Premenstrual Syndrome—Myth or Reality?
Her behavior is erratic and unpredictable. One moment she is agreeable; the next she is argumentative. She utters words of hopelessness. Despite your expressions of comfort, she overreacts to what you say and do. A small issue is likely to get blown out of proportion and become fuel for a raging fire. After a few days, or a week or so, this “other” woman suddenly disappears, and she is once again her normal self . . . for a time.
ADMITTEDLY, not all women undergo such dramatic mood changes. However, prior to the onset of menstruation, some women may have recognized in themselves this female counterpart of Dr. Jekyll and Mr. Hyde. What causes such mood changes? Is such behavior truly the result of changes during the menstrual cycle?
What Is PMS?
According to the American Journal of Psychiatry, women who experience “cyclic occurrence of symptoms that are of sufficient severity to interfere with some aspects of life” and that appear consistently prior to menstruation may be suffering from PMS (premenstrual syndrome). Although there are no laboratory tests that can diagnose PMS, women with PMS must experience a symptom-free phase of one or two weeks during each cycle. By this definition, doctors estimate that only 10 percent of women suffer from PMS.
Other clinicians have a different view of PMS. They argue that a larger percentage of women, between 40 and 90 percent, suffer from PMS. They define the term to include the experiencing of various complaints, such as weight gain, fatigue, joint pain, abdominal cramps, migraines, irritability, breast tenderness, crying spells, cravings for food, and mood swings. More than 150 symptoms are associated with PMS. Women, including those who no longer menstruate, may experience any or several of these symptoms. Generally, however, a woman experiences PMS during her 30’s. For the majority of women, PMS symptoms are distressing but manageable. In this article we will focus on these sufferers of less severe PMS.
Nancy Reame, a researcher at the University of Michigan, reported that PMS is seen as “a generic health problem” in the United States, but in other countries there are many differences in the type and severity of symptoms. “Some report much more significant physical symptoms, and other cultures report more emotional symptoms,” she said. Reame, who has done research in China, cited the Chinese as an example. “In the Chinese culture it’s not okay to have emotional symptoms.” As a result, she noted, women will focus on cramps when asked about menstrual problems.
The Beginnings of PMS
PMS was first discussed by Dr. Robert T. Frank of New York in 1931 in his paper “The Hormonal Causes of Premenstrual Tension.” He observed women who suffered with fatigue, lack of concentration, and nervous tension prior to menstruation.
It was 22 years later that Katharina Dalton and Raymond Greene, English physicians, published a paper in a medical journal in which they coined the term “premenstrual syndrome.” Dr. Dalton referred to PMS as “the world’s commonest, and probably the oldest, disease.” Her findings of the effect PMS could have on a woman’s behavior came to the fore in 1980. She and other doctors were called in to diagnose two British women charged with murder. They theorized that a woman’s behavior could be influenced by hormonal fluctuations during her menstrual cycle. Based on their diagnosis of PMS, the murder charges in both cases were reduced. In one decision the defendant received a lesser charge of manslaughter on the grounds of “diminished responsibility.”
Incidents of destructive behavior on the part of women, as in the foregoing, seem to be isolated cases. The cause of such behavior and the minor distressing symptoms a majority of women experience around the time of menstruation continue to be debated on the pages of medical and nonmedical journals.
Is such behavior really the result of cyclic hormonal fluctuations in a woman’s body? Or is the idea of raging hormones and the unruly female body simply a myth? There are differences of opinion as to what effect, if any, hormonal fluctuations have on a woman’s behavior. Many researchers and doctors agree that a better understanding of the interaction between the brain and the ovarian hormones during the menstrual cycle is a key to knowing why some women suffer with PMS.
The Menstrual Cycle
About once every four weeks, a woman’s body enters a highly complex cycle of hormonal fluctuations. Referred to by many as the “curse,” the word “menstruation” comes from the Latin mensis, meaning “month.”
To start the cycle, the hypothalamus of the brain sends a message to the pituitary gland. When the message is received, the pituitary secretes FSH (follicle-stimulating hormone). FSH travels through the blood to the ovaries and triggers the production of estrogen. As estrogen increases, the pituitary reacts by sending out LH (luteinizing hormone). LH slows down the secretion of FSH. One egg cell matures and travels down into the womb. After the egg cell is released, the hormone progesterone is secreted. If the egg is not fertilized, progesterone and estrogen levels drop rapidly.
Without hormones to support it, the lining of the uterus degenerates, with blood, fluid, and some tissue being discharged through the vagina. It takes about three to seven days for a woman’s uterus to shed the lining completely, ending one menstrual cycle. As one cycle ends, the brain again releases hormones, signaling the start of a new cycle.
A Battle of the Hormones?
Some argue that an imbalance of estrogen and progesterone is what produces premenstrual symptoms in a woman. They assert that the hormones normally work together to achieve a perfect balance. When more of one is produced than of the other, a battle occurs, and casualties are left behind in the female body.
Elevated estrogen levels may make some women feel irritable. For others, progesterone wins out, causing them to feel depressed and fatigued.
Other researchers disagree with the theory that a hormonal imbalance causes PMS. They argue that psychological and social factors play major roles in producing premenstrual symptoms in certain women. Patient Care, in reporting on the causes of PMS, states that “no clear-cut differences have been found in the patterns, ratios, amounts, or timing of gonadal hormones in women with or without severe PMS.”
Stress, for example, may speed up, delay, or intensify PMS symptoms. The book PMS—Premenstrual Syndrome and You: Next Month Can Be Different notes: “Stress inhibits the release of hormones and an inadequate supply of hormones can lead to the kind of hormonal imbalance that worsens PMS symptoms.” Medical, financial, or family problems may appear more intense and less manageable before menstruation.
The Fear of Stigmatization
Some researchers contend that a woman may be viewed as a less-than-ideal worker or decision maker if she manifests symptoms related to her menstruation. “It’s a way that the society keeps women in their place. If you’re impaired once a month, that means that you then shouldn’t be out doing these serious, powerful, influential things,” argues Barbara Sommer, a psychologist.
Other researchers contend that women have accepted PMS because it allows them to use the condition as an excuse for their behavior. In an interview in Redbook magazine, Dr. Carol Tavris, author of The Mismeasure of Woman, states that PMS “allows women to say, ‘What’s medically wrong with me?’ not, ‘What is wrong in my life that’s making me feel crummy?’”
In 1985, women psychiatrists on the Committee on Women of the APA (American Psychiatric Association) fought against the inclusion of PMS in the APA’s Diagnostic and Statistical Manual. Although it is cited in the appendix of the current (1987) manual as “late luteal phase dysphoric disorder,” a task force of the APA has proposed listing “premenstrual dysphoric disorder” (PMDD) in the main text of its next edition. Listing it in the manual would make it an official psychiatric disorder.
“It doesn’t belong anywhere in the book at all because it’s not a mental disorder,” notes Dr. Paula Kaplan, former adviser to the task force. “The next time a woman is nominated for attorney general, she’ll be asked: ‘Have you had PMDD?’” she said.
A Search for Relief
The medical profession continues to debate the issue of PMS. Many theories are emerging on the exact cause and treatment of PMS. Some doctors feel that there may be 18 varieties of PMS, each producing different symptoms. One recent study reported that zinc may play a role in triggering PMS symptoms. Another study suggested that a vitamin-B6 deficiency may be at the root of the problem, causing mild depression in some.
Treatments such as light therapy, sleep manipulation, deep relaxation technique, antidepressant drugs, and progesterone suppositories are tried by women seeking relief from recurring PMS symptoms. As yet, no consistently effective treatment has been found.
Women who suffer from unmanageable symptoms prior to menstruation should consult a doctor. Each case of PMS is unique, and each woman deserves sound medical advice and proper care. Because PMS can mimic other serious conditions, such as thyroid disease, endometriosis, and depression, a physical exam is important.
It is recommended that prior to the first visit to the doctor, a woman keep a detailed diary or calendar of physical and emotional symptoms she experiences premenstrually. Knowing the days when she may be prone to moodiness, irritability, or depression can help her to adjust her schedule accordingly. It can also help her determine whether she is suffering from PMS.
Doctors may suggest reducing factors that cause stress in her life. A nutritious diet and regular exercise can also combat PMS. A high-carbohydrate, low-protein diet improved the moods of some depressed premenstrual women, said a university study. A regular workout or a brisk walk during the day may also aid in fighting fatigue and the blues.
Of course, family members, particularly a husband, can help. They should strive to be especially kind, considerate, and understanding when a woman’s monthly cycle causes her difficulties.
The Debate Continues
Some claim that labeling normal emotional and physical changes a woman experiences during her menstrual cycle as a “syndrome” is incorrect. And others discredit PMS, claiming that it stigmatizes women.
However, for a number of women, PMS is real. Every month, symptoms are experienced that make coping with a family and a job difficult. A search for relief and understanding can prove frustrating as many in the medical profession and lay persons continue to debate the reality of PMS.
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Family members can help by being especially kind and considerate