PMS as a mental illness?

[MadrasT]

Last edited Sun Jun 3, 2012, 08:52 AM - Edit history (2)

The other day on the radio I heard that people are trying to get PMS added to the DSM-V as a mental illness. This is the book psychiatrists use to diagnose and classify mental illnesses such as schizophrenia, bipolar disorder, etc.

It was on NPR that I heard it, and it was being lauded as a great advancement for women.

To me it sounds like a huge step back.

They want to make it so that women with symptoms of PMS can officially be diagnosed as... "mentally ill".

I need to learn more, but... what do you think?

(I would add a link but I am on a mobile.)

[hr]
Edit to add: I can't find that particular radio segment on the web anywhere. Here is a link to an old NPR interview. If you search for "PMS" once you get to this page, there is some conversation about it: The Art of Diagnosis

Here is a brief excerpt:

DR. JONATHAN METZL:
If we are in the business of treating PMS with psychiatric drugs, in part what we're saying is that there is a level of insanity to the suffering of [LAUGHS] PMS.
BROOKE GLADSTONE:
Jonathan Metzl, psychiatrist and author of Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs.
DR. JONATHAN METZL:
Historically speaking, psychiatric drugs have been used to convey the message that if you’re not just suffering from an illness but if you’re not a good mother, if you are not a good wife, these are all conditions that can be treated with psychiatric medications.

And I can say that historically the blurriness of that line has gotten psychiatry into a lot of trouble. The “mother’s little helper” phenomenon in the '70s is one example of that.

If you Google "PMS DSM-V" you can find more discussion about it.

It is specifically "PMDD" or "Premenstral Dysphoric Disorder" that will be added to DSM-V.

[dipsydoodle]

1. I don't normally post here but

sounds completely absurd to me and I have no real notion of any women agreeing with that much.

[hlthe2b]

2. I agree. This sounds horrendous...

I'll have to add any more thoughtful comment after hearing the story or seeing some summary, but at first glance I find this absurd and alarming.

[MadrasT]

3. Hi hlthe2b

I added a bit more to my OP.

This is a complex question and I don't know much about what they are proposing, specifically.

I am just not sure that the benefit of adding severe PMDD to the DSM-V (so it is recognized as real and woman can get treatment for it) is better than the stigma of having "PMS" = "Mental illness".

(I would love it more if mental illness was destigmatized, but that isn't the world we live in today.)

But when I heard it on the radio I was thinking, "Whooooaaaaa Nellie, they want to officially diagnostically label women with PMS "crazy" now?"

I understand that severe PMDD is not the same as more generic PMS, but still.

Women are not "crazy" and I don't like anything that might add fuel to that particular fire.

[redqueen]

4. Can't add anything to that... agree completely. nt

[boston bean]

6. It's still pre-menstrual.

Doesn't that give anyone a clue.

Seriously, you would think some harvard, yale, ivy league school dumb dumb could put together that it's a hormonal imbalance.

Meaning it is "physical" not mental.

[redqueen]

10. Well other physical issues are classified as mental disorders,

I thought the reason was because they affected the brain. Not sure though.

[boston bean]

12. Well maybe it is above my pay grade,

but I do think they should focus on the physical causation, which imho, would be hormonal.

But what the hell would I know, I'm just a woman who has experienced hormonal changes......

Doesn't seem enough research is done in that avenue, and to call it a mental illness, changes the type of treatment one might receive.

[redqueen]

13. Yeah, it's above my pay grade too, for sure.

I just remember learning about how certain mental disorders are caused by problems with neurotransmitter production, processing, etc. in the brain.

I'm not even sure if hormones are considered neurotransmitters, so it still might be something else altogether. I know they sure affect the frick out of brain function. Not only from monthly mood swings but also the pregnancy rollercoaster. And next up, menopause!

[Thrushcross]

45. Physical Causation of Pre-Menstrual Dysphoric Disorders

Rest assured that Pre-Menstrual Dysphoric Disorders as well as all other forms of hormonal and neuro-regulatory disorders are investigated into their physical causation in hopes of creating better treatments. In the case of PMDD many views are considered in its biological cause, from my perspective as a pre-med student with Bachelor's of Science degrees in Neuroscience and and a minor in Medical Sciences (currently working on a Master's of Science degree in Medical Sciences) the most convincing explanation is that concerning the regulation of ovulation through estradiol and androstenadiols.

The idea is that several neurohormones, called androstanediols, are created from the side-cleavage of cholesterol into androstenidione, which then goes through either of two pathways to create estradiol but we are going to focus on androstenione, androstenione modulates gonadotropin secretion (these are a type of protein known as glycoproteins secreted by the human anterior pituitary gland in the brain) these gonadotropins create luteinizing hormone which regulates ovulation in females (stimulates spermatogenesis and testosterone release in males). The underactivity of luteinizing hormone production in individuals with PMDD may be linked to the discomfort, inflammation, and pain they feel. Where as the neuromodulation of the gonadotropins may also contribute to serotonin based depression and anxiety.

I hope this was helpful or at the least informative, I did my best to summarize, but it is a complicated process.

[HereSince1628]

14. I don't see why an illness couldn't involve both...

Although it's certainly true that the psychiatric profession has had very little sense of the organic associations of Axis I and Axis II disorders until relatively very recently.

IMO the persistence of the false dichotomy that mental illness is NOT medical illness contributes to the lack of acceptance and empathy toward mental illness.

Most people in this forum are aware of depression. Many people in this thread are aware of anti-depressants called SSRI's and SSNRI's which are used to treat depression.

SSRI's treat depression by chemically manipulating the brain's receptivity to hormones. Serotonin, the second "S" in SSRI, is a hormone. The "N" in SSNRI stands for norepinephrine, norepinephrin is also a hormone.

Even though we know that depression responds to this physical, chemical, manipulation, I do believe that almost everyone would accept that depression is a mental illness.

As cellular biology and neuroscience develop and increasingly offer overlapping understanding, the distinction of 'medical' and 'mental' have broken down.

[boston bean]

15. I'm not a medical doctor, but I think

my pre menstrual hormonal imbalances originate in my ovaries, I think.

So, I don't think using a drug that works on the brain is as helpful as a drug that would focus on the true biologic reason.

Just my humble opinion, ready to change, if offered evidence that points to a brain function of this particular hormonal imbalance.

[HereSince1628]

29. I think you accept that estrogen is produced of the ovaries

(its also produced in some other tissues but, in women, it's mostly in the ovary)

Your ovaries are indeed influencing your brain. Here is a short list of parts of the brain influenced by various forms of estrogen:
Basal forebrain cholinergic system.
Midbrain serotonergic system.
Brainstem catecholaminergic systems.
Hippocampus.
Spinal cord.
Glial Cells.
Cerebral vasculature.



Here is a short list of BRAIN functions and dysfunctions known to be influenced by estrogens:

Affect (emotions and mood--including depression as discussed elsewhere),
verbal memory and dementia,
motor coordination and movement disorders; fine motor skills,
perception of space and the ability to solve hand-eye coordination and spatial problems,
excitability and epilepsy,
stroke,
receptivity to pain.

[boston bean]

31. my point is if it is the hormones

affecting the brain, why not focus on the hormonal aspect.

Seems to me that this is not sufficiently covered in medical science.

[HereSince1628]

34. maybe for various reasons

I think in an ideal world the specific presentation would guide treatment choice.

I cant speak to PMS. But there are many mental illnesses wherein the illness includes maladaptive learned behaviors. Such behavior might and I emphasize might...continue even after the chemical cause that resulted In the need for the bebavior is gone.

It's a common thing for our acquired habits to become self sustaining. If such a habit was dysfunctional a person might need and want assistance, in extinguishing the habit.

Sorry for the typos I had to move to a Kindle....

[Thrushcross]

44. Psychiatric Medicine and Neuro-Endocrine Modulation

It seems you may have succumbed to a common misconception of psychiatric medicine. The labeling of disorders as psychiatric in nature does not mean that they are considered to be solely "mental" illnesses, there are many illnesses and disorders that cause emotional or behavioral changes and as such find classification in many different fields of medicine, for example Lupus Erythematosus is categorized in the DSM for its tendency to cause symptoms of anxiety, psychological distress, and in extreme cases confusion, memory loss, and psychosis, however you will also find it classified in several areas of medicine as an autoimmune disorder or set of autoimmune disorders. A common misconception is that classification as a disorder into one form of medicine means that it is exclusive to that field, which is not the case as the study of medicine is one of overlapping magisteria.

In the case of PMS or more specifically the category of Pre-Menstrual Dysphoric Disorders under the category of hormonal disorders, it is important to realize that medicine does focus on physical causes of all disorders be them "mental" or not, inclusion of these disorders will not change the method of treatment, it will simply allow for a standardized set of criteria to be created for the diagnosis of these disorders. Treatment will still be handled from the bio-psycho-social approach, psychological symptoms such as major depressive episodes or generalized anxiety will still be treated with anxiolytics and antidepressants respectively, pain will be treated with analgesics, and gonadotropin releasing hormone agonists will assist in reproductive health.

Furthermore, it's important to realize that this addition was called for and supported by the American College of Obstetrics and Gynecology and is being added to emphasize the need for a multifaceted approach in the treatment of this category of disorders as well as the other slew of disorders that individuals experience as a result of improper androgenic hormone regulation.

A good page to read for the details of this addition is http://www.medscape.org/viewarticle/563338 and provides a comprehensive overview of the professional need for DSM classification as well as a proper example of the treatment of disorders from the biopsychosocial approach. It may be of interest to you or other readers/posters that many other androgenic hormone disorders are being/have been considered for inclusion in revisions to the DSM for both males and females and these decisions often go without fanfare or public recognition as they're simply a means of professional organization and standardization of clinical diagnosis and procedure.

Thank you for reading, I hope my post was helpful.

[redqueen]

16. Thanks!

It's been a while since I learned that stuff, I thought some of those neurortransmitters were hormones, but couldn't quite recall.

The first "S" is for selective, right?

[CrispyQ]

20. This:

IMO the persistence of the false dichotomy that mental illness is NOT medical illness contributes to the lack of acceptance and empathy toward mental illness.

I've never understood how we can treat mental illness like it's not part of the body. That makes absolutely no sense to me. Thank you for the excellent post! That was quite fascinating & brings back other fascinations about the brain.

One of the best books I read was "The Three Pound Universe." It was an amazing read, many, many years ago. I don't know if it's still in print. And here is a magical book about the brain, that wows kids & adults alike:

http://www.amazon.com/Amazing-Brain-Robert-Ornstein/dp/0395585724/ref=sr_1_1?s=books&ie=UTF8&qid=1338733932&sr=1-1

The illustrations are fantastic! They show the brain in sections, as it evolved, in the same environment as the time of it's evolutionary history. I can't explain it very well, but it's an outstanding book.

[MadrasT]

22. Right, exactly. Which is all part of my ambivalence about this.

Mental illnesses are very real medical conditions and should be treated with as much empathy and compassion as physical illnesses.

(And not like people who have them are weird and crazy and defective.)

So it should be fine for PMDD to be added to the DSM.

But I know in real life, much of society has a whole different view about things that are classified as mental illness.

It is infuriating to me, but it is real.

I want women who suffer from PMDD to be able to get treatment. But I don't want them to have to run the risk of being labelled by society as "crazy".

*sigh*

[mzteris]

26. A great many "mental health issues"

are caused by chemical health imbalances in the brain.

[boston bean]

30. understood.

My point is that there are hormonal imbalances associated with the ovaries.

I wish there was more of a focus on that, versus the brain, and masking symptoms.

That is all. It has nothing to do with not understanding that many mental illnesses are caused by chemical imbalances in the brain.

[BlueIris]

5. Jesus Christ. Mental illness?

I just read some interesting tips on combatting PMS issues in a book about nutrition (yes, by a real doctor.) He seemed to think it's the result of deficiencies in B vitamins (B1, B6 and B3, specifically) and magnesium.

I think the DSM-V is shaping up to be the biggest disaster since, well, the DSM-IV.

[MadrasT]

8. I agree.

Most of the the DSM-IV to DSM-V changes I have heard are not a net positive in my opinion.

(I am a psychiatry geek and I have read DSM-IV cover to cover for fun.)

A lot of psychological conditions can be combated naturally. I was on antidepressants for about a decade then I stopped because I didn't like the side effects.

About a decade later I got depressed again. I am now supplementing with Omega3, Vitamin D, B12, and Magnesium and I have never felt better.

That being said, I *also* know people for whom psychiatric medications are a godsend. I think they are way overused though.

[HereSince1628]

7. There are all kinds of issues surround the DSM revision

(My interest in this thread is mental health and the DSM, I don't have any experience or particularly special knowledge about PMS)

Mental illness is shrouded in stigma and denial. One of the debates among members of the APA has been about pathologizing and codifying as disease common excursions from normal thinking, emotion, and behavior. The debate is complicated and it isn't just about the nature of mental pathology. It's about social acceptance, it's about insurance and funding of medical care, it's about how mental health care can be delivered.

Pathologists define illness and disease as negative departures from normal function. If we consider something like the human respiratory system, we have no problem in recognizing a viral 'cold', with runny nose, watery eyes, and sneezing as a departure from normal function, we also have no problem recognizing pulmonary infections with high fever, lung congestion, difficulty breathing and loss of ability to gas exchange as illness. Viral colds we see as no big deal, pneumonia we do see as a big deal. They are opposite ends of a spectrum of severity of illness. Viral colds usually are sub-clinical (we don't usually go to a clinic because of them), while pneumonia is not only clinical, it could become severe and potentially life threatening.

The point is that although researches give illnesses names and place them into categories of pathology, illnesss isn't merely categorical it also occurs along a spectrum of severity.

Mental illness results in excursions from normal function in some combination of thought, emotion, or behavior. Grief is an excursion from normal function. Is grief a mental illness? Some argue yes, some argue no. For most people grief from a loss is like a cold, it's experienced and it goes away, usually without seeing a counselor (professional or not). But for some people grief cripples their thinking and behavior, making it impossible to do activities that define normal daily living. Should society's and the mental health professions respond to grief at only one end of this spectrum? Should no grieving person get mental health care, because we don't want to pathologize "normal grief" and have someone assume the costs of treatment and the tax on mental health facilities that level of attention would create? Should we not treat some people because most people want to avoid the label of being dx'd with a mental illness?

Premenstrual syndrome (PMS) (also called PMT or premenstrual tension) is a collection of physical and emotional symptoms related to a woman's menstrual cycle. Two to ten percent of women have significant premenstrual symptoms that are separate from the normal discomfort associated with menstruation in healthy women.

I think the inclusion of PMS in the DSM generates similar concerns. Some people recognize the rise in irritability as a departure from normal others do not. Pathologizing PMS as a mental illness in the DSM is feared by some because mental health dx's are followed by various forms of shunning and discrimination. What's the cost benefit? A small percent of women might have their lives burdened by extreme versions of PMS, should an entire gender be stigmatized because they routinely become sub-clinically irritable? Questions like that are important, and beyond my ability to answer.


Meaningful insurance coverage for mental health is hard to come by. American health insurers won't pay for treatment for diagnoses that don't fall under the rubrics presented in the DSM. If PMS isn't in the DSM, the vast majority of American woman would get no insurance coverage for it, including the 2-10 percent who have symptoms that go beyond 'normal' discomfort. Because the DSM isn't just a diagnostic manual, it has become THE manual of billing codes for mental health care.

The folks who want to get treatment to all who need it, are motivated to push for expansion of recognized conditions (the DSM usually includes a category called NOS, not otherwise specified to provide a path for billing); the folks who want to reduce payments for mental health care (which would be the insurance industry and all it's lobbyists) are motivated to push for fewer recognized conditions.

The question becomes what puts a person in which camp about the DSM and PMS? Is it fear of stigma? Fear that women will be sterotyped as mentally ill and then discriminated against? And if it is that fear, are those who push that position REALLY comfortable with upto 10% of women being denied insurance coverage and care if and when they are unfortunate enought to have symptoms that go 'beyond normal discomfort?"

These are questions that get played out on MANY illnesses in the DSM. They are very important. And I hope that my attempt to point them out isn't seen as being disruptive, hurtful, rude, insensitive, over-the-top, or otherwise inappropriate. It's just the view of a person who struggles with the social and economic issues of having a severe mental illness. A person who is watching, with some anxiety. the APA's various debates on the content of the DSM-V.

[MadrasT]

9. Not disruptive at all.

This is exactly the kind of thing that I am interested in talking about.

I do understand the importance of including conditions in the DSM as a gateway to treatment delivery and how that relates to insurance approval and things like that.

It is a multifaceted situation for sure.

Thanks.

[redqueen]

11. I really appreciate that you shared this.

The insurance aspect of this is important, and bears examination, seeing as we live in such a backwards country healthcare-wise.

Thanks very much for your thoughtful and thorough response.

[Hatchling]

19. I was in the 2-10% group.

I would hesitate to have my behavior labeled a mental illness as it was at the time. I was sent to a shrink and labeled borderline because my erratic behavior was problematical to me and my family. FInally I found a therapist who figured out the root cause of my problems, sent me to a PMS specialist who worked with me on medications that might help. She also helped me with coping strategies around my mood swings.

But being labeled crazy by my family certainly didn't help my self esteem very much.

The ultimate cure for me was when I needed a total hysterectomy. Within months the "wildness" I experienced each cycle was gone along with the pain and other discomforts.

[seabeyond]

21. this is why i tend to keep my mouth shut. we all experience differently. most i know, meh...

the first day, or right before the start, pain. and maybe one is a little more blunt. get the fuck out of my face. as opposed to, please leave me alone. lol.

i am still waiting for the emotional trauma and drama, tears ect, of premenopausal and menopausal. i had been so conditioned that when women went thru this the whole world changes. to the extent years ago i told hubby he would just have to be patient at that time. nothing.

[MadrasT]

24. I am so sorry you went through that.

I did have extremely bad physical symptoms from menstruation but no emotional problems. I had a uterine ablation and it fixed all my physical distress. It made a world of difference to me to get a whole week a month of my life back without all that horrible pain.

[Little Star]

37. Did people stop calling you crazy after a total hysterectomy and

the "wildness was gone"?

What you described sounds physical not mental to me.

[Hatchling]

41. By that time the people who called me crazy had abandoned me.

The new people in my life do not call me crazy.

And it was completely physical, i.e hormonal. After the surgery, I felt a physical relief that cast no doubt in my mind that the hormones were at fault. An added plus was instant menopause so I had very minimal menopausal symptoms.

Someone who is bi-polar (another "mental illness" that is physical) is treated with more compassion than a woman who has estrogen poisoning.

More proof that the P wants to keep women down by promoting that we are crazy half the month. I feel positive that if there were some concentrated research into the problem this issue could be resolved.

[seabeyond]

42. sigh...

"people who called me crazy had abandoned me."

good riddance. i am sorry. and i am glad that things are in order now.

[Little Star]

43. I agree.

[CrispyQ]

23. Everything in your second to last paragraph concerns me.

The question becomes what puts a person in which camp about the DSM and PMS? Is it fear of stigma? Fear that women will be sterotyped as mentally ill and then discriminated against? And if it is that fear, are those who push that position REALLY comfortable with upto 10% of women being denied insurance coverage and care if and when they are unfortunate enought to have symptoms that go 'beyond normal discomfort?"

Fighting the stigma of mental illness is difficult enough without these uncivilized insurance issues to deal with too. This line sums up all the problems with the American health care system:

[center]includes a category called NOS, not otherwise specified to provide a path for billing[/center]

Thank you for the thoughtful post.

[ismnotwasm]

48. That's a pretty cool post

I'm a women who never suffered from PMS, not really, never paid attention to my cycle. I would tell women that I don't use negative self talk about my own period or menses in general. I often wondered how much of self-disgust affected PMS, (which WOULD quite possibly put it into a mood disorder category) yet I still know women who suffer horribly, and they are otherwise confident women.

So physical or mental or a bit of both? It seems the physical affects the mental and then the question goes further than physiology. Severe PMS is no joke, and I would never tell a women to 'think her way out of it' (although I used to infer that when I was younger--a stupid thing to imply)

[BlueToTheBone]

17. Don't forget the root word of hysterectomy

is hysterical.

[redqueen]

18. It's actually "hystera" - womb.

Hysterical is an offshoot, resulting from the times when men blamed women's wombs for a long list of issues that many people of both sexes might suffer from. (Not sure why men who displayed such 'symptoms' weren't similarly pathologized - lol just kidding, it's totally because of the P.)

[mzteris]

25. PMDD isn't PMS

so I wouldn't be so quick to dismiss it being treated differently.

It should set women apart no more than any other mental health disorder despite the fact that only women can get it. Only women have postpartum depression, too and I don't see anyone complaining about that.

If you don't know the difference between those two things one's like a hangnail and the other is like having your arm chopped off.

[MadrasT]

28. Fair point.

PMS is not equal to PMDD. Thank you for clarifying!

(Although I have also seen similar criticism of the changes proposed for postpartum depression. Basically, that postpartum depression is not significantly different from other types of depression in symptoms or in treatment path, so there is no need to attach the label "postpartum" to it and make it a "woman's problem". Those critics think that just calling it "depression" would be fine.)

[mzteris]

32. There's postpartum depression and then

there's POSTPARTUM DEPRESSION. You know the type that causes women to kill their children. NOT the same thing as the "blues" following childbirth.

Again, - these are hormonally and chemically induced changes. Akin to "depression" - but not the same.

For those who suffer from life-long depression or depressive episodes, an "incident" of post-partum depression is a quite different event.

[redqueen]

33. How is postpartum depression significantly different from the type not precipitated by giving birth?

Postpartum psychosis is different from depression, but again, I'd need to see some evidence that it's somehow significantly different than any other type of psychosis, in any other way than the cause / precipitating event.

[seabeyond]

27. but, then, lets look at Postpartum depression

The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect — depression.

Many new moms experience the baby blues after childbirth, which commonly include mood swings and crying spells and fade quickly. But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Rarely, an extreme form of postpartum depression known as postpartum psychosis develops after childbirth.

Postpartum depression isn't a character flaw or a weakness. Sometimes postpartum depression is simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms — and enjoy your baby.

it is very real. i had a tad of it with my first son. there were moments, between lack of sleep, stress, ect.... where i experienced some very real and odd images. never to the point where i felt child was in danger, but moments for me to take a second in pause.

[redqueen]

35. Interesting.

http://articles.chicagotribune.com/1993-05-16/features/9305160065_1_premenstrual-dysphoric-disorder-pms-paula-caplan

It's estimated that 20 to 40 percent of women have some premenstrual symptoms. Only 3 to 5 percent are thought to suffer from symptoms severe enough that they would meet the criteria for PMDD, which includes feelings of helplessness, persistent or marked anger or irritability and other symptoms that interfere with regular activities.

But opponents say there could be social and political fallout for women who carry the diagnosis.

Paula Caplan, a clinical and research psychologist at the University of Toronto, is worried that during child-custody or mental-competency hearings women could be asked, "Have you ever been diagnosed as having premenstrual dysphoric disorder?"

And why, she asks, is there no parallel category for men? For instance, delusional dominating personality disorder, or testosterone-based aggressive disorder?

Most important, Caplan says, the research simply does not justify creating this category. The association may be obliged to agree. After reviewing more than 400 studies on the condition, currently called late luteal phase dysphoric disorder, a six-member work group reached an impasse.

I wonder what has changed since then.

I hope it's not another symptom of the backlash against women we've seen rise so drastically since the 80's.

[MerryBlooms]

36. I want my menoapause symptoms declared everything and anything under the sun

lol
Seriously, this shit's unbelievable. If I can qualify under ANY and ALL diagnosis, sign me up! I want the whole physician enchilada- drugs AND counseling! 3 years and counting... the hot flashes are kicking my ass.

[Little Star]

38. lol! Join the club.

[MerryBlooms]

39. Ugh, it's miserable and the more I try to control it, the worse it becomes.

I don't go anywhere these days without a couple of paper towels in my handbag and an ice water.

[Little Star]

40. I swear to you....

I've been going through that for about 15 years. Not joking. It sucks!

When I was working there were years I just carried a coat in my car just in case I ever broke down. But for many winters here in MA I never even so much as put on a coat.

My husband told me to just go walk up and down the driveway a few times to melt the snow and ice because it would save him a lot of work snow blowing and shoveling. lol True story.

[LiberalLoner]

47. I take black cohosh and soy every day

Took about a month to start working but it helped so much. I forgot to take it for a few days and the hot/cold/hot/cold as I call it came back. Then I knew for sure I should keep taking it.

I don't know if you've tried those yet?

[LiberalLoner]

46. There are so many examples of misogyny in medicine.

One example that comes to mind is having been told by a doctor when I was 12 that my terrible cramps were all in my head. Doctors believed that up until it was shown ibuprofen gave relief.

When I had everything removed, doctors saw both my uterii had adenomyosis, which causes intense pain and very heavy flow with each period. It wasn't all in my head - there was clear evidence for my symptoms.

I think I could give hundreds of examples like that. I'm so tired of this stuff sometimes. It gets old. It's not something you ever forget, having a doctor fail you and look down on you like that.