Premenstrual Syndrome

Premenstrual Syndrome

Reviewed by Faisal Zaidi

Premenstrual syndrome describes physical and emotional symptoms that some women report in the days before a period. The research supports two findings at once: expectation raises reported symptoms, and in women with the syndrome there is a measurable abnormal response to normal hormone changes.

What it is

Diane Ruble's 1977 study in Science separated what women believed about their cycle phase from their actual phase. Women led to believe they were premenstrual reported more physical symptoms, such as water retention, than women led to believe they were between periods. Ruble argued that, because questionnaires pick up these beliefs, earlier conclusions about the size and physical basis of menstrual changes needed re-examining.

A 1998 study at the US National Institute of Mental Health, with Peter Schmidt as first author, tested the hormonal side. Suppressing ovarian function reduced symptoms in women with the syndrome compared with placebo; adding back estradiol or progesterone brought symptoms back in those women but caused no change in mood in 15 women without the syndrome. The authors concluded that in women with the syndrome, symptoms represent an abnormal response to normal hormonal changes.

In effect

In the general population, the cycle seems to explain less of mood than is commonly assumed. Sarah Romans and colleagues followed a random sample of Canadian women aged 18 to 40 through 395 complete cycles of daily mood records. Only half of the mood items showed any link with cycle phase, mostly with menstruation itself, and physical health, perceived stress and social support predicted mood much better. They concluded that their results did not support the widespread idea of a specific premenstrual low mood. David Robson's The Expectation Effect (2022) draws on the neuroscientist Gina Rippon in chapter 9 to discuss the part expectation plays in premenstrual syndrome.

What it does not say

The expectation findings do not show that premenstrual symptoms are imaginary, or that a woman reporting them is mistaken. The hormone findings do not show that every low mood before a period is hormonal. The studies describe different groups: women in the general population, and women diagnosed with the syndrome. None of this is guidance on diagnosis or treatment, which is a matter for a qualified professional.

Sources

  1. Ruble, D. N. (1977). Premenstrual symptoms: a reinterpretation. Science, 197(4300), 291-292. doi:10.1126/science.560058
  2. Schmidt, P. J., Nieman, L. K., Danaceau, M. A., Adams, L. F., & Rubinow, D. R. (1998). Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. New England Journal of Medicine, 338(4), 209-216. doi:10.1056/NEJM199801223380401
  3. Romans, S. E., Kreindler, D., Asllani, E., Einstein, G., Laredo, S., Levitt, A., Morgan, K., Petrovic, M., Toner, B., & Stewart, D. E. (2013). Mood and the menstrual cycle. Psychotherapy and Psychosomatics, 82(1), 53-60. doi:10.1159/000339370
  4. Robson, D. (2022). The Expectation Effect: How Your Mindset Can Transform Your Life. Canongate. Chapter 9, "Untapped genius".