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Is PMT really just a load of BS?

<p>PRE-MENSTRUAL tension (PMT) as it is popularly called, or premenstrual dysphoric syndrome (PMDS or PMS), its more modern acronyms, has been around in popular culture since Hippocrates tread this earth and in its history PMS has been intertwined with medicine, law and politics.</p>

It has been recognised for centuries that women experienced both physical and psychological symptoms before and during the early days of menstruation. They consisted of feelings of bloatedness and abdominal discomfort as well as tension, irritability, impaired concentration and low mood.

It is the emotional features that have attracted most attention and in particular irritability and low mood has been a constant feature, irrespective of definition or century. It was the paper by RT Frank in 1931 and published in the 'Archives of Neurological Research', which first accorded the constellation of symptoms the name pre-menstrual tension.

Katherina Dalton, a British gynaecologist in 1964, provided a further boost to the idea that this condition wasn't simply a figment of the imagination, but was one which was real and could be measured. In her best-selling book 'Once a Month' she suggested that the symptoms were due to reductions in the levels of progesterone or in the oestogen/progesterone ratios and that it could be treated with progesterone. However, few were able to replicate this research.

By the 1980s the role PMT in certain crimes had been successfully argued in the courts largely due to the evidence of Dr Dalton as a defence witness. She asserted that the mood changes associated with PMT had a causal role in some cases of violent crime, resulting in a change of plea from murder to manslaughter, due to diminished responsibility. This is seldom argued in more recent cases.

Feminists have been divided in their views of PMT.

Some were irritated by the use of PMT as a defence in cases of serious crime, arguing that this distinguished women from men before the law and would ultimately impede the achievement of full equality.

Alternatively other women's rights supporters believed that for the first time PMT was being recognised as the debilitating and demotivating condition that it really was, thereby enabling women to receive treatment and achieve their full potential. And the mainstay of treatment has been with antidepressants such as Prozac and not hormones, vitamins or lifestyle changes although all have been examined.

Over the years the name has also changed from PMT to premenstrual syndrome (PMS). A more severe form of premenstrual dysphoric disorder (PMDD) affecting women in the second half of the cycle is also said to exist.

Now doubt is being cast on whether PMS exists or not, by the findings of a study published in the October issue of 'Gender Medicine'.

The study was carried out by Dr Gillian Einstein, associate professor of psychology and her team at the University of Toronto.

The study was a systematic review in which all the scientific papers on a particular topic are examined and only those of the highest quality are then selected for in-depth analysis. It examined 47 studies, of which 41 had sufficient numbers to make the study valid.

More than one million women from the general population participated and in 36.6pc there was no association with any phase of the cycle. 41.5pc had changes to mood in two phases of the cycle and only 13.5pc had changes in the premenstrual phase.

The authors concluded that there was no clear evidence of a specific premenstrual negative mood syndrome among women in the general population. The authors speculated that this belief was probably culture-bound due to expectations and myth.

This study will no doubt be controversial and clearly will be challenged. Meanwhile, where does this study leave those who had verdicts of murder reduced to manslaughter due to responsibility being diminished in the premenstrual phase of their cycle and how do the families of victims now feel?

Could it be that this study will open up old cases and present new challenges to the courts? Only time will tell, but for the moment PMT/PMS remains a controversial and divisive diagnosis.