Physiology or the
disease
Research on the menstrual
cycle
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