In medical school, I have learned to take chest pain seriously. When a patient presents with angina, there are established guidelines, strong evidence, and standardized protocols to adhere to. However, when a patient enters the clinic describing mood swings, fatigue, or pain associated with their menstrual cycle, clinicians often respond vaguely, saying, “That’s normal.” Behind this simple statement resides decades of overlooked research in the study, funding, and treatment of menstrual health.

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) impact millions globally. Up to 75 percent of menstruating individuals experience PMS symptoms, with 3 percent to 8 percent meeting the criteria for PMDD, which is a severe and frequently debilitating mood disorder. These symptoms are significant; they disrupt work, relationships, and overall quality of life. Despite their commonness, menstrual disorders continue to be underdiagnosed, underfunded, and understudied.

The weight of ignored symptoms

For many individuals with menstrual cycles, the luteal phase is accompanied by more than just cramps. PMS includes physical discomfort, mood fluctuations, irritability, and fatigue. PMDD, acknowledged in the DSM-5, features severe emotional symptoms that can resemble major depressive disorder. Yet in clinical settings, patients reporting these conditions often experience dismissal or inconsistent care.

In a survey of over 3,000 employed women in Japan, only 4.9 percent sought medical assistance during an eight-month span despite significant premenstrual symptoms. Those few who did pursue medical help reported notably lower work productivity, underscoring an urgent need for earlier detection and support. This concern has not been adequately addressed. It’s not that the symptoms are rare or subtle; rather, our healthcare systems have yet to be structured to take them seriously.

The burden is real. Beyond daily interruptions, PMDD has been linked to a heightened risk of suicidal thoughts, depression, and considerable functional impairment. It is difficult to believe that if these symptoms were related to another organ system, such a drastic divide between prevalence and research engagement would exist.

Historical bias and existing deficiencies

Presently, PMS is largely treated with a limited number of off-label treatments such as SSRIs or oral contraceptives. While these can be effective for certain patients, others report ongoing or worsening symptoms and adverse side effects from these therapies. There is a lack of personalized care for premenstrual health and even less understanding of the mechanisms behind these disorders.

The underfunding of menstrual health is not merely an oversight; it stems from long-standing gender biases in research. For many years, the female sex was excluded from clinical trials and animal studies to “avoid hormonal variability,” causing substantial gaps in our understanding of how hormonal cycles affect physical and mental health. Consequently, menstrual physiology remains somewhat of a “black box” in conventional medicine.

Now is the time to prioritize menstrual health. As clinicians and student clinicians, we cannot wait for others to address this issue. We are primary stakeholders in this challenge and essential to the solution. So what actions can we take?

A call to action for clinicians and policymakers

To achieve meaningful progress, clinicians must regard patients’ menstrual experiences with seriousness, providing validation and tailored management rather than dismissal. A simple change in perspective, treating menstrual issues with the same seriousness as other chronic symptoms, can significantly improve clinical interactions. Acknowledging patient experiences, ruling out comorbidities, employing standardized questionnaires, and ensuring structured follow-up should become standard practice, not the exception.

Medical education for aspiring clinicians must also advance. Menstrual health is typically only briefly covered in preclinical courses, often as a minor note in reproductive physiology. It seldom features in psychiatry, primary care, or internal medicine training. Integrating PMDD and PMS further into clinical education would empower future clinicians to diagnose and address these conditions with the same seriousness given to other chronic disorders.

Moreover, policy changes need to extend beyond clinic walls. Physician advocacy is vital in influencing employer policies, state laws, and insurance standards. Their voices should resonate in political discussions to effect real change. Although it may seem daunting, enacting legislation around PMDD is achievable. In 2023, Spain became the first European nation to enact menstrual leave laws. The United States lacks comparable federal protections. Acknowledging PMDD as a genuine medical condition that may require workplace accommodations and insurance coverage could relieve millions of individuals.

I understand that implementing these calls to action is no small task. However, menstrual cycles are not merely a niche area of health. They represent a vital biological reality for nearly half the population. The persistent chasm between patient experiences and clinician understanding is both a gap in scientific knowledge and an issue of equity. As medical students, residents, and practicing clinicians, we are uniquely equipped to change the narrative. We can illuminate menstrual health, bringing it from obscurity into the realm of evidence-based, patient-centered care it rightfully deserves.

Cynthia Kumaran is a medical student.