Coming off Endo Month and Adeno Month, here’s the next conversation we need to stop avoiding.
We’ve just spent the last couple of months talking about endometriosis and adenomyosis - the pelvic pain, the heavy bleeding, the fatigue, and the absolute circus of trying to get taken seriously.⁴⁶⁸¹² And now we need to talk about the other thing women get quietly dismissed for, especially when it shows up alongside pain: cyclical mood symptoms.
Because if your mental health tanks in the two weeks before your period, and you’re told it is “just stress” or “just anxiety”, you are not alone.⁹¹⁰ And you are not imagining it.
This is where PMDD often sits - in that messy intersection between hormones, brain chemistry, life stress, and healthcare systems that are not particularly good at recognising conditions with patterns.¹⁴ So today we’re focusing on something practical: what self-advocacy actually looks like when you’ve got PMDD symptoms, pelvic pain symptoms, or both - and you are tired of leaving appointments feeling like you apologised for existing.
Why this matters after Endo and Adeno Month
Endometriosis and adenomyosis are chronic, inflammatory, oestrogen-influenced conditions that can co-exist and often come with recurring pain, fatigue, heavy bleeding and a huge mental load.⁸ They are also famously under-recognised and frequently diagnosed late, which means many women end up in “expert mode” simply to access basic care.⁴⁶
PMDD has a different symptom profile, but the care experience can sound painfully familiar: long delays, symptoms being psychologised, being told it is “in your head”, being bounced between providers, and having to start over again and again.⁹¹⁰
That is the bridge here. We are not leaving the conversation at pelvic pain; we are widening it to include cyclical mental health too, because women do not experience symptoms in tidy little silos.⁸
PMDD in plain English - and why it is often missed
PMDD is a severe premenstrual disorder where symptoms are cycle-linked, often ramping up in the luteal phase - roughly the two weeks before bleeding - and easing shortly after menstruation begins.¹⁴
And that pattern matters.
PMDD diagnosis is built on prospective daily symptom tracking over at least two cycles, not a one-off conversation based on memory.¹⁴ Which means that if you walk in and say, “I feel awful sometimes”, you risk getting filed under general anxiety or depression. If instead you can say, “My symptoms spike every luteal phase, here is my tracker, and here is the impact”, you are showing clinicians the pattern they need to investigate properly.¹⁰¹⁴
What self-advocacy actually looks like
Self-advocacy is not aggression, and it is not about becoming a “difficult” patient. It is a set of behaviours that research repeatedly describes as speaking up about symptoms and needs, actively engaging with the healthcare team, preparing questions, using support people, and seeking second opinions when care is not working.⁶ For women who have already been dismissed, it is often the only way to get traction.¹²¹³
1) Start with data
Yes, it is annoying. Yes, it works.
Symptom tracking is one of the most useful tools you have across PMDD and pelvic pain conditions.
For PMDD, guidelines emphasise prospective daily ratings over at least two cycles.¹⁴ For endo and adeno, tracking pain, bleeding, fatigue, bowel or bladder symptoms, and functional impact helps build a clearer clinical picture and supports referral conversations.⁸¹² Tracking also supports health literacy and can improve confidence and communication. In pilot RCTs, a menstrual tracking app improved menstrual health literacy and was associated with reduced PMS or PMDD symptom burden and reduced absenteeism.¹¹
Keep it simple. Track:
timing - where you are in your cycle
symptoms - mood, pain, bleeding, sleep, gut, energy
severity - even a 1-10 scale is useful
impact - missed work, cancelled plans, relationship conflict, self-care ability
If you feel overwhelmed, start with one sentence a day. Consistency matters more than perfection.
2) Use cycle-aware language
Often, the difference between getting a shrug and getting a plan is how clearly the pattern comes across.
Instead of saying, “I feel anxious sometimes”, try: “My mood symptoms spike in the two weeks before my period and ease within a few days of bleeding.”¹⁴
Or: “My pelvic pain peaks around menstruation and flares cyclically.”⁸
That kind of wording helps cue hormonal and structural mechanisms rather than vague reassurance.⁸⁹
3) Go in with three questions
Appointment brain is real, so write these down in your Notes app before you go:
“What are we ruling out?”
“What is the plan and timeframe?”
“If this does not work, what is next?”
Shared decision-making is explicitly recommended in PMDD management, including aligning options with patient preferences and comorbidities.¹⁴
4) Bring a support person if you can
A witness can change the dynamic. They remember what was said, they help you stay grounded, and they reduce the chance that you walk out wondering whether you imagined the whole thing.
Research on women’s experiences of dismissal and medical gaslighting in chronic conditions highlights the emotional harm of invalidation and the value of supportive, validating clinical interactions.¹²¹³
5) Know when to seek a second opinion
A second opinion is not disloyalty. It is healthcare.
If you have been dismissed repeatedly, given no follow-up plan, or left in a cycle of “try this and disappear”, you are allowed to change providers. PMDD patient experience research describes people repeatedly restarting with new clinicians and how continuity and documentation improve outcomes.⁹ Endometriosis research similarly describes the need to “fight” for referrals and comprehensive care.⁴
A second opinion is not drama. It is self-preservation.
The truth about being labelled “anxious”
Anxiety can be real, and it can also be used too lazily.
What we are trying to avoid is the pattern where cyclical symptoms get flattened into a personality flaw, pain gets minimised, mood changes get psychologised, and women get treated like unreliable narrators of their own bodies.⁹¹²¹³
Self-advocacy matters because it helps you resist internalising that dismissal.
And here is the conversation we want to open up: what is one sentence you wish you had said in a past appointment?
FAQs
How do I know if it’s PMDD or “regular PMS”?
PMDD is typically more severe than PMS and significantly affects daily functioning, relationships, or work. Diagnosis depends on prospective daily symptom tracking over at least two cycles to confirm timing and severity.¹⁴
Why is symptom tracking such a big deal for PMDD?
Because daily tracking helps distinguish PMDD from other mood disorders and reduces reliance on memory, which can be unreliable when symptoms are distressing or cyclical.¹⁰¹⁴
Can PMDD overlap with endometriosis or adenomyosis?
Yes. Endometriosis and adenomyosis often co-exist, and PMDD can overlap with them too, meaning pain, fatigue, heavy bleeding, and mood symptoms may stack together.⁸
What symptoms suggest endo or adeno rather than PMDD?
Pelvic pain, heavy bleeding, painful sex, bowel or bladder symptoms, and cyclical pain flares are more suggestive of structural pelvic conditions such as endometriosis or adenomyosis.⁸
What should I say to my GP to be taken seriously?
Be specific about timing and impact. For example:
“My symptoms spike in the two weeks before my period and ease after bleeding begins, and they are affecting my ability to function at work and at home.”¹⁴¹⁰
What if I feel dismissed or gaslit?
That experience is unfortunately common and can be deeply harmful. Bring written symptom timelines, trackers, and consider taking a support person with you. If there is no meaningful follow-up plan, seeking a second opinion is appropriate.⁹¹²¹³
Do tracking apps actually help?
Pilot RCT evidence suggests tracking apps can improve menstrual health literacy, increase confidence in recognising patterns, and may reduce PMS or PMDD burden.¹¹ App quality varies, but consistent tracking itself is the key benefit.¹⁷
What does evidence-based PMDD treatment include?
Guidelines support a range of options including SSRIs, hormonal therapies, psychological interventions, lifestyle measures, and education, ideally guided through shared decision-making between patient and clinician.¹⁴
Where can I get support for endo or adeno in Australia?
Organisations such as QENDO provide education, advocacy resources, symptom tools, and community support for Australians navigating endometriosis and adenomyosis.⁵
When should I seek urgent help?
If your symptoms include thoughts of self-harm, suicidal feelings, or you feel unsafe, seek urgent medical or crisis support immediately.
References
Illinois State University. (n.d.). Exploring attitudes and communication about menstrual health [Master’s thesis]. Illinois State University. https://ir.library.illinoisstate.edu/cgi/viewcontent.cgi?article=3151&context=etd
Chen, T., Kao, C.-J., Miaw, Y.-S., et al. (2024). Gut microbiota dynamics and menstrual cycle regulation. Frontiers in Endocrinology, 15, 12036781. https://pmc.ncbi.nlm.nih.gov/articles/PMC12036781/
Peckham, H., Osborne, R., & et al. (2022). Sex differences in immune responses. Frontiers in Immunology, 13, 8859064. https://pmc.ncbi.nlm.nih.gov/articles/PMC8859064/
Alcaraz, M. J., et al. (2025). Inflammation and hormonal variability. Frontiers in Physiology, 16, 12678643. https://pmc.ncbi.nlm.nih.gov/articles/PMC12678643/
QENDO. (n.d.). About QENDO. Retrieved April 2026, from https://www.qendo.org.au/aboutqendo
Hughes, J. M., et al. (2024). Menstrual health education in schools: A mixed-methods study. BMJ Open, 14(1), e075316. https://bmjopen.bmj.com/content/14/1/e075316
Lim, S., & Bae, H. (2023). Digital media and menstrual stigma: An analysis of online discourse. International Journal of Communication, 17, 4709. https://ijoc.org/index.php/ijoc/article/download/22355/4709
Zhou, L., et al. (2025). Artificial intelligence and menstrual health tracking: A systematic review. Frontiers in Digital Health, 7, 12110143. https://pmc.ncbi.nlm.nih.gov/articles/PMC12110143/
Lee, S. H., et al. (2023). Sleep and hormonal fluctuations across the menstrual cycle. Frontiers in Neuroscience, 17, 10193729. https://pmc.ncbi.nlm.nih.gov/articles/PMC10193729/
Motta, M. B., et al. (2022). The role of exercise in menstrual health and inflammation. Nutrients, 14(2), 8785767. https://pmc.ncbi.nlm.nih.gov/articles/PMC8785767/
Zanini, A., et al. (2024). Mobile health apps for menstrual tracking: User experience and adherence. JMIR mHealth and uHealth, 12(1), e54124. https://mhealth.jmir.org/2024/1/e54124/
Australian Women’s Health Research Alliance. (2024). Women’s Health Research Report 2022. https://australianwomenshealth.org/wp-content/uploads/2024/03/whr.2022.0052.pdf
Zhao, Y., et al. (2024). Lifestyle factors and menstrual health outcomes in young women. JAMA Network Open, 7(3), e2833711. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833711
American College of Obstetricians and Gynecologists (ACOG). (2023). Management of premenstrual disorders: Clinical practice guideline. https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/12/management-of-premenstrual-disorders
Zumstein-Shaha, M., et al. (2025). Psychosocial determinants of menstrual wellbeing. Frontiers in Psychology, 16, 11924280. https://pmc.ncbi.nlm.nih.gov/articles/PMC11924280/
Patel, R., et al. (2024). Hormonal tracking and digital literacy among women. Frontiers in Public Health, 12, 11195808. https://pmc.ncbi.nlm.nih.gov/articles/PMC11195808/
Rodriguez-Santos, L., et al. (2025). Cross-cultural perceptions of menstrual wellbeing. Frontiers in Women’s Health, 7, 12117836. https://pmc.ncbi.nlm.nih.gov/articles/PMC12117836/
