In the rush-hour train one evening last summer, I looked around at all the women in the carriage. Middle-aged women hurtling towards the suburbs. Pregnant women holding their lower backs. Teenage girls slick with sebum. Elderly women standing stoically by the doors. I realised every one of them will have some story about how their reproductive systems have affected their lives. And I thought: how much have you kept secret?

Because one day in our early lives as women, everything changes. We start bleeding. And in an instant we’re no longer a child. I was on a crazy golf course overlooking Cromer pier when I experienced period pain for the first time. My lower body rippled with a new sensation. It was a pain that didn’t fit inside my body, burning through my thighs. I explained to Dad that I didn’t feel well. I was aware of the shift in his gaze towards me in a way that I absolutely did not have the language for. That British coastal perfume, thick with sun-roasted kelp and old deep-fat-fryer oil, took the nausea that came with these sharp churns to another level. I had to sit down on the grass. The pain spoke to me. It told me my human fabric had changed. As evidence of the encoding that happened, now when I hear seagulls, I still have flash visions of lying down holding my belly.

I’m in my mid-30s now and my periods have always been a physical and mental slog. It is thought that 90% of women experience some premenstrual changes, even if mildly. There are more than 150 clinically identified symptoms of PMS, including irritability, anxiety, depression and headaches. A laugh riot, in other words.

I have spent years trying to gain autonomy over the way my hormones seem to make my mind and body behave. Around five years ago, prompted by a breakdown-of-sorts, I sought help for the anxiety I had done my very best to conceal from everyone, including myself, for well over a decade. After talking to my GP, I tried all sorts of interventions in my quest for emotional stability. I was referred to (almost exclusively male) gynaecologists whose conversations and hormonal prescriptions made me feel either a) madder or b) ever so slightly less mad for a short amount of time. I tried acupuncture, vitamin supplements and diet changes. I realised this precise, reliable emotional state I sought was elusive at best.

Instead, I was surprised by a growing sense of peace. Addressing the patterns of my mood with a therapist, we looked closely at the shame I attached to being sensitive, sad or scared in the second half of my cycle and asked where it came from. After researching anxiety, I started training to become a psychologist and began researching hormones. I started to see things in a way I never thought I would. I had a new question, and that was: what am I seeking relief from?

I’ve come to believe that greater awareness of our hormonal processes can help us not only to manage our corresponding moods, but also to conceptualise what a mood actually is: a state of being that is, by its nature, temporary, and rarely directly attributable to one thing. It’s an interesting dichotomy, that we can be quite disconnected from what’s actually going on when our hormones are fluctuating – when oestrogen dramatically rises, for example, during ovulation – and yet be so ready to self-police when we feel anything other than sanguine and pain-free.

We blame so much on being “hormonal”: irrationality, “bad” decision-making, angry outbursts, low self-esteem. That wasn’t the real me, we might think, agonising over a knee-jerk decision we made at work, or taking offence at a throwaway comment in the pub. It was my hormones. The same phrase could cover everything from wanting to kill your partner at the dinner table to having frantic sex with them on it.

In some ways, “hormonal” is the modern-day “hysterical” – a word most women will have their own associations with. Mine are profuse. Years and years of secretly believing that I am just on the cusp of losing control: of my emotions, my appetite, my sexuality. Sometimes, I think I’m a hair-trigger away from exploding. Because I’ve quietly believed I’m… well, too much. Almost every woman I have known well has spoken of this belief; one they mostly keep tucked up, because admitting the fear means facing the idea that maybe we don’t have inherent autonomy; that our woman-ness will always “get” us in the end. What if there was a different way of looking at things? What if we could work towards dismantling the self-blame and, therefore, stop othering this fundamental part of who we are? Acknowledging that the stigma surrounding female reproductive processes is still alive and well is the first rung, I think, on the ladder towards self-acceptance. Most women know the crack of relief when someone dares to start talking about periods, the reality of birth, miscarriage or menopause, and other women say, oh thank God. This stigma is like an iceberg. The tip above the surface is women’s day-to-day suffering with whatever process they’re going through; a suffering they feel unable to fully express, perhaps through fear of embarrassment, of disgusting others or that they’ll be dismissed. Underneath the surface is the way women’s health and pain has been, still is, viewed and treated in society.

It is sweet fantasy to say that all the myths, misinformation and ickiness surrounding female reproductive processes have been – finally – banished into the fusty past. It’s silly, really, because the word “hormonal” applies as much to a testosterone-charged City banker as it does to a woman about to have her period. The metabolic processes of all organisms can only take place in very specific chemical environments and, in the human body, hormones are special chemical messengers that, as part of the endocrine system, help to control most major bodily functions. Male, female, or anywhere on the spectrum of gender, hormones keep us alive. Yet “hormonal” is still a tool for explaining away a woman’s experience of her changing biochemistry. And so we try and keep schtum, lest we be slapped with such a historically damaging label: hysterical.

When I effectively ran out of PMS treatment options, it made me realise how entrenched my analysis of my own thoughts and behaviour was in more general ideas of how I “should” or “shouldn’t” be as a woman. In therapy and in my psychological study, I realised how the workings of my inner world are often in collision with the outer world and all the expectations I perceive it to have of me. A better understanding of what goes on inside us, of the connection between our bodies and minds, is an important part of reclaiming meaning. We are not post-biology. We are protecting no one by pretending that we don’t bleed. We are not protecting ourselves by ignoring the external factors that may affect our bodily experiences, including the way modern medicine still doesn’t take the variance of women’s pain – or the voice describing that pain – seriously.

Women can wait between four and 10 years after first seeing a doctor with symptoms of endometriosis and a diagnosis. The average is seven-and-a-half years. In 2017, the National Institute for Health and Care Excellence released guidelines urging GPs not to overlook symptoms of the disorder, because for it to be repeatedly inferred that you are overreacting to your pain, your experience of that pain is going to become stained with confusion, fear and guilt. It is difficult to argue that medicine does not have an inherent bias against women. Women presenting at hospitals with pain are not only given fewer painkillers than men, but are often offered sedatives instead. Treatment for women with coronary heart disease is delayed compared to men. All these facts are corroborated by robust data. When a woman says how she feels, what she wants or what she needs, someone always knows better.

Knowing ourselves better gives us the power to ask for better. For example, I used to panic sometimes at the pain I can have with ovulation. I knew I always felt it, but didn’t know why. Learning that mittelschmerz (the German words for “middle” and “pain”) is thought to be caused by one of our eggs rupturing through a sac (follicle) on an ovary, releasing fluid and a small amount of blood that can travel through the ovary wall and irritate nerves in the lining of the abdominal cavity, was a strange comfort. So, too, was learning from a prominent gynaecologist that he has seen women presenting in A&E in tears with acute pelvic pain, whose only clinically significant finding turns out to be recent ovulation. This shit is real and it hurts. What’s sad is that my private experience alone didn’t feel like good enough evidence to finally ask for pain relief.

On some level, a focus on a woman’s changing biochemistry throughout her cycle – or any other reproductive process – might be seen to remove some of the stigma. It’s just my hormones. That there could be a clear, chemical “reason” for a certain type of behaviour or way of feeling is, on the surface, legitimising and reassuring. Although, if any woman is able to ride out days of feeling low each month by being aware of her cycle patterns; or finds that telling herself that the way she’s feeling is “just chemical” is a strategy that stops her going up into that second gear of self-analysis and existential woe, I absolutely lift my hat to her. Personally, given what I now know about the imprecision of the science of how our hormones can affect our mood, I try to resist thinking that I am a chemically controlled robot. I try to see my distress as part of a mini-ecosystem that includes my changing hormones, asking myself: what else is going on to upset my mind? How physically well am I right now? What helps?

Research tells us that our hormonal fluctuations do seem to affect how chemical signals pass through our brain – as any neuroscientist would tell you, we just don’t know exactly how or why. In all fields of brain study it is accepted that mental distress is not caused by one thing in isolation. The electrical, chemical brain is not extricable from the subjective mind. What we talk about is multi-causality: a fancy word for the concept that lots of different factors contribute to how we feel mentally. Therefore, when we talk about processes happening in a woman’s body that place us at “increased risk” of depression or anxiety, it seems not just blindingly logical, but respectful to consider that body in the wider scheme of things.

Perhaps, then, a more realistic phrase than, “It’s just my hormones,” would be, “My hormones might predispose me to feeling terrible sometimes.”

Our fluctuating biology is not the whole story but a significant part of our emotional lives. The hormonal changes and symptoms of menopause are very real and can be very hard. When my hormone levels change, notably at ovulation (soaring oestrogen) and in the week before I get my period (soaring progestogen, high oestrogen), it really can feel like I’ve stepped inside the skin of a different person – that I am not myself. But what is “myself” if not a sensitive-by-design brain and body that is always changing and responding to the world it inhabits and the people around it? From what fixed, ideal state do I feel I am slipping when I am more emotional for the second half of the month?

As human beings, rhythm is part of our deep core. Breathing, pumping, contracting: these are all actions of the body that keep us alive and keep our species going. Menstruation is another rhythm unique to women. But while our biology and what is happening inside us is important, we cannot act as if the body is an anatomical drawing floating in space; that it is nowhere. Clearly, if a woman’s premenstrual distress is such that she feels unable to function, she should, in an ideal world, be receiving dedicated healthcare and support. Is there something wider we should be asking about how, as a society, we frame what women say and do when they are anything other than sanguine, nurturing and polite?

Are we saving up anger, our base need for affection, and our tears for three weeks of the month? As our hormonal levels shift, could they be acting as a kind of “truth serum”, lubricating the passage of what we really want to say or do? It’s a radical idea and I quite like it. What if what we feel during those times of the month when we are so quick to say we are being irrational is the most “real” we are? The science surrounding whatever signalling changes happen in the emotion-processing parts of our brain during the menstrual cycle is too fuzzy to definitively say otherwise. Could it be that, when the mantle of self-censorship drops and we are less caught up with fearing how we’ll be seen, we’re accessing all that historical oppression and, in short bursts, letting it go? All that so-called “excess”, the stuff that makes a woman “hysterical” could just be… truth.