Premenstrual Syndromes What Is Premenstrual Syndrome?
Premenstrual Syndrome (PMS) encompasses a range of physical and emotional symptoms that occur cyclically in the luteal phase of the menstrual cycle. Historically, PMS was often misunderstood and stigmatized. For example, Erle Henrikson’s 1948 study, which described PMS as the “Bitch Syndrome,” reflected deeply ingrained misogynistic views. Henrikson’s observations, focusing on “perfectionistic” women, suggested that higher achievers who were dissatisfied with their roles experienced more severe symptoms (Speroff, 1988). This perspective was influenced by prevailing stereotypes and lacked scientific rigor.
By the 1970s, feminist critiques challenged these negative and dismissive characterizations. Feminist scholars, including Delaney, Lupton, and Toth (1976), advocated for the use of terms like “premenstrual changes” rather than “symptoms,” emphasizing a more nuanced understanding of menstrual experiences. In 1979, feminist epidemiologist Nancy Woods coined the term “premenstrual symptoms or experiences” (Woods & Hulka, 1979), marking a significant shift in recognizing these experiences as legitimate and deserving of scientific study.
The 1980s saw professional medical organizations formalize PMS as a clinical diagnosis. Meetings in the United States and the United Kingdom led to the establishment of PMS as a recognized medical condition (Dawood, McGuire, & Demers, 1985; Halbreich, 1997). Despite some skepticism about the scientific basis for diagnosing PMS, it was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) in 1987 under the label Late Luteal Phase Dysphoric Disorder (LLPDD). This designation was later revised to Premenstrual Dysphoric Disorder (PMDD) in the DSM-IV, reflecting a more structured approach to understanding and diagnosing the condition (American Psychiatric Association, 1986).
Premenstrual Syndrome and Feminists
The debate over PMS is not only a matter of medical classification but also reflects broader sociopolitical issues. Feminists argue that labeling PMS and related conditions as medical disorders can perpetuate harmful stereotypes and overlook underlying social and cultural factors. The diagnosis of PMS and PMDD can pathologize normal menstrual experiences, diverting attention from social factors that might contribute to women’s distress.
This critique suggests that medical diagnoses can reinforce patriarchal structures by framing women’s menstrual experiences as pathological rather than normal variations in women’s health. Feminist perspectives emphasize that addressing social determinants and cultural attitudes toward menstruation is crucial for a more comprehensive understanding of PMS.
Health Classification of Premenstrual Syndrome
The classification of PMS has significant implications beyond mere terminology. The way we label and define menstrual experiences influences social, political, and medical frameworks. The dominant biomedical model often overlooks alternative perspectives and the lived experiences of women. For instance, PMS classification can lead to medical interventions that might not address underlying social and psychological factors affecting women.
The challenge lies in integrating diverse viewpoints into the classification of menstrual health. While biomedical perspectives focus on symptoms and physiological mechanisms, incorporating feminist and sociocultural viewpoints can provide a more holistic understanding of PMS. This approach recognizes that women’s experiences are shaped by a complex interplay of biological, psychological, and social factors.
Nursing Research on Premenstrual Syndrome
Nursing research has played a pivotal role in advancing our understanding of PMS and related conditions. The Society for Menstrual Cycle Research (SMCR) has been instrumental in promoting a woman-centered agenda that considers both normative and pathological aspects of menstrual experiences.
One notable contribution is the 1981 Guidelines for Non-Sexist Research, developed by a national task force of psychologists (Psychology of Women Division, 1981). These guidelines aimed to address gender biases in research and improve the scientific study of menstrual health.
Since 1986, the National Institute for Nursing Research has supported research on menstrual cycle and menopause-related health conditions (Reame, 2001). This research has explored various aspects of menstrual health, including comorbidities such as sleep disturbances, fibromyalgia, and mood disorders. Studies have examined how menstrual phases affect conditions like gastrointestinal issues, cardiovascular health, and neurocognition (Golding, Taylor, Menard, & King, 2000; Taylor, D., 1999; Woods, Lentz, Mitchell, & Kogan, 1994; Shaver, Giblin, Lentz, & Lee, 1988; Heitkemper et al., 1995; Reame, 2001; Williams, 2003).
Social Impact of Menstrual and Nursing Research
Nursing research has highlighted the importance of understanding the social context of menstruation. Studies have documented how stressful life circumstances and socialization impact menstrual symptoms. Research by Nancy Woods and her team examined the influence of social factors on perimenstrual symptoms, including sex role orientation, stress, and health practices (Brown, MA, & Woods, 1986; Brown, MA, & Zimmer, 1987a, 1987b; Macdougall, 2000; Mitchell, E., Woods, Lentz, & Taylor, 1991; Mitchell, 1999; Mitchell, ES, Woods, & Lentz, 1987, 1993; Mitchell, ES, Woods, Lentz, Taylor, & Lee, 1992; Mitchell, ES, Woods, & Mariella, 2003; Oleson & Woods, 1986; Taylor, DT, & Woods, 1991; Taylor, D., Woods, Mitchell, & Lentz, 1987; Woods, 1985).
Research has also explored the impact of menstrual symptoms on work, relationships, and family dynamics (Brown, M., & Zimmer, 1986; Roberts, SJ, & Garling, 1980; Robinson, K., 1997). These studies emphasize that menstrual health is not just a personal issue but one with broader social implications.
Premenstrual Syndrome and Treatment
Treatment for PMS has evolved as our understanding of the condition has improved. Nurses have detailed patterns of perimenstrual symptoms, including PMS and dysmenorrhea, to inform treatment approaches. Early research focused on symptom patterns and the development of diagnostic criteria for clinical assessment.
One significant contribution to PMS research was Nancy Woods’ epidemiologic studies, which assessed women’s daily experiences of symptoms across multiple menstrual cycles (Woods, Most, & Dery, 1982; Woods & Hulka, 1979; Woods, Mitchell, Lentz, Taylor, & Lee, 1987). This approach shifted the focus from predefined symptom criteria to a more nuanced understanding of individual experiences.
Measuring Premenstrual Experiences
Advancements in measurement techniques have allowed for a more detailed understanding of perimenstrual experiences. Researchers like Ellen Mitchell and colleagues have developed sophisticated models to classify and analyze menstrual experiences (Mitchell, ES, et al., 1991; Mitchell, ES, et al., 1987, 1993; Mitchell, ES, et al., 1992). These models incorporate both quantitative and qualitative data, capturing the complexity and variability of menstrual symptoms.
Methodologies such as interviews, cross-cultural research, and ethnography have provided deeper insights into menstrual experiences, including variations across cultures and social contexts (Berg, J., 1999; Beyene, Taylor, & Lee, 2001; Brown, M., & Zimmer, 1986; Dan & Al-Gasseer, 1991). Research has also explored how menstrual symptoms affect various aspects of life, including work and family dynamics (Brown, M., & Zimmer, 1986; Roberts, SJ, & Garling, 1980; Robinson, K., 1997).
Nursing Research Outcomes for Premenstrual Syndrome
Nursing research has expanded the scope of therapeutic interventions for PMS beyond traditional clinical trials. Early studies examined the effectiveness of non-pharmacologic treatments such as biofeedback, autogenic training, and self-help groups (Amato, 1987; Heczey, 1980; Heinz, 1986; Miota, Yahle, & Bartz, 1991; Morse C, Dennerstein, Farrell, & Varnavides, 1991; G Morse, 1999; Taylor, D., & Bledsoe, 1986).
In the 1990s, research focused on complementary therapies and cognitive-behavioral interventions (Cohen, SM, 1989; Groer, 1993; Morse, G., 1999). A significant clinical trial funded by the NIH tested non-pharmacologic treatments, including personal and environmental stress management strategies (Taylor, D., 1996, 1999, 2000). This trial highlighted the importance of addressing both personal and social stressors in managing PMS.
Scientific Rationalized Care for Premenstrual Syndrome
The integration of scientific research into self-care has been a major achievement in menstrual cycle research. Diana Taylor’s 2002 publication, “Science-Based Self-Help for PMS,” provided evidence-based recommendations for managing PMS without medication (Taylor, D., & Colino, 2002). This book and similar initiatives have helped translate research findings into practical advice for women.
Professional organizations, such as the Association of Women’s Health, Obstetric and Neonatal Nursing, have developed clinical guidelines based on empirical evidence (Association of Women’s Health, Obstetrical & Neonatal Nursing, 2003). These guidelines emphasize differentiating between normal cyclic changes and severe symptoms that require medical intervention.
The development of evidence-based therapeutic models is crucial as more nurses take on roles as primary care providers. Ongoing clinical trials and research should continue to focus on understanding menstrual health, improving treatment options, and promoting effective self-care strategies.
Conclusion
Premenstrual Syndrome and its management have evolved significantly over the past few decades. From early misconceptions and stigmatization to a more nuanced understanding and evidence-based treatment approaches, the field has made considerable progress. The integration of feminist perspectives, scientific research, and nursing care has enhanced our understanding of PMS and contributed to more effective management strategies. Future research should continue to explore the complex interplay of biological, psychological, and social factors affecting menstrual health, with an emphasis on evidence-based care and the inclusion of diverse perspectives.