PMS: Fact or Fiction-- IT'S FACT BABY!
"PMS is a complex disorder apparently linked to the cyclic activity of the hypothalamic- pituitary-ovarian axis. It is associated with a wide variety of symptoms recurring regularly at the same phase of each menstrual cycle followed by a symptom-free phase each month" (Norris, Sullivan, 3). Symptoms of PMS include: irritability, tension, depression, fatigue, headache, weight gain, bloating, craving for foods, acne, breasts swelling and tenderness, increased appetite and/or thirst, and aggravation of pre-existing conditions. 85% of women experience these symptoms of PMS monthly, although only 5-10% of these PMS sufferers professional and personal lives are seriously disrupted. This 5-10% of PMS sufferers constitutes 3.7 million American women. PMS contributes to divorce, child abuse, alcoholism, hindered professional development and accidents. PMS is an understudied, misdiagnosed and misunderstood phenomenon that affects many aspects of many people's lives. We believe that PMS is a physiological state that is exacerbated by environmental and hereditary factors. Our study surveys twenty pairs of daughters and mothers to find out correlations between physiological changes and environmental and hereditary factors, which we believe affect physical discomfort and mood changes prior to menstruation. The similarities between the answers of mother-daughter pairs are not due to chance. Thus, there must be some reason(s) that mothers and daughters report the exact same/similar degrees of symptoms. Mothers as a group and daughters as a group report similar degrees of PMS symptoms, with the exception of depression and sexual activity. Our study is unable to locate the reasons that mothers and daughters have similar PMS experiences, but it leads us to think that future study would be worthwhile because these similarities do exist.
PMS is a biologically based phenomenon experienced by women cross-culturally. We hypothesize that environmental and social factors determine how women express and deal with PMS. We hypothesize that women will show a significant increase in perceived physical discomfort and perceived mood changes approximately one to ten days before menstruation, indicating Pre-menstrual Syndrome. We hypothesize that the mother-daughter pairs in our surveys will show similar perceived PMS symptoms.
Animals have different kinds of reproductive symptoms. Birds are animals who reproduce using Breeding periods. They are only fertile during certain times of the year, spring for example. The number of hours of daylight may act as a signal for when birds may reproduce.
Some animals reproduce by External stimuli: An external force in an animal's environment triggers ovulation. Rabbits and cats reproduce through this method. Hours following the sex act, the female ovulates. Spontaneous ovulation is a third type of reproductive system. An animal is able to reproduce at specific times within a cycle. Menstruation is an example of spontaneous ovulation. All primates menstruate, but they lose less blood and experience fewer periods than human females because these primates spend more time pregnant and nursing.
Women experience "cryptic ovulation," which hides what phase of her menstrual cycle she is in. Wright claims that this is an evolutionary advantage because this causes a man to stay with his partner, because he is never sure whether or not she is pregnant with his child. This is beneficial for the woman because she receives a high male parental investment.
A woman's menstrual cycle contains four parts: the follicular, luteal, premenstrual and menstrual phases. The follicular phase lasts for 10-14 days, the luteal phase spans 8-10 days, the premenstrual phase 4-6 days and the menstrual phase last for 3-7 days. The lengths of each of these parts vary for individual women. During the follicular phase, the pituitary gland secretes FSH, a hormone that causes ovarian follicles, which contain eggs, to become larger. Then, the pituitary gland secretes LH, a luteinizing hormone. The follicles secrete estrogen, which stop the production of FSH. At the end of the follicular phase, ovulation takes place. The follicle collapses, and starts to make progesterone. At this point, if the egg is not fertilized, the premenstrual phase of menstruation begins within eight to ten days. As estrogen and progesterone levels decrease, menstruation begins.
Menstruation occurs as the endometrium, the lining of the uterus that would nourish a fetus, is expelled from the woman's body ( Rittenhouse, 1989). Samuel Smith defines Premenstrual syndrome (PMS) as "the cyclic recurrence, in the luteal phase of the menstrual cycle, of a combination of distressing physical, psychological, and/or behavioral changes of sufficient severity to result in deterioration of interpersonal relationships, and/or interference with normal activities" (11). Although there are over 200 physical and psychological symptoms reported by woman, including the exacerbation of preexisting conditions, (Schiff, Smith 23), there are three symptoms of PMS that must be present for a diagnosis: (1) specific temporal relationships of symptoms to menstruation; symptoms present during the luteal phase of the
menstrual cycle are absent during the follicular phase of the cycle; (2) symptoms must be severe
enough to interfere with some aspect of lifestyle; (3) PMS is a repetitive phenomenon; symptoms
are present month after month, to some degree (Schiff, Smith 11).
Prior to 1980, PMS was defined as premenstrual tension. PMS was first labeled as Premenstrual Tension (PMT) by Frank in 1931 (Rittenhouse 1). During this time, PMS was not seen as a major problem in woman's health-- PMS was a private matter-- and the "cure" for PMS was often tranquilizers, diuretics, psycho. medications, etc. (Rittenhouse 95).
Between 1980-85 PMS was seen as a "social problem" when in 1980 and 1981 the PMS as insanity defense was first used in two highly publicized trials. In the early 1980s some feminists questioned the validity of PMS and labeled it as an attempt to justify the "inequality" of gender. Many people believe that if a woman suffers from premenstrual syndrome, she is less able than a non-premenstrual person to deal with all aspects of life. This notion has been disproved in many different studies, but the belief persists, and haunts women in schools, workplaces and homes.
In a recent study conducted by Joan Chrisler, 20 women and 11 men from a New Jersey college agreed to take the "Torrence Tests of Creative Thinking" over an interval of six weeks. The study showed that there were no significant differences between the creative ability of men and women at any point during the six weeks. None of the women's scores dropped during the premenstrual phases of their cycles. In fact, some of the women's scores actually increased during this phase. The researchers theorized that the women's false anticipation that PMS would lower their scores may have caused them to try to compensate for this belief. (Taylor, Woods, 1991).
It is now widely believed that PMS is a "real" problem. Currently, there are attempts to clearly define and study PMS symptoms and discuss PMS as a social and medical issue in popular, feminist and medical literature. However, only recently has PMS received the scientific study that it deserves. Various studies have been conducted to find the cause of PMS. Dalton believes that PMS is a "biologically grounded hormonal disorder due to a deficiency of progesterone during the premenstrual phase. This deficiency of progesterone creates a chemical imbalance which affects both the mind and body" (Rittenhouse 10). However, Dalton's hypothesis has not been "universally approven and there is still no scientific evidence for a specific reproductive endocrine catalyst to evoke the PMS symptoms reported by woman (Schiff, Smith 4).
Many gynecologists and psychologists believe that premenstrual syndrome is not directly related to the physical process of the menstrual cycle. They claim that premenstrual symptoms such as backaches, headaches, crying spells, fatigue, etc. are caused by other life situations. They believe that a woman is unable to respond to problems in an appropriate manner, therefore her reaction manifests itself in premenstrual symptoms. Dr. Sturgis, a gynecologist, states that "many dysmenorrheic [painful menstruation] patients had found that menstrual cramps were, for them, a satisfying and appropriate response to their problems. When this response was denied two of them [through treatment], they resolved the resulting conflict by developing a bleeding ulcer and mucous colitis"(Debrovner, 19).
Dr. Notman, a psychiatrist, believes that our conception of femininity and womanhood lead women to develop premenstrual syndrome. He claims that if a young woman has seen her mother experience premenstrual symptoms, or painful menstruation, then she will think that in order to be a true woman, she must undergo the same discomforts. Notman states that "even if a girl's menses are not particularly distressing or painful, she may respond to them or to any discomfort, in the way which is the accepted style, which may have been her mother's style. This is one way of being feminine as she perceives it" ( Debrovner, 56). Dr. Sturgis, a gynecologist, claims that PMS is caused by women suppressing their emotions. He says, "...the reaction to a life situation may be answered by suppression of an appropriate response...the conflict may cause...a ‘functional' endocrine disorder...far removed from the original disturbing life situation" (see chart) (Debrovner, 17).
Between 1973-82 The World Health Organization (WHO) completed a study that examined perceptions and patterns of menstruation. They found that the majority of women in the cultures investigated reported the same physical discomfort during the menstrual cycle. Specifically, Pre-Menstrual Tension (PMS) and general perceptions/patterns of menstruation are not influenced by culture or geographic location. However, factors such as socio-economic status, education, women's prescribed role in society, etc. influenced the types of symptoms reported (such as higher perceived intensity of pain, psychological changes, etc.).
Also, WHO study found that there is an almost universal occurrence of similar menstruation myths and taboos. It is hypothesized that these perceptions of menstruation are part of a broader explanation: psychogenic-- males "fear" menstruation blood; sociogenic-- males and females are socially distant in cultures which leads to misunderstandings.
The charts included in this section, compare the percentages of women in the 14 cultures studied who experienced different symptoms before, during and after menstruation. The t-test shows that there is a significant difference between symptoms experienced during menstruation and after menstruation. This shows that women report less symptoms directly after menstruation. The different charts show, respectively: the percentage of women who reported PMS physical discomfort, the percentage of women per culture who think that menstruation is "dirty," the percentage of women per culture who believe that femininity is related to menstruation, the percentage of women per culture who reported that they experienced mood changes during PMS.
Many myths about menstruation exist throughout the world. Some myths claim that: menstruating women are "unclean" * "the glance of a menstrual woman takes the polish from the mirror and the person who next glances in it will be bewitched" -Aristotle *menstrual women spoil food *sex during menstruation used to be a sin in the catholic church *Moslem menstrual women are forbidden in mosques *a recent study found that women still hold these beliefs, including a few others such as: a menstrual woman should not shave her legs, exercise or walk on cold floors with bare feet (study conducted by Janice Jurgins and Bethel Powers in Menstruation, Health and Illness)
1. Researched the topic of menstruation and PMS, and developed a hypothesis to test with surveys.
2. Compiled our research and presented our findings to the NS II class.
3. Created surveys based on surveys in Premenstrual Syndrome and Modern Management of Premenstrual Syndrome. We modified these surveys in order to test our hypothesis.
a. PMS Rating Scale, answered by twenty pairs of mothers and daughters. See Survey 1. We adapted it so that both daughters could complete the survey and then help their mothers fill out the survey over the telephone, e-mail, etc., instead of having a researcher interview the respondents.
b. Daily Stress and Symptom Inventory (see Survey 2) : This survey consisted of a check list of physical and mental symptoms and activities such as irritability, fatigue, smoking, meditation. The survey was given to men and women in the sophomore Western class. The respondents were asked to check the symptoms and activities that they experienced everyday for one month. This survey was intended to show difference (or lack of differences) among men's and women's physical and mental health and activities over one month. We expected to find patterns that may have been attributed to menstruation and PMS. We discovered, however, that due to the involved nature of the questioners, few of the subjects completed the survey. Therefore, we eliminated the survey.
c. Daily Physical and Emotional Inventory (see Survey 3) : This survey is similar to the Daily Stress and Symptom Inventory, but respondents recorded their own symptoms (instead of having a list given to them) over a time period of one month. This survey could have helped to show any biases in our questions from surveys one and two. We gave this survey to men and women in the sophomore Western class. Again, few respondents completed the survey, thus we did not use it in our study.
d. Menstrual Period Cycle for month of April (see Survey 4)
e. intended to give all female respondents of surveys two and three this survey, in order to see if there was any correlation between their physical and mental health and PMS. This survey would have allowed us to gauge women's PMS symptoms without them telling us. This could have enabled us to avoid negative cultural connotations about PMS.
4. We hounded women and their moms in order to compile our data from survey one.
5. Analyzed our data from survey one using Statview and Cricket graphs
a. We went through the forty surveys and tallied each mother's and daughter's responses to each of the ten questions on the survey. We also looked at each individual mother/daughter pair (twenty pairs in all), and tallied how many responses were exactly the same. In order to see if the mother/daughter pairs' same answers were due to chance, or some other reason, we generated twenty pairs of random numbers using a scientific calculator.
b. We used Statview to compare the mother/daughter pairs' answers to the values we generated for our experimental group. Then we used Statview to compare observed versus expected values for each pair. We completed the paired t-test to show if the means for the actual and experimental groups were similar.
c. We used Statview to compare mothers' and daughters' responses to each of the ten questions on the survey. If there were no responses for the "severe" category we placed it into the "moderate" category. We used the Contingency tables to create a summary table, observed frequencies and expected values for each question. If the p-value was significant, we used Cricket program to make a bar graph.
Table 1: The Observed Frequencies for Rows, Columns Table compares column 1 (the actual number of same responses for each mother-daughter pair) with column 2 (the random number generation). This table just reports our data. The Expected Values for Rows, Columns Table shows the values we would expect to get if the actual mother-daughter pairs and the random number generation mother-daughter pairs had similar means (e.g., no significant different, the nulll hypothesis is true).
We ran the paired t-test to compare the actual mother-daughter similar response versus the random mother-daughter similar responses. The degrees of freedom is 18; the T-Value is 2.306; the P-Value is .0332. The P-Value is significant because it is less then .05; therefore, the two means are statistically different-- the null hypothesis is void. Thus, the patterns of the mother-daughter pairs' number of same responses is not due to chance. We think that this similarity in mothers and daughters is due to environmental and/or genetic factors. However, our survey does not allow us to distinguish between possible causes.
QUESTION DF CHI-SQUARE P-VALUE
1: irritability 3 2.5 .46
2: tension 4 4.3 .36
3: efficiency 4 1.7 .79
4: depression 3 11.9 .008*
5: motor coordination 2 .46 .79
6: mental functioning 3 3.5 .32
7: eating habits 2 4.9 .08
8: sexual activity 2 8 .018*
9: physical symptoms 3 .38 .95
10: social impairment 3 .67 .88
* = significant value
This chart shows that most of the tests for each question did not yield a significant P-Value because mothers' and daughters' responses were similar.
Question 1, Irritability-Hostility: The P-Value is .46 and this shows that the means for the mothers' versus daughters' rankings of severity of irritability-hostility are similar. The graph visually shows that the "mild" ranking was the most common response for both mothers and daughters. This supports are hypothesis that mothers and daughters experience similar PMS symptoms. We hypothesize that this similarity is due to environmental factors in the home and/or genetics. Perhaps, ones' culture also contributes to this similarity through socially constructed ideas about PMS. We also believe that the same cultural, environmental factors within the home and genetics factors primarily contribute to the mother-daughter similarity in questions 2, 3, 5, 6 and 10 because they had similar P-Values to question 1. Please see above chart.
Question 4, Depression: The P-Value is .008; this is significant because it is less than .05. Therefore, the means for the mothers' and daughters' rankings of the severity of depression are significantly different (e.g., not due to chance). The graph shows that most mothers reported "trivial" or "no" depression while daughters reported "mild" to "moderate-severe." We hypothesize that this difference is due to a generational gap: that is, the younger generation is more susceptible to and/or allowed to express depression.
Question 7, Eating Habits: Although there is no statistically significant difference between mothers and daughters eating habits during PMS, we graphed this because most daughters reported a "mild" change while the mothers were more evenly distributed between "no, mild and obvious" changes.
Question 8, Sexual Drive & Activity: The P-Value is .018 and this is significant. 15 daughters reported that they experienced a "mild" change in sexual drive and activity during PMS while only 5 mothers did. The mothers reported 9 "no" change in activity while daughters reported 3; these differences could be due to age differences and/or mothers not wanting to tell their daughters about their sex lives. If we had asked the mothers ourselves, instead of daughters, we think that the means would be similar.
Question 9, Physical Symptoms: The P-Value is .95 and that means that the mothers and daughters reported similar ranking of physical PMS symptoms. The chart shows that the mother and daughter bar graphs are almost identical. We believe that this is primarily due to genetic causes, although how one "deals" with physical pain could be influenced by their environment: cultural and home.
The similarities between the answers of mother-daughter pairs are not due to chance. Thus, there must be some reason(s) that mothers and daughters report the exact same/similar degrees of symptoms. Our study is unable to locate the reasons that mothers and daughters have similar PMS experiences, but it leads us to think that future study would be worthwhile because these similarities do exist. Mothers as a group and daughters as a group report similar degrees of PMS symptoms, with the exception of depression and sexual activity.
Our study presupposes that PMS is a physiological phenomenon which is influenced by cultural perceptions of menstruation, environmental cues and heredity. Mothers' and daughters' responses about depression and sexual drive and activity, however, differed from each other. We hypothesize that these differences are due to cultural influences. It is now socially acceptable for young women to express feelings of depression. Today, there are many images of women who become sad during PMS in the media. This might influence how women report the symptoms. Younger women may feel comfortable admitting to higher levels of depression because they are told by society that it is normal. They are more able than older women to report depression. These women are not "making up" their depression, it is rooted in physiological changes in hormones. Mothers and daughters may have different responses to the question about sexual activity due to cultural attitudes about sex. Mothers might feel uncomfortable talking about sex with their daughters. Therefore, in a future study, we would suggest that researchers personally interview each of the respondents.
After completing our research and study we have new questions. Perhaps some PMS symptoms are caused by heredity, and passed down from mother to daughter, such as physical symptoms and depression. These two symptoms have the potential to exacerbate other symptoms like tension, sex drive, hostility, menta/cognitive functioning and eating habits. These other symptoms are also influenced by cultural factors. Throughout the world, it is socially acceptable for women to express different symptoms, if they talk about menstruation at all. We would suggest that a future study designs a method to discover the causes of PMS symptoms, heredity vs. environment, or a combination of both. In our opinion, this would be beyond the scope of a Discovery Lab.
We would suggest, for future Discovery Labs, that students attempt to administer the surveys that we made but could not use. These surveys have the potential to show if women are socially conditioned to report the socioculturally recognized PMS symptoms. We hypothesize that men and women would report different symptoms, especially marked by the PMS phase of a woman's cycle. We would also suggest that the students have some form of commitment to the surveys, such as a grade, so that they are sure to complete them honestly and fully for an entire month. Also, it would be beneficial to expand the pool of subjects that is used in the mother/daughter survey. Representation of different ethnic, cultural and economic backgrounds would strengthen the study. Perhaps posting this survey to the World Wide Web would help accomplish this goal.
Carter, Bonnie Frank, and Benson E. Ginsburg, eds. Premenstrual Syndrome: Ethical and Legal Implications in a Biomedical Perspective. New York: Plenum Press, 1987.
Christin, Barbara, and Robert Snowden. Patterns and Perceptions of Menstruation: A World Health Organization International Collaborative Study. New York: St. Martin's Press, 1983.
Debrovner, Charles H. Premenstrual Tension: A Multidisciplinary Approach. New York: Human Sciences Press, Inc., 1982.
Lein, Allen. The Cycling Female: Her Menstrual Rhythm. San Francisco: W.H. Freeman and Company, 1979.
Lupton, Mary Jane. Menstruation and Psychoanalysis. Chicago: University of Illinois Press, 1993.
Norris, Ronald V., Colleen Sullivan. Premenstrual Syndrome. Rawson Associates: New York, 1983.
Rittenhouse, C. Amanda. The Emergence of Premenstrual Syndrome: The Social History of a Women's Health ‘Problem.' Bell and Howell Company: Ann Arbor, 1989.
Schiff, Isaac, Samuel Smith, eds. Modern Management of Premenstrual Syndrome. Norton Medical Books: New York, 1993.
Taylor, Diana L., Nancy F. Woods, eds. Menstruation, Health and Illness. Hemisphere Publishing Corporation: New York, 1991.
Wade, Carlson. PMS Book: What You Need to Know. Keats Publishing, Inc.: New Canaan, 1984.
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