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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