Historical Narrative
Ancient Greek medical writers associated the uterus with a powerful and often dangerous influence over the entire female body and mind, a belief crystallized in the concept of hysteria — derived from the Greek word for uterus. Hippocratic authors wrote of the uterus as a wandering organ capable of migrating through the body and producing emotional disturbance, and periodic disturbances of mood and temperament in women were commonly attributed to the humoral disruptions surrounding menstruation. The retention of menstrual blood was held to be particularly dangerous, capable of producing melancholic and even violent episodes.
Galen elaborated on these ideas, placing menstruation within his broader humoral system and arguing that the monthly evacuation of blood was essential to maintaining the female body's balance. Disruptions to this process, or the buildup of residues he characterized as corrupt or excessive, were invoked to explain the emotional turbulence some women experienced cyclically. Galenic gynecology, transmitted through Byzantine compilers and Arabic translators, shaped Western European medical thought about menstruation for over a millennium.
Medieval European physicians and healers, many working within monastic or scholastic traditions, inherited and reinforced these frameworks. Hildegard of Bingen, the twelfth-century abbess and medical writer, described the influence of menstruation on female temperament in terms drawn from both humoral medicine and her own theological understanding, framing cyclical emotional changes as part of the broader condition of female nature shaped by the Fall.
The seventeenth and eighteenth centuries brought gradual shifts in anatomical knowledge but relatively little change in the cultural interpretation of premenstrual emotional experience. Physicians who embraced iatrochemical or iatromechanical frameworks substituted new vocabularies — fermentation of humors, hydraulic pressures in the nervous system — without fundamentally revising the underlying assumption that female reproductive physiology was inherently destabilizing to mental equilibrium.
The nineteenth century saw the emergence of increasingly medicalized accounts of premenstrual disturbance. American gynecologist George Beard, who popularized the diagnosis of neurasthenia, situated premenstrual complaints within a broader narrative of nervous exhaustion affecting middle-class women. French and British alienists debated the relationship between menstruation and insanity, with some physicians arguing that premenstrual periods represented windows of heightened susceptibility to mental breakdown or criminal impulse — arguments that had troubling legal and social applications.
The first explicitly clinical description of what would later be conceptualized as premenstrual dysphoric disorder is often attributed to Robert Frank, an American gynecologist who in 1931 published a paper describing what he called premenstrual tension, characterizing it as a syndrome of nervous irritability, fluid retention, and emotional disturbance linked to elevated estrogen levels in the luteal phase. Frank's paper was among the first to propose a hormonal rather than purely structural or moral explanation.
Katharina Dalton, a British physician working in the mid-twentieth century, became the most prominent advocate for what she termed premenstrual syndrome, or PMS, conducting extensive clinical research and arguing vigorously for its recognition as a legitimate medical condition rather than a psychosomatic complaint or cultural artifact. Dalton's work was simultaneously influential and controversial, with critics arguing that her framing pathologized normal female physiology.
The proposal in the 1980s to include what was then termed late luteal phase dysphoric disorder in the Diagnostic and Statistical Manual of Mental Disorders sparked intense debate among psychiatrists, feminists, and legal scholars, with critics warning that formal psychiatric classification could be used to discriminate against women professionally and legally. That debate shaped the eventual cautious inclusion of premenstrual dysphoric disorder in subsequent editions and reflected the enduring difficulty of separating the science of female reproductive physiology from the cultural weight that had accumulated around it across millennia.
Key Historical Figures
Historical narrative only — this page describes how Premenstrual dysphoric disorder was understood historically. It is not medical advice and does not describe current diagnosis or treatment. Sourced from verified medical history references (NIH, Encyclopaedia Britannica, and standard medical history texts). See our medical disclaimer.