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May 3, 2015 | by  | in Science |
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Bloody Nonsense

Turns out PMS isn’t even a thing. If you ask, three of every four menstruating women say they experience PMS. But a review of research led by University of Toronto has found no link between negative moods and the pre-menstrual phase. “There is so much cultural baggage around women’s menstrual cycles, and entire industries built around the idea that women are moody, irrational, even unstable, in the phase leading up to menstruation,” says Dr. Gillian Einstein, one of the U of T experts who analysed 41 research studies into PMS. “Our review, which shows no clear evidence that PMS exists, will be surprising to many people, including health professionals.”

Thirty-five of the 41 papers reviewed found no link between mood and the menstrual cycle whatsoever. Not a peep. Of the six (13.5 per cent) papers that did show any relationship, several were found to be biased because the participants were not “blinded” to the purpose of the study—the women in the study knew that the researchers wanted to know how moody their PMS made them.

No change in mood is a far cry from the depiction of PMSing women in pop culture or the health education classroom, where it is taken for granted that changes in mood and behaviour are symptoms of being female. Dylan Moran beautifully demonstrated for us in stand up how difficult it is for young men to talk to a woman about her periods: “Listen, LISTEN… I agree… with everything… you’re carving… on the kitchen table, I do. But do you think maybe this might have something to do with your per-ARGH! (laughter) That first high kick to the thorax generally does the trick.” PMS humour may seem innocent enough, except that the myth of the PMS Witch follows people into the real world. My two favourite PMS jokes are “men’s rights activists” justifying the gender pay gap by citing the disabling effects of PMS, and Marc Rudov answering the question “what is the downside of having a woman become the President of the United States?” with “you mean besides the PMS and the mood swings right?” on Fox News.

But if it doesn’t exist, how come so many people (and their partners) report PMS symptoms? “Before women even get their first period, they have heard about PMS. The notion is so ingrained in our culture that some of these studies are actually biased because women know the study is about PMS,” says Einstein. What Einstein is suggesting, then, is that PMS is a cultural phenomenon, not a medical one. As it turns out, PMS is primarily a Western notion: according to Professor Jane Ussher who studies women’s health psychology at the University of Western Sydney, the concept of PMS doesn’t exist in Hong Kong, China or India.

Someone should probably mention this to the medical community. Premenstrual syndrome is recognised by mainstream medicine and was first described in 1931. A wide variety of symptoms including anxiety, depressed mood, crying spells, mood swings, irritability and anger are attributed to the condition. In severe cases, when mood swings appear to be impacting the person’s work and relationships, it is called premenstrual dysphoric disorder (PMDD). Textbooks will tell you that the causes of PMS and PMDD are unclear but that the wonderful medical catchall “hormonal changes” appear to play an important role. Underlying depression and anxiety are common in both PMS and PMDD diagnoses.

Of course, there are physical symptoms such as bloating and cramping related to the pre-menstrual phase, and just like a headache or a cold, severe period pain could make you irritable. But that is very different from saying that hormonal changes result in a temporary mood disorder. It seems bizarre that PMS is so widely accepted as a condition when no correlation between mood changes and the premenstrual phase (let alone a causal link between hormone changes and mood) has been demonstrated. It matters because if we are brushing off negative mood as the result of PMS then we aren’t addressing the real problems. As Einstein says, “There are so many things going on in women’s lives that can have a distinct impact on their moods—stress, lack of social support, economic hardship, physical ailments. Looking at these factors is key to the concept of evidence-based medicine.”

Sadly, this wouldn’t be the first time medical professionals have wrongfully attributed moodiness to female biology. Female hysteria was a common medical diagnosis for hundreds of years, with symptoms including nervousness, sexual desire (God forbid), insomnia, fluid retention, irritability, loss of appetite for food or sex, and “a tendency to cause trouble” attributed to the disease. In other words, having opinions, emotions, sexual desire, lack of desire or attempting to have any agency over your own life was medicalised if the person exhibiting these “symptoms” was female.

The Ancient Greeks thought hysteria was caused by the uterus literally wandering around the body. In the nineteenth century Dr. Russell Trall, a hydrotherapist in the United States, claimed (without supporting evidence) that up to 75 per cent of women suffered from female hysteria. The American Psychiatric Association didn’t drop the term until the early 1950s. Women were treated for hysteria with vibrators or water hoses (to induce orgasm), clitoridectomies (surgical removal of the clitoris), hysterectomies (surgical removal of the uterus), or even institutionalised.

How do patients and doctors become deceived into believing in a condition that doesn’t even exist? I don’t think that female hysteria was a malicious lie on the part of the medical profession, and I don’t want to discredit the experiences of people who “suffered” from the condition. I imagine that many women have had negative emotions and mood, or behaved in ways that were “troublesome” to their community. I just don’t think it was because their uterus or any other part of their female anatomy was misbehaving. Rather, it seems to me that the concept of female hysteria was a symptom of community-wide gaslighting against women.

Gaslighting is a recognised form of mental abuse (with studies and data to back it up) in which information is twisted to favour the abuser (in this case the male-dominated community) with the intent of making victims doubt their own perception and sanity. It’s a great way to keep the oppressed, oppressed. The disturbing part is that both abuser and abused can believe this twisted world view. The oppression becomes internalised.

People believed that women were more fragile, irrational and emotional than men, and that they belonged in domestic situations. So if a woman was sexually frustrated or just frustrated with her lot of housekeeping and child rearing, everyone including the woman in question thought it was because there was something wrong with her. We know that internalised sexism, internalised homophobia and internalised racism makes individuals think less of themselves, and make people believe that they are treated differently for a good reason.

Which is why it’s important that we think about the new evidence against PMS very seriously. To this day we label women “crazy” and “hysterical” when they express anger, frustration or distress. Women dismiss their own anger as over-reacting rather than as a justified response to angry-making things. In a world where we teach men that they can behave how they like and women to be accommodating, it’s all too easy to attribute a woman’s discontent to some irrational, biological basis. Especially something as vague and recurring as the “premenstrual phase”.

I am aware that many people will not appreciate being told that they are imagining their symptoms. Given the number of women who say they experience PMS first hand, it seems arrogant of me to dismiss the condition. And of course, there is no way to show definitively that PMS doesn’t exist. It may be that the studies conducted so far have been too narrow in their definitions of mood changes. All I ask is that we consider an internalised misogyny check-up on what we think we know about PMS. Because if the conversation was being driven by empirical evidence and research, we wouldn’t be blaming uteruses and female hormones for everything. Maybe then we would be forced to acknowledge some of the real problems women have to deal with.

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