PMS PROPOSAL HAYS

This research topic submitted by rebecca kebbel and molly farrell (farrelma@miavx1.miamioh.edu) on 2/25/98.

PMS: FACT OR FICTION
by Molly Farrell & Rebecca Kebbel

ABSTRACT:
“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 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 will survey women and their 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.

HYPOTHESIS:
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 think that environmental (e.g., stress, nutrition, sleep, etc.) and hereditary (female relatives’ perceived symptoms) factors equally exacerbate physiological changes during the menstrual cycle: follicular, luteal, pre-menstrual and menstrual phases.

INTRODUCTION:
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 lutenizing 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 womyn, 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 womyn’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. However, 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 womyn (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 sastisfying 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).

METHODS:
Fifteen women will record perceived physical discomfort and perceived mood changes daily, for a period of one month. These fifteen women and their mothers will record their general beliefs and personal histories with PMS. Please see surveys.

RATING SCALE
FOR PREMENSTRUAL TENSION SYNDROME

Name:
Identification No.:
Rater:
Date:

Please circle the most appropriate score for each term:

1. Irritability-- Hostility
(Irritable, hostile, negative attitude, angry, short-fused, yelling and screaming at others)

0. Not irritable
1. Doubtful, trivial
2. Mild. Occasional outbursts of anger and hostile behavior.
3. Moderate. Irritable behavior evident; frequent outbursts.
4. Severe. Affects most interactions between myself and significant others.

2. Tension
(Tense, restless, jittery, upset, high-strung, unable to relax)

0. Not tense
1. Doubtful, trivial.
2. Mild, occasional tension.
3. Moderate. Tense, jittery, unable to relax; restless behavior evident.
4. Severe. Constantly tense and upset.

3. Efficiency
(Decreased efficiency, easily fatigued)

0. No disturbance.
1. Doubtful, trivial.
2. Mild. Somewhat reduced efficiency.
3. Moderate. Easily fatigued, gets much less done than usual.
4. Severe. Fatigue causes serious interference with functioning.

4. Depression

0. Not depressed.
1. Doubtful, trivial.
2. Mild depression; somewhat blue, sad.
3. Marked spontaneous emotional sadness; occasional crying; feelings of loneliness.
4. Severe, obvious persistent.

5. Motor Coordination
(Clumsy, prone to accidents, lowered motor disturbance)

0. No disturbance.
1. Doubtful, trivial.
2. Mild clumsiness, feel awkward.
3. Moderate. Frequent “accidents” while doing simple housework or on the job.
4. Severe impairment in motor coordination; e.g., unable to write properly, unable to drive.

6. Mental/Cognitive Functioning
(Forgetful, poor concentration, distractible, confused, lowered judgment)

0. No disturbance.
1. Doubtful, trivial.
2. Mild. Slight forgetfulness and distractibility.
3. Moderate. Performance impaired by poor concentration, cognitive disorganization, forgetfulness, etc.
4. Severe. Marked deterioration in cognitive capacity, poor judgment, leading to regrettable decisions.

7. Eating Habits

0. No change.
1. Mild increase in food intake, eating at odd, irregular hours, mostly snacks and sweets.
2. Obvious, marked increase. Uncontrollable cravings for sweets, chocolate, etc.

8. Sexual Drive & Activity

0. No Change.
1. Mild but consistent increase or decrease in sexual drive, desire, libido.
2. Marked change in sexual drive with definite change in sexual behavior.

9. Physical Symptoms
(Painful or tender breasts; swelling of abdomen, breasts, ankles, or fingers; water retention; weight gain; headaches; low-back pain; etc.)

0. No physical symptoms.
1. Doubtful, trivial.
2. Mild. Some symptoms, increased awareness of bodily changes.
3. Moderate. Obvious changes and complaints.
4. Severe. Physical symptoms are incapacitating. Pain and discomfort.

10. Social Impairment
(Avoidance of social activities and interactions with family, at home, at work, at school, etc.)

0. No social impairment.
1. Doubtful, trivial.
2. Mild avoidance of social activity.
3. Moderate but obvious impairment of social activity, mainly noticeable at home and with family.
4. Severe. Marked impairment of most social interactions including at work or school; withdrawal, isolation.

STRESS INVENTORY
Name:
Date:

Please check if you did or did not do any of these activities today.

YES NO
TAKE TRANQUILIZERS
TAKE CAFFEINE
SMOKE
EAT SWEETS
EAT SALTY FOODS
DRINK ALCOHOLIC BEVERAGE
EXERCISE
TALK WITH A FRIEND
MEDITATE
UNHAPPY FOR NO PARTICULAR REASON
POWERLESS TO CHANGE THINGS
TELL A JOKE
TAKE A WALK
TAKE ASPIRIN
USE RECREATIONAL DRUGS


SYMPTOM INVENTORY
NAME:
DATE:


Please check to what extent, if any, you experienced any of these symptoms today.

ABSENT MODERATE SEVERE
IRRITABILITY
BACKACHE
DIARRHEA
FATIGUE
CRAMPS
LACK OF CONCENTRATION
INCREASED ENERGY
CLUMSINESS
ACNE
OVARIAN PAIN
CRAVINGS FOR SWEET FOODS
HEADACHES
INCREASED ARGUMENTS
BREAST SWELLING
CRAVING FOR SALTY FOODS
INCREASED SEX DRIVE
DECREASED SCHOOL/WORK PERFORMANCE
WEIGHT GAIN
FORGETFULNESS
DECREASED SEX DRIVE
TENDER/PAINFUL BREASTS
DEPRESSION
RUNNY NOSE
SORES IN MOUTH
CONSTIPATION
SUSPICIOUSNESS/PARANOID
ANGER
CRYING SPELLS
MOOD SWINGS
CONFUSION
BURST OF ACTIVITY
DISTRACTIBLE
INCREASED ALCOHOL CONSUMPTION
SEIZURES
INCREASED NEED FOR RELIGION
DIZZINESS OR FAINTNESS
AVOID SOCIAL ACTIVITIES
RESTLESSNESS
GENERAL ACHES AND PAINS
TENSENESS
INDECISION

WORKING BIBLIOGRAPHY

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. Marttin’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 Franciso: 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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