The PMS Controversy
Research shows there is no relationship between daily moods and changing hormone levels. But is PMS really no more than a cultural myth?
Written by Healthy Magazine Staff
During that time of the month, a woman’s mood is victim to fluctuating hormones…right?
While it may be surprising to many, and while my wife may never forgive me for writing this, research doesn’t support the connection between the premenstrual phase and mood changes. In fact, PMS has cultural underpinnings that propel myths and do disservice to women everywhere.
Researchers in Canada analyzed a large database of studies with the goal of dispelling myths about the mood and menstrual cycle. After examining 47 total studies, they found that only 7 showed an association of negative mood with the premenstrual phase.
“Taken together, these studies failed to provide clear evidence in support of the existence of a specific premenstrual negative mood syndrome in the general population,” the authors wrote. “This puzzlingly widespread belief needs challenging, as it perpetuates negative concepts linking female reproduction with negative emotionality.”
But PMS is still a recognized condition in the medical community, although its defining characteristics can be somewhat broad and vague. In fact, many people don’t even know what PMS is, beyond the idea of some vague emotional symptoms. And the ignorance is justified, as medical professionals themselves have had trouble nailing down specific symptoms and diagnostic criteria. This may contribute to the common PMS myths that all women have it, which is not even close to true (high estimates put it at 30%). In past decades, more than 150 symptoms have been used to diagnose PMS, according to Robyn Stein DeLuca of the Department of Psychology at Stony Brook University.
“After five decades of research, there’s no strong consensus on the definition, the cause, the treatment, or even the existence of PMS,” she explained in a TED talk. “We know there’s a strong cultural component to the belief in PMS because it’s nearly unheard of outside of Western nations.”
In the 90s, the Diagnostic and Statistical Manual of Mental Disorders (DSM), the authoritative manual for mental health professionals, redefined PMS as PMDD, Premenstrual Dysphoric Disorder. In the new DSM guidelines, authors outlines 11 possible symptoms, and set the criteria that at least 5 of the 11 symptoms must be met for a PMDD diagnosis. They also clarified that for a PMDD diagnosis, symptoms must appear the week before menstruation starts, and must improve once menstruation has begun. And of the 11 symptoms, a person must have at least one from these four: marked mood swings, irritability, anxiety, or depression.
The other symptoms include decreased interest in activities, difficulty in concentrations, fatigue and changes in appetite. Under this criteria, 3-8% suffer from PMDD.
“Not all women, not most women, not the majority of women, not even a lot of women: three to eight percent,” DeLuca said. “For everyone else, variables like stressful events or happy occasions or even day of the week are more powerful predictors of mood than time of the month, and this is the information the scientific community has had since the 1990s.”
DeLuca blames a variety of things for the misconceptions about PMS. She points to TV and media that promote the idea that every one gets PMS. She also blames the industry that profits off “fixing” PMS, including books, supplements, drug developers and physicians in general.
Why myths about PMS do women a disservice.
When a woman expresses intense emotion, we as a society may be tempted to blame PMS. This incredibly destructive and backward mindset undermines the competence, intelligence and achievements of women everywhere.
PMS myths may lead men to dismiss ideas from a coworker, spouse or peer. For women, PMS myths sometimes become something to hide behind in an unhealthy way. Whether it’s eating an entire cheesecake or blowing up at a friend, women shouldn’t automatically point to their hormones. This immediate association prevents women from addressing the issues that are actually causing stress and anger.
Some reading this article may wonder if the message is that PMS is all in the head. Not quite. So guys, don’t go saying that to your female peers (which would be the bravest thing any guy has ever done ever). The point is that most women don’t experience the PMS, and that emotions shouldn’t be firstly attributed to their reproductive system. Other women do experience PMS, even if numbers are inflated by cultural influence. In the journal American Family Physician, researchers say that PMS influences 20-32 percent of premenopausal women, compared to the 3-8% of women influenced by PMDD.
Research does show that more than 80 percent of women report one or more physical, psychological or behavioral symptom during the luteal phase of the menstrual cycle, without experiencing a substantial disruption to daily functioning. In other words, most women do experience some symptom in relation to their menstrual cycle, but it is rarely severe enough to cause serious issues. So trouble sleeping, fatigue, headaches, digestion issues, etc. cannot be dismissed. But things like irritability, anxiety, emotion and depression should not be immediately blamed on PMS.
Important Sidebar: Menstrual Molimina
This comprises 3-4 symptoms that occur during the luteal phase of your cycle, which is the time between ovulation and when your period starts. Symptoms include breast tenderness, food cravings, fatigue, sleep problems, headaches, etc. Molimina is not PMS. It is better described as the physical response your body feels as hormone levels change, which doesn’t interfere with your daily routine. They are natural, healthy feelings that are part of the reproductive process which don’t need fixing.
Sources: Gender Medicine, ajp.psychiatryonline.org, bestpracticeobgyn.com, ncbi.nlm.nih.gov, ted.com