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Robyn Stein DeLuca: The good news about PMS
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Everybody knows that most women go a little crazy right before they get their period, that their reproductive hormones cause their emotions to fluctuate wildly. Except: There's very little scientific consensus about premenstrual syndrome. Says psychologist Robyn Stein DeLuca, science doesn't agree on the definition, cause, treatment or even existence of PMS. She explores what we know and don't know about it -- and why the popular myth has persisted.
Robyn Stein DeLuca - Psychologist
Robyn Stein DeLuca asks, What do we really know about PMS? Full bio
Robyn Stein DeLuca asks, What do we really know about PMS? Full bio
Double-click the English transcript below to play the video.
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
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
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
cause extreme emotions
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and that the great majority of women
are affected by this.
are affected by this.
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Well, I am here to tell you
that scientific evidence says
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.
the good news about PMS.
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But first, let's take a look
at how firmly the idea of PMS
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,
or magazine articles,
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you'll see how widely assumed it is
that everyone gets PMS.
that everyone gets PMS.
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In an article in the magazine Redbook
titled "You: PMS Free,"
titled "You: PMS Free,"
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readers were informed that between 80
to 90 percent of women suffer from PMS.
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,
suffer from PMS,
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and that it plays a major role
in women's mental and physical health,
in women's mental and physical health,
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and a couple of years ago,
even the Wall Street Journal
even the Wall Street Journal
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ran an article on calcium
as a treatment for PMS,
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
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,
on the definition, the cause,
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the treatment, or even
the existence of PMS.
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
cognitive and physical symptoms
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from the time of ovulation
to menstruation.
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,
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.
some of these symptoms.
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What I'm saying is that
getting some of these symptoms
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
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,
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,
could have PMS,
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my dog could have PMS.
(Laughter)
(Laughter)
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Some researchers said
you had to have five symptoms.
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
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.
were just as important.
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For many years, because
there was no standardization
there was no standardization
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in the definition of PMS,
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when psychologists tried
to report prevalence rates,
to report prevalence rates,
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their estimates ranged
from five percent of women
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.
and almost everyone had PMS.
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Overall, the weaknesses in the methods
of research on PMS have been considerable.
of research on PMS have been considerable.
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First, many studies asked women
to report their symptoms retrospectively,
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,
prospective reporting,
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which involves keeping
a daily log of symptoms
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,
on white, middle-class women,
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which makes it problematic
to apply study findings to all women.
to apply study findings to all women.
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We know there's a strong
cultural component to the belief in PMS
cultural component to the belief in PMS
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because it's nearly unheard of
outside of Western nations.
outside of Western nations.
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Third, many studies failed
to use control groups.
to use control groups.
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If we want to understand
the specific characteristics
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.
to women who don't have PMS.
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And finally, many different types
of questionnaires were used
of questionnaires were used
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to diagnose PMS, focusing
on different symptoms,
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
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,
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,
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 --
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.
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;
before menstruation starts;
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the symptoms must improve
once menstruation has begun;
once menstruation has begun;
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and the symptoms must be absent
the week after menstruation has ended.
the week after menstruation has ended.
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One of these symptoms must come
from this list of four:
from this list of four:
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marked mood swings, irritability,
anxiety, or depression.
anxiety, or depression.
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The other symptoms could come
from the first slide
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
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
that the symptoms
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should be associated with
clinically significant distress --
clinically significant distress --
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there should be some kind
of disturbance in work
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
should now be documented
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by keeping a daily log
for at least two cycles in a row.
for at least two cycles in a row.
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And finally, the DSM required that
the emotional disturbance
the emotional disturbance
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should be more than simply an exacerbation
of an already existing disorder.
of an already existing disorder.
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So scientifically speaking,
this is an improvement.
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,
that's required,
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and the reporting and timing of symptoms
have both become very specific.
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.
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:
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
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,
than time of the month,
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and this is the information
the scientific community has had
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
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.
in psychology journals.
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The questions is, why hasn't this
information trickled down to the public?
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
of messages that women receive
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from books, TV, movies, the Internet,
that everyone gets PMS
that everyone gets PMS
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go a long way in convincing them
it must be true.
it must be true.
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Research tells us that the more
a woman believes that everyone gets PMS,
a woman believes that everyone gets PMS,
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the more likely she is
to erroneously report that she has it.
to erroneously report that she has it.
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Let me tell you what I mean
by "erroneously."
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
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
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
the persistence of the PMS myth
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has to do with the narrow boundaries
of the feminine role.
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
taking on the label of PMS
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allows women to express emotions that
would otherwise be considered unladylike.
would otherwise be considered unladylike.
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The near universal definition
of a good woman
of a good woman
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is one who is happy, loving,
caring for others,
caring for others,
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and taking great satisfaction
from that role.
from that role.
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Well, PMS has become a permission slip
to be angry, complain, be irritated,
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
in a woman's environment
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are much more likely to cause her
to be angry than her hormones,
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.
of responsibility or criticism.
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"Oh, that's not who she is.
It's out of her control."
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.
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,"
it's just that time of the month,"
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her ability to be taken seriously
or effect change is severely limited.
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.
thriving industry.
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Amazon.com currently offers
over 1,900 books on PMS treatment.
over 1,900 books on PMS treatment.
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A quick Google search
will bring up a cornucopia
will bring up a cornucopia
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of clinics, workshops and seminars.
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Reputable Internet sources
of medical information
of medical information
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like WebMD or the Mayo Clinic
list PMS as a known disorder.
list PMS as a known disorder.
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It's not a known disorder,
but they list it.
but they list it.
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And they also list the medications that
physicians have prescribed to treat it,
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
say that the success of medication
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in treating PMS symptoms
vary from woman to woman.
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,
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.
improvement for a great number of women.
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This has not been the case
with these treatments,
with these treatments,
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and FDA regulations say that
for a drug to be deemed effective,
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.
significant improvement.
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So we have not had that at all
with these so-called treatments.
with these so-called treatments.
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However, the financial gain
of perpetuating the myth
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,
drugs like anti-depressants or hormones,
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medical protocol requires that they have
physician follow-up every three months.
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
reap untold profits
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when women are convinced
they should take a prescribed medication
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,
like tension and irritability,
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even though they only contain
a diuretic, a pain reliever
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,
with the magical powers of caffeine,
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but I don't think reducing tension
is one of them.
is one of them.
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Since 2002, Midol has marketed
a Teen Midol to adolescents.
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,
and that it will make you a monster,
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but wait, there's something
you can do about it:
you can do about it:
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Take Midol and you will be
a human being again.
a human being again.
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In 2013, Midol took in 48 million dollars
in sales revenue.
in sales revenue.
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So while perpetuating the myth of PMS
has been lucrative for some,
has been lucrative for some,
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it comes with some serious
adverse consequences for women.
adverse consequences for women.
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First, it contributes
to the medicalization
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
of conceptualizing
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women's reproductive processes
as illnesses that require treatment,
as illnesses that require treatment,
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and this has come at many costs,
including excessive Cesarean deliveries,
including excessive Cesarean deliveries,
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hysterectomies and prescribed
hormone treatments
hormone treatments
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that have harmed rather than enhanced
women's health.
women's health.
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Second, the PMS myth also contributes
to the stereotype of women
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
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.
the competence of all women.
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Women have made tremendous strides
in the workforce,
in the workforce,
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but still there's a minuscule number
of women at the highest echelons
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,
who makes for a good CEO or senator,
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someone who has qualities like
rationality, steadiness, competence
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,
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
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
for four to six months
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and found that the number
of mood swings they experienced
of mood swings they experienced
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and the severity of those mood swings
were no different.
were no different.
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And finally, the PMS myth
keeps women from dealing
keeps women from dealing
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with the actual issues
causing them emotional upset.
causing them emotional upset.
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Individual issues like
quality of relationship or work conditions
quality of relationship or work conditions
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or societal issues like racism or sexism
or the daily grind of poverty
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,
the source of their negative emotions,
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but it also takes away the opportunity
to take any action to change them.
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,
because of the menstrual cycle,
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the great majority don't
get a mental disorder.
get a mental disorder.
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They go to work or school,
take care of their families,
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
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
the tired old PMS myth of women as witches
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and embrace the reality of high emotional
and professional functioning
and professional functioning
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the great majority of women
live every day.
live every day.
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Thank you.
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(Applause)
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ABOUT THE SPEAKER
Robyn Stein DeLuca - PsychologistRobyn Stein DeLuca asks, What do we really know about PMS?
Why you should listen
Robyn Stein DeLuca is a Research Assistant Professor in the Department of Psychology at Stony Brook University where she's taught Women's Studies through the lenses of psychology and healthcare for over fifteen years. DeLuca studies the psychology of pregnancy, including postpartum depression and the psychosocial consequences of cesarean delivery. For two years, she was the Executive Director of the Women in Science and Engineering (WISE) program at Stony Brook. In 2015, DeLuca received a graduate certificate in Religious Studies and Education from the Harvard Divinity School. She teaches and speaks often about the role of women in Judaism, Christianity, and Islam.
More profile about the speakerRobyn Stein DeLuca | Speaker | TED.com