Introduction
Any female-presenting person above the age of 12 has likely heard something
along the lines of “Calm down, you must be on your period” in response to a demeanor that strays at all from neutral. The idea that women are delusional, dramatic, and slaves to their menstrual cycles is a longstanding stereotype that coincides with premenstrual syndrome (PMS). PMS has a wide variety of definitions, but a commonly accepted one is “a collection of predictable physical, cognitive, affective, and behavioral symptoms that occur cyclically during the luteal phase of the menstrual cycle and resolve quickly at or within a few days of the onset of menstruation.”(1) Although these symptoms are characteristic of a genuine disorder, PMS is often regarded as an excuse for women to act dramatic within the days leading up to menstruation or a way for other people to disregard women’s feelings, problems, or genuine medical needs. The perpetuation of stereotypes surrounding PMS in media and throughout society are directly harmful to the mental health, proper reproductive health education, and medical care of people who menstruate across the globe.
What are PMS and PMDD?
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are defined relatively similarly in a clinical setting, but their differences come in when these terms are applied. PMS is used to refer to broad cases where “the symptoms included are menstrual migraine, menstrual molimen and premenstrual tension not otherwise specified. Approximately 3% to 8% of women of reproductive age report much more severe premenstrual symptoms [PMDD] of irritability, tension, dysphoria, and lability of mood, which seriously interfere with their lifestyle and relation- ships. Without relief from these symptoms, a woman's functioning in the home, in social situations, and at work can be substantially impaired each month, often over a span of many years.”(2) PMDD greatly lowers the quality of life of its sufferers and is often compared to things like bipolar disorder and major depressive disorder (3). This disorder is fairly common, yet it is not recognized by the World Health Organization in its report over the burden of mental and physical disorders (containing 483 disorders)(3). Due to this under representation of the realities of PMS and PMDD in media and research, the masses are undereducated on the subject. This leads to sufferers not being properly informed to understand the cause of their symptoms and, therefore, not seeking proper treatment for them.
A main problem with the clinical recognition of this disorder is the lack of its appearance in the DSM (Diagnostic and Statistical Manual of Mental Disorders) until the DSM-IV. Even being included in the manual, its cutoff points and restrictions made it difficult for some very-affected sufferers to be acknowledged as having PMDD. The DSM-IV makes a harsh cutoff for sufferers of PMDD to have at least 5 severe symptoms (3). This restriction remains controversial but has not been harshly addressed. If a sufferer of PMDD does happen to find out their diagnosis and wants to seek treatment, they will likely still be faced with adversity. “A major problem with the ascertainment of treatment seeking of women with PMS and PMDD is that most published studies were conducted prior to the increased awareness of the efficacy of SSRIs for PMDD and the FDA approval of Sarafem™ for PMDD. Thus, earlier studies are not likely to reflect current SSRI use patterns.”(3) Only 1/3 of women who were surveyed after being treated for PMS and/or PMDD (using one or more of the following: exercise, natural progesterone, diet changes, antidepressants, stress reduction, estrogen, and anxiolytics) in the early 2000s said they were satisfied with their treatment (3). All in all, PMS and PMDD are not taken seriously, not included in education systems enough, not included properly in women’s advocacy systems, and not researched enough for treatment options.
How Does PMS Affect the Studying and/or Working Woman?
To understand how premenstrual syndrome could affect a person’s life in school
and/or in the workplace, you must understand how the menstrual cycle works. The
menstrual cycle is a hormonal cycle controlled by multiple parts of the brain that usually lasts around 21 to 35 days on average and depending on the person. Many factors affect this cycle such as genetics, birth control methods, physical health, weight, etc. but to understand where PMS comes into play, we will just focus on the average/normal menstrual cycle. The cycle is divided into sections or phases based on the function being produced by the reproductive organs at that time. The phases are the menstruation phase, the follicular phase, the ovulation phase, and the luteal phase. In a typical 28-day cycle, the menstruation phase refers to days one through five on average and is when the lining of the uterus will shed if pregnancy has not occurred (4). The follicular phase follows menstruation and typically lasts from days six to 14. This is when estrogen levels increase to thicken the lining of the uterus and follicle stimulating hormone also increases, causing follicles within the ovaries to grow (one of which will mature into an ovum/egg between days 10 and 14)(4). The ovulation phase refers to around one day, usually around day 14, where a sudden increase in luteinizing hormone causes the ovary to release the mature egg in a process known as ovulation 4 . The final phase, luteal, lasts from day 15 until the end of the cycle until it is time for menstruation again. This is when the uterus is preparing the uterine lining for pregnancy and the egg for fertilization. If the egg is fertilized, it implants in the uterine wall and begins a pregnancy and if the egg is not fertilized, menstruation occurs and begins a new cycle.(4)
(8)
PMS occurs during the luteal phase of the menstrual cycle, therefore, people
who experience its symptoms are doing so for around a week on average. Taking this into account for every single menstrual cycle a woman goes through in an academic year or a year in the workplace, almost a quarter of their time at school or work would be impacted by PMS symptoms. This is made even worse by lack of treatment, support, and education for these issues. Cross-cultural issues also affect this problem. Many communities see menstruation as dirty or shameful, further stigmatizing women’s issues and making them less likely to seek help when they are experiencing PMS symptoms. “In Hong Kong, about 10% of the secondary schools were found to have no sex education on the topic of menstruation. Less than half of the secondary schools in Hong Kong who responded to a survey (n = 348 schools) indicated that the schools had formulated an overall policy in the implementation of sex education. Thus, when these adolescent girls approach puberty, those with lack of support or education may not be well prepared to handle all the associated changes accompanying their menstruation.”(5) Menstrual cycles in general make it harder for young girls and women to attend classes and keep up with schoolwork due to the need for products (which oftentimes are not
provided in school) and time to properly change those products to maintain hygiene. In addition to this baseline issue, women experiencing PMS symptoms have even more difficulty with schooling with increases in mood swings, anxiety, physical discomfort, and many other symptoms. Many schools do not provide sex education at a high enough capacity (or any at all) to provide these students with enough knowledge to understand their bodies and how to advocate for them. In a study of 94 schoolgirls aged 14 through 18, an educational program was developed and presented to the experimental group while a control group received no presentation or information (5). “The schoolgirls in the experimental group reported less PMS symptoms 3 months after the educational program, while no significant changes were found in the control group.”(5) Learning about the way their menstrual cycle worked, why PMS symptoms arose, and how to treat them on an individual level gave the students the tools they needed to manage their own bodies and improve their overall experience during the premenstrual phase of their
cycle. This, in turn, improves their schooling experience.
It is understandable that young girls who are just going through puberty would have struggles regarding their menstrual cycles, but what issues are facing adult women who still struggle with PMS symptoms? Women make up approximately 46% of the workforce (6). Common issues that arise from PMS symptoms in the workplace include decreased work quality, absence from work, and decreased self-esteem. All of these together compiled with the over 150 other documented PMS symptoms make it a genuine challenge for many women to live up to their personal standards of work (6). While this may sound like an excuse to get out of doing work, this is rarely the case. Women are often discriminated against during hiring processes and promotion processes due to these stereotypes. In many cases, an outsider would never know a woman was experiencing any adverse symptoms during her menstrual cycle. Women have had to overcompensate for the lack of trust and high levels of sexism in the workplace for as long as they have been allowed to work, so putting on a smile and pretending that everything is okay is an extremely common practice. This should not have to be the case, though. If the workplace was more commonly a place of understanding, support, and education for its employees, PMS symptoms could be shared and dealt with in healthier ways that would boost the esteem and trustworthiness of the women in the workplace while not encouraging slacking or deflecting work. "The best way to conquer PMS is by understanding the symptoms and taking action to
alleviate them.”(6)
How PMS Stereotypes Feed the Idea of the “Delusional Woman”
Many of the common sexist narratives we see today stem from a logical fallacy surrounding premenstrual syndrome. “While a causal association between the female reproductive system and ill health is not necessarily ‘wrong’ or sexist, a widespread (yet incorrect) assumption that a generalized converse logical position also holds true, is much more problematic. That is, ‘if ill health is caused by the womb (in some women), then all women are ill (by virtue of having wombs).’ Indeed, it is this logical fallacy that underpins much of the myth of the irrational female.”(7) From around the 16th century, the term “hysteria” had been used to describe women having really any demeanor other than happy and pleasant. This term was used to consistently enforce the idea that women were physically, emotionally, and intellectually inferior to men.(7) This term is now considered outdated and hurtful, but its messages are still carried today through stereotypes associated with premenstrual syndrome. To a lot of people, PMS is just another way of saying a woman is being hysterical, dramatic, delusional, or irrational
due to the simple fact of her being a woman. As we have learned, this is absolutely not the case, but the lack of correct information in mainstream media and within education systems perpetuates this harmful array of myths. “PMS research has, so far, been typified by contradictory, irreplicable, and usually highly contested, findings. This may partly be explained by the fact that for most of its history, it has been subject to a form of confirmation bias, or circular logic. By focussing on mood-based menstrual symptoms and neglecting those that are physical, PMS research unavoidably overlooks critical elements in the etiology (cause), prevalence, patient experiences, and treatments of menstrual cycle-related symptoms as a whole.”(7)
Conclusion
What can we do about the harmful stereotypes surrounding premenstrual
syndrome? This is a complicated question because the solution must be systematic. We need to see change in film representations of PMS, the sex education system, the general education system, the menstrual cycle tracking applications, to workplace, and anywhere else where the concept of women, menstrual cycles, or dysphoric disorders could possibly arise. People need to educate themselves on what goes on during the menstrual cycle, what PMS means, how to address its symptoms, and how to deal with inappropriate stereotypes in real time. In the current state of our society, it is more important now than ever that our young girls and women are knowledgeable about their own bodies to the level that they can confidently and correctly advocate for themselves. “Explicitly recognizing and countering the myth of the irrational female and its influence on the way in which PMS is clinically described and managed, is an important step toward better supporting those who do experience cyclical symptoms, without unintentionally implying that the menstrual cycle is itself a form of illness, or any sort of ‘biological’ justification for gender inequality.”(7)
References
(7)Bobel, C., Winkler, I., Fahs, B., Katie, Hasson, A., Arveda, E., & Roberts, T.-A. (2022). The Palgrave Handbook of Critical Menstruation Studies. Retrieved from https://library.oapen.org/bitstream/handle/20.500.12657/41299/2020_Book_ThePalgraveHandbookOfCriticalM.pdf?sequence=1#page=323
(5)Chau, J. P. C. (1999). Effects of an educational programme on adolescents with premenstrual syndrome. Health Education Research, 14(6), 817–830. https://doi.org/10.1093/her/14.6.817
(4)Cleveland clinic. (2022, December 9). Menstrual Cycle (Normal Menstruation): Overview & Phases. Retrieved from Cleveland Clinic website: https://my.clevelandclinic.org/health/articles/10132-menstrual-cycle
(Image)DO, A. H. (2013, October 17). Your menstrual cycle — the basics. Retrieved from Women’s Health Network website: https://www.womenshealthnetwork.com/pms-and-menstruation/your-menstrual-cycle-the-basics/
(3)Halbreich, U., Borenstein, J., Pearlstein, T., & Kahn, L. S. (2003). The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology, 28(3), 1–23. https://doi.org/10.1016/s0306-4530(03)00098-2
(2)Steiner, M. (2000). Premenstrual syndrome and premenstrual dysphoric disorder: guidelines for management. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1408015/pdf/jpn00088-0045.pdf
(6)Tempel, R. (2001). PMS in the Workplace. AAOHN Journal, 49(2), 72–78. https://doi.org/10.1177/216507990104900203
(1)Zaka, M., & Mahmood, K. (2012). PRE-MENSTRUAL SYNDROME-A REVIEW (pp. 1684–1691). Retrieved from https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=7755d18524f1c89e21cfa59c0d2cde1b3527d218