A History of How PMDD Became a Diagnosis

For centuries, menstruation has been surrounded by stigma, misunderstanding, and silence. While many people experience mild changes in mood, energy, and body during their cycle, for some, the symptoms are severe, life-disrupting, and cyclical, appearing predictably in the luteal phase and easing after menstruation begins. Today, we know this as Premenstrual Dysphoric Disorder (PMDD), but recognition of PMDD as a diagnosable condition has been a long and contested journey.

From Premenstrual Tension to PMS

The earliest modern description of what we now call PMDD appeared in 1931, when physician Robert T. Frank described premenstrual tension as cluster of emotional and physical symptoms, including irritability, fatigue, and poor concentration, linked to hormonal causes. This was the first medical account systematically connecting the menstrual cycle with recurring mood and behavioural changes.

By the mid-20th century, the term shifted to premenstrual syndrome (PMS), reflecting a wider array of symptoms, from bloating and cravings to depression and anxiety. PMS became a household phrase, but it was often trivialised in culture and medicine.

Phrases like “She’s just PMS-ing” dismissed genuine suffering, creating barriers to research and care.

Epidemiological studies (research looking at patterns of health and illness in groups of people) later confirmed that many experience PMS, but only a smaller subset suffers from more disabling, cyclical symptoms (Yonkers et al., 2008).

In the UK, many also referred to Premenstrual Tension (PMT), a term still used interchangeably with PMS, though PMT historically emphasised physical discomfort more than emotional changes. At Feminine Rhythm, we hold space for all these experiences, helping women discern and navigate the physical and emotional challenges with greater ease and empowerment.

The DSM Journey How PMDD Gained Recognition

The psychiatric community took a pivotal step in 1987 when the DSM-III-R included Late Luteal Phase Dysphoric Disorder (LLPDD) in its appendix as a condition needing further study. Though not a formal diagnosis, this marked recognition that severe cyclical mood symptoms might be an actual psychiatric entity.

Debate began to emerge, with some clinicians seeing clear symptom patterns, while others worried about pathologising menstruation or reinforcing gender stereotypes.

Through the 1990s, the condition was renamed Premenstrual Dysphoric Disorder (PMDD) and remained in the DSM-IV appendix as needing further research.

Researchers emphasised the importance of prospective daily symptom tracking, which helped distinguish PMDD from premenstrual exacerbation of existing mood or anxiety disorders.

In the late 1990s there was a turning point with clinical trials showing that SSRIs (e.g., fluoxetine) could reduce luteal-phase symptoms rapidly, sometimes within days, increasing PMDD’s biological credibility and bringing acceptance into the medical community.

However there was still concerns about over-medicalisation and pharmaceutical influence.

Finally, in 2013, PMDD was officially recognised in the DSM-5 under Depressive Disorders. To receive a diagnosis, doctors look for a clear pattern of symptoms that rise and fall with your cycle. Symptoms appear in the luteal phase (the week or two before your period) and ease once bleeding begins.

To meet the criteria, at least five symptoms must be present, and one of these has to be emotional, such as intense mood swings, irritability or anger that feels hard to control, deep sadness or hopelessness, or high anxiety and tension.

The remaining symptoms can include difficulty concentrating, fatigue or low energy, changes in appetite or cravings, sleep problems, feeling overwhelmed or out of control, and physical discomfort like bloating, breast tenderness, or muscle and joint pain. These need to tracked over at least 2 monthly cycles to begin to see a pattern.

Ongoing Challenges: Social and Medical

Despite formal recognition, challenges persist. Some critics still argue that diagnosing PMDD risks pathologising menstruation or reinforcing stereotypes of women as “emotionally unstable.”

Many clinicians underutilise daily symptom charting, leading to misdiagnosis, while others may dismiss symptoms as “just bad PMS.”

At Feminine Rhythm, we often hear about the years of dismissal before finally receiving validation.

Biological research now suggests PMDD is not caused by abnormal hormone levels but by heightened sensitivity to normal hormonal fluctuations, with serotonin and GABA pathways affected.

Increasingly, research is also pointing to the link between trauma and PMDD, showing how past stress or unresolved trauma amplifies the brain and body’s sensitivity to these hormonal changes causing disruption in the nervous system and HPA axis dysregulation.

This is opening the way for a variety of healing avenues, from SSRIs and hormonal interventions to more holistic approaches such as nervous system regulation practices, nutrition and lifestyle changes, such as those offered in our Somatic Course. In our somatic course we educate women on there bodies to empower there healing process.

Moving Toward Compassionate Care

The ACOG Clinical Practice Guideline (2024) emphasises individualised care that integrates medical, psychological, and lifestyle approaches.

At Feminine Rhythm, we expand this further by honouring the feminine journey through 1-1 PMDD Coaching, recognising PMDD not only as a medical diagnosis but also as a sacred initiation into body-awareness, boundaries, and cyclical living.

The history of PMDD reflects a story shaped by stigma, science, and advocacy.

From Frank’s 1931 account of “premenstrual tension” to DSM-5 recognition, this journey was fuelled by the lived experience of countless women and menstruators who refused to let their suffering remain invisible. At The Feminine Rhythm, we believe that healing and empowering cycle awareness is a revolutionary step forward in women’s health and generational healing.

PMDD awareness is growing, and with it a movement toward care that is both evidence-based and deeply soul-honouring.

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If you’d like to explore more, check out these related blogs and resources:

• Period Insomnia and PMDD: How Hormones Affect Sleep Before Your Period

• PMDD and ADHD: Understanding the Connection and How to Manage Both

• When the Cycle Feels Like a Storm: My Journey with PMDD

References

• American College of Obstetricians and Gynecologists (ACOG). (2024). Clinical practice guideline: Management of premenstrual disorders. Obstetrics & Gynecology, 143(6), 1211–1230. https://doi.org/10.1097/AOG.0000000000005482

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• Frank, R. T. (1931). The hormonal causes of premenstrual tension. Archives of Neurology and Psychiatry, 26(5), 1053–1057. https://doi.org/10.1001/archneurpsyc.1931.02230110127009

• Hantsoo, L., & Epperson, C. N. (2015). Premenstrual dysphoric disorder: Epidemiology and treatment. Current Psychiatry Reports, 17(11), 87. https://doi.org/10.1007/s11920-015-0628-3

• Hartlage, S. A., Freels, S., Gotman, N., & Yonkers, K. A. (2012). Criteria for premenstrual dysphoric disorder: Secondary analyses of relevant data sets. Archives of General Psychiatry, 69(3), 300–305. https://doi.org/10.1001/archgenpsychiatry.2011.1368

• Steiner, M., Steinberg, S., Stewart, D., Carter, D., Berger, C., Reid, R., & Grover, D. (1995). Fluoxetine in the treatment of premenstrual dysphoria. New England Journal of Medicine, 332(23), 1529–1534. https://doi.org/10.1056/NEJM199506083322301

• Yonkers, K. A., O’Brien, P. M. S., & Eriksson, E. (2008). Premenstrual syndrome. The Lancet, 371(9619), 1200–1210. https://doi.org/10.1016/S0140-6736(08)60527-9