Is PMS Overblown? That’s What Research Shows

If PMS is a myth, then what on earth can we blame for all the lady-rage?

You may have seen the article in The Star or The Globe and Mail or The Atlantic about the recently published research review by a team of medical researchers who assert that “clear evidence for a specific premenstrual phase-related mood occurring in the general population is lacking.” Judging from the headlines and the online comments, this proposition is surprisingly controversial–probably because the headlines were frequently misleading, suggesting the findings are much broader than they are. Some online commenters are especially angry, insulting the intelligence and methods of the researchers, proclaiming that of course hormones affect moods, as does menstrual pain, citing examples of their own or their wives’ experience.

But Sarah Romans, MB, M.D.; Rose Clarkson, M.D.; Gillian Einstein, Ph.D.; Michele Petrovic, BSc and Donna Stewart, M.D., DPsych–the five medical scholars who reviewed all the extant studies of PMS based on prospective data–did not claim in the now-infamous Gender Medicine review study that PMS does not exist, or that hormones do not affect emotion or mood. The variety of research methods used in other studies prevented them from conducting a meta-analysis–a statistical technique that allows researchers to pool results of several studies, thus suggesting greater impact–so the authors instead looked at such study characteristics as sample size, whether the data was collected prospectively or retrospectively (that is, at the time of occurrence or recalled from memory), whether participants knew menstruation was the focus of the study and whether the study looked at only negative aspects of the menstrual cycle. Although their initial database searches yielded 646 research articles dealing with the menstrual cycle, PMS, emotions, mood and related keywords, only 47 studies met their criteria of daily prospective data collection for at least one full cycle.

When the authors scrutinized these studies, they found that, taken together, there is no basis for the widespread assumption in the U.S. that all (or even most) menstruating women experience PMS. In fact, only seven studies found “the classic premenstrual pattern” with negative mood symptoms experienced in the premenstrual phase only. Eighteen studies found no negative mood associations with any phase of the menstrual cycle at all, while another 18 found negative moods premenstrually and during another phase of the menstrual cycle. In other words, the symptoms these women experienced were not exclusively premenstrual, making the label inaccurate. Four other studies found negative moods only in the non-premenstrual phase of the cycle.

So let’s be fair, angry online commenters (and careless journalists): The researchers aren’t telling you menstrual pain is all in your head, or that your very real period pain won’t affect your mood. Sarah Romans did tell James Hamblin of The Atlantic,

The idea that any emotionality in women can be firstly attributed to their reproductive function—we’re skeptical about that.

Rightly so–feminists have been saying this for decades. Feminist critiques of PMS as a construct point to both the ever-increasing medicalization of women’s lives and the dismissal of women’s emotions, especially anger, by attributing them to biology.

Part of what makes PMS difficult to study, and difficult to talk about, is the multiple meanings of the term. In the research literature, there are more than 150 symptoms–ranging from psychological, cognitive and neurological to physical and behavioral–attributed to PMS. There is no medical or scientific consensus on its definition or its etiology, which also means there is no consensus on its treatment.

In everyday language, its meaning is even more amorphous. Some women and girls use PMS to mean any kind of menstrual pain or discomfort, as well as premenstrual moodiness. Some men and boys, as well as some girls and women, use it to diminish a woman’s or girl’s emotions when they disagree with her, or want to dismiss her opinions, or are embarrassed by her feelings.

Even researchers are influenced by entrenched cultural meanings. Romans and her colleagues observed that none of the 47 studies analyzed variability in positive mood changes, which they attribute to biases of the researchers. Many women have reported anecdotally that they feel more energetic, more inspired or other positive feelings during their premenstrual phase, but this is seldom studied or regarded as a “syndrome.” Romans and colleagues note that most measures of menstrual mood changes only assess negative changes, so even if positive changes are occurring, researchers are missing them. They also cite research indicating that both women and men tend to attribute negative experiences to the menstrual cycle, especially the premenstrual phase, and positive experiences during the premenstrual phase to external sources.

Romans and her colleagues do not deny the existence of menstrual pain, or even the existence of PMS. What their study shows is that very few women experience cyclic negative mood changes associated with the premenstrual phase of their ovulatory cycle. PMS is not widespread, and the authors are careful to distinguish it from premenstrual dysphoric disorder (PMDD), which is rarer still. As Gillian Einstein, one of the researchers, told the Toronto Star, “We have a menstrual cycle and we have moods, but they don’t necessarily correlate.” She did not add, but I will, that it it is unfair and unreasonable to assume that every woman’s moods should be attributed to her menstrual cycle and to refuse to take her feelings seriously.

Cross-posted from re:Cycling, blog of the Society for Menstrual Cycle Research.

Photo via Flickr user dearbarbie licensed under Creative Commons 2.0.


  1. Norse Winter says:

    I once dated a guy whose father came from a culture where you just ignore the wife (and then wonder why she’s miserable and ‘nags’) lol and as rational as I would attempt to be with this guy, it seems he had already learned from his parents how a woman should be treated, regardless of my explaining anything in a rational manner, he’d just completely dismiss it. No human being likes being dismissed, so naturally, my reaction was anger. But since I knew he wasn’t capable of understanding basic human anger (so long as it came from a woman) I would just tell him “eh, it’s just that time of the month..” (even though, had he kept track, he’d see I’d say that more than enough times to match a cycle) LOL!

    So my point is, it’s kind’ve like pop-psychology. Easy/lazy solutions to really complicated matters. So I can imagine that’s probably how our ancestors and culture developed into making people believe this myth… even women themselves who dismiss their own complex emotions.

    One great thing came from that horrid relationship, though. I was able to really appreciate handsome guys who actually ARE capable of thinking and being rational. No more hiding my feelings with easy tricks as “it’s just PMS” though… Haha x)

  2. It is not just men who are dismissive of women, their anger and PMS. Sometimes fellow women are as bad or worse, like my own mother. I have found for myself that trying to “make it work” with someone who does not give two s***s about the other peson’s feelings is a waste of time and energy. If anything, it dos not work, it only gets progressively worse until one walks away from the situation. People have gotten away with this kind of stuff because most women tend to stick around the situation longer than appropriate. Could biology factor into that? I don’t know; I think cultural conditioning plays a bigger role, mostly because most women have seen their female relatives and friends stay too long in unhealthy situations.

  3. I don’t have menstrual pain, so it’s not pain that changes my emotional state before my period. The day before my period, in many if not most of my cycles, I cry far more easily, and am more irritable than usual. I’ve been having periods for 31 years, I’m a health care practitioner used to careful observation, and I think I know what I’m talking about. Period.

  4. The only people affected by the “time of the month” are the ones who have the “time of the month” on their minds.

    Sadly, because of how badly used ‘pre-menstrual syndrome’ is, I just believe ‘PMS,’ is just for people who can’t make a rational argument with women. With almost everyone, it seems, it’s become like ANOTHER ‘bad word’ used to refer to womenkind…

    Also, “Lady-Rage” is mostly caused by the Sexists. So blame it on the Sexists.

  5. This is a brilliant article. I took AP Psychology last year and there was a whole page in the textbook dedicated to debunking the PMS myth, and this article did so in a significantly more interesting and well-worded way. Bravo.

  6. I am sometimes skeptical of research on women that concludes with blanket statements, such as PMS does exist, or does not exist. I suspect that within women, there is a great deal of variability, such that some women DO experience such symptoms of PMS, and some women may not; such variability in perceptions of PMS may be related to variability in women’s hormone levels and changes in their cycle. While most women have a menstrual cycle, there is a lot of variability in how the cycle plays out. Personally, I would always forget when my period was coming, but inevitably be very horny for a day, followed by cranky, and lo and behold, my period would arrive the next day.

    It’s that same type of blanket-statement research that bothers me in investigating women’s sexuality. For instance, does the G-spot exist? In reality, it may exist for some, but not for others.

    What would be MORE interesting would be to identify women who appear to have PMS and compare them to women who seem to not have PMS, then determine if there are differences in how the hormone levels fluctuate over the menstrual cycle for these two groups.

    • “What would be MORE interesting would be to identify women who appear to have PMS and compare them to women who seem to not have PMS, then determine if there are differences in how the hormone levels fluctuate over the menstrual cycle for these two groups.”

      There are none. The levels of estrogen, for example, have no definitive association with a woman’s moodiness and behavior. This same concept is seen with depression. Those who are depressed have the same levels of serotonin as those who are not depressed. (Of the non-depressed, 25% have low serotonin, 50% have average levels, and 25% have high levels. Of the depressed? The numbers are the same…)

      Can we get over this sexist crap already and stop reducing women to basic animals whose thoughts and behaviors are driven simply by hormones? How about some respect?

      • Um, sorry to point out, but we are all basic animals whose thoughts and behaviours are driven simply by chemicals, some of which are hormones. It’s evolutionary, it’s biological and it’s irrefutable. All of us, men, women, republicans, presidents, god men, Jimi Hendrix, everyone. Believing in anything else would be invoking ghosts in the machine and cognitive *constructs* of humanly unique will.
        What bothers me the most is that it is true that we are all irrational beings, it is true that hormones and moods and hunger and the need to go to the loo and all those other “basic” things dictate the larger portion of our behaviour, all of us know it to be true. We are all cranky when hungry, irrational when angry, etc. Ignoring a condition that women testify to having every month like clockwork and living under the delusion that we are all free, ever volitional, ever under control superbeings no matter what our stomachs and uteruses say is not empowering, it is disempowering because it creates an unreasonable expectation from women. Only a realistic phenomenally driven model of capabilities can ever grant true freedom of choice and action to any individual, irrespective of gender. It is unfair for example, to a starving person, to say that oh, “incapacity to think because you’re starving is a social construct, it is the norm’s way of oppressing you, come act like a fully satiated person and be productive and rational RIGHT NOW YOU GO STARVING JOE” Maybe the satiated do oppress the hungry, but only on acknowledging the effect of hunger on decision making and solving it would one equalize tinge. Unfortunately evolutionary baggage like PMS might not be easy to escape if one wants natural periods and the constant ability to have kids like evolution planned.
        While I do not deny the oppressive nature of patriarchal constructs, I do believe some very careful thinking is required before dismissing something as a construct that has elements of phenomenal truth in it.

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