Robyn Stein DeLuca: The good news about PMS

416,200 views ・ 2015-03-17

TED


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00:13
How many people here have heard of PMS?
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Everybody, right?
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Everyone knows that women go a little crazy
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right before they get their period,
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that the menstrual cycle throws them onto an inevitable hormonal roller coaster
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of irrationality and irritability.
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There's a general assumption
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that fluctuations in reproductive hormones cause extreme emotions
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and that the great majority of women are affected by this.
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Well, I am here to tell you that scientific evidence says
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neither of those assumptions is true.
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I'm here to give you the good news about PMS.
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But first, let's take a look at how firmly the idea of PMS
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is entrenched in American culture.
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If you examine newspaper or magazine articles,
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you'll see how widely assumed it is that everyone gets PMS.
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In an article in the magazine Redbook titled "You: PMS Free,"
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readers were informed that between 80 to 90 percent of women suffer from PMS.
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L.A. Muscle magazine warned its readers
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that 40 to 50 percent of women suffer from PMS,
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and that it plays a major role in women's mental and physical health,
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and a couple of years ago, even the Wall Street Journal
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ran an article on calcium as a treatment for PMS,
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asking its female readers,
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"Do you turn into a witch every month?"
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From all these articles, you would think there must be a mountain of research
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verifying the widespread nature of PMS.
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However, after five decades of research,
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there's no strong consensus on the definition, the cause,
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the treatment, or even the existence of PMS.
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As most commonly defined by psychologists,
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PMS involves negative behavioral, cognitive and physical symptoms
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from the time of ovulation to menstruation.
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But here's where it gets tricky.
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Over 150 different symptoms have been used to diagnose PMS,
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and here are just a few of those.
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Now, I want to be clear here.
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I'm not saying women don't get some of these symptoms.
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What I'm saying is that getting some of these symptoms
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doesn't amount to a mental disorder,
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and when psychologists come up with a disorder
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that's so vaguely defined,
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the label eventually becomes meaningless.
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With a list of symptoms this long and wide,
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I could have PMS, you could have PMS,
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the guy in the third row here could have PMS,
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my dog could have PMS. (Laughter)
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Some researchers said you had to have five symptoms.
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Some said three.
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Other researchers said that symptoms were only meaningful
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if they were highly disturbing to you,
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but others said minor symptoms were just as important.
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For many years, because there was no standardization
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in the definition of PMS,
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when psychologists tried to report prevalence rates,
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their estimates ranged from five percent of women
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to 97 percent of women,
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so at the same time almost no one and almost everyone had PMS.
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Overall, the weaknesses in the methods of research on PMS have been considerable.
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First, many studies asked women to report their symptoms retrospectively,
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looking to the past and relying on memory,
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which is known to inflate reporting of PMS
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compared to what's called prospective reporting,
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which involves keeping a daily log of symptoms
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for at least two months in a row.
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Many studies also exclusively focused on white, middle-class women,
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which makes it problematic to apply study findings to all women.
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We know there's a strong cultural component to the belief in PMS
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because it's nearly unheard of outside of Western nations.
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Third, many studies failed to use control groups.
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If we want to understand the specific characteristics
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of women who have PMS,
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we need to be able to compare them to women who don't have PMS.
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And finally, many different types of questionnaires were used
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to diagnose PMS, focusing on different symptoms,
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symptom duration and severity.
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To do reliable research on any condition,
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scientists must agree on the specific characteristics
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that make up that condition
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so they're all talking about the same thing,
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and with PMS, this has not been the case.
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However, in 1994,
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the Diagnostic and Statistical Manual of Mental Disorders,
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known as the DSM, thankfully --
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it's also the manual for mental health professionals --
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they redefined PMS as PMDD,
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Premenstrual Dysphoric Disorder.
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And dysphoria refers to a feeling of agitation or unease.
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And according to these new DSM guidelines,
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in most menstrual cycles in the last year,
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at least five of 11 possible symptoms
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must appear in the week before menstruation starts;
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the symptoms must improve once menstruation has begun;
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and the symptoms must be absent the week after menstruation has ended.
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One of these symptoms must come from this list of four:
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marked mood swings, irritability, anxiety, or depression.
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The other symptoms could come from the first slide
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or from those on the second slide,
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including symptoms like feeling out of control
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and changes in sleep or appetite.
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The DSM also required now that the symptoms
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should be associated with clinically significant distress --
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there should be some kind of disturbance in work
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or school or social relationships --
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and that symptoms and symptom severity should now be documented
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by keeping a daily log for at least two cycles in a row.
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And finally, the DSM required that the emotional disturbance
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should be more than simply an exacerbation of an already existing disorder.
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So scientifically speaking, this is an improvement.
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We now have a limited number of symptoms,
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and a high impact on functioning that's required,
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and the reporting and timing of symptoms have both become very specific.
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Well, using this criteria
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and looking at most recent studies,
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we see that on average,
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three to eight percent of women suffer from PMDD.
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Not all women, not most women,
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not the majority of women, not even a lot of women:
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three to eight percent.
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For everyone else, variables like stressful events or happy occasions
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or even day of the week
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are more powerful predictors of mood than time of the month,
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and this is the information the scientific community has had
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since the 1990s.
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In 2002, my colleagues and I published an article
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describing the PMS and PMDD research,
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and several similar articles have appeared in psychology journals.
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The questions is, why hasn't this information trickled down to the public?
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Why do these myths persist?
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Well, certainly the onslaught of messages that women receive
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from books, TV, movies, the Internet, that everyone gets PMS
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go a long way in convincing them it must be true.
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Research tells us that the more a woman believes that everyone gets PMS,
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the more likely she is to erroneously report that she has it.
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Let me tell you what I mean by "erroneously."
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You might ask her, "Do you have PMS?"
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and she says yes,
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but then, when you have her keep a daily log
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of psychological symptoms for two months,
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no correlation is found between her symptoms
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and time of the month.
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Another reason for the persistence of the PMS myth
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has to do with the narrow boundaries of the feminine role.
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Feminist psychologists like Joan Chrisler
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have suggested that taking on the label of PMS
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allows women to express emotions that would otherwise be considered unladylike.
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The near universal definition of a good woman
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is one who is happy, loving, caring for others,
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and taking great satisfaction from that role.
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Well, PMS has become a permission slip to be angry, complain, be irritated,
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without losing the title of good woman.
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We know that the variables in a woman's environment
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are much more likely to cause her to be angry than her hormones,
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but when she attributes anger to hormones,
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she's absolved of responsibility or criticism.
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"Oh, that's not who she is. It's out of her control."
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And while this can be a useful tool, it serves to invalidate women's emotions.
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When people respond to a woman's anger
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with the thought, "Oh, it's just that time of the month,"
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her ability to be taken seriously or effect change is severely limited.
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So who else benefits from the myth of PMS?
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Well, I can tell you that treating PMS
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has become a profitable, thriving industry.
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Amazon.com currently offers over 1,900 books on PMS treatment.
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A quick Google search will bring up a cornucopia
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of clinics, workshops and seminars.
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Reputable Internet sources of medical information
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like WebMD or the Mayo Clinic list PMS as a known disorder.
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It's not a known disorder, but they list it.
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And they also list the medications that physicians have prescribed to treat it,
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like anti-depressants or hormones.
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Interestingly, though, both websites say that the success of medication
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in treating PMS symptoms vary from woman to woman.
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Well, that doesn't make sense.
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If you've got a distinct disorder with a distinct cause,
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which PMS is supposed to be,
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then the treatment should bring improvement for a great number of women.
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This has not been the case with these treatments,
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and FDA regulations say that for a drug to be deemed effective,
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a large portion of the target population
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should see clinically significant improvement.
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So we have not had that at all with these so-called treatments.
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However, the financial gain of perpetuating the myth
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that PMS is a common mental disorder
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and is treatable is quite substantial.
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When women are prescribed drugs like anti-depressants or hormones,
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medical protocol requires that they have physician follow-up every three months.
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That's a lot of doctor visits.
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Pharmaceutical companies reap untold profits
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when women are convinced they should take a prescribed medication
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for all of their child-bearing lives.
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Over-the-counter drugs like Midol
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even claim to treat PMS symptoms like tension and irritability,
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even though they only contain a diuretic, a pain reliever
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and caffeine.
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Now, far be it from me to argue with the magical powers of caffeine,
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but I don't think reducing tension is one of them.
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Since 2002, Midol has marketed a Teen Midol to adolescents.
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They are aiming at young girls early,
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to convince them that everyone gets PMS and that it will make you a monster,
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but wait, there's something you can do about it:
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Take Midol and you will be a human being again.
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In 2013, Midol took in 48 million dollars in sales revenue.
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So while perpetuating the myth of PMS has been lucrative for some,
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it comes with some serious adverse consequences for women.
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First, it contributes to the medicalization
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of women's reproductive health.
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The medical field has a long history of conceptualizing
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women's reproductive processes as illnesses that require treatment,
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and this has come at many costs, including excessive Cesarean deliveries,
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hysterectomies and prescribed hormone treatments
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that have harmed rather than enhanced women's health.
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Second, the PMS myth also contributes to the stereotype of women
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as irrational and overemotional.
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When the menstrual cycle is described as a hormonal roller coaster
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that turns women into angry beasts,
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it becomes easy to question the competence of all women.
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Women have made tremendous strides in the workforce,
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but still there's a minuscule number of women at the highest echelons
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of fields like government or business,
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and when we think about who makes for a good CEO or senator,
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someone who has qualities like rationality, steadiness, competence
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come to mind,
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and in our culture, that sounds more like a man than a woman,
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and the PMS myth contributes to that.
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Psychologists know that the moods of men and women
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are more similar than different.
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One study followed men and women for four to six months
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and found that the number of mood swings they experienced
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and the severity of those mood swings were no different.
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And finally, the PMS myth keeps women from dealing
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with the actual issues causing them emotional upset.
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Individual issues like quality of relationship or work conditions
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or societal issues like racism or sexism or the daily grind of poverty
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are all strongly related to daily mood.
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Sweeping emotions under the rug of PMS
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keeps women from understanding the source of their negative emotions,
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but it also takes away the opportunity to take any action to change them.
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So the good news about PMS
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is that while some women get some symptoms because of the menstrual cycle,
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the great majority don't get a mental disorder.
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They go to work or school, take care of their families,
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and function at a normal level.
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We know the emotions and moods of men and women
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are more similar than different,
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so let's walk away from the tired old PMS myth of women as witches
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and embrace the reality of high emotional and professional functioning
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the great majority of women live every day.
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Thank you.
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(Applause)
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