In medical school, I’ve been taught to take chest pain seriously. If a patient presents with angina, there are clear guidelines, robust evidence, and standardized protocols to follow. Yet, when a patient comes into the clinic describing mood swings, fatigue, or pain tied to their menstrual cycle, the responses of clinicians are often vague, stating, “That’s normal.” Behind that simple phrase lies decades of neglect in how we study, fund, and address menstrual health.
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) affect millions of people worldwide. Up to 75 percent of menstruating individuals report PMS symptoms, and 3 percent to 8 percent meet diagnostic criteria for PMDD, which is a severe and often debilitating mood disorder. These symptoms are not trivial; they interfere with work, relationships, and quality of life. Despite their prevalence, menstrual disorders remain underdiagnosed, underfunded, and understudied.
The burden of neglected symptoms
For most people with menstrual cycles, the luteal phase brings more than cramps. PMS encompasses physical discomfort, mood changes, irritability, and fatigue. PMDD, which is recognized in the DSM-5, involves severe emotional symptoms that can mimic major depressive disorder. Yet in the clinic, patients reporting these experiences often encounter dismissal or inconsistent care.
In a survey of over 3,000 working women in Japan, only 4.9 percent sought medical help during an eight-month period despite substantial premenstrual symptoms. The few individuals who did seek medical help reported significantly lower productivity at work, highlighting an unmet need for earlier recognition and support. This issue has not been properly addressed. Not because the symptoms are rare or subtle, but because our health care systems are not yet designed to take them seriously.
The burden is real. In addition to daily disruptions, PMDD has been associated with increased risk of suicidal ideation, depression, and significant impairment in functioning. It is hard to imagine that if these symptoms arose from another organ system, there would be such a profound gap between prevalence and research attention.
Historical bias and current gaps
Today, PMS is still largely managed with a handful of off-label therapies like SSRIs or oral contraceptives. These can certainly be effective for some patients, but others report persistent or worsening symptoms and side effects using these treatments. There is little individualized care for premenstrual health, and even less mechanistic understanding of why these disorders manifest in the first place.
The underfunding of menstrual health is not a simple oversight, but rather the result of historical gender bias in research. For decades, the female sex was excluded from clinical trials and animal studies to “avoid hormonal variability,” leading to enormous gaps in understanding how hormonal cycles influence physical and mental health. As a result, menstrual physiology remains a sort of “black box” in mainstream medicine.
The time to pursue menstrual health is now. As clinicians and student clinicians, we cannot wait for someone else to solve this. We are a primary stakeholder in this problem and a necessary part of the solution. So what can we do?
A call to action for clinicians and policymakers
To make meaningful progress, clinicians should take patients’ menstrual experiences seriously, offering validation and individualized management rather than dismissal. A simple shift in mindset starts with treating menstrual complaints with the same depth and seriousness as other chronic symptoms can transform clinical encounters. Validating patient experiences, ruling out comorbidities, using standardized questionnaires, and offering structured follow-up should become routine, not exceptional.
Medical education for student clinicians must also evolve. Menstrual health is typically covered briefly in preclinical courses, often as a side note in reproductive physiology. It rarely appears in psychiatry, primary care, or internal medicine curricula. Further integrating PMDD and PMS into clinical training would empower future clinicians to diagnose and treat these conditions with the same seriousness as other chronic disorders.
Finally, policy changes must extend beyond the clinic. Physician voices are powerful in shaping employer policies, state legislation, and insurance standards. They should be heard in political spaces to make a true change. Although it seems like a heavy feat, legislation surrounding PMDD is possible. In 2023, Spain became the first European country to pass menstrual leave legislation. The United States currently has no comparable federal protection. Recognizing PMDD as a legitimate medical condition that may warrant workplace accommodations and insurance coverage could ease the burden for millions.
I recognize that to deploy these calls to action is no small goal. However, menstrual cycles are not a niche sector of health either. They are a central biological reality for nearly half the population. The persistent disconnect between what patients experience and what clinicians understand is both a scientific gap and an equity issue. As medical students, residents, and practicing clinicians, we are uniquely positioned to reshape the narrative. We can move menstrual health out of the shadows and into the evidence-based, patient-centered care it deserves.
Cynthia Kumaran is a medical student.
