Emerson Wickham
Who Is Healthcare Policy Actually Designed For?
A Politics Graduate's Perspective on PMDD
During my four years at University of Glasgow, it was not until my final one that I uncovered an explanation for the decade of negative mental symptoms I had been experiencing. After cyclically struggling to meet deadlines and attend classes throughout my bachelor’s degree, I discovered the phenomenon of PMDD.
While I felt instant relief at having a name that explained my mysterious mental health ailments, the question that followed this discovery was slower to arrive, but harder to shake: why had this diagnosis taken so long to receive?
This central query anchors this piece. Not the experience of PMDD itself, but the political and institutional decisions that ultimately determine how long people wait for answers, and why some conditions receive those answers faster than others.
What exactly is PMDD?
Premenstrual Dysphoric Disorder is a cyclical condition affecting almost 5-8% of people who menstruate. These numbers, however, are thought to be woefully under representative due to epistemic lack of diagnoses. In the luteal phase of the menstrual cycle, two weeks before a normal period, the condition causes severe mood changes. An onslaught of symptoms appear that are consistent with anxiety, depression, rage, as well as more physical changes, that are significant enough to negatively affect relationships, work, and daily functioning.
Importantly: this is not severe PMS. It is a recognised psychiatric condition included in the DSM-5 and ICD-11, the major diagnostic classification systems used internationally. Despite this fact, most people, including many GPs, have never heard of it.
The Female Policy Gap
When contextualising PMDD within the UK policy landscape, its history has been short-lived; the National Institute for Health and Care Excellence (NICE), which sets English clinical standards, published its first dedicated PMDD guidance in 2024. Two years ago, this guidance arrived, despite the condition existing in diagnostic manuals for decades.
Far from accidental, this gap in female healthcare reflects a consistent pattern in how conditions affecting menstruating individuals are treated within healthcare systems. In fact, 1 in 4 individuals with PMDD are misdiagnosed with bipolar disorder, thus delaying effective treatment and psychiatric care. Across the board, these issues are under-researched, under-funded, and under-recognised, until patient advocacy forces institutional attention.
The Scottish government published its Women’s Health Plan in 2021, alongside England’s corresponding health plan: both were the first of their kind. These national frameworks committed to improving outcomes for women across menstrual health, menopause, fertility, and reproductive care. Main commitments of these plans were to improve menstrual health education in medical schools and reduce gynecology waiting times, both aims represent steps toward genuine progress.
Furthermore, Scotland has published phase two of their plan, with a focus on educating Scottish healthcare providers on diagnosing and managing menstrual cycle mood disorders.
It is difficult not to notice, however, how the same PMDD goals published in phase one of Scotland’s plan, have transferred to the second, set to be rolled out between 2026 and 2029. Other menstrual conditions, including PMOS and Endometriosis, face similar delays in both funding and national education.
Implementing meaningful policy changes on the ground requires infinitely more funding from the Scottish government; commitments are not nearly the same as action. Guidance directed towards GPs in oft-discarded textbooks is not the same as a professional who recognises the issues you are describing to them.
At the End of the Day, It’s All Politics
We must ask ourselves: who is making the decisions about which conditions receive extensive research funding, which symptoms are included in medical training, and which patients are treated as clinically significant?
Institutions are the answer. Spanning funding bodies, government departments, and clinical committees, these institutions reflect societal and physical priorities, championing certain general welfares over others. The blind spots are evident to anyone paying attention: particularly anyone affected with a condition they were never told existed on to begin with.
It is not a conspiracy theory to assert that conditions affecting exclusively, or primarily, women and people who menstruate have been categorised as less urgent, serious or more psychosomatic than equivalent conditions affecting men.
Endemic deficits in female-based health research have long been a hallmark of the NHS; it is a structural bias that has created measurable consequences for women and girls across the country.
According to the PMDD project, the average diagnostic delay for this disorder is twelve years. When I learned that figure, upon counting backwards I realised that it mapped almost exactly onto my own experience: a decade spent wondering why every half-month seemed to derail my ability to function, both socially and academically. Endometriosis has a similar rate of delay, at eight years. Still, PMDD remains completely absent from any mandatory GP training curricula.
As a student of Politics, I was taught that institutional inertia and negligence do not change on their own: change only occurs when people name problems publicly, when organisations build an information base that makes ignorance untenable, and when enough political pressure accumulates that makes doing nothing harder than acting.
These indisputable necessities are what spurred the creation of the Women’s Health Strategy, as well as the arrival of NICE’s PMDD guidance in 2024.
As Students, What Can We Do?
If any student or professional resonated with this experience, there are a few things worth knowing.
In the UK, the PMDD Project is a registered charity that is working to improve clinical recognition and policy support for this disorder; their website has accessible information and resources for navigating healthcare appointments.
The International Association of Premenstrual Disorders (IAPMD) is alternatively a global network of peer support and research advocacy and offers similar resources to help sufferers create symptom lists as evidence for GPs. For those suffering with other menstrual disorders, Endometriosis UK has far-reaching campaigns specifically on menstrual health policy and diagnosis delays.
Advocating for your own healthcare rights in a setting that is often uneducated and unresponsive is exhausting, and it should never be your responsibility alone. Although, one of the most effective ways to be taken seriously, by default, is to systematically track your symptoms across cycles using a diary or app, and to bring that documentation to appointments for consideration.
This is how I received my diagnosis, and I was lucky enough to be believed over the course of my ten-minute phone interview, a moment that felt equal parts vindicating and infuriating after years of uncertainty and denial.
After barely scraping by with both my educational deadlines and personal goals every half of the month, for longer than I care to remember, I want to minimise the confusion and despair associated with not having a name for your health struggle: policy change often begins with the affected naming the problem. This is me naming it, shaming it, and owning an often ignored ‘female’ diagnosis, that now I am not ashamed to advocate for.