Perceived Stress and Severity of Perimenstrual Symptoms: The BioCycle Study
Conclusions: These analyses show that higher perceived stress precedes an increased severity of perimenstrual
symptoms. Stress reduction programs may be an effective, nonpharmaceutical treatment for physical and
psychological symptom relief.
40%–60% of reproductive-aged women experience
PMS is a collection of physical, behavioral, and psychological
symptoms that occur in the late luteal phase of the menstrual
cycle, abate during menses, and are generally absent
during the week after menses.9
Asuspected etiological pathway is linked to slight irregularities
in the normal variation of ovarian hormones throughout the
menstrual cycle, as ovulation suppression is known to avert
premenstrual symptoms;15 however, differences in reproductive
hormone levels have not been consistently identified.
High perceived stress in the previous month was associated
with a significantly increased risk of moderate=severe
symptoms for all 5 psychological and the majority of physical
symptoms, with odds ranging from 2.0 to 3.0 for most of the
symptoms (Table 2). Adjustment for age, education, and
passive and active smoking did not have an appreciable impact
It is not clear how stress may contribute to increased perimenstrual
symptom severity, although stress-induced changes
in ovarian hormone levels and neurotransmitters may be
54 Stress reduction programs
we agree with Wang et al.54 that stress reduction
programs for reducing psychosocial stress may be a
potentially noninvasive and cost-effective method for PMS
relief compared with pharmaceutical treatments.
Premenstrual Syndrome as Scientific and Cultural Artifact
Between 1931 and 1980 there were steady references to premenstrual issues in the medical
literature. In her review of the PMS literature, Rittenhouse states: “[a]uthors generally
constructed PMS as a medical phenomenon requiring management and treatment by a
physician or a psychiatrist/psychologist. However, PMS was not seen as a major problem
for the majority of women” (Rittenhouse, 1991:416). Nor was PMS seen as a major research
problem for most scientists.
Dalton’s own popularity, notoriety, and authority as a PMS “expert” heightened when she
served as the chief defense medical expert in a 1981 murder trial in London, in which she
successfully argued that the defendant was not responsible for murdering her lover because
she suffered from a severe form of PMS (see Laws et al., 1985 for an account of this trial). The
publicity generated from this trial and Dalton’s claims of successful progesterone treatments
found many different audiences in the United States and brought publicity to PMS.
Heneson points out that PMS acquired medical
legitimacy: “After years of telling women their problems were ‘all in the head,’ the proportion
of doctors who accepted PMS as a real disease reached critical mass” (1984:67).
Studies of the history of menstruation in human society point out that menstrually related
disorders are often associated with the practice of labeling women and their behaviors crazy
(dating back to ancient Greek writings) (see Delaney et al., 1988; Martin, 1987; Olesen and
Her answer is that it is no accident that the initial interest in
what is now called PMS emerged during the 1930s: “It strikes me as exceedingly significant
that Frank was writing immediately after the Depression, at a time when the gains women
had made in the paid labor market because of World War I were slipping away. Pressure was
placed on women from many sides to give up waged work and allow men to take the jobs”
In an article in Ms. magazine, members of the Boston Women’s Health
Book Collective continue their advocacy by claiming that “the cure for PMS may lie in
resocialization and societal change, not medicine” (1992b:76).
PMS is a serious problem that can be debilitating for those suffering from its effects. The loss
of control, mood swings and depression often impairs one’s function within the family and at
work. The cartoons displayed here are not meant to offend, or belittle the seriousness of the
problems PMS sufferers have to face. Humor can often serve as an introduction to discuss a
sensitive subject. That is the sole purpose wherein this material is provided (1995:http://www.
The images and humor are contradictory and ambivalent. Granted
some of the jokes (e.g., the pit bull joke) are in bad taste and do promote an extremely
negative image of women. On the other hand, “PMS Barbi” seems like a perfect and ironic
inversion of the stereotype of the perfect American woman.
The discussion of PMS humor and artifacts brings us to the important consideration that
one very significant way in PMS is “real”—that PMS is an industry. The PMS industry
consists of what I call the 3 P’s (products, pills, and prescriptions). Most of the PMS humor
and artifacts are found as products that are bought and sold in the economic marketplace.
The postcards, greeting cards, calendars, cartoon and humor books, and songs all come with
a price tag attached. Greeting cards currently cost anywhere from $1.25 to $3.00; books,
calendars, and t-shirts run in the $10 to $15 range. PMS products will be available as long as
people are buying these and other PMS-related products.
The market for over-the-counter PMS products was so great that the Food and Drug
Administration (FDA) came up with its own definition of PMS in 1982. Its Advisory Review
Panel on Miscellaneous Over the Counter Internal Drug Products defined PMS as
A recurrent symptom complex that begins during the week prior to menstruation and usually
disappears soon after the onset of the menstrual flow. This symptom complex consists
predominantly of edema, lower abdominal pain (including cramps), breast tenderness, headache,
abdominal bloating, fatigue, and the feelings of depression, irritability, tension and anxiety (as
quoted in Golub, 1992:182).
Another important piece of the PMS industry is the PMS self-help books. Most of these
books are soft cover, relatively inexpensive ($3-7), have been written since 1980, and
are found in mainstream bookstores. Most of these books are written (solely or in joint
authorship) by physicians or therapists associated with PMS or Women’s Health clinics
(e.g., Lark, 1984; Norris and Sullivan, 1983; Nazzaro and Lombard, 1985). They usually
include short histories about PMS, and medical, nutritional, and exercise advice to overcome
This image has allowed women to use PMS as an excuse to express their emotions or to account for their otherwise “strange” behaviors.
Other people (husbands, children, doctors, lawyers, judges, juries, co-workers) have also
used PMS to explain women’s behavior often within a scientific or medical framework that
then gives physicians and scientists “expert’ legitimacy over women’s bodies and minds.
Analgesics – UK – June 2014 The Consumer – Pains Experienced and Treatments Sought
The Menstrual Mark: Menstruation as Social Stigma
Clearly, the stigmatized status
of menstruation has detrimental consequences for girls’ and
women’s self-esteem, body image, self-presentation, and
sexual health. Feminist therapists, educators, and healthcare
providers can consider ways to alleviate these negative
consequences and to assist girls and women in their efforts
to resist the stigma of menstruation.
Equally important is
the evidence that suggests that menstrual status, both actual
and symbolic, primes and elicits negative attitudes toward
women. Challenging the stigma of menstruation and
learning to appreciate, or at least not loathe, menstruation
may have a positive impact on girls’ and women’s wellbeing
as well as their social status.
Efficacy of progesterone and progestogens in
management of premenstrual syndrome: systematic review
There is no evidence to support the claimed
efficacy of progesterone in the management of
There is insufficient evidence to make a definitive
statement about progestogens, but current
evidence suggests that they are not likely to be