Of Course Your Pain is Real: Understanding The PMS Debate

“I could not hate this author or this article more.”

“Thanks for the man-splaining.”

These are just a couple of the angry responses to an excerpt from Frank Bures’ book published on Slate.com about PMS.

 

There were hundreds of comments from women who definitely wanted to kill this guy; they felt ignored and invalidated. I imagine that the title of the excerpt didn’t help:

“Is PMS Real or is it Just a Figment of our Menstruation-fearing Culture.”

 

No one likes being told that something they experience is only a figment of their imagination. Many of the commentators testified to their experiences of migraines and awful cramps related to menstruation, and more than a few mentioned the medical field’s long history of attributing women’s pain to being all in their heads. New York Magazine’s Science is US blog posted a response to this titled: “Yes PMS is Real – and So Is Our Tendency to Ignore Women’s Pain.”

 

But wait a minute. When did PMS become the label for migraines and debilitating cramps? There seems to be a wide disconnect in the way some people use this label that is fueling confusion and resentment. The conditions that cause severe menstrual-related pain that many women mentioned as proof of their PMS, like endometriosis and PCOS (polycystic ovarian syndrome) are conditions acknowledged by physicians to be painful and requiring medical treatment. But these don’t have anything to do with PMS as it is generally understood.

 

People generally use the label of PMS, to refer to psychological symptoms (moodiness, irritability) and some physical symptoms (bloating, breast tenderness) that are thought to occur in the week before menstruation.  But as I presented in my Tedx Talk “The Good News About PMS,” the definition of PMS gets murky from there. Over the years, psychologists have done such a bad job defining PMS by including up to 150 possible symptoms, and not being specific about timing, intensity, or duration of symptoms, such that anyone and everyone could receive this diagnosis. And Bures does refer to this problem in his book. But he certainly could have been clearer. The inaccuracy of the PMS diagnosis was such a problem that it doesn’t appear in the DSM (the manual of mental disorders used by mental health professionals). There is no official diagnosis of PMS that physicians or psychologists use. It was just too vague to identify anything meaningful.

 

What is in the DSM is the diagnosis of PMDD. This refers to Premenstrual Dysphoric Disorder. And the criteria for this diagnosis are very clear: There are only a total of 11 possible symptoms: marked anxiety, depression, irritability, or mood swings, and decreased interest in activities, difficulty concentrating, lack of energy, appetite and sleep problems, feeling out of control, and physical symptoms like breast tenderness/bloating. To be given this diagnosis a woman has to experience at least one of the first 4, and at least 4 other symptoms from the list. The symptoms have to be so severe that they effect her daily functioning at work or in relationships, and they have a to appear only in the week before her period and get better after her period starts. And, they have to be documented for at least 2 to three menstrual cycles in a row. Using that criteria, there are several studies that show that between 3% and 8% of women are diagnosed with PMDD.

 

So why does the concept of widespread PMS have such staying power in public opinion? A couple of reasons. First, some women do experience some physical and psychological symptoms before they get their periods. I’m not saying that doesn’t happen. What I’m saying is that these symptoms don’t reflect a disease that needs treatment. The moods of women and men go up and down for all kinds of reasons, and the degree to which the great majority of women experience changes in mood during the month is not outside the normal range of human behavior. We have this perception that the healthy human always has an even mood but that is just not the case. And our bodies don’t always feel exactly the same. Some days we feel great and some days we don’t. Muscles ache, we get occasional headaches, or we feel tired. Again, the symptoms like this that many women get before their period are not outside the normal human range of feeling. It is inaccurate to call these symptoms a disease, and it is dangerous.

 

Why is it dangerous? Well anyone can see that a lot of effort is put into convincing people that PMS exists. It’s in magazines, the internet, movies, and the ubiquitous PMS jokes. There is a lot of investment in the idea that women are hormonally crazed and out of control.

One of the best sources of this myth is the PMS joke. What do you get when you mix PMS with a gps? A bitch who can find you.

What does PMS stand for? Poor Man Syndrome, Psychotic Mood Swing, or Pardon My Sobbing.

 

The dangerous power of this myth is revealed when it is argued that most women become crazy, hormonal lunatics every month, because then you can justify keeping them out of power – out of the boardroom and out of the White House. You have erased the reality that the great majority of women function emotionally and professionally at a very high level on a daily basis. Women have a tremendous amount to offer in many facets of society, but they can’t bring their strengths to arenas they aren’t allowed to enter because of a persistent but inaccurate myth about their competence.

 

Central to the PMS myth is the idea that women’s anger is regularly caused by fluctuating hormones (and not reason). This is dangerous because it makes it easy to ignore and invalidate women’s feelings. Their concerns at home or in the office can be easily swept under the rug with a cavalier “it’s only PMS.” It shuts women down and silences their voices.

 

So while women’s monthly experiences should not be invalidated, the way in which we label them has far-reaching consequences for women’s status and opportunity.

 

Dr. Robyn Stein DeLuca is a scholar, speaker, and author on the subjects of Health Psychology, Reproduction, and Religion.

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3 Responses

  1. Endaevour Ed

    Severe menstrual cramps can be a part of the natural period cycle, and not necessarily something to do with PCOS or endometriosis. Sometimes this runs in families. Such pain is debilitating, but not abnormal. Some women have a difficult menopause, others don’t. I’m talking here about physical symptoms.

    You can understand why women who are hwalthy, but have debilitating menstrual pain could easily misunderstand your point. At least a clarification is in order.

  2. Endaevour Ed

    Ok, my comment does not seem to have appeared, so I’m posting again.

    Severe menstrual cramps are not necessarily a sign of PCOS endometriosis. Sometimes it runs in families, and starts at menarche. Often, but not inevitably, it reduces in intensity as a woman grows older. This pain may be debilitating, but is NOT abnormal and does not require systemic treatment. Similarly, women’s experiences of menopause may be different. Some have troubling symptoms, others don’t.

    You could imagine why your piece upsets otherwise healthy women who have painful periods. Your piece does sound dismissive of their experiences. At least a clarification is in order.

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