PMS: A Social Construct?

For the construction of the article, papers from the year 1953 until 2017 were reviewed; during these years, premenstrual syndrome (PMS) passed from being unacknowledged by society or medical circles to being identified, named, and defined. However, there are still no standardised methods for diagnosing it.

Illustration by carmigrau https://www.instagram.com/carmigrau/

In the beginning, PMS was described as “a condition of indescribable tension and a desire to find relief by foolish actions difficult to restrain" (Greene and Dalton, 1953), the condition described included weight gain and headaches, that had relieved themselves by the end of the menstrual cycle, when a woman's period arrived. Later, Puech (1942) added fever and lumbar pain to the diagnosis; Israel (1938), also observed transient nymphomania that similarly ended as menstruation arrived. Many authors began to research and so enrich the diagnosis of PMS, but did not always see it far from a psychological condition.

In later research, hormone fluctuation was discovered to be a symptom of the menstrual cycle. Medicine progressed, and some women could now be treated for intense PMS symptoms. Being that in the 50’s it was understood that there was a need for an increase in the hormonal ratio to express PMS symptoms: "a large proportion of women, estimated to be around 40%, suffer a variety of symptoms during the final week or so of the menstrual cycle. In occasional cases, similar symptoms may occur at monthly intervals or during various points of the menstrual cycle." Green and Dalton (1953). Nowadays, there have been adjustments to the definition of PMS, as discoveries have been made in to PMS' possible causes. PMS is now acknowledged as not only being somatic, or 'water retention' as it was commonly diagnosed, for some women PMS symptoms can have a major impact on normal day-to-day functioning.

Female menstrual cycle, ovulation process and hormone levels

An important element to consider in regards to PMS is serotonin levels. Serotonin is a neurotransmitter that the brain synthesizes, that is commonly known for contributing to a person's feelings of well-being and happiness. Serotonin decreases significantly on the days prior to menstruation, during the luteal phase. It must also be acknowledged that, along with the hormonal fluctuation related to the menstrual cycle, there are also related to seasonal variation, affected directly by the amount of sunlight and other environmental features.

The International Statistical Classification of Diseases and Related Health Problems (ICD), is a globally used diagnostic tool for epidemiology, health management, and clinical purposes. In the ICD (ICD-10), many symptoms related to PMS are classified in the range N00–N99: “diseases of the genitourinary system”, specifically, N94: “pain and other conditions related to the female genital organs and the menstrual cycle."

It is estimated that women suffer from PMS the most intensely during their twenties and mid-thirties, as symptoms increase during a woman's most fertile years. According to Malpartida (2017), 75% of women suffer from PMS. Freeman (2003) said on the matter: "A differential diagnosis to distinguish PMS from other medical and psychiatric conditions is important for appropriate treatment. No hormone or laboratory test indicates a PMS diagnosis. The current diagnostic standard requires confirmation of subjective symptom reports by prospective daily diaries." Numerous symptoms can be attributed to PMS, including a spectrum of physical, behavioral, and emotional distress. Severe PMS can involve emotional symptoms such as irritability, mood swings, tension, and in the most extreme cases depression, which could be an indicator for Premenstrual dysphoric disorder (PMDD). To deal with theses symptoms, women should seek help, however, many women will simply accept their PMS symptoms, although, some foods and practices might help to mitigate. More often than not however, women will not seek help.

PMS is not a social construct, the hormone oscillation is real, and so are the many symptoms such as swelling and breast tenderness, headaches, fatigue, mood swings, irritability, and some others. It is common for women to experience the typical symptoms of PMS during their fertile years, but when it passes from being sadness to depression and disabling physical pain, the situation should become clearer; if the symptoms are seriously impeding someone's ability to the most impairing the symptoms are, the sooner it medical help should be provided to have a diagnosis and treatment.

Sources:

- Ampudia, M. K. M. (2017). SINDROME PREMENSTRUAL. 2, 4. Biggs, W. S. (n.d.). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. 7.

- Freeman, E. W. (2003). Premenstrual syndrome and premenstrual dysphoric disorder: Definitions and diagnosis11Adapted from the symposium on Premenstrual Syndrome and Premenstrual Dysphoric Disorders, July 17, 2000, Rhodes, Greece. Psychoneuroendocrinology, 28, 25–37. https://doi.org/10.1016/S0306-4530(03)00099-4

- Greene, R. (n.d.). THE PREMENSTRUAL SYNDROME. PREMENSTRUAL SYNDROME, 8.

- León-García, M. (n.d.). Serotonina, ciclo menstrual y síndrome premenstrual. 9, 6.

- Parlee, M. B. (n.d.). THE PREMENSTRUAL SYNDROME. PREMENSTRUAL SYNDROME, 12. Richardson, J. T. E. (1995). The premenstrual syndrome: A brief history. Social Science & Medicine, 41(6), 761–767. https://doi.org/10.1016/0277-9536(95)00042-6

- Rodin, M. (1992). The social construction of premenstrual syndrome. Social Science & Medicine, 35(1), 49–56. https://doi.org/10.1016/0277-9536(92)90118-A Salamat.pdf. (n.d.).

Image sources:

- Imagen de Ciclo menstrual femenino Fotografía de Stock. (n.d.). Retrieved 24 January 2022, from https://www.freejpg.com.ar/imagenes/premium/648725122/ciclo-menstrual-femenino

- Brochure, The Menstrual Cycle | Objects | Collection of Cooper Hewitt, Smithsonian Design Museum. (n.d.). Retrieved 24 January 2022, from https://collection.cooperhewitt.org/objects/1108723075/ Erin Blakemore. (n.d.). How PMS Became a Thing—JSTOR Daily. Retrieved 15 January 2022, from https://daily.jstor.org/pms-became-thing/