Saying yes, saying no : understanding women’s use of the label "PMS"
Creators: name: Moore, Shelley
Publisher: name: University of British Columbia
Year: 2009

description: This dissertation explored factors related to heterosexual women's use of the label "PMS" and the question of why so many women who say that they have PMS do not meet prospectively-based researcher criteria. Participants were recruited through Vancouver city newspapers and posters for a study of emotional, behavioural, and health patterns. They were screened for hysterectomies, ovariectomies, pregnancy, and chronic illnesses. The 58 women in this study (mean age=34.5) provided daily prospective data over a mean of 15 weeks for 15 variables representing 4 different types of symptoms: mood, relationship, concentration and work performance, and physical and activity symptom types. At the beginning of the study, they completed the Beck Depression Inventory. During a final interview they completed various questionnaires regarding romantic relationships, stress, history of abuse, and attitudes toward menstruation. During her final interview, each woman was asked whether she had ever had PMS and, if so, what she believed caused it. Only 16% of the women met researcher-designated criteria for PMS and 9% met researcher-criteria for PDD (Premenstrual Dysphoric Disorder, APA, 1994), but 60% believed that they currently had PMS. There was very little match between researcher-designations and self-designations for any of the 15 prospective variables. Instead, consistent with schematic theories of PMS, it was women's attitudes toward menstruation that were most strongly related to self-designation. Women who said that they currently had PMS were more likely to view menstruation as debilitating, natural, and predictable. They had higher depression scores and reported more frequent and enduring experiences of anger. More of these women reported having been emotionally abused as an adult, emotionally abused as a child, and physically abused by a past or current romantic partner. Although women who said that they had never had PMS perceived menstruation as more bothersome, they believed that women should be able to ignore it. Current-Say and Never-Say women did not significantly differ for other forms of abuse, partner satisfaction, or daily uplifts. Daily hassles did not reach statistical significance at the multivariate level, but univariate significance indicated that Never-Say women might experience fewer daily hassles than Current-Say women. The prospective data were analyzed idiographically using prediction analyses. Current-Say women demonstrated more uncharacteristic cyclicity during the midcycle phase across the 15 variables and 4 symptom types. Never-Say women showed more uncharacteristic cyclicity during the postmenstrual phase. No differences were found for other phases. These findings, and other results, argue against the use of simple premenstrual-postmenstrual and premenstrual-intermenstrual difference measures in diagnosing PMS or PDD. It was concluded that, although the women's self-designations did not match their prospective data, they could not be explained simply as a mislabelling of negative cyclicity in other phases. There was also mixed evidence for the hypothesis that women's reports of having "PMS" were part of a generalized over-reporting of symptomatology or dissatisfaction. Possible explanations for women's self-designations are discussed, including schematic representations of both menstruation and general illness and a "contrast hypothesis" modified from the version proposed by McFarlane and Williams (1994). This contrast hypothesis suggests that cyclical changes occurring during a particular non-premenstrual phase are related to women's self-designations according to (a) the timing of these changes relative to the visible and salient menses, in conjunction with (b) their attitudes toward menstruation. Close to half (45%) the women who said that they had experienced PMS attributed their perceived PMS to a bidirectional model of physiology and environment, and 58% of the women saying that they had PMS believed that it happened occasionally rather than inevitably. Overall, the women's representations of menstrual cyclicity were neither simple reflections of cultural stereotypes nor pervasively negative, but rather diverse and complex. The results that link depression, anger, and specific forms of abuse to self-designations suggest that women saying that they have PMS are indicating difficulties that may or may not be menstrually-related. Researchers and other professionals need to assess the nature of those difficulties in women presenting with "PMS".