This blog post unpicks some of the myths surrounding PMS (Premenstrual Syndrome), in an attempt to better define symptoms as being caused by, or relating to, the menstrual cycle. I am building on the work of others, including the psychologists, Dr Robyn Stein DeLuca and Professor Jane M Ussher. In fact, please watch Dr DeLuca’s TED talk, to get an overview of a variety of PMS myths:
As Dr DeLuca explains in her talk, PMS is still most commonly defined as primarily a psychological issue, albeit with associated physical and behavioural symptoms. Its most severe form, PMDD (Premenstrual Dysphoric Disorder), is listed within the DSM (the Diagnostic and Statistical Manual of Mental Disorders).
This is unusual in that other hormonally-driven issues that result in severe mood swings, as well as physical and behavioural symptoms, are classified under endocrinology, not psychiatry e.g. hyper/hypothyroidism, which affects the sexes more equally.
Another issue is that no differentiation is made between ‘normal premenstrual changes’ that commonly occur, but for the vast majority of people have no major impact on their lives or health, and those that severely debilitate a minority of people who menstruate. Including normal menstrual changes as part of the diagnostic criteria for PMDD (a severe mood disorder) suggests that they are part of a serious medical condition, rather than typical changes associated with the menstrual cycle.
So, as Dr DeLuca says, “I’m not saying women don’t get some of these symptoms. What I’m saying is that getting some of these symptoms doesn’t amount to a mental disorder, and when psychologists come up with a disorder that’s so vaguely defined, the label eventually becomes meaningless”.
This emphasis on psychological symptoms, and lack of differentiation between normal and severely debilitating experiences, has resulted in an inadequate, and somewhat misleading, understanding of the relationship between the menstrual cycle and ill health.
Rather than investigating why many (physical and mental) health issues are triggered, or worsened, at different points in the menstrual cycle, we tend to default to applying a catch-all diagnosis of ‘PMS’ to describe all cyclical experiences. This doesn’t help anyone.
In my opinion, this is looking at things the wrong way around. I would rather find out what the timing of ‘PMS’ symptoms can tell us about the mechanism(s) underlying these symptoms, in general.
For instance, since we know that ‘PMS’ symptoms occur (or worsen) during the luteal phase of the menstrual cycle, there must be something about falling levels of oestrogen, and/ or progesterone or the subsequent physiological processes they stimulate, which can trigger certain symptoms?
This could offer new insight into the diagnosis and treatment of prevalent, and truly life-affecting, conditions such as depression and anxiety.
Alas, the concept of ‘PMS’, itself a likely product of the menstruation taboo, has, so far, obscured the wonderful medical research potential that lies in knowing that (some) people experience symptoms in association with phases of their menstrual cycle (and/ or hormonal medication). Including many symptoms that are shared across a range of chronic health issues that disproportionately affect people who menstruate.
So, perhaps we ought to start talking about ‘menstrual cycle-related symptoms’, rather than perpetuating harmful gendered stereotypes through the use of the misleading term ‘PMS’?