TW: Mentions of depression, anxiety, reproductive disorders, and suicide as a symptom.

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In April of 2023, I was diagnosed with a condition called Premenstrual Dysphoric Disorder (PMDD). The International Association for Premenstrual Disorders defines PMDD as 

“a cyclical, hormone-based mood disorder with symptoms arising during the premenstrual, or luteal phase of the menstrual cycle and subsiding within a few days of menstruation”

It is important to clarify that PMDD is not a hormone imbalance, but a severe negative reaction in the brain to the rise and fall of estrogen and progesterone in the body during the natural menstrual cycle. 

Although PMDD affects nearly 1 in 20 women worldwide, PMDD was only officially internationally recognized in 2019. There is also a huge lack of research into the condition, commonly attributed to the medical community’s lack of interest or funding in researching disorders affecting female reproductive health. 

A common way the PMDD community describes our condition is like PMS on steroids, but with added intense anger, depression, and anxiety. However, this is not to undermine the seriousness of the condition. PMDD can be life-threatening with 34% of women with PMDD having attempted suicide to escape the debilitating symptoms of the disorder. See this list from Johns Hopkins for all 49 of the most common PMDD symptoms. 

 

 

The moment I received my diagnosis was a huge relief after months of cyclical suffering and fear about what was happening to my body, to me. My life had been completely upended by a simple medicine change 8 months prior. I went from a mostly happy, motivated, socially involved person to someone who couldn’t leave their room or even take care of their most basic needs for almost two weeks a month. The time in between these episodes, I was living in fear, not knowing when the next episode would begin. 

The first time PMDD was even suggested to me was in an emergency therapy appointment mid-depressive episode in January. Immediately, something clicked and everything that was happening to me began to make sense. Then, I did what I do best: fall down a rabbit hole of research. 

It’s shocking how much isn’t taught to young women about the female reproductive system.

In the months between this revelation in January and my appointment with my GP in April, I dove deep into the world of menstruation and the female reproductive system. In a way, the more I learned, the better I felt about my situation. Knowing what was happening in my body made the daily burden of my symptoms a little easier to bear. Connecting with community, like the amazing PMDD community on Reddit, helped me to not feel alone in my experience. 

One of the best resources turned out to be the 28ish Days Later podcast, hosted by India Rakusen and produced by BBC Radio 4. In 28 short episodes, India Rakusen explores the details of what occurs biologically in every phase of the menstrual cycle and engages in discussion with experts about reproductive conditions and experiences, like PMDD, endometriosis, pregnancy, miscarriage, menopause, and more.

I highly recommend this podcast to anyone even slightly interested in women’s reproductive health.

Throughout the series, India Rakusen engages in conversation with Maisie Hill, the author of Period Power. Maisie Hill describes herself as a “Menstrual Health Expert, Coach & Practitioner” with professional training in Chinese Medicine Acupuncture, life coaching, massage, as a doula, and more.  In Period Power, Hill proposes “the Cycle Strategy,” a way of interpreting the phases of the menstrual cycle as seasons. In this way, she encourages returning to the “natural cycle” and tuning into one’s body, which can only be truly done without taking birth control. Podcast Episode “Day Twenty-Two: Love and the Cycle” explores what life according to a woman’s cycle could look like in a romantic relationship.

Birth control has become a bit of a hot topic recently as more people debate the risks and side effects of the medication (specifically the pill) that are often under-explained to first-time takers and under researched in general. There is a growing movement of women who come off of the pill and experience significant changes in their mood and behavior.  Some women even leave long-term romantic partners after losing feelings seemingly from coming off the pill.

Yet, some individuals go further and contest that birth control is standing in the way of a woman achieving a higher level of “womanhood” that can only be reached by living according to her cycle. Hill’s “Cycle Strategy” is a less radical version of the Red School’s “Inner Seasons” teaching. The Red School is an organization claiming to have developed a “radical new approach to health, creativity, leadership, and spiritual life” that is “rooted in the bloody, wild, radical power of the menstrual cycle.”

The Red School also offers programming around “Menstruality,” which they define as:

Menstruality is a term coined by Jane Catherine Severn, pointing to a woman’s Inner Intelligence or organising principle that is working her from her first bleed at menarche, throughout her menstruating years and menopause and into her post-menopause years. It is leading her Home to Herself.

In this way, the Red School, and others like it, equate the ability to menstruate “naturally” (i.e. without contraceptives) with the essence of womanhood. A woman can only ascend to her true self through the process of aligning her life with her “natural” hormonal cycle and tapping into to her “Inner Intelligence.” Hill and the Red School are only two voices in a much larger conversation advocating for women to come off birth control, almost regardless of the potential dangers. I found their arguments to be particularly exclusionary to people who rely on birth control to alleviate painful periods and other reproductive conditions, as well as people who are women by their own definition, yet do not have a uterus.

This larger conversation of what makes a woman was quite harmful to me at the time for the reasons above. Reading Period Power and other similar works, such as In the Flo by Alisa Vitti, made me feel like I did not have a choice in my medical care if I wanted to live out my gender identity. That, if I were to choose the FDA recommended treatment for PMDD (a type of birth control called Yaz), I would somehow be less of a woman and lose the “beautiful and unique opportunity” to connect with my cycle in a pure way.

But what makes a woman? I don’t personally believe there is one correct answer to that question. Each person gets the opportunity to define their gender and identity for themselves. No medication can take that ability away from them or make their gender experience any less valid. Conversations where generalized biological factors are used as all-powerful determining factor of identity fail to consider the vast spectrum of human experience and biology. In my eyes, Women are women, no matter their ability to menstruate or the choices they make on managing their menstruation.