Depending on whom and how you ask, about half of women worldwide report some symptoms of premenstrual syndrome, give or take. PMS is a medical condition in which many women experience emotional fluctuations in the week before their periods. Since women have been getting their periods since time immemorial and the illness is so prevalent, one would imagine that people have always noticed it. In truth, connecting emotions with periods is actually a relatively recent idea. Medical and popular beliefs about what creates and what constitutes premenstrual syndrome have varied widely, sometimes bordering on the absurd. It should come as no surprise, then, that the history of PMS is rooted in some serious sexism.

Ideas about Periods and Illnesses, Before “PMS” was a Thing

For millennia—literally, millennia, beginning in Ancient Greece—doctors believed that just about anything emotionally or mentally “wrong” with women was due to an illness called hysteria. Hysteria was thought to be caused by a wandering or otherwise disorderly uterus. (Fun fact: vibrators were first invented as a treatment for hysteria.) That was pretty much the standard diagnosis for any undesirable personality trait in a female patient during the 1800’s, until people realized that it was absolutely ridiculous sometime around a hundred years ago.

Victorian ladies crying (photographer unknown)

Victorian ladies crying (photographer unknown)

In the mid 1800’s, doctors began to write articles that connected hysteria and periods. The earliest instance that I could find was in an article from 1864, entitled “The Differential Diagnosis of Hysterical Affectations.” The article linked the “hysterical headache” to menstruation (in any phase), which may come with symptoms of laughter, weeping, labored breathing, rapid pulse, “whirlwinds of excitement,” pains in the belly, skin sensitivity, and even death. This is my personal favorite 19th century medical article about the emotional aspects of menstruation:

“The most common disorder is migraine, which may be looked upon as the beginning of a slight cereberal [=mental] excitation… eccentricities of character are sometimes developed, and may attain an extreme degree… the most frequent mental disturbance takes the form of modification of the natural disposition, which becomes quarrelsome and contradictory, and renders the patient a torment to the household. Terrible fits of jealousy are also often produced… numerous observations testify to the development of dipsomania [=alcoholism], kleptomania, etc. Erotomania, likewise, is of frequent occurrence, and a case is on record in which the patient, in a state of extraordinary genital excitement, demanded to be led to a house of prostitution.

The most serious of all these troubles is homicidal mania, of which a certain  number of well-attested cases are known… All of these complications usually cease with or soon after the menstrual period… The prognosis of menstrual insanity is, indeed, comparatively favorable… leeching and blistering may be of some use… Finally, when actual insanity is concerned, we must not forget that opium, morphine, atrophine, and small doses of tartar emic are very efficacious sedatives.” – Gynaecology: Mental Aberration During Menstruation, in Medical and Surgical Reporter. (1891)

By the early 1900’s, some doctors started writing about an illness called “premenstrual fever,” which was associated with tuberculosis. (As I’ve pointed out in a previous article, during the late 19th and early 20th centuries, doctors had some seriously misguided beliefs about tuberculosis.) In a 1912 article entitled “Progress of Medical Science,” a doctor detailed a condition called “menstrual insanity,” which was observed in one patient. The article casually noted that the woman had fallen ill with “menstrual insanity” after her husband had molested their daughter, because periods are always to blame for totally legitimate female concerns.

Women with hysteria under hypnosis - D. M. Bourneville and P. Regnard

Women with hysteria under hypnosis – D. M. Bourneville and P. Regnard

Who First Proposed “PMS” as we Know it Today?

Robert T. Frank , © Duke University

The first “modern” study on PMS is attributed to a gynecologist by the name of Dr. Robert T. Frank, who published his paper “The Hormonal Causes of Premenstrual Tension” in 1931. As a doctor who specialized in female hormones, he argued that “premenstrual tension” was caused by hormonal imbalance. Frank believed that women would seek relief through foolish and irrational behaviors that needed to be taken into account if women were to enter the workforce. The “premenstrual tension” that he described then and in subsequent publications was much closer to our idea of PMS now:

“Disability resulting from premenstrual phenomena are common to such a degree that account of them is taken in all industrial corporations employing women. Among the premenstrual phenomena to be expected and to be considered as physiologic are increase in size of the breasts, with a feeling of tension and fullness; feeling of tension and fullness with throbbing in the pelvis; a slight increase in frequency of urination; slight pelvic pain referred either to the iliac fossae or suprapubic region; an irritability, sensitiveness, increase in emotional instability, and feeling of general tension. Transient skin eruptions of the type of erythema, or an increase of existing acne, are likewise physiologic… All of these symptoms disappear rapidly with the onset of the menstrual flow, sometimes as if by magic if the beginning flow is profuse. To a certain extent this rapid relief is explained by our demonstration of the female sex hormone.” – Robert T. Frank, The Endocrine Aspects of Gynecology (1935)

Hormone testing for PMT, from Robert T. Frank, The Endocrine Aspects of Gynecology

Hormone testing for PMT, from Robert T. Frank, The Endocrine Aspects of Gynecology

The medical literature over the following couple decades was largely dismissive of Frank’s theory, though more and more women reported symptoms of it as knowledge of the syndrome became widely known. In reaction to this rather underwhelming response in the medical and scientific community, in 1953, Drs. Katharina Dalton and Robert Greene published “The Premenstrual Syndrome” in the British Medical Journal, arguing that PMS was real and indeed attributable to hormonal fluctuations.

What was the reaction in the medical community and in public belief?

1970's Kotex Ad

1970’s Kotex Ad

Considering that PMS is so widely experienced among women and diagnosed with such regularity, you would think that everyone was in agreement about it from then on. Actually, not really. If you run a search for “premenstrual syndrome” in an academic database like JStor, ProQuest, or Google Scholar, you’ll find literally tens of thousands of articles across a multitude of disciplines, representing many theories and opinions. One very noticeable trend is a surge of sociological and anthropological studies by feminist scholars that found its peak sometime around the late 70’s, many of which argued that PMS was entirely a sociological construct created by men, pointing to its dubious history and lack of conclusive scientific evidence. Other feminist scholars argued that denying PMS was an effort to silence women’s concerns about their bodies.

“Premenstrual tension syndrome” became a topic of fierce public debate in the early 1980’s when a few court cases were brought to trial in which women were defended on the basis of mental illness by way of PMS… successfully. In one case, a woman was acquitted of murder; another acquitted in a case of theft. On this basis, some argued that women should be excluded from careers and even from holding public office because of a biological incapability to make decisions rationally. (Yeah, this was still a thing in the 1980’s.) While some feminists denounced the decision because of those implications, other feminists applauded it because they saw it as a public acknowledgement of a neglected women’s health issue.

The Takeaway

As a historian with absolutely no medical training, my expertise ends here. I can say this much: when you look at the history of PMS, there are some compelling similarities to hysteria, from which it directly evolved. Though PMS is extremely pervasive, it’s hard to pin down. It is diagnosed through self-reported symptoms, generally by women who already believe that they have it. It’s used as a way to completely disregard female opinions and feelings as fundamentally irrational. Like hysteria, it’s a catch-all diagnosis for anything otherwise undiagnosable, which is only given to women. As of now, there are over two hundred symptoms under the umbrella of premenstrual syndrome. I am absolutely not implying that women do not experience the symptoms of PMS, nor am I suggesting that PMS is “all in your head.” (Though, to be fair—depression, anxiety, and post traumatic stress disorder are also “all in one’s head,” and they’re no less real.) If I do have a central thesis here—and I’m not sure I do—it’s only to say that some of the things we take for granted about women’s health are historically rooted in some ridiculously sexist assumptions… like the millennia-old belief that uteruses make people crazy.

Feature image via Wikipedia