. In fact, for every piece of research into PMS there are five studies into erectile dysfunction (ED), according to ResearchGate. Yet over 90% of women experience at least one symptom of PMS while just 19% of men are affected by ED. So why isn’t more known about a condition that debilitates millions of women around the world?
- Dr Yonkers explains that "there are just a handful of us" in her field of research and that she is "one of the few investigators" who has received funding from the National Institutes of Health (NIH), the United States’ medical research agency. PMDD was only formally recognised in 2013 when it was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a text used to help diagnose psychiatric conditions in the US. "That certainly helped us make the case for the need to take a look at this," Dr Yonkers tells me. "But let's be honest, at least in the United States, as well as other areas of the Western world, there is a tradition of not taking women's complaints seriously."
- The first mention of what we now know to be symptoms associated with the menstrual cycle is found in an ancient Egyptian document called The Kahun Gynaecological Papyrus (from around 1800 BC). This listed symptoms like headaches, sensitivity to light, abdominal pain and heavy bleeding, which were attributed to the "wandering womb", an evil creature that moved around the body. The unexplained mysteries of the womb have also historically been linked to witchcraft and demonic possession.
- For Charlie, simply recognising what was at the root of her mood swings, brain fog and lethargy was a major help in managing her condition. "It’s understanding the cyclical nature of it and knowing that it has a finite ending and a rhythm to it," she says. "And, at the bare minimum, no matter how horrible it is, it is contained to that time and I just try to really enjoy, be productive in and celebrate that time when I don’t have PMS."
Dr Peter Schmidt, principal investigator at the US’s National Institute of Mental Health, has been studying PMS since the 1980s in an effort to find out what causes the condition, why some women experience it more severely than others and how it can be treated. - Dr Schmidt says his research suggests that PMS isn’t caused by "a deficiency or excess of any particular hormone" but rather by the differing reactions of women’s bodies to normal changes in hormone levels during the month. What predisposes some women to these responses, and not other women, is still not fully known.
- In 2017, Dr Schmidt found evidence of a possible genetic predisposition in women with PMDD. "Genetic can mean both genes they were born with but also – particularly relevant for that study – epigenetic changes, so changes where the environment may influence the way in which genes are expressed."
- When the study was published, his colleague Dr David Goldman called the findings "a big moment for women’s health" and said they proved that women’s symptoms were "not just emotional behaviours they should be able to voluntarily control". Dr Schmidt hopes that the NIH will be able to build on this research and, in the future, create a new drug called dutasteride (medication normally used to treat an enlarged prostate) which could be used to treat PMDD. He is also hoping that new potential treatments will be found from the genomics studies that are currently underway but these, he notes, "will be a way off in the future".
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