One doctor once wrote that PMS turns Sweet Sues into Horrible Hannahs.
Today, researchers know that about 90 percent of women experience some symptoms of premenstrual syndrome, or PMS, such as menstrual cramps, bloating, back pain, and mood changes. Most people accept PMS as a legitimate experience today, but that hasn’t always been the case.
One noteworthy thing about PMS is that early physicians and researchers barely mentioned it or its symptoms. Medical texts throughout history have focused more on actual periods—almost to an obsessive degree—than period pain. Male physicians were absolutely fascinated by menstruation and what it meant: Were periods punishment for women, the "descendents of Eve?" Were “abnormal” periods a sign of the devil? Were periods a sign of health? Or of illness?
Still, there are some clues that physicians picked up on PMS symptoms early on, even if it wasn’t yet called PMS (it earned that name in the 1980s). One of the earliest mentions of PMS symptoms was in the 2nd century, when the Greek physician Soranus wrote that women were “tense” before their periods—although it’s unclear if he meant physical tension (cramps or muscle pain) or emotional tense (irritability or other mood changes), or both.
The Obsession with Periods
While ancient texts were lacking in PMS talk, an obsession with menstruation picked up several centuries later. Gynaeciorum libri, a gynecology text from the 1580s, blamed period pains on “bad-quality period blood,” which was considered punishment for an improper or unhealthy woman.
On the other hand, Gynaeciorum libri stated that “normal” menstruation would “bless [women] with many good things.” At a time when sexual reproduction was considered paramount for women, menstrual problems were considered very dangerous to humanity as a whole. Too much bleeding, not enough bleeding, no bleeding, and bleeding with pain were all considered potential problems that demanded treatment, for the sake of the human population.
And then, of course, there was the theory of the four humors—an ancient theory of disease that was used to explain just about every health problem for centuries, until it was finally disproven by germ theory. The ancient theory states that the body requires a careful balance of “humors” (bodily fluids) to maintain good health and disposition: blood, phlegm, black bile, and yellow bile. (The common practice of bloodletting stemmed from this theory.)
Many believed that women menstruated because they were carrying excess blood, causing them to be “unbalanced” until the menstrual blood was “purged” via their monthly menstruation. This imbalance of the four humors in the days leading up to the period created the perfect scapegoat for things like cramps and mood swings.
The “Madness” of Menstruation
A few centuries later, the 1800s brought more attention to the physical and emotional changes women experienced before and during menstruation—but not in a very sympathetic way. Menstrual problems became linked to madness and insanity in the 19th century—so much so that “insanity” from menstruation was frequently (and successfully) used as a defense for crimes in court.
The idea of menstrual madness continued—and it could be argued that it still continues today. The 1969 novel The French Lieutenant’s Woman by John Fowles centered on a woman who accused a man of rape and used letters for proof—letters that turned out to be written by her. This was discovered when they realized the letters followed the “monthly—or menstrual—pattern” and were hysterical, psychotic, and irrational.
However, the 1900s also brought more understanding to periods and period pain. In the 20th century, American gynecologist Robert Frank recognized the role of estrogen in painful periods, and he named the phenomenon “premenstrual tension.”
This helped validate PMS for women, but it still took decades to be accepted by doctors and the general public alike. Even when it was accepted, it was still regarded with little sympathy and was often used to discredit women as incapable of holding jobs, leadership positions, or other endeavors beyond housewife.
In 1973, one physician remarked in the health column of the Baltimore Sun that PMS turned a “Sweet Sue” into a “Horrible Hannah.” He even went so far as blaming PMS for causing divorce and breaking up families, and said bickering couples should see the doctor’s office before the attorney’s office.
Premenstrual Syndrome Today
PMS earned its modern name in the 1980s, reflecting its acceptance as a real disorder and not just a “tension.” Many women choose to treat their PMS symptoms with hormonal birth control, while others simply alleviate their cramps with OTC meds like ibuprofen. (Here are other tips for relieving menstrual cramps.)
Other women just endure their cramps and other symptoms, which can have consequences on their quality of life. One 2019 study surveyed nearly 33,000 women and found that almost 15 percent reported absenteeism from work because of menstruation and related symptoms, while about 80 percent reported presenteeism—attending work but not being productive—for an average of 23 days a year.
And of course, some very lucky women don't experience PMS at all. While researchers know certain things that can make cramps and other PMS symptoms worse (like caffeine), they don't have any reason with sufficient evidence for why some women have PMS and others don't.
Today, researchers also have more knowledge about what constitutes “normal” cramps and mood changes, and what suggests a more serious problem. For example, severe bleeding and menstrual pain could be endometriosis, and major mood changes before menstruation could suggest premenstrual dysphoric disorder, or PMDD. Here are other potential causes of severe menstrual cramps.
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How PMS became a thing. JSTOR Daily, 2016. (Accessed on January 25, 2020 at https://daily.jstor.org/pms-became-thing/.)
King H. Midwifery, obstetrics, and the rise of gynaecology: the sixteenth-century compendium. Routledge, 2017.
Mishra S, Marwaha R. Premenstrual dysphoric disorder. (Accessed on January 25, 2020 at https://www.ncbi.nlm.nih.gov/books/NBK532307/.)
Premenstrual syndrome (PMS). Washington, DC: Office on Women’s Health, U.S. Department of Health and Human Services. (Accessed on January 25, 2020 at https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome.)
Schoep ME, Adang EMM, Maas JWM, De Bie B, Aarts JWM, Bieboer TE. Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32,748 women. BMJ open. 2019;9:e026186.