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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.