Should women with PMS get free therapy on the NHS?

More than a million women who struggle with severe PMS should be offered free therapy, according to the Royal College of Obstetricians and Gynaecologists. It argues that Cognitive Behavioural Therapy (CBT) is more effective than antidepressants. Is this a breakthrough, or yet another way of pathologising femininity?

Four in 10 women report anxiety, depression, irritability, mood swings and a dip in confidence in the days leading up to their period. Women, and their partners, often describe a Jekyll-and-Hyde type “me” and “not me” difference. This discourse stems, partly, from the media – women are often portrayed as being “out of control”, and at the mercy of their raging hormones.

CBT for PMS seems to work – when it works – by giving women back a sense of hope. For example, where a woman might interpret changing physiological cues as unmanageable, leading to a sense of loss of control, a CBT therapist might encourage them to keep a diary to map their experiences at different phases of the menstrual cycle, in order to train the body to self-soothe. Or perhaps even to question perfectionist standards that make feeling bad seem disastrous.

Though CBT may help individual women feel empowered, the advice is pretty basic. And, at a societal level, the medicalisation of PMS has huge costs. The NHS is broke. It’s difficult to get therapy for even the most serious problems. By framing PMS as a disorder that 40% of women suffer from, we create a new population that views its experiences as abnormal, and without the means to be helped. By framing it as a disorder, we also turn our gaze away from its causes: the sexism of the Jekyll and Hyde depictions that provide the lens through which we interpret body and mood changes. The issues that the emotional premenstrual surge often attempt to communicate are often far from irrational. The sudden fury, say, at always doing the washing-up, the feelings of not being appreciated, being ugly; such issues are deeply embedded within gender dynamics. Framing PMS as a disorder requiring medical intervention is thus an obscurating political act.

Rather than promising to offer CBT to more than a million women, a call unlikely to be heeded in cash-strapped times, we must attempt instead to educate girls in the trials, tribulations, beauty and power of the female reproductive system. We must listen to our bodies, and to one another again – not to the discourse of disorder.

Jay Watts is a clinical psychologist, psychotherapist and senior lecturer working in London

Should women with PMS get free therapy on the NHS?