Friday 23 March 2018

Is PMS all in your head?

For many women, the days before their period are filled with misery and mood-swings. But a growing number of experts are questioning the 'hormone myth'. Are they right, asks our reporter

Psychologist Robyn Stein DeLuca says it's time to reject the hormone myth, even if you hold on to your hot water bottle
Psychologist Robyn Stein DeLuca says it's time to reject the hormone myth, even if you hold on to your hot water bottle
PMS angst

Lorraine Courtney

Telling a woman that her PMS is just some excuse to avoid work and behave badly will always land you in trouble. But that's exactly what psychologist Robyn Stein DeLuca has done.

In her new book, The Hormone Myth: How Junk Science, Gender Politics And Lies About PMS Keep Women Down, DeLuca argues that PMS (or premenstrual syndrome to use its full name) is a convenient myth that perpetuates the sexist notion that women are hysterical and not in control of their own emotions. A myth that also gives women an excuse to not pull their weight for a few days every month.

She argues that it's time for women to reject the "hormone myth", that it's the product of flawed research and is an attempt to keep women firmly "in their place". #

"The evidence is clear," she says. "For the great majority of women, changes in hormones caused by reproductive events don't cause mental disorders."

DeLuca also gave a TED talk on the topic in 2014. In the video, she admits that some women might experience a few nasty effects of PMS, but points out that there is no good definition of what PMS is. Plus she doesn't think it impacts daily life.

DeLuca isn't the first academic to question the possibility of PMS being psychological, rather than biological. A 2012 study by scientists at the University of Toronto claimed there is "no clear evidence that PMS exists".

Researchers analysed 41 studies on the subject and found that only a handful could link mood swings and the premenstrual period. They concluded, "Taken together, these studies failed to provide clear evidence in support of the existence of a specific premenstrual negative mood syndrome in the general population. This puzzlingly widespread belief needs challenging, as it perpetuates negative concepts linking female reproduction with negative emotionality."

We do tend to over-attribute women's emotional problems to hormones and sexism often creeps in. During the last US presidential election a controversial article was published in Time magazine dismissing concerns about now 70-year-old Hillary Clinton's age by suggesting that "biologically speaking, postmenopausal women are ideal candidates for leadership".

The article went on to explain the science behind estrogen and how once levels drop after menopause, those pesky hormones don't cause any more problems.

When Donald Trump didn't like Megyn Kelly's aggressive approach in interviews, he suggested she was probably bleeding from her wherever. Then there's the age-old joke - "Is it that time of the month? Hurr-hurr-hurr" - that makes us all feel like it's our duty to be unaffected by our own biology.

I'm one of those women who feel bad at that time of the month (cramps, bloating and feeling a bit meh) but can still function. Should my symptoms be diminished? And are they just in women's heads?

As a gynaecologist and a woman, Dr Karen Flood doesn't believe that PMS is a myth and she points out that the International Society of Premenstrual Disorders (ISPMD) would disagree also. "However, it is not clear why some women develop premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) and others do not," she says.

"You could say this also about why people react differently to medications. I think that denying the presence of the PMS actually serves to 'keep women down'. It is experienced mildly by up to 75pc of women, severely in 3pc to 8pc. We need to be empowering women to acknowledge that an issue exists, and to seek help."

And in fact, she says, there is solid evidence that premenstrual hormones affect mood. "Tissues throughout the body are sensitive to hormone levels that change throughout a woman's menstrual cycle," says Dr Flood. "Studies suggest that rising and falling levels of hormones (for example estrogen and progesterone) may also influence chemicals in the brain, including a substance called serotonin, which affects mood.

"Levels of estrogen and progesterone are similar in women with and without these conditions. The most likely explanation, based upon several studies, is that women who develop PMDD are highly sensitive to normal changes in hormone levels."

Dr Sharon Moss, Consultant Gynaecologist at the Beacon Hospital, doesn't dismiss PMS either and says our bodily processes are complex and intertwined, so that everything works together to create PMS, which, yes, she believes can be debilitating.

"I see women suffering with varying degrees of symptoms related to their menstrual cycle, and in particular in the days or weeks before their periods - ranging from mildly annoying problems to symptoms that render them incapable of functioning normally."

PMS refers to a group of physical and behavioural symptoms that occur in a cyclic pattern during the second half of the menstrual cycle. PMDD is the severe form of PMS. Common symptoms include anger, irritability, depression, and internal tension that are severe enough to interfere with daily activities.

"PMDD is a more severe manifestation of PMS, usually with marked mood disturbance," says Dr Moss.

"This can then affect the daily functioning of the individual to the point of being detrimental to their professional and personal interactions. Charting of symptoms will often confirm the diagnosis of PMS or PMDD. Importantly, there is often a symptom-free interval that is noted - usually between the period and ovulation."

It's hard to explain the impact that PMDD has on your life, says Dublin Inquirer editor Lois Kapila. "I still feel so ashamed of myself for how it made me. At its worst point, each month I would get deeply depressed, anxious, so tired I really struggled to pull myself out of bed, fuzzy-headed so I couldn't think clearly, argumentative, and insecure, and withdrawn.

"One of the worst things is the impact it has on your personal relationships; it's hard to understate the amount of patience my husband has had. Then, each month, you get your period and feel better and piece together your self-worth, your energy returns for a while, you can think clearly and you rebuild trust in relationships - and then it all falls apart again, and again, and again, and it's exhausting and you dread the rest of your life, having to go through it again."

Lois realised that she was experiencing something more than regular PMS around six or seven years ago. "Because it's cyclical and monthly, it's easy to convince yourself when you are in the feeling-good part of the month that the feeling-bad part of the month is just your imagination or to hope, perhaps, it won't happen this month. That sounds really stupid but it's a cycle that can make you feel extremely unsure of yourself.

"I went to see a doctor when I was out of town once about three years ago for something different and my husband nudged me to mention how miserable I was before my periods. He advised me to see a doctor when I was back in Dublin, and I did. She didn't use the words PMDD, but said that she thought it was my hormones, and put me on the pill."

That helped a bit but Lois still had lots of physical symptoms each month and while it was less of a clear pattern, she still had the some of the cyclical depression, anxiety, irritability, tiredness.

"I went back to a clinic a few times, was switched between pills - and a few months back when I went to a doctor and said I was wondering whether anything could be done, he told me that it couldn't be my hormones as the pill I was on basically knocked them out.

"He suggested counselling - but because of the constellation of physical and mental health symptoms and the timing, it just seemed so tied to my period.

"I almost gave up at that point, to be honest. But after a few bad months, I went to see a specialist in London in September and it has completely changed my life. He took me off the pill, and put me on Oestrogel and testosterone gels and the pill, Utrogestan. It's still early days, but I feel like I haven't felt since before adolescence."

"It is important to distinguish between underlying depression (which often worsens before menses) and true PMS or PMDD because the treatments are quite different," says Dr Flood.

There is no single test that can diagnose PMS or PMDD. The symptoms must occur only during the second half (luteal phase) of the menstrual cycle, most often during the five to seven days before the menstrual period, and there must be physical as well as behavioural symptoms. In women with PMS or PMDD, these symptoms should not be present between days four through 12 of a 28-day cycle.

"Women with underlying depression often feel better during or after menses, but their symptoms do not resolve completely," says Dr Flood. "On the other hand, women with PMS or PMDD have a complete resolution of symptoms when their menses begin. Some women who think they have PMS or PMDD actually have depression or an anxiety disorder."

In spite of continual debate about the causes and cures of PMS, and even if it exists at all, we are no closer to understanding it. There is still a big variance in PMS theories and despite lots of research, scientists struggle to quantify, to describe and to treat PMS.

The upside is that women's health issues have advanced, from moon madness and hysteria, to PMS and even to the possibility, put forward by the American Psychiatric Association, that premenstrual syndrome should become a recognised disorder - "late luteal phase dysphoric disorder".

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