When it comes to secondary school science, there’s no denying that there’s much to be desired. 

We’re taught about the menstrual cycle and female hormones through the lens of reproduction and fertility. The process that the uterus goes through to prep for pregnancy is imparted in a cold and clinical fashion, with the highs and lows of our hormones easily traceable on charts that span 28 days. We’re taken through the physiology of the female reproductive system.

But what we’re not taught is the damaging emotional and mental fall out from the intense fluctuation of hormones, widely known as premenstrual syndrome (PMS).

It is, therefore, no wonder that some people are quick to dismiss PMS as a mere fabrication; a fictional narrative born out of people wanting to attribute emotional distress to their menstrual cycle, rather than being introspective and taking a look at their work-life balance or close relationships. As reported by the Daily Mail, Jane Ussher, a professor of women’s health psychology at Western Sydney University, believes that PMS is little more than a cultural myth, adding that “those in caring relationships are less likely to report symptoms than those in more one-sided partnerships”. It’s clear that to ‘experts’ like Ussher, understanding and treating PMS is seen as unimportant and unnecessary.

The US Department of Health and Human Services describes PMS as “a combination of physical and emotional symptoms that many women get after ovulation and before the start of their menstrual period”, extending to trans and non-binary folk who also menstruate. 

It is believed that PMS occurs due to oestrogen and progesterone levels falling significantly in the days after ovulation if the person is not pregnant. Common symptoms, as listed by the NHS, are “mood swings, feeling upset, anxious or irritable, tiredness or trouble sleeping and bloating”, the same wording that can be found in most health resources. 

It’s arguable, however, that the language used to describe PMS is in itself limiting. ‘Moodiness’ and ‘irritability’ make the condition sound flippant and irrational when the reality is that PMS is a great deal more than being a little bit pissed off.

When Mongi’s PMS started four years ago, the symptoms were barely there. However, over the last year it has become unbearable: “Every single time, it literally feels like having malaria, something I experienced several times as a child, except now, I get emotional.” During the five-to-eight-day period that her PMS normally lasts, on the second day, she often finds that she’s unable to even think about working. “I work from home so deal with challenging deadlines for my freelancing projects and usually when I set projects around that time, I’ll be honest, I fail to make the deadline,” she says. “I’ve abandoned projects and have been rated terribly because of this but sometimes, I’m shaking so much and the fever I normally get makes me feel delirious.”

For Dee*, sometimes the pain means that she’ll be bedridden for a few days every month. “Sometimes it’s just physical symptoms that affect me the most, and if it’s exhaustion, I will have to go and lie down or risk passing out. I even fall asleep at random moments,” she tells Stylist. “When I’m in the middle of a project, I have to dig really deep to keep going because I cycle between feeling depressed, low and completely hopeless.”

Alongside the physical, there’s also the colossal mental and emotional impact which can feel insurmountable in the midst of PMS. As someone who lives with anxiety and manages it through therapy, Nicole finds that sometimes on the days before her period starts, she feels like she’s gone back in time to a point pre-counselling.

“I actively have to remind myself that it’s rooted in my hormones, not in reality,” she says. “It’s a constant discussion – yes, you feel awful but no, it’s not because of the external trigger that you’ve responded to, but rather the physiological shit you have to put up with.

“I reckon I’m pretty rational and reasonable but in those few days, I do just have to step back. It’s not that I don’t trust my judgments or responses, I just acknowledge that some emotional decisions might be worth revisiting in a few days.” For others, the extreme shift in mood and emotional balance can spark dark ideations. “I get serious mood swings,” notes Lexi. “I didn’t have to track my cycle because I knew that when I was suicidal, my period would soon appear.”

In some cases, PMS can even heighten other illnesses and conditions as Liv quickly discovered. When she first developed OCD four years ago, she found that her intrusive thoughts and obsessions were getting worse around three or four days before she came on her period. 

“OCD is made up of two parts – obsessions and compulsions. Anxiety produces the obsessions, which cause compulsions, which then feed the obsessions,” Liv explains. “So if you imagine that PMS is making that anxiety a bit worse, then the whole vicious cycle takes on a whole new nightmarish quality when I’m about to come on my period.” 

Others have found that PMS goes hand in hand with its lesser-known but equally debilitating sibling premenstrual dysphoric disorder (PMDD), described as a very severe form of PMS. Fiona* experiences symptoms of suicidal thoughts, irritable bowel syndrome brought on by anxiety, body tremors, eye twitches and more. “My PMDD affects my work,” she says. “I had to take so many sick days in my last job that I was given a verbal warning on my absences. I didn’t feel comfortable enough to let my employer know what the issue truly was for fear of being told it wasn’t a legitimate thing.”

According to the National Association for Premenstrual Syndrome, it’s estimated that “as many as 30% of women can experience moderate to severe PMS, with 5-8% suffering severe PMS/PMDD, this being around 800,000 in the UK”. With such high numbers of individuals experiencing similar symptoms just before their periods, it’s insulting to refer to it as a myth in the way that Usher does, asserting that “women from other cultures do not report many emotional signs of PMS”. 

It’s critical to remember that when we’re talking about ‘women’s health’, we’re often only talking about white women’s health as black and brown women have been historically excluded from medical studies. Alongside this, there’s the prevalent racial bias within pain perception, leading to medical professionals believing that black people are able to withstand more pain than their white counterparts and therefore impacting our pain assessments and therefore the treatment we’re recommended. Usher’s assumption that women from other cultures – a vacuous statement in itself – show fewer PMS symptoms only begs the question of whether she, a white woman, even knows what pain looks like for people whose discomfort falls outside of what is deemed normal or acceptable?

For those living with PMS, the casual dismissal of the condition can feel hopeless and unfair. “If this isn’t acknowledged, those who have it are going to keep looking lazy and irresponsible to the employment market,” Mongi states. “Married with the fact that periods usually start during adolescence, the PMS story is often tied in with general growing pains and is seen as a phase,” adds Nicole.

“PMS can present in so many ways that people don’t often realise,” Dee outlines. “It’s linked to so many other conditions including hypothyroidism, so when people say it’s not real, I often wonder how they would cope with living my life.”

*Names have been changed.

Images: Getty, Unsplash