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The myth of premenstrual moodiness

From the time of Plato and Hippocrates, women’s emotions have been attributed to the menstrual cycle. The Greeks believed the womb travelled around the body, causing all manner of ailments – sex and pregnancy…

Negative premenstrual moods are neither widespread, nor inevitable. Petras Gagilas

From the time of Plato and Hippocrates, women’s emotions have been attributed to the menstrual cycle. The Greeks believed the womb travelled around the body, causing all manner of ailments – sex and pregnancy were prescribed as the cure. In the Victorian era, the diagnosis of hysteria was widespread, and women’s dissatisfaction and marital disobedience were again blamed on the womb.

Today, the bible of psychiatry, the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM), focuses on premenstrual madness – defined as Premenstrual Dysphoric Disorder (PMDD). This is the latest incarnation of the “disorder” first described as Premenstrual Tension (PMT) and later changed to Premenstrual Syndrome (PMS), to encompass the broad range of emotions purportedly experienced by premenstrual women.

But a recent study has challenged the veracity of premenstrual mood change. The systematic review of 47 scientific studies, found that approximately 40% reported no association between mood and menstrual cycle, 40% reported negative mood during both the premenstrual and menstrual phase, and only 15% reported increased negative mood premenstrually. This suggests that PMS or PMDD is not a common problem in the general population of non help-seeking women who took part in the studies reviewed.

Indeed, many studies reported positive changes in the premenstrual phase, including increased creativity, energy, and sexual drive. But none of the studies reviewed examined whether positive mood varied consistently across the menstrual cycle, reflecting the research focus on negative premenstrual change.

So why is the belief in premenstrual moodiness so prevalent in Western culture? Cultural images of premenstrual madness abound – YouTube clips and cartoons depict the dangers of the premenstrual monster, while self-help books compete to counsel women on coping with premenstrual change. Drug companies advocate a biomedical cure, with the market for premenstrual antidepressants expanding every year.

The notion of premenstrual irrationality, unreliability, and irritability is a consistent theme throughout, invariably attributed to raging hormones, and reinforcing the perception of menstruation as a curse – and the premenstrual woman as out of control.

Many women believe the hype, but while premenstrual mood change is commonly reported on retrospective surveys, a cyclical pattern is frequently not found when mood is measured every day. Premenstrual negative mood is also attributed to hormones, while the rest of the month women see life stress as the cause for discontent.

These negative expectations can become a self-fulfilling prophesy, with many women diagnosing themselves as having PMDD or PMS, and, as a result, not looking for alternative causes for their distress.

Belief in the premenstrual monster or madwoman is a phenomenon peculiar to Western cultures. Researchers have found that women in India, China or Hong Kong report physical changes over the menstrual cycle, but don’t report negative mood premenstrually, or attribute negative mood to PMS.

Equally, the longer Asian or Latina women migrants live in the United States, the more likely they are to report PMS. This has led to PMS and PMDD being described as cultural-bound syndromes, challenging the legitimacy of the widespread psychiatric diagnosis of premenstrual mood change.

But all this doesn’t mean that premenstrual change is completely a myth. A small minority of women – between 1.3% and 5% – experience premenstrual changes that can have a significant effect on their lives. The most frequently reported symptoms are feelings of depression, anger, or irritability, which can affect relationships with family and friends.

Interestingly, severe premenstrual distress is more common in women in their mid 30s, or older, who have multiple responsibilities – juggling home, work and children, with little support. Premenstrual distress is also higher in women who experience relationship difficulties, or lack of understanding and support from their partner.

For three weeks of the month, such women silence their irritation and unhappiness, conforming to societal expectations of the “good woman”. Premenstrually, this self-silencing is broken, but the expression of negative thoughts and feelings is invariably dismissed as PMS. This means that nothing changes in the circumstances of women’s lives, and the cycle of self-silencing and frustration begins again.

These premenstrual emotions are not a sign of women’s madness. They are an understandable reaction to the stresses and strains of life, which are expressed at a time of the month when it’s acceptable for women to be angry, or when the woman feels she can’t contain her feelings any more.

Psychological interventions that help women to manage the stress in their lives, and teach them to express their feelings throughout the month, as well as engage in self-care, significantly reduce premenstrual distress. Women in lesbian relationships, who report partner empathy, also find premenstrual change less distressing, and are better able to cope.

Negative premenstrual moods are neither widespread, or inevitable. The perpetuation of the legacy of the wandering womb is simply damaging to women; it’s a myth and should be acknowledged as such.

Join the conversation

27 Comments sorted by

  1. Sou from Bundanga

    logged in via Twitter

    This is the first I knew of PMS being claimed, or in this case disclaimed, by psychiatrists. I hope the rest of the medical profession isn't going back to saying 'it's all in your head, dearie - take a holiday'!

    For those of us who have been afflicted PMS seriously disrupts work and general living for a few days each month. The main symptoms being difficulty in coordination (affecting speech, driving and other motor skills), migraine and general brain fog. Mood change is one of the least concerns. The cure is menopause and maybe pregnancy.

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  2. Alice Gorman

    Lecturer at Flinders University

    Apart from anything else, the prospect of painful cramps (for those who suffer them), constant self-monitoring, and being awash with blood for days would be be enough to make anyone a bit cranky sometimes. And then a few weeks later you have to go through it all over again.

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  3. Pamela H.

    logged in via email @hotmail.com

    I think some women use it as an excuse to be nasty. I never had issues around that time.

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    1. Judith Olney

      Ms

      In reply to Pamela H.

      I often suffered mood swings around my period, and would find myself really dreading that time of the month. I suffered extreme pain, nausea, headaches, bloating, and changes to my skin and hair, I also suffered dry eyes, and general aching, as if I had flu once a month.

      These were very real symptoms, which made me irritable, and less patient with those around me. I found that knowing that I had all this to look forward to once a month made me depressed, particularly in the days just before…

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  4. Comment removed by moderator.

  5. Ann Paterson

    Director

    If PMS is a myth, why was that image chosen to illustrate this article?

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  6. Sue Ieraci

    Public hospital clinician

    It would certainly be useful to separate the alleged psychological impact of the menstrual cycle from the real physical impact.

    We know that hormonal surges through the menstrual cycle are quite dramatic. For some women, this can result in bloating and, commonly, migraine. As Dianna mentions, one can have heightened libido pre-ovulation. Then the first few days of bleeding can cause quite distressing pain - especially in young women.

    Some women sail through, others suffer. Transition stages are difficult - menarche and menopause. No need to discount the impact of the menstrual cycle - just to be precise about what the impacts are.

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  7. Craig Minns

    Self-employed

    I'm obviously not a woman, but I've had long-term cohabiting relationships with several women and they all became moody and difficult to deal with during the pre-menstrual phase. As a result I learnt to be extra-solicitous and "understanding" at that time.

    The article smacks of an attempt at feminist-inspired revisionism and self-promotion rather than a serious effort. I'm less than impressed by authors who self-refer extensively...

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    1. Chris Saunders

      retired

      In reply to Craig Minns

      Well your tits hurt, and you are often constipated, and you could do with a good irresponsible long sleep which you don’t get and the poo does not come and it’s all anticipation and nothing on the horizon but work and behaving yourself, and being nice or else you get into an argument which is wonderfully destructive and you’re feeling decidedly suspenseful and then it comes and what is it all about? Well, a little bit of blood which means you are not pregnant and relief and/or disappointed and then…

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    2. Matt Stevens

      Senior Research Fellow/Statistician/PhD

      In reply to Craig Minns

      Agreed, it just the usual feminist drivel. Funny, how i would ask my ex 'if any thing was wrong?' only to get her screaming back at me 'nothing is the matter'. Funny how people answer questionnaires based on what they think, when often what the people around them think would be more accurate!

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    3. Emily Smith

      logged in via Facebook

      In reply to Craig Minns

      Well, then it probably depends on a woman because I personally never know that it is coming. No symptoms, and it is pretty irregular so even counting days does not help...

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  8. Jens O

    ...

    Since this article is aiming to be a myth-buster, I was quite amused to hear again about the myth that men aren’t able to express empathy... :)

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Jens O

      Wow - did you get this from "Premenstrual distress is also higher in women who experience relationship difficulties, or lack of understanding and support from their partner."?

      I have been waiting for the anti-feminists to weigh in and complain that articles about menstruation only ever mention women...

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    2. Jens O

      ...

      In reply to Jens O

      Sue, if anything, I am a male feminist or a ‘masculist’ since I oppose discrimination against men and the same labeling that you yourself are opposing for women. And that’s usually appreciated by modern feminists...

      The sentence you quoted, when followed by ‘Women in lesbian relationships, who report partner empathy, also find premenstrual change less distressing, and are better able to cope’ - implies that men are a cause of PMS and that avoiding men will resolve this, thus pointing towards what…

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Jens O

      Jens - you have missed the context of my throw-away line. It was not referring to you personally, but to certain regular commenters here who reliably turn up on any thread relating to women and plead discrimination.

      Perhaps it wasn't funny....

      Having said that, though, your further comment is again puzzling. All the author appears to be saying is that people who menstruate know the bodily symptoms and discomforts better than people who don't. Are you arguing for the right to menstruate, so that you can have real empathy?

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  9. Jane Ralls

    GP

    I think PMS is definitely real for many women, but irritability and difficulty functioning well are the main features rather than a mood disorder. Also many women with a low grade depression will cope for the rest of the month but de-compensate when they are also pre-menstrual: they need their depression treated (all month).
    I think this article risks invalidating women who really experience changes - they need empathy (as you say) not dismissal. The fabulous thing about gender is how different we are, and I think efforts to minimise real difference between men and women does everyone a disservice. I encourage people to befriend their ailments - PMS can be a wake up call to change one's life and make it easier as far as possible!

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  10. none at all

    none

    To a normally observant male, the subtle signs of a woman's menstrual cycle are usually evident, given regular close contact, such as living or working together. I've been aware of this and made tactful allowances accordingly for many years. The increased attention to appearance and tendency to flirtatiousness around ovulation time are often quite unmistakable, although these ovulatory and pre-menstrual changes may not be apparent to the subject. I always assumed that this was an evolutionary advantage, allied to the survival of our species.

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    1. Dianna Arthur
      Dianna Arthur is a Friend of The Conversation.

      Environmentalist

      In reply to none at all

      @Bob Buick

      "I've been aware of this and made tactful allowances accordingly for many years."

      Well thank you, so kind.

      Just as I have made allowances for men behaving badly throughout my lifetime.

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    2. none at all

      none

      In reply to none at all

      Thank you, Dianna. If only each sex would make such allowances for the problems of the other! Your tolerance is admirable and presumably accompanies a dose of humility, as you'll be well aware that both sexes have their problems. I see that you're an environmentalist, so I presume that explains your understanding of the male component of your environment, which is closer to home than animals, trees etc. for most of us, although all are important.

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  11. Lynne Newington
    Lynne Newington is a Friend of The Conversation.

    Researcher

    This "pre menstrual madness" it was also once believed, affected virgins, nuns and gave way to vapours to women causing visions and messages from God, giving claim to them being unable to trust.
    I thought it was either Jerome or Augustine who expressed these views, especially Jerome, who never trusted woman's sexuality, altho always surrounded by them, rich ones that is, who could pay for his works "spiritual works" for the church.
    Nothing new there.

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  12. Yvonne Jasper

    Retired programmer

    Thank you for one of the best laughs I have had in a while. I am still laughing. Is this just to see how big our bite is?

    One of the best film lines ever is Whoopi Goldberg (in The Associate) saying in response to a male taunting her with being pre-menstrual is: "If I had PMS you'd be dead."

    So true, so true.

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  13. Roger Crook

    Retired agribusiness manager & farmer

    Having lived in a house for 20 years with a young wife and two daughters with just a couple of years between them,and, in addition my 'very young' mother for her years mother.
    I obviously spent many years totally misunderstanding my place in the house and the meaning of community cycling.
    Joke. Question to man
    Q. Why do 90% of women suffer from PMS?
    A. Errr, I dont know
    Reply. Raging and stamping foot, 'Well they just do - ALRIGHT!

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  14. Tom Hennessy

    Retired

    Quote: From the time of Plato and Hippocrates, women’s emotions have been attributed to the menstrual cycle.

    Answer: And lo and behold the 'scientists' TODAY say , they were wrong ?
    Surprise , surprise. Their deduction , in their day , was based PURELY on evidence based medicine. They dedeuced BY recognition OF the moodiness of women during their menses and the relief of said moodiness by the menses OR bloodletting. Bloodletting is where they PROVED the 'connection' by the relief of the moodiness BY bloodletting and the same relief of moodiness by menses , blood loss , period. Giving evidence to there being MORE to the loss of blood than simply shedding of the womb lining and is more related to the relief of plethora , too much blood.
    "Is Menstruation Obsolete?"
    "The Basis of Therapeutic Bloodletting"

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  15. Linda Hazell

    Casual Lecturer

    I was disappointed by this article. It was very dismissive and didn't seem to add much clarity either through careful definitions or critiques of studies. I have experienced (or believe I have experienced) premenstrual symptoms. In my case it was an overwhelming feeling of inadequacy limited to 12-24hrs about 3-5 days before menstruation. I had this feeling for many cycles before recognising that it was linked to menstruation. It was such a sense of relief when I made the connection because…

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  16. Chloe Adams

    writer

    The inner skeptic in me says that this article is just reiterating what reviews state, but there are no meaningful conclusions here.
    Why?
    Well for starters, who really has the time to analyse each study?
    The review that you quote includes how many studies, now within each study the findings depend on what type of tests were used, the power of each hypothesis, significance and so on. Then there is the use of the word correlation. Do I really have to go on?

    Your article does not provide any concrete…

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