Physiology or the
disease

Research on the menstrual
cycle

Research on menstruation

(an overview)



Danger of the „wandering womb” in works by
Plato and Hippocrates



Two practical questions as a research starting
point in modern times:



Are women driven mad by menstruation?



Are women fit to work during menstruation?



Different scope of research in different
periods



Rediscovering of the same topics

Trends in research 1870-

1920



Opinion that women are incapacitated
by menstruation questioned in many
research:



Mary Putnam Jacobi

(1877) The Question

of Rest for Women during Menstruation



286 women surveyed - 58% no menstrual
problems, others only some pain



Conclusion: enforced rest is a result of men’s
wishes and not a physiological requirement

Trends in research 1870-

1920



Leta Stetter Hollingworth

- PhD in 1914 in

psychology at Columbia University



First PhD in psychology awarded to a woman at that

university



PhD research - hypothesis that women

are less competent or less able to work

during menstruation



Results - no evidence for a

menstrually related rhythm in

women’s cognitive performance or

abilities

Trends in research 1920-

1965



Increase in number of studies / papers on

menstruation



In the first edition of Psychological Abstracts (1927)



3 abstracts out of 2730 on menstrual cycle



In the end of 1960s



30-40 abstracts per year



David Macht

studies on menotoxin (1943)



“plants exposed to the fluids from the menstruating

woman are definitely retarded in growth”



toxic to goldfish, depress maze-running behaviour in

rats



no clear evidence whether menotoxin is toxic to the

male genitalia

Trends in research 1920-

1965



Menstruation and madness - the link
examined mainly by psychoanalysis



women who adopt a non-traditional
female role or experience a conflict
about the role they should adopt -
experience more period pain and more
emotional distress before the menstruation



The introduction of the concept of
premenstrual tension

Premenstrual tension

The concept



Robert Frank

(1931) –

the gynaecologist
credited with
establishing the
existence of
premenstrual tension
(PMT)



Physical & psychological
symptoms in the days
immediately prior to
menstruation attributed
to oestrogen



PMT = Dysfunction



Karen Horney

(1931)



PMT – a mixture of:



psychological response to
fantasies & anxieties
associated with pregnancy,



frustration caused by
cultural restriction of female
sexuality



symptoms triggered by
physiological processes of
preparation to pregnancy



premenstrual tension (PMT)
might be interpreted as a
result of unconscious desire
for a child



PMT is not pathology

Premenstrual tension /

syndrome

The development of the concept



Katarina Dalton

(1953) renamed PMT into

Premenstrual syndrome (PMS)



Change because:… the disorder was seen to contain

a wider array of symptoms than tension



1987 – Late luteal phase dysphoric disorder

(LLPDD) – in DSM-IIIR



2000 – Premenstrual dysphoric disorder

(PMDD) in DSM-IV



Up to 150 symptoms have been associated with

PMS/PMDD



Premenstrual syndrome – has been studied

extensively (“PMS hysteria” -

A. Walker

, 1997)

Criteria for diagnosis of PMDD (PMS) (in

DSM-IV)

(Experiences during the premestrual phase not present

after the period)



Feeling suddenly sad,
trearful, irritable or angry



Persistent & marked
anger or irrtability



Marked anxiety, tension,
feeling of being ‘on edge’



Markedly depressed
mood, self-deprecating
thoughts



Decreased interest in
usual activites



Feelig tried or marked lack
of energy



Difficulty in concentrating



Marked change in apetite,
overeating or specific
food-carvings



Oversleeping or disfficulty
in sleeping



Physical symptoms, e.g.
breast tenderness,
swelling, headaches, joint
or muscle pain, weight
gain

Premenstrual syndrome -

definition by

O’Brien

, 1987



A woman can be said to be suffering form
premenstrual syndrome (PMS) if she
complains of regularly recurring
psychological or somatic symptoms, or
both, which occur specifically during the
luteal phase of the cycle. The
symptoms must be relieved by the onset
of, or during, menstruation; there must
be symptom-free week following
menstruation

Contemporary definition of

PMS



PMS can be
diagonsed if



a woman experiences
a 30% increase in at
least 2 psychological
symptoms
premenstrually (i.e. 5
days before
menstruation)



symptoms are present
over a minumum 3
(ideally 3 cycles)



Interesting to
note:



When women
describe
premenstrual
sensations



physical terms for
their own experiences



psychological terms
for other women
experiences

The prevalence of PMS

(Jane M. Ussher, 2006)



Autralian studies



95% of women – experience at least mild
symptoms premenstrually



40% - experience moderate distress (PMS)



11-13% - experience severe distress
(PMDD)



Selected European studies



30% out of 80 women (pure PMS)



14% out of 670 women

PMS as the legal defence

Examples



(PMS) „…is now firmly established as a

clinical condition, a psychiatric illness

worthy of medical, psychological, or legal

intervention: women are at risk of being

officially deemed mad once a month…”

(p.26)



PMS used as a legal defence in crimes such

as: shoplifting, road traffic offences, assaults



In UK cases R v Craddock (1981), R v

English (1982) – a defence for murder

Cognitions and the menstrual

cycle Research findings



Performance
on cognitive
tests is not
affected by
menstrual
cycle phase

Cognitions and the menstrual

cycle - research findings



Studies by

D. Kimura & E. Hampson

(1993,

1994) - hypothesis that performance on

“feminine” tasks (eg. verbal fluency,

articulation, perceptual speed) and

“masculine” tasks (eg. manipulation,

mathematical reasoning) is related to level of

sex hormones both in men and in women



no hormone-related fluctuation on “gender

neutral” tasks,



differences on feminine / masculine tasks

Psychophysiological

processes - selected findings



Night vision more sensitive in mid-cycle



Sensitivity to odours higher around

the ovulation



Fluctuation in ability to discriminate

sounds across the cycle - women who

take oral contraceptives are more

sensitive to sounds



Lower sensitivity to

touch

premenstrually and higher around

ovulation

Mood, well-being and the

menstrual cycle



Inconsistent results



menstrual cycle has no effect on mood (eg.

Slade,

1984;

Swandby

, 1981;

Ainscough

, 1990)



significant differences between cycle
phases on variety of mood measures (eg.

Walker & Bancroft

, 1990;

Choi &Salmon

, 1995)



CONCLUSION: cycles should not be analysed
out of the context of the rest of women’s lives

Mood, well-being and the

menstrual cycle



Increased risk of suicide in the second half

of the cycle



Violent acts more often during the

premenstrual phase (Methodology!)



In premenstrual / menstrual phase more

preference to comedy programmes



Prospective studies of mood, that measure

hormones, fail to demonstrate that women’s

emotions are affected by menstruation to the

extent that culturally we believe that they

are

Food carving, eating and the

menstrual cycle



Food carving - 5 546 women tested
(

Dye, Warner, Bancroft

, 1995)



premenstrual week (74,3%)



during menstruation (56,3%)



postmenstrually (26,9%)



Types of carvings



sweets, chocolate

Premenstrual syndrome -

theories



Endocrine - dysfunction or abnormality of
ovarian endocrinology

(progesterone)



Psychosomatic - women with PMS have
more difficult life circumstances - experience
more stress



Neuroendocrine - altered sensitivity to
neurotransmiters (serotonin)



Interactive or biospsychosocial

Premenstrual syndrome - a

woman’s perspective



Warner & Bancroft

(1990) - higher self-

identification as having PMS among

women working part-time than either

full-time workers or women without

paid work



In women under 25 with no children

PMS more often in cohabiting women

than in single



Relationship difficulties - risk factor

or cause of PMS

Psychology and PMS

theoretical approaches



Individual differences



Biological rythm



Cultural beliefs



Stress

Psychology and PMS -

theoretical approaches



Individual differences - personality

sex-role orientation



recent findings - personality differentiate

between those who seek professional help

and those who do not



Menstrual cycle as biological rhythm



premenstrual symptoms = jet lag (!)



daily rhythms have become desynchronised

by the effect of menstrual cycle

Psychology and PMS -

theoretical approaches



Cultural beliefs about the menstruation,

cognitive processes



beliefs bias the perception of a woman and those

around her



young women who in adolescence had been

encouraged to adopt a sick role during

menstruation were more likely to report menstrual

symptoms



women with PMS perceive their bodily states

differently



Afro-Caribbean & Chinese ethnic gropus living in UK

report PMS less frequntly then Caucasian women

Psychology and PMS -

theoretical approaches



Models of stress



women with PMS react differently to

stressors in luteal phase



Women with PMS adopt different coping

strategies in response to stressors

experienced in different phases of the cycle



PMS women - more physical health

problems, less satisfaction with social life,

lower levels of social support

Integrated model of

premenstrual syndrome

Hormonal

changes

during the

cycle

Individual

beliefs

about the

cycle

Stressors,

life

circumstanc

es

Woman’s individual experiences

with the menstrual cycle

Cultural and social

factors

Professional

concept of

PMS

Individual concept of PMS

What is the next step?



Psychologists at the
turn of the twenty-
first century will be
asking different
questions about the
menstruation from
those psychologists
at the turn of the
twentieth.



A. Walker

, 1997