“We didn’t have a choice about PMDD”: Author Shalene Gupta on Misdiagnosis, Rage, and Reclaiming Power

When I read The Cycle, I felt seen. Shalene Gupta’s personal account of living with premenstrual dysphoric disorder (PMDD) articulates an experience many of us know intimately: extreme emotional volatility that’s hard to explain and often misunderstood.

I sat down with her to speak about what led her to write the book, the long road to diagnosis, and what still needs to change.

The Missing Diagnosis

“I was inspired to write my book about PMDD, a form of very severe PMS, where people have severe psychiatric symptoms right before their period or during their period, which means anger, rage, depression, then it influences your ability to function,” she tells me. 

“What was happening is for several years I was having really horrible fights with my partner and I had no idea why, ‘cause normally, I’m even-keeled, I’m conflict-averse, and then all of a sudden I would just blow up.”

She was diagnosed at 30. Her first reaction: “Why have I never heard about this? Why did it take so long?”

High Functioning, Low Reserves

Shalene has spent most of her career in high-pressure roles, working as a journalist and writer. I asked how she balanced that kind of intensity with a condition like PMDD.

“I don’t want people to think that people with PMDD are less capable,” she says. “At the same time, I don’t want to make light of how much it does impact people.”

She explains what many ambitious people with PMDD do: overcompensate. “So I have two weeks where I’m full of energy and I’m superhuman—I can work out twice a day. I can work 12 hour days, 14 hour days.”

Many professionals end up working double-time during the “good” half of their cycle when they feel superhuman, only to crash hard in the other half. 

“It’s almost like PMDD forces me to slow down. It’s what’s kept me from burning out.”

Menstrual vs. Mental Stigma

Even in 2025, talking about menstruation in professional spaces still feels risky. Shalene knows this all too well.

“I was at a writer’s conference in an elevator full of men and they noticed, oh, you’re a speaker here, you’re a writer. What did you write about? And I just said, well, PMDD… It’s a menstrual health disorder and I explain what it is, and right before your period…”

She pauses. “The entire elevator goes quiet. And I’m just like… Unfortunately, there’s no way to get out of this elevator. I’m stuck here until the doors open.”

“If it had just been a mental health disorder,” she adds, “I don’t think there would’ve been as much stigma.”

“You’re Making It Up”

So many of us have had that frustrating experience of explaining our symptoms to a healthcare provider, only to be met with blank stares or brushed off entirely.

Shalene still regularly encounters healthcare providers who’ve never heard of PMDD. She praises one standout GP who admitted his limits: “You probably know more about PMDD than I do—why don’t you tell me what’s worked?” 

But that kind of humility and openness is rare.

“A lot of people have had health providers tell them: that doesn’t exist. You’re making it up.”

One of the biggest diagnostic hurdles, Shalene mentions, is that doctors often don’t even think to ask: “Does this happen regularly?” or “Could this be tied to your cycle?”

The menstrual cycle is foundational to our biology. And yet it’s missing from studies, ignored in diagnoses, and often left out of treatment plans altogether. “It’s not just about PMDD,” she says. “It affects depression, anxiety, sleep, appetite, neurodivergence, you name it.”

When you eventually do get treatment, it may mean managing uncomfortable side effects like suppressed libido or weight gain. There’s no universal solution.

“You are the one living through the symptoms,” Shalene says. “Depending on your personal life circumstances and goals, that may affect what you’re willing to tolerate and what you’re not willing to tolerate.”

(Pseudo)Science

Recent research has identified three biological subtypes of PMDD, depending on which hormone the brain reacts to. But as Shalene points out, the research is young.

She compares the current state of PMDD research to breast cancer treatment in the early 1980s: “We knew it existed, but not the different types.” 

Understanding these subtypes could help tailor treatment, but it will take time for that knowledge to reach everyday clinical care.

With research still developing, PMDD has become a breeding ground for misinformation and “wellness fluff.” Shalene is especially aware of how hard it is for the average person to parse what’s real.

“I love that social media spreads awareness, but just check your sources,” she urges. “You don’t need to read academic journals. Just make sure it’s evidence-based.”

PMDD or Just Me?

For many, the line between emotional response and hormonal shift is blurry. That’s especially true during conflict.

“I was feeling really bad about that. I was like, how do I know anything is real?” she recalled. “They all kind of sat me down. They were like, you have never made anything up. When you’re upset, there is a valid reason. The question is, is your reaction proportional?”

She’s learned to flag emotional responses early—before they spiral. “It’s easy to just be like, hey, you know, that really bothered me. Can we do something about this?”

Medication was a turning point for Shalene, but coping also takes honest communication and support. She’s learned to tell her husband, “I’m PMDD’ing right now. I can’t have a constructive conversation.”

Over time, they’ve developed little strategies. For example, Shalene sends angry GIFs to soften the mood. Humor, she says, “takes the sting out.”

One of the most powerful parts of The Cycle is the idea that there might be a kind of strength in PMDD. “I used to carry so much guilt,” Shalene admits. “Now I try to remind myself—this is a chronic condition. I didn’t choose this.”

She doesn’t sugarcoat the reality: “It’s awful. The treatments are imperfect. I focus on these silver linings because we have no choice.” For her, PMDD has made her better at conflict resolution, a stronger advocate in her relationships and at work, and more empathetic to others.

One Day, Just Another Prescription

In her book, Shalene hoped PMDD might one day feel as manageable as her asthma: just something she treats, not something that defines her. A year later, she’s closer, but not there yet.

When she went to urgent care and asked for both an inhaler and fluoxetine (an SSRI-type antidepressant), she was shocked by the contrast: “They handed me inhalers, no questions asked. But with the SSRIs, it was like the Spanish Inquisition.” The stigma is still strong.

Helene echoes the struggle: being brushed off, offered homeopathy, or told that antidepressants were a “last resort.” Shalene responds with shared frustration: 

“You're gonna try every single thing you can think of. You're at the doctor's because nothing has worked.”

The double standard, she said, is still strong. “Until the medical establishment is comfortable, it is hard to, as an individual, be comfortable.”

Even though the medical system may not be there yet, our conversation closes with a sense of solidarity and resilience: those of us living with PMDD are finding ways to support each other, and ourselves.

Read The Cycle: Confronting the Pain of Periods and PMDD by Shalene Gupta now.