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PMS as a process of negotiation: Women’s experience and management of premenstrual distress

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Abstract

The absence of reports of Premenstrual Syndrome (PMS) in contexts such as China, Hong Kong, and India has led to the conclusion that PMS is a culture-bound syndrome. This qualitative study examines whether is it possible for women in a Western cultural context to negotiate negative premenstrual change in order to effectively avoid or reduce premenstrual distress. Sixty women who self-defined as a 'PMS sufferer' took part in one-to-one interviews, which were analysed using theoretical thematic analysis from a material-discursive-intrapsychic (MDI) perspective. Three major themes were consistently identified across relationship type and context, reflecting women's strategies of premenstrual self-regulation and coping: 'Self-monitoring and awareness: recognition and acceptance of premenstrual change'; 'Coping through self-regulation of premenstrual distress', including: 'avoidance of stress and conflict', 'escaping relational demands and responsibilities', and 'care of the self'; and 'Coping as an inter-subjective experience'. These findings challenge the view of PMS as a fixed unitary syndrome, suggesting that premenstrual change is an ongoing process of negotiation, in which women are agentic subjects, not passive 'PMS sufferers'. This has implications for therapists working with women reporting moderate-severe PMS, suggesting that the reframing of 'symptoms' as normal change, behavioural coping strategies, and self-monitoring, can effectively reduce premenstrual distress.
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PMS as a process of negotiation:
Women’s experience and management
of premenstrual distress
Jane M. Ussher a & Janette Perz a
a Centre for Health Research School of Medicine, University of
Western Sydney , Sydney , Australia
Accepted author version posted online: 16 Jan 2013.Published
online: 05 Feb 2013.
To cite this article: Jane M. Ussher & Janette Perz (2013) PMS as a process of negotiation: Women’s
experience and management of premenstrual distress, Psychology & Health, 28:8, 909-927, DOI:
10.1080/08870446.2013.765004
To link to this article: http://dx.doi.org/10.1080/08870446.2013.765004
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PMS as a process of negotiation: Womens experience and
management of premenstrual distress
Jane M. Ussher* and Janette Perz
Centre for Health Research, School of Medicine, University of Western Sydney, Sydney, Australia
(Received 29 August 2012; nal version received 7 January 2013)
The absence of reports of Premenstrual Syndrome (PMS) in contexts such as
China, Hong Kong, and India has led to the conclusion that PMS is a culture-
bound syndrome. This qualitative study examines whether is it possible for
women in a Western cultural context to negotiate negative premenstrual change
in order to effectively avoid or reduce premenstrual distress. Sixty women who
self-dened as a PMS sufferertook part in one-to-one interviews, which were
analysed using theoretical thematic analysis from a materialdiscursiveintra-
psychic perspective. Three major themes were consistently identied across
relationship type and context, reecting womens strategies of premenstrual
self-regulation and coping: Self-monitoring and awareness: recognition and
acceptance of premenstrual change;Coping through self-regulation of pre-
menstrual distress, including: avoidance of stress and conict,escaping rela-
tional demands and responsibilities, and care of the self; and Coping as an
inter-subjective experience. These ndings challenge the view of PMS as a
xed unitary syndrome, suggesting that premenstrual change is an ongoing
process of negotiation, in which women are agentic subjects, not passive PMS
sufferers. This has implications for therapists working with women reporting
moderatesevere PMS, suggesting that the reframing of symptomsas normal
change, behavioural coping strategies, and self-monitoring, can effectively
reduce premenstrual distress.
Keywords: PMS; premenstrual change; coping; self-regulation; psychological
distress; qualitative research
In Western medicine, negative premenstrual change is positioned as Premenstrual
Syndrome (PMS) or Premenstrual Dysphoric Disorder (PMDD), a xed and unitary
pathology within the woman deemed to be caused by bio-medical (Steiner & Born,
2000) or psychological (Bancroft, 1993) factors. It is estimated that premenstrual
distress is of the same magnitude as major depressive disorder in reducing womens
quality of life and economic functioning (Halbreich, Borenstein, Pearlstein, & Kahn,
2003), with between 13 and 19% of North American women experiencing symptoms
that could meet a PMDD diagnosis each month (Halbreich et al., 2003), and 75% meet-
ing the diagnosis of PMS the same symptoms as PMDD, but experienced to a lesser
magnitude (Steiner & Born, 2000).
*Corresponding author. Email: j.ussher@uws.edu.au
Psychology & Health, 2013
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However, the absence of reports of premenstrual psychological distress in many
non-Western cultures, such as China, Hong King and India (Chang, Holroyd, & Chau,
1995; Hoerster, Chrisler, & Gorman Rose, 2003; Yu, Zhu, Li, Oakley, & Reame, 1996),
and reports of an association between diagnosis of PMDD and acculturation in Asian,
Latina and Black women living in North America (Pilver, Kasl, Desai, & Levy, 2011),
raises questions about the validity of individualising bio-medical and psychological
theorising of premenstrual change. This has led to the suggestion that PMS and PMDD
are socially constructed labels (Parlee, 1994), or culture-bound syndromes (Chrisler,
2004). From a feminist social constructionist perspective, premenstrual change is
deemed to be a normal part of womens experience, which is positioned as PMS or
PMDD because of Western cultural constructions of the menstruating woman as labile
or dysfunctional, and the premenstrual phase of the cycle as a time of pathology (e.g.
Chrisler & Caplan, 2002; Rodin, 1992; Ussher, 2006). As a result, women engage in
practices of self-policing, monitoring premenstrual moods and behaviour in relation to
often unrealistic feminine ideals of calmness, consistency and capability (Brooks, Ruble,
& Clarke, 1977; Ussher, 2004), and blaming themselves, or their bodies, for perceived
premenstrual transgressions (Chrisler & Johnston-Robledo, 2002).
However, one of the problems in this social constructionist analysis is that it can
appear to deny the reality of premenstrual distress and marginalise the material aspects
of womens lives associated with self-diagnosis of PMS (Ussher, 1996). There is con-
vincing evidence that some women experience embodied and psychological change,
accompanied by an increased sensitivity to emotions, or to external stress, during the
premenstrual phase of the cycle (Sabin Farrell & Slade, 1999; Ussher & Wilding,
1992). Emotions such as anger, sadness or irritability as well as creativity or sexual
desire can also feel more powerful than usual premenstrually (Chrisler, Johnston,
Champagne, & Preston, 1994; King & Ussher, 2012), and the multiple tasking which is
a normal part of most womens lives can be more difcult (Slade & Jenner, 1980). This
can lead to distress when the responsibilities of home and work cannot be accommo-
dated at the same time (Ussher & Perz, 2010). There is also a growing body of research
reporting an association between relationship strain and reports of PMS, with evidence
that relationship satisfaction can deteriorate premenstrually (Clayton, Clavet, McGarvey,
Warnock, & Weiss, 1999). This suggests that the most commonly reported psychologi-
cal symptomsof PMS and PMDD anger and irritation (Bancroft, 1993) could be
conceptualised as a legitimate response to the material circumstances of womens lives,
including over-responsibility, lack of support or relationship tension (Figert, 2005;
Ussher, 2004). This does not reify the construction of premenstrual distress as a psychi-
atric disorder; but, it does suggest that some women do experience changes in emotion
or reactivity at this time, which can lead to self-diagnosis as a PMS sufferer(Ussher,
2003b, p. 136).
A further criticism of social constructionism is that it negates womens agency and
their ability to resist gendered constructions of distress (Cosgrove, 2000). There is evi-
dence that Western women can experience negative premenstrual changes in emotion,
behaviour or embodiment, but not discursively construct these as PMS, and not experi-
ence distress associated with such change (Cosgrove & Riddle, 2003). Such women
have been positioned as false negativesin the menstrual cycle research literature
(Hamilton & Gallant, 1990), implying that they havePMS, but are not admitting it.
This categorisation negates womens negotiation and resistance of bio-medical discourse
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associated with PMS, and reinforces the notion of women as passive dupes, rather than
active agents who continuously make sense of and interpret their own bodily experi-
ences, in order to cope with negative premenstrual change in multiple ways.
In order to address these criticisms, whilst also acknowledging the validity of femi-
nist social constructionist critiques, a critical realist epistemological standpoint has been
proposed for researching premenstrual change and PMS (Ussher, 1999). Critical realism
recognises the materiality of the body, and other aspects of experience, but conceptua-
lises this materiality as always mediated by culture, language and politics (Bhaskar,
1989). More specically, a materialdiscursiveintrapsychic (MDI) model of PMS,
within a critical realist framework, has been put forward (Ussher, 1999). The MDI
model provides a multidimensional analysis of the interconnections between the embod-
ied and psychological experience of premenstrual change; the material and relational
context of womens lives; PMS and PMDD as socially constructed categories; and the
psychological negotiation women engage in to make sense of their experience. This
approach was adopted in the present study to examine womens strategies of self-
regulation and coping in the context of negative premenstrual change.
Self-regulation and coping associated with negative premenstrual change
Whilst considerable research effort has been expended documenting womens premen-
strual distress, little attention has been given over to the self-regulation of negative pre-
menstrual emotion, or to other aspects of premenstrual coping. Equally, the small
number of studies that have been conducted report contradictory results. It has been
suggested that womens coping strategies vary across the menstrual cycle, with emotion-
focused coping increasing, and task avoidance, as well as social diversion-oriented
coping decreasing premenstrually (Mitchell & Mitchell, 1998). Conversely, it has been
reported that women who report higher rates of depression premenstrually are more
likely to engage in avoidant coping, independent of cycle phase (Kuczmierczyk,
Johnson, & Labrum, 1994). There is a need for further research to explore womens
strategies of premenstrual coping, as well as to examine the meaning and consequences
of different strategies utilised. These strategies could include: proactive coping, focusing
on preventing or modifying an anticipated stressful event (Aspinwall & Taylor, 1997);
anticipatory coping, preparation for a stressful event which cannot be avoided (Breznitz,
1983); and coping, activities to master, tolerate, reduce or minimise environmental
demands or stress (Folkman & Lazarus, 1985) with negative premenstrual change
acting as the stressful event(Ussher & Wilding, 1991). Emotional self-regulation, the
control and direction of behaviour and emotions (Fiske & Taylor, 1991), may also be
involved in premenstrual coping, as it is utilised in psychological interventions which
aim to alleviate premenstrual distress (e.g. Blake, 1995; Ussher, Hunter, & Cariss, 2002).
As it has also been reported that partners can impact upon womens experience and
management of premenstrual change (Jones, Theodos, Canar, Sher, & Young, 2000;
Ussher, Perz, & Mooney-Somers, 2007), with higher levels of partner support found in
lesbian relationships (Ussher & Perz, 2008), research on premenstrual coping also needs
to acknowledge relational context, and to include women in both lesbian and heterosex-
ual relationships.
Coping is not simply an intrapsychic phenomenon. Chrisler (2008) argues that gen-
der-role socialisation and beliefs about femininity affect womens sense of whether and
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when they can regulate themselves. This includes: the internalisation of unrealistic
standards against which women measure successfulemotional self-regulation; the
inuence of self-objectication, self-sacrice and over-responsibility on self-monitoring
of internal sensations and needs; and gendered constructions of power and self-efcacy
which can affect self-regulatory strength. Chrisler describes PMS as an archetypal
example of a disorderwhere absence of self-regulation, particularly in relation to the
expression of anger, is positioned as pathology, with the fear of being overwhelmed by
the menstrual monsterdescribed as a recipe for psychological disaster, as women
are socialised to believe that they need to work at self-control in every waking hour
(Chrisler, 2008, p. 2). Chrisler suggests that there needs to be more research at the
intersection of the psychology of gender and the psychology of self-regulation in order
to understand how and why women fear losing control, and how to help them to leave
that fear behind(Chrisler, 2008, p. 2). Women who experience negative premenstrual
change are an ideal focus for such research, given the common descriptor of the PMS-
self as out of control(Chrisler, 2008, p. 1; Ussher & Perz, 2010, p. 440).
Much of the previous research on coping with negative premenstrual change has
adopted solely quantitative methods, using standardised questionnaires to assess coping.
This research is of importance in providing statistical data on types of coping strategies
women adopt, and the association with distress. However, it has been suggested that
qualitative research is needed in order to facilitate in-depth examination of womens
subjective experience of self-regulation (Chrisler, 2008), which will provide a more
nuanced insight into the processes involved in the negotiation and management of nega-
tive premenstrual change. The aim of the present exploratory study was thus to use
qualitative methods to examine womens accounts of self-regulation and coping in the
context of negative premenstrual change, within a MDI framework.
Method
Participants and recruitment
Sixty women were selected for interview from a larger mixed-methods study examining
the construction and experience of premenstrual change in self-diagnosed PMS suffer-
ers. The participants were Australian women aged 22 to 48 (average age 35, SD 6.3);
80% were partnered, with 90% of partnered women co-habiting. Sixty-six per cent of
participants identied as heterosexual, the remainder as lesbian and 47% reported hav-
ing children, with 47% of those with children indicating that their children lived with
them. Of the 82% of the sample that reported being employed, 52% were engaged in
full-time employment. The majority of participants (98.5%) were Anglo-Australian,
with one woman identifying as Asian, and all were resident in an urban location in
Australias largest city. Participants were recruited from a range of contexts in order to
attract women from different age groups, relationship status and sexual identities: adver-
tisements in the media; womens health centres; online chat-rooms and email lists; a
relationship counselling organisation; and a lesbian motherbaby network. Women who
were interested in taking part contacted the research team by email or telephone, and
were sent an information sheet, consent form, survey and details of online survey com-
pletion, interview contact form, and reply paid envelope. Following completion of the
survey, sixty women who reported three or more psychological premenstrual symptoms,
and who rated their distress on a Likert scale as six out of ten or more, were
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purposefully selected for interview, to ensure the inclusion of a range of relationship
types (lesbian/heterosexual) and contexts (presence of children; single vs. cohabitation).
Ethics approval was received from the University Human Research Ethics Committee
and pseudonyms have been allocated to all participants.
Procedure
One-to-one semi-structured interviews, lasting between 45 and 90 minutes, were con-
ducted by the rst author (n= 4), or by two women researchers in the authorsresearch
team (n= 56). The interviews took place in a private location chosen by the participant
(e.g. their home or place of work), or in an interview room in a university building.
Interviews were audio-recorded, and participants were compensated $25 for their time
and travel expenses. We kept the interview questions open and general to avoid being
misleading, and conducted the interview as a discussion between interviewer and partic-
ipant. The interviewer began by asking women to describe a typical experience of
PMS, how this varied across relational contexts, and to describe strategies of coping.
Data analysis
Our aim was to identify key themes in womens construction and experience of premen-
strual change, and the ways in which women negotiate and cope with PMS, in the con-
text of relationships. The analysis was conducted using thematic analysis, which has
been described as a foundational method, as the techniques of analysing themes within
data are common to the majority of variants of qualitative analysis (Braun & Clarke,
2006). We adopted a theoretical thematic analysis, informed by a MDI approach
(Ussher, 1999), and knowledge of research on coping. All of the interviews were tran-
scribed verbatim. A subset of the interviews were then independently read and reread
by both authors and a research assistant to identify rst-order codes, such as embodied
changes,emotional distress,relational issuesand PMS at work, and triggers for
premenstrual distress. The entire data set was then coded using NVivo, a computer
package that facilitates organisation of coded qualitative data. All of the coded data was
then read through independently by both authors. Codes were grouped into higher-order
themes, a careful and recursive decision-making process, which involved checking for
emerging patterns, for variability and consistency, and for making judgements about
which codes were similar and dissimilar. The thematically coded data were then collated
and reorganised through reading and rereading, allowing for a further renement and
review of themes, where a number of themes were collapsed into each other, and a the-
matic map of the data was developed. In this nal stage, a core category coping with
negative premenstrual changewas developed, which essentially linked many of the
themes.
All of the women interviewed described PMSin the same way, as being character-
ised by heightened premenstrual irritability, intolerance of others and oversensitivity.
Women described themselves premenstrually using terms such as irritable,cranky,
short-tempered,snappy,confrontational, having a short fuse,bitey,impatient,
grumpy,stroppy,frustrated,stressed,annoyedor teary(Ussher & Perz, 2013).
These feelings were positioned as out of controlby the majority of interviewees. I
physically feel like I cant stop it. Its just this physical feeling of I dont know, anger
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inside;I cant help it;its feeling out of control; and I dont have control over how
I feel at all. However, two-thirds of the sample gave accounts of engagement in negoti-
ation of premenstrual feelings and coping strategies, which meant that the PMS-self
was not positioned as inevitably out of control. Three major themes within the core cat-
egory coping with negative premenstrual changewere consistently identied across
relationship type and context: Self-monitoring and awareness: recognition and accep-
tance of premenstrual change;Self-regulation of premenstrual distress, including:
Avoidance of stress and conict,Escaping relational demands and responsibilities,
and Care of the self; and Coping as an inter-subjective experience. Each of these
themes is discussed in detail below. For each participant, age and sexual identity is pro-
vided for the rst quotation presented.
Results
Self-monitoring and awareness: recognition and acceptance of premenstrual change
The rst stage of negotiating negative premenstrual change was engagement in a pro-
cess of self-monitoring, through awareness that such change is taking place and recog-
nition that it is a premenstrual experience. Thus, Monica (41, lesbian) said: I kept a
note of my cycle regularly so that I would know when I was going to start feeling tired
so I could explain to myself what was happening. Olivia (34, heterosexual) told us:
Sometimes I actually look at it in advance and say, well my periods are due around
here, so my PMS would probably be due around here, so Ill be more aware around
that time. Whilst Monica and Olivia used a diary to record their menstrual cycle
changes, other participants reported listening to myself(Katie, 38, heterosexual), or
general tuning into not just my emotional state but my own bodily state(Merrin, 44,
heterosexual), suggesting that they were executing self-monitoring in the moment, rec-
ognising negative premenstrual change as it occurred. Some women also gave accounts
of recognising such change retrospectively, after they had been triggeredwhen in a
premenstrual state, resulting in a determination to be more aware in future months:
(I tell myself) Gee, I must remember this for next month, so Im aware of it, because if
there is something youre going to get upset about, theres always going to be something
that triggers you off, and if you realise it rst then I will know it. I never think to write
the dates down. Mmmmm. (Caroline, 46, heterosexual)
One of the primary functions of this awareness was to position premenstrual emo-
tions as understandable rather than as pathology, thus resisting the discursive position-
ing of the woman as mad, bad or dangerous (Chrisler & Caplan, 2002). As Olivia told
us, its a weight off my mind. Cause at rst I used to think I was going a little crazy
its helped me deal with, those are PMS feelings”’. Similarly, Danni (30, heterosex-
ual) tells herself, Oh, OK, I know now, youre not actually the wicked witch. Partici-
pants in the present study who did not describe anticipatory awareness of negative
premenstrual change were more likely to self-pathologise, describing themselves as
crazyor mad(Stephanie, 44, lesbian), a nut case,absolute psychoor Schizo
(Sandra, 32, heterosexual), out of my mind,ora complete loony(Joanne, 48,
heterosexual), when they were premenstrual.
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In contrast, participants who reported awareness of premenstrual change said that it
helped them to understand it moreand normalise it(Sophia, 28, lesbian). For a num-
ber of our participants, this normalisation resulted in a strategy of tolerance of negative
premenstrual change, which was recognised to be temporary. As Helena (38, lesbian),
told us I would just go with it and go,Oh look, in two days (laugh) this will be ne
(laugh)and Judith (39, lesbian) said you just sort of have to keep going. This does
not mean that premenstrual mood change was embraced, but it was not positioned as
an illness or sign of madness, rather, as something that part of being a woman. Recog-
nition and acceptance of negative premenstrual change can also function to give women
permission to engage in emotional regulation and coping strategies to avoid or reduce
premenstrual distress; providing the willpower(Chrisler, 2008, p. 2) to self-regulate.
Thus, Merrin told us: Ill actually give myself permission to actually go and lie down
for half an hour. Even half an hour will make substantial amount of difference.
This was a coping strategy reported by many participants in the study, as is outlined
below.
Coping through self-regulation of premenstrual distress
Avoidance of stress and conict
The premenstrual coping strategy most commonly reported by participants was self-reg-
ulation through avoidance of people or situations that had the potential to provoke
anger and irritation, which Joan (31, heterosexual) described as being rile(d) up:
If I had to put it in a nutshell it would also be there was certain people that I could be with
at that time of the month and certain people I couldnt. So yes, that is gonna have an effect
on life because there were certain things I couldnt go to, because I knew that person
would rile me up.
Judith described feeling trappedand like a caged tiger or something, pacingwhen
she was premenstrual. She said that whilst she loved her children to death, it was
probably the only time that I ever feel that I would just want to get up and walk away
and go away by myself for a couple of days. Successful planning can lead to the exe-
cution of this desire to avoid stress. For example, Rachel (37, heterosexual) reported if
I can avoid something on that week I will, and Sophia told us the kids I try not to
get into conict, into confrontation with them.
Whilst accounts of premenstrual emotional regulation were most commonly reported
in a family or couple context, a number of participants gave accounts of avoidant cop-
ing in a work context. Jacinta (31, lesbian) described experiencing frustrations with
peopleand frustrations with the systems that you work withresulting in her feeling
that her colleagues were all a bunch of dickheads when Im premenstrual. She told us
that she wished she lived in one of the cultures or traditions where the woman goes
away for a week, which would allow her to say See ya, Im goingwhen she was pre-
menstrual. Melanie and Kathryn described how they enacted this goal of withdrawal at
work:
Ind I get more annoyed by other people or what they say affects me more so I guess I
sort of withdraw a bit, especially at work. (Melanie, 23, heterosexual)
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I knew that I was a bit more, you know, on an uneven keel, so I just diverted my phone,
you know, and let people know that I wasnt taking calls, you know, so that then I can
manage that quite effectively. (Kathryn, 33, lesbian)
However, many participants were unable to anticipate and thus avoid situations or peo-
ple who could elicit premenstrual anger or irritation. As a result, they described coping
with occurrences of negative premenstrual emotion through exertion of self-control,
leaving a situation when they had become angry, in order to avoid escalation of con-
ict. Thus, Katie (38, heterosexual) told us about a situation where It was in the
kitchen and I can remember just getting so cranky I just went in and sat down in
um our formal lounge room just to stay away from everyone because I was just so
angry. Similarly, Lillian (44, heterosexual) described being angry with her two boys,
but feeling alrightonce she got away from the situation.
This exertion of self-control was not without emotional effort for women, as Casey
reported its taken every ounce of energy and sort of restraint that Ive got.
In some ways, this is reminiscent of the pattern of self-silencing which Jack (2001)
has associated with womens depression, where women repress their own feelings, in
particular their anger, and put the needs of others rst, in order to avoid relationship
conict or loss. Many participants in the present study were overt in their descriptions
of self-silencing as a premenstrual coping strategy, as Olivia (34, heterosexual) told us,
I try and keep a bit more of a lid on it. Not that Im pushing it down I talk about it
when I feel a bit better. Jill (31, heterosexual) talked about training herself to step
back and chillso that she didntexplode:
I usually feel stressed in the lead up. If it gets to the point where I actually need to say
that, I know the pressure cooker, little thing on the top bouncing up and down, you know,
um at that point and its almost like a last resort for me. If I know Im going to explode, I
try to train myself to step back and chill.
In the above accounts, women are pre-empting or avoiding premenstrual ruptures in
self-silencing through effectively monitoring and regulating their environment, in order
to regulate their premenstrual emotional reactions. In some accounts, this was posi-
tioned as necessary for the protection of others. For example, Alice (34, heterosexual)
described hibernating, because of a fear of not being able to rein yourself in, and
wanting to avoid hurting people with words, because its not their fault. However,
participants more commonly described premenstrual self-silencing, or avoidance of con-
tact with others, to protect the self, as Fiona (44, heterosexual) reported I will avoid
having contact with other people, or putting myself in situations where I know that Im
going to be vulnerable. Similarly, Kathryn (33, lesbian) said, I just wanted to really
minimise anything that would impact on me cause I knew I was really sensitive. This
suggests that self-protection can be a motivation for self-silencing in accounts of
premenstrual change.
Escaping relational demands and responsibilities
A further self-regulatory coping strategy described by participants was the desire to
escape from relational demands and responsibilities. As Eleanor (43, heterosexual) told
us I guess thats the time where I feel, hey, Im just not feeling 100% and I just want
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you all to stop putting demands on me, you know?The son, the dog, the work, every-
body. Merrin described taking time to rest premenstrually, and contrasted this with
how she copes with her family responsibilities the rest of the month, when she pays
little attention to her own bodily state, and prioritises the needs of her children:
Ive got three children, and theyre a little bit older now but my attentiveness (is) to their
needs and I might deny things like realising I need to go to the toilet for example, I can
carry that for a long period of time or even my own hunger or whatever You just you
become by nature more outwardly focused so, just being attentive to my own bodily state,
even very basic functions, I think Ive lost my capacity to sort of pay attention to those
things.
The materiality of the mothering role, combined with the predominant cultural represen-
tation of the mother as ever-bountiful, ever-giving, (and) self-sacricing(Bassin,
Honey, & Kaplan, 1994, p. 2), has been recognised by many feminists to be a factor in
premenstrual distress (Ussher, 2011). Recognising premenstrual change acted to legiti-
mate Merrin taking time-out for herself, absolving her from responsibility to care for
others, even if only for half an hour, which allowed her to self-regulate her premen-
strual emotions and reduce distress.
Many women were only able to legitimate time-out from responsibility when they
were premenstrual. For example, Eleanor told us that her premenstrual week was the
only time she allowed herself to veg out in terms of not doing the washing up after
dinner, or not bothering to do the ironing and then pay the consequences of ironing as
we go. Similarly, Olivia said that Ill try and take things easy in the house a bit
Ill ask for a bit more help, and Jackie (33, heterosexual) said that whilst she normally
worried about housework, I just dont care. Dont cook dinner and things like that.
In each of these accounts, women are implicitly revealing the critical self-surveil-
lance they engage in for three weeks of the month, wherein they judge themselves
against the standards of good wife and mother, who is self-renouncing, competent and
capable (OGrady, 2005), and where having a lazy dayviolates standards of idealised
femininity (Chrisler, 2008, p. 8). Premenstrually, participants described being a little
easier on myself being a little kinder(Olivia), cutting myself a little bit of slack
(Merrin), being gentler on myself(Celia, 43, heterosexual), a little bit nicer to
myself(Danni) or being self indulgent and precious(Nancy, 28, lesbian), suggesting
that critical self-surveillance is relaxed at this time. This serves to legitimate
engagement in coping strategies that function to care for the self, in order to self-
regulate emotion and avoid or reduce premenstrual distress.
Care of the self
Whilst many participants reported wanting to be alone premenstrually in order to avoid
difcult situations or people, women also craved solitude for positive reasons, in order
to care for the self. As Jill told us, solitude is wonderful, being by yourself, doing your
own thing. A number of women described wanting time-out in order to be comfort-
able(Joan), or to engage in self-preservation(Jackie). As Jackie continued, you just
need rest, you know. And you dont feel like being cheered up, because youre just
just want, you know, a bit of peace. Joan described the premenstrual phase as a time
when she would go to the ocean, as the best, most calming thing that I can do for
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myself. Katie described spending a long time in the shower listening to myselfand
allowing herself to forget that she should be doing things in the kitchen and the kids
are at you. Melanie said I just need half an hour in front of the TV and not to talk too
much, and Marylin said I dont really want to go out. Id rather curl up with a book
and have a quiet time. Similarly, Casey (40, lesbian) said when Im in those zones, I
mean, if its the weekend, Im more than happy to stay at home and just with the DVD
and put music on and just kind of be in my own bubble. And be in the zone. Tracy
said I need annelette sheets (laugh). You know, just that comfort. Comfort and, um,
you know, comfort food and comfort environment and a bath.
A number of women described a combination of time-out and exercise. Jocelyn (47,
lesbian) achieved this through gardening: Ive got a really big garden that I maintain
and I like to take myself out there and yeah I suppose I do like to be a little more
alone around that time. Maggie described going for a walk serving a similar function,
sometimes I just like to go out and go for a walk and just put the headphones on, I
nd that helps, getting out by yourself makes a difference, as did Merrin I go for a
walk. Many participants also described resting and eating a healthy diet as proactive
coping strategies utilised to facilitate self-care and reduce premenstrual distress. As
Melanie told us, I try to get more sleep and make sure that I eat well, and Amy (43,
heterosexual) said what Im trying to do around those physical symptoms (is) just
really, try and eat very well, and get rest. Similarly, Tracy said Not drinking caffeine
beverages. Alcohol. Avoiding sugars. Controlling food cravings was also described as
an active coping strategy by a number of women:
I really, really want to be eating all the chocolate and all the pizza in the world, but if I
do, its going to make me feel crapper. (Shona)
However, these dietary coping strategies were also accompanied by psychological or
behavioural strategies, demonstrating that coping is complex and multi-faceted
(Folkman & Lazarus, 1985).
Premenstrual coping as an inter-subjective experience
Womens ability to self-regulate negative premenstrual emotion and engage in coping
strategies to reduce premenstrual distress was also inuenced by the response of their
partner, children or close friends. A number of participants gave accounts of time-out
being facilitated by family members. Joan told us that I dont know quite what do to
with myself sometimes, and by saying, you know, I need to withdrawhe (partner)
understands. Similarly, Susannah said we both realise its a very good thing to have
your own time, Caroline described her children as saying to her Mum, do you think
you should go for a run todayif she was in a cranky mood, and Fiona said that my
husband knows how to deal with it Hell sort of go well give her some space and
shell get over it. Support could also consist of spending time with a woman when she
was premenstrual, and facilitating her self-care. Sheridan (35, lesbian) described this as
having a pyjama and TV nightwith her friend, which was comforting. Conversely,
women who were single reported that it was easier to engage in self-care, as they did
not need to negotiate having their own space(Celia). This may provide partial expla-
nation for the previously observed nding that women who are single are less likely to
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report premenstrual distress (Dalton, 1977); they do not experience conict or responsi-
bility for others in the home, and can more easily take time-out from interaction with
others in order to engage in self-care.
Whilst there were no notable differences between accounts of premenstrual change
and coping in heterosexual and lesbian women, all of the interviewees who were in les-
bian relationships reported that their partner was supportive, being able to empathise
with and understand premenstrual change, thus facilitating premenstrual coping. As
Shea (23, lesbian) commented: In terms of the response its just really understand-
ing and I guess supportive its just like, This is how Im feeling. Thats okay”’.
Similarly, Linda (36, lesbian) told us, Im extremely lucky that Helen [her partner] is
an extremely understanding person and so I get what I need at that time. Women in
lesbian relationships were also more able to divest themselves of responsibilities in the
home premenstrually, with the support of their partner. For example, Jocelyn said that
her partner was very understanding, and that shed do the housework on those days
(and) doesnt expect too much from me. Bec (42, lesbian) described worrying about
household nances when she was premenstrual, and her partner saying dont worry
about it, Ill x it up and well work it out later. Casey described how her partner
would take some of the responsibility, cook dinner, and run her a bath when she was
premenstrual, allowing Casey to just be.
In contrast, supportive reactions from male partners were only reported in approxi-
mately half of the heterosexual relationships, most commonly in contexts where women
were able to name PMS and articulate their premenstrual needs. As Joan said of her
relationship with her husband, we have ways of dealing with it and supporting each
other for actually being able to recognise whats going on and that we know that it will
pass, and maybe eventually it will get better. Equally, only a small proportion of the
heterosexual women who asked for practical support in the home premenstrually
received it. As Janice told us, on my anxious day he is really supportive, like, hell
do the housework, or dinner, and all kinds of stuff. Merrin described:
a couple of occasions where Ive felt so unwell, when I was so exhausted that Ive just
said that I cant cook dinner tonight, and I just sort of left him to it, with very little notice
and he mobilised take-away because hes not a good cook.
These differences across relationship contexts suggest that gendered roles performed
within, or outside, a heterosexual matrix inuence the inter-subjective negotiation of
premenstrual change.
Discussion
Bio-medical constructions of negative premenstrual change as pathological syndromes
as PMS or PMDD function to reinforce self-policing associated with the reproductive
body, leading to women pathologising the premenstrual-self. However, the ndings of
the present study suggest that through awareness and normalisation of premenstrual
change, as well as engagement in active coping strategies, Western women can resist
negative cultural discourse associated with PMS, reject self-pathologisation, and avoid
or ameliorate premenstrual distress. These ndings lend support to previous suggestions
that negative premenstrual change can be conceptualised as a stressor, for some women
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(Ussher & Wilding, 1991). In their groundbreaking analysis of coping processes,
Folkman and Lazarus (1985, p. 167) describe stress as a dynamic unfolding process,
not a static unitary event, which can change from the anticipation stage to the
outcome stagewith concomitant changes in emotions, coping, and the use of social
support(p. 168). The same can be said of womens accounts of negative premenstrual
change, which was experienced as an unfolding process, changing from anticipation to
outcome stage, depending on womens strategies of negotiation and coping, as well as
their social support.
The majority of participants interviewed in the present study reported a consistent
pattern of negotiation and management of negative premenstrual change. This process
began with self-awareness, which functioned to provide recognition and acceptance of
premenstrual change. This is analogous to mindfulness-based practices which lead to an
appreciation of the temporally based dimension of self and emotion, through paying
attention to bodily-based experiences and sensations as they occur, without negative
self-judgement (Epstein, 1995). This facilitates acceptance that feelings are rarely con-
stant, allowing premenstrual change to be positioned as a normal part of womens expe-
rience, rather than something that is pathological, necessitating psychiatric diagnosis or
cure(Ussher, 2003b). It also means that women are less likely to engage in the cycle
of guilt and self-blame associated with the experience or expression of premenstrual
emotion which has been reported in previous research (Cosgrove & Riddle, 2003).
In turn, this gave women permission to engage in proactive coping to avoid pre-
menstrual distress, anticipatory coping to prepare for distress, and coping strategies to
reduce premenstrual change or distress when it occurred, with self-regulation central to
each. This leads to the conclusion that PMS is not a xed unitary illness, but rather, an
ongoing process of negotiation, with levels of distress associated with the mode of
appraisal and coping adopted by women (Ussher, 2002). In this view, PMS is not the
underlying pathology that causes distress, but is the distress itself; a diagnostic label
given to describe negative premenstrual change (Jones et al., 2000).
Avoidance of stress, conict or responsibility during the premenstrual phase of the
cycle, the most common management strategy reported in by women, functions as both
a proactive and anticipatory coping strategy. Women are focusing on preventing or
modifying an anticipated stressful event(Aspinwall & Taylor, 1997), as well as
preparing for a stressful event which cannot be avoided (Breznitz, 1983), premenstrual
distress. Avoidance has been described as maladaptiveand a reection of trait anxi-
etyin previous research conducted with women who report PMS (Kuczmierczyk et al.,
1994, p. 304), implicitly pathologising this style of coping. However, participants in the
present study described effectively diminishing negative emotional experiences through
anticipatory awareness and subsequent avoidance of situations that might provoke anger
or distress. This suggests that avoidance involves effective self-regulation and planful
problem-solving (Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Gruen, 1986), rather
than reecting maladaptive or neurotic tendencies. In instances where anticipatory or
proactive coping strategies are not exercised, primarily because women could not pre-
dict conict, or could not avoid children or work colleagues, participants reported
engaging in coping strategies to minimise environmental demands or distress (Folkman
& Lazarus, 1985), which usually involved leaving the situation, further demonstrating
that coping is complex and multi-faceted.
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It has been previously reported that many women who present as PMS sufferers
report premenstrual ruptures in self-silencing, wherein anger and frustration repressed
for three weeks of the month is openly expressed (Perz & Ussher, 2006; Ussher & Perz,
2010). This has been described as a redeployment of the reproductive body to meet
womens emotional needs (Elson, 2002), as the expression of emotion that contradicts
cultural constructions of the good wife and mother is legitimated through being posi-
tioned as PMS (Ussher, 2003a). However, this was not the case in the present analysis,
as women gave accounts of maintaining self-silencing premenstrually, or wanting to be
alone to protect others from premenstrual anger. Accounts of time-out to protect the
self, and the absence of self-pathologisation, suggest that self-care was a strong motiva-
tion for self-regulation of both negative premenstrual change and the premenstrual self.
These accounts are evocative of the room of ones ownthat Virginia Woolf identied
as so important to womens creativity, as well as their sanity (Woolf, 1957), described
more recently as an essential health promoting resource for women(Forssen &
Carlstedt, 2006, p. 175). In accounts of coping with negative premenstrual change,
women did not literally need a room of their own in order to take time-out from others;
they could achieve solitude and divest themselves of responsibilities by engaging in
gardening, watching TV, reading a book, taking a long shower or exercise. Whilst exer-
cise has previously been acknowledged to be an effective coping strategy for premen-
strual distress (Kirkpatrick, Brewer, & Stocks, 1990), these accounts suggest that the
absence of interaction with others, and the ability to focus on care of the self through
exercise, also allows women to regulate negative premenstrual change, and avoid pre-
menstrual distress.
Many women also described engaging in dietary control premenstrually. This could
be framed as a positive strategy of self-regulation, reecting self-awareness of the nega-
tive impact of a diet high in caffeine, alcohol, fat, sugar or carbohydrate on premen-
strual emotions (Bussell, 1998). As one participant said when discussing chocolate and
pizza cravings, its going to make me feel crapper. However, these strategies could
also be conceptualised as examples of bodily regulation inuenced by the cultural con-
struction of women as needing to be slim and in control of their eating (Bordo, 1993),
reecting misogynistic beauty ideals of thinness (Jeffreys, 2005). This suggests that
there is a ne line between self-surveillance of diet and self-care.
Partners and other family members were implicated in challenging self-surveillance
and facilitating womens premenstrual management and self-care, reinforcing the
importance of social support in self-regulation (Finkel & Fitzsimons, 2011) and coping
(Lazarus, 1990). This also supports previous research reports of PMS as an inter-subjec-
tive experience, wherein supportive partners were found to alleviate premenstrual dis-
tress, and unsupportive partners to exacerbate it (Frank, 1995; Jones et al., 2000;
Ussher & Perz, 2013). Partners who recognise premenstrual distress, and support
women in taking time for themselves, are effectively challenging gendered discourses
which position good women as needing to be self-renouncing and in control, allowing
womens self-policing to be relaxed at this time of the month. This was more com-
monly reported in lesbian relationships, which could be explained by previous research
which reports that women in same-sex relationships are more likely to manifest a capac-
ity for mutual empathy, empowerment and relational authenticity (Mencher, 1990), as
well as innovation and adaptability in dealing with both relational needs and domestic
tasks (Connolly, 2005, p. 270). This demonstrates that gender is not something that we
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are, but something that we do (Butler, 1990), a performance that is invariably negoti-
ated differently outside of a heterosexual matrix, as different role expectations,
opportunities and constraints apply.
Womens self-regulation and coping in the context of negative premenstrual
change is not solely an intra-psychic process; discursive constructions of gender, and
of PMS, are also implicated, conrming Chrislers (2008) view that gender-role soci-
alisation and cultural beliefs about women inuence self-regulation. Equally, the
material context of womens lives plays a part in premenstrual distress. Whilst many
women, particularly those with children, position anger or irritation about burden of
care as a premenstrual symptom(Ussher, 2003a), we could reframe it as a legiti-
mate reaction to over-responsibility, or absence of partner support in the home. In
this vein, Figert (2005, p. 110) argues that we need a return to a menstrual hut
and its monthly release from traditional womens roles of cooking, cleaning and fam-
ily duties. This is a release that many of the participants in the present study gave
themselves permission to take, as the discursive construction of PMSas a time
when self-care is permissible legitimates women taking time-out from daily stress or
responsibility. This demonstrates resistance of gendered discourse which emphasises
womens self-renunciation (Jack, 1991) and positions womens self-care as selsh
(OGrady, 2005).
The resource accumulation(Aspinwall & Taylor, 1997, p. 420) that is necessary
for women to resist such discourse and engage in coping strategies is also gendered;
some women interviewed in the broader study did not have the material resources or
social support to avoid stress or engage in self-care premenstrually (Ussher & Perz,
2013), gendered experiences which have been associated with the development of
womens psychological distress more generally (Ussher, 2010). These women did not
appear to have the willpower skillpower and self-efcacywhich Chrisler (2008,
p. 2) describes as essential to self-regulation, instead, pathologising premenstrual anger
or desire to be alone and seeing inability to emulate ideals of the competent, coping
superwoman as a failure. However, rather than positioning this as a psychological trait
or limitation of the individual woman, we could conceptualise it as a reection of inter-
nalised gendered constructions of femininity which position women who are angry,
unapproachable or turn-inward as having something wrong with them (Chrisler &
Caplan, 2002), and superwoman as the norm (Chrisler, 2008).
Conclusions
Previous research on PMS and PMDD has focused on documenting the nature, magni-
tude or aetiology of premenstrual distress, primarily adopting quantitative methods,
within a positivist epistemology. The present study has adopted a critical realist episte-
mological standpoint, and a MDI model, to examine self-regulation and coping associ-
ated with negative premenstrual emotion. There is a need for further research to
examine the nature and consequences of the myriad strategies women adopt to cope
with negative premenstrual change, as well as the factors that may help, or hinder, in
this process. Such research could usefully combine quantitative measures of coping,
self-regulation, and self-efcacy, with qualitative accounts of the negotiation and
management of premenstrual distress; one limitation of the present study is that such
quantitative measures of coping were not collected.
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A further limitation of the present study was our focus on women who self-
diagnosed as PMS sufferers, in order to avoid the reication of PMS or PMDD as
diagnostic categories. Comparison of women who meet standardised diagnostic crite-
ria for PMS (Bancroft, 1993), with women who self-present with PMS, but who do
not meet such criteria, as well as women who report negative premenstrual change,
but do not adopt the label PMS sufferer-described in the research literature as false
positives and false negatives, respectively (Hamilton & Gallant, 1990) - would also
be useful, in order to evaluate whether self-regulation and coping differs across these
groups of women. As there is also evidence that ethnicity or cultural group may
inuence womens experience and construction of premenstrual change (Pilver et al.,
2011), it would also be useful to include women from a range of cultural back-
grounds.
The ndings of the present study have implications for therapists and health psy-
chologists who work with women who present with PMS, or PMDD. Rather than
positioning womens premenstrual management strategies as maladaptive avoidance
(Kuczmierczyk et al., 1994), or failure to cope with daily living, they could be
reframed as effective coping strategies, and women are encouraged to gain control
through internalising notions of the self as an expert coper and developing strategies
to effectively manage negative premenstrual change. These ndings provide explana-
tion for why cognitive-behavioural therapies which focus on positive reframing of pre-
menstrual change (Blake, Salkovskis, Gath, Day, & Garrod, 1998; Morse, 1999),
coping skills training (Kirkby, 1994; Morse, Dennerstein, Farrell, & Varnavides, 1991),
or a combination of the two (Hunter et al., 2002; Ussher et al., 2002), are effective in
reducing premenstrual distress. In a recent meta-analysis of randomised controlled
trials for moderatesevere premenstrual distress (Busse, Montori, Krasnik, Patelis-Sio-
tis, & Guyatt, 2009), a range of therapeutic techniques including cognitive therapy,
narrative re-authoring, behavioural interventions including exercise, healthy eating,
self-care, and relaxation training, as well as self-monitoring, were found to have had a
consistent effect on reducing premenstrual anxiety and depression, as well as a positive
impact on behavioural changes. Further research is needed to examine whether the
involvement of partners can increase the effectiveness of such interventions, as is sug-
gested by previous research on the relational context of PMS (Jones et al., 2000). It
would also be useful to examine whether specic components of therapeutic interven-
tions are associated with effective management of premenstrual distress, comparing
cognitive, behavioural and self-monitoring strategies. There is thus consistent evidence
that Western women can negotiate and cope with negative premenstrual change, using
strategies that are effective in dealing with more general life stress; the challenge to
researchers and clinicians is to determine which management strategies work most
effectively for premenstrual women.
Acknowledgements
This study was funded by a Discovery Grant from the Australian Research Council, An
examination of the development, experience and construction of premenstrual symptoms: A
comparative study of different relationship contexts(DP0558831). Thanks are offered to Julie
Mooney-Somers, Lee Shepard, Beverley Johnson, Helen Vidler, Emily May, Margaret Boulos and
Chloe Parton for research support and assistance.
Psychology & Health 923
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... Researchers who have focused on the reproductive life events and bipolar disorder have primarily used quantitative methods, with few studies in this area being conducted, and there is a dearth of research examining the subjective experiences of women living with bipolar disorder. Qualitative research can provide insight into the meaning of experiences, as well as the ways in which women negotiate mood change associated with reproductive life events (Ussher & Perz, 2013). For example, Perich, Ussher, et al. (2017) conducted a small scale interview study which explored the meaning of menopause for women with bipolar disorder and found that women constructed the experience of mood changes through a biomedical framework of bipolar disorder, rather than a menopausal framework, and positioned menopause as a trigger or cause of increased mood disturbance. ...
... For younger women, awareness and self-monitoring also featured as important, with self-monitoring playing a role in both managing bipolar disorder and reproductive health across the menstrual cycle. These findings support those found by other researchers, indicating awareness and insight improves psychiatric treatment outcomes in the course of illness in bipolar disorder, as well as the management of premenstrual distress (L atalov a, 2012; Ussher & Perz, 2013), however it also indicates that there are differences depending on women and their stage of life. The role of self-monitoring and how this may lead to awareness for women to make informed choices regarding their health treatment requires further exploration. ...
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Little is known about how women with bipolar disorder construct and experience reproductive life events across the lifespan. We analyzed qualitative data from 29 semi-structured interviews with women aged 22-63 years (reproductive, menopause and post-menopause phases) using thematic analysis through a social constructionist framework. Themes of “Losing a sense of self-agency and self-worth” contained accounts of feeling out of control because of both bipolar disorder and reproductive life events. “Building a sense of personal autonomy and positive self-image” included accounts of acceptance and management of mood change over time, particularly for women in menopause and post-menopause life phases.
... Extra time spent washing and choosing concealing clothing supports ideas that women's engagement in body work is timeconsuming (Chrisler, 2018), reflecting the strength of cultural pressures placed on women to manage their bodies to maintain secure bodily boundaries (Colls, 2007). Isolating the self confirms previous premenstrual research suggesting that women engage in avoidance of others as a form of coping, avoiding situations that have the potential to provoke anger and stress (Ussher & Perz, 2013). The present findings suggest that women may avoid others in fear of anticipated judgement of the premenstrual body. ...
... In the present study, women described feeling less able to resist upward social comparisons and negative feelings about the body when they were premenstrual. This may be a consequence of negative emotional changes experienced premenstrually, which often include self-criticism (Ussher & Perz, 2013), or upward social comparison may be a factor which exacerbates premenstrual distress. In combination, fragmentation of body parts, self-scrutiny and upward social comparison suggest a form of self-objectification (Fredrickson & Roberts, 1997) previously found within the premenstrual phase (Ussher & Perz, 2020a). ...
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Women's body shame and body dissatisfaction increase in the premenstrual phase of the cycle, associated with premenstrual distress. However, the meaning and consequences of premenstrual body dissatisfaction remain underexplored. The aim of this study was to explore how women who report premenstrual body dissatisfaction construct and experience their bodies, using qualitative arts-based methods. Four hundred and sixty women completed online open-ended survey questions and 16 women took part in body-mapping and an interview. Thematic analysis identified three major themes: construction of the premenstrual body as abject, manifested by positioning of the body and self as fat, leaking and dirty; self-policing and self-regulation through increased scrutinising and concealment of the premenstrual body; and resistance of cultural constructions of idealised femininity. These findings emphasise the need to acknowledge changes in body dissatisfaction across the menstrual cycle, and the implication for women's feelings about the self. Internalisation of negative constructions of the female body plays a role in women's experience of premenstrual change and distress. There is a need for further research to examine the role of body management behaviours in premenstrual body dissatisfaction and distress.
... After 21 interviews no more new codes were found, and thus saturation was achieved. We provided figures to indicate whether the results had been obtained from few (1-3), some (4-8), many (9)(10)(11)(12)(13)(14)(15)(16)(17)(18), or most (19)(20)(21)(22)(23)(24)(25)(26)(27)(28) participants. COREQ criteria were applied for reporting qualitative research [20]. ...
... Although PMS/PMDD's aetiology is still not fully understood, a currently widely accepted assumption is that underlying pathophysiology is an abnormal sensitivity to normal changes of ovarian hormones [10,11]. This hormone sensitivity has been associated with genetic and biographic factors like history of trauma [9,10,21,22]. ...
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Background General practitioners (GPs) encounter women suffering from premenstrual symptoms. Often women with premenstrual problems experience little understanding from GPs. Views of GPs will influence their approach to these women and their care. Insight into these views is lacking but could help in designing educational programmes for GPs. Objectives To explore the views of Dutch GPs towards aetiology, diagnostic process, and preferred treatment of premenstrual symptoms. Methods In 2017, we conducted a qualitative, semi-structured, interview survey among 27 GPs, varying in age, gender, and practice setting. Results Important themes emerged from the interviews: ‘no need for a symptom diary,’ ‘PMS defined as illness’ exclusively in case of disruption of normal functioning, and ‘symptomatic treatment’ as preferred approach. Most GPs considered PMS to be a physiological phenomenon, with taking history as an adequate diagnostic tool. Almost all GPs regarded a normal cyclical hormonal cycle as causal; many also mentioned the combination with personal sensitivity. Some pointed to a dividing line between physiological condition and illness if women could not function normally in daily life. Lastly, the approach GPs preferred was focussing on relieving symptoms of individual patients. In addition to explaining the hormonal cycle and lifestyle advice, all GPs advocated oral contraceptives, and if necessary psychological support. GPs expressed negative feelings about prescribing antidepressants. Conclusion GPs considered physiological changes and personal sensitivity as aetiological factors. We recommend more training to improve GPs knowledge and more insight into the burden of women with PMS. A symptom diary is an essential diagnostic tool for GPs.
... PMS is a complex disorder characterized by mood changes such as irritability, depression, and physical symptoms limited to 7-14 days before the onset of the late luteal phase of the menstrual cycle [2]. Some authors suggest that PMS is not a fixed unitary syndrome but rather a diagnostic label that is socially applied to negative premenstrual changes, which may be specific to westernized cultures [3]. Thus, epidemiological surveys are needed to capture the prevalence of PMS in different contexts. ...
... Along with the fact that female-specific diseases such as PMS have increased, more women are aware of the existence of PMS in the information-oriented society, and more women are suffering from PMS. Because some previous studies have suggested that PMS may be a socially constructed disorder [3], the recent increase in recognition of PMS in Japan may be attributed to social construction. On the other hand, in Japan, child maltreatment has recently been socially recognized by the Child Guidance Center (which is similar to Child Protection Services in the United States or the United Kingdom), and reported cases were found to be 40 times more numerous than they were 20 years ago [22]. ...
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Childhood maltreatment history has known relationships with various mental and physical diseases; however, little is known about its association with premenstrual syndrome (PMS). In this study, we investigated the association between childhood maltreatment history and PMS among young women in Japan. In a Japanese city, we approached 3815 women aged 10–60 years who visited a gynecology clinic and one general practice clinic. A questionnaire on childhood maltreatment history and PMS was administered to them. We observed that women with histories of childhood maltreatment demonstrated a significantly increased risk of PMS compared with those without such histories (odds ratio: 1.47, 95% confidence interval: 1.20–1.81). Particularly, women with childhood physical or emotional abuse demonstrated a stronger association with PMS, whereas other forms of childhood maltreatment (emotional neglect, witnessing of intimate-partner violence, or sexual abuse) were not associated with PMS. Our results illustrate that childhood maltreatment may be a risk factor for PMS.
... Unfortunately, treatment interventions for PMS have remained a significant challenge (15). Over the recent two decades, several studies have been conducted to examine the effectiveness of various pharmacological and nonpharmacological treatment alternatives on PMS (16,17). While medications effectively relieve PMS syndrome, they have several side effects: nausea, sleep problems, sexual dysfunctions, headache, gastrointestinal problems, vomiting, and drowsiness (18,19). ...
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Premenstrual syndrome (PMS) is a common problem for women of reproductive age, affecting various aspects of their lives. While various in-person psychotherapeutic interventions, including Mindfulness therapy, have yielded promising results in reducing PMS symptoms, due to the COVID-19 Pandemic, psychotherapists are providing their services via online methods. Therefore, the present study is the first one worldwide to examine whether smartphone-based Mindfulness training can reduce symptoms of PMS and improve the quality of life in women with PMS. We recruited 80 Iranian women (aged 25-45) with PMS through online advertising who were randomly allocated into two groups of 40. The intervention group underwent two online introductory group sessions followed by 8 weeks of Mindfulness practice, while the control group received no intervention. Before and after the intervention, participants completed the 12-Item Short-Form Health Survey and the Premenstrual Symptoms Screening (PSST) questionnaires. Data were analyzed using the Analysis of Covariance (ANCOVA). Following the intervention, the mean scores of PMS symptoms were significantly lower in the intervention group than in the control group (p < 0.001; η2 = 0.18). Likewise, the quality of life score was significantly higher in the intervention group (p < 0.001; η2 = 0.14). Our results indicated that the smartphone-based Mindfulness training intervention could be an effective treatment modality for women with PMS symptoms, especially during the COVID-19 Pandemic, which has posed limitations for in-person therapies. Clinical trial registration: https://fa.irct.ir/trial/59924, identifier: IRCT20180607040000N2.
... Premenstrual syndrome (PMS) is one of the most common menstrual disorders in women of reproductive age [1]. This syndrome is a recurrent combination of bothersome physical, psychological, or behavioral changes during the secretory phase of the menstrual cycle [2] which decrease rapidly with the onset of menstruation [3,4]. Its most common symptoms are anxiety, depression, fatigue, anger, irritability, feeling out of control, confusion, changes in appetite and sleep, bloating, and breast tenderness. ...
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Background Premenstrual syndrome (PMS) is one of the most widespread menstrual disorders in women of reproductive age. This recurrent syndrome is a combination of physically, mentally, or behaviorally disturbing changes occurring during the secretory phase of the menstrual cycle. The aim of this study is to determine the effect of a cognitive-behavioral therapy-based educational intervention using social networks on PMS in female health center employees in Rudbar, Iran. Methods/design A randomized superiority controlled trial will be conducted involving 140 female employees of health centers affiliated with the Guilan University of Medical Sciences, Rudbar. The study involves a block size of 4 and 6 in a randomly varied order, 140 women who meet all the inclusion criteria will be randomly and equally divided into 2 groups: the intervention and the control groups. Those in the former group will receive a cognitive-behavioral therapy-based treatment for eight consecutive weeks on the social network platform WhatsApp; however, those in the control group will not be offered any treatment except usual care practices (unprotocolized usual care). The study’s primary outcome is the severity of PMS symptoms, and the secondary outcomes include general self-efficacy, work-related quality of life, the impact of PMS on daily life, coping with the symptoms, and experiencing anxiety and depression at the beginning of the study to identify people with PMS. A daily record of the symptoms will be completed for two consecutive months by all female employees aged 20–45 years who wish to participate in the study. According to the initial screening, those with moderate to severe PMS will be included. We will use the MLwin software for the analyses. All questionnaires will be completed by both groups immediately and 8 weeks after the termination of the treatment. The data will be analyzed using linear mixed-effects modeling with random intercepts and slopes. Discussion It is anticipated that the findings of the present study may demonstrate the effectiveness of the cognitive behavioral therapy intervention on the severity of PMS symptoms that could guide healthcare providers in opting for suitable treatment alternatives for the syndrome. Ethics and dissemination The research proposal is approved by the Human Ethics Committee of Qazvin University of Medical Sciences (IR.QUMS.REC.1399.252). The results of this intervention trial will be submitted for publication in a peer-reviewed research journal. Trial registration Iranian Registry of Clinical Trials IRCT20180218038789N4. Registered prospectively on October 28, 2020
... Reappraisal and suppression are two common strategies that people use to deal with their negative emotions (Ussher & Perz, 2013). Reappraisal involves changing the meaning of emotional events so that they alter emotional experience (Gross & John, 2003). ...
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Abstract The aim of the current study was to compare women with premenstrual syndrome (PMS) and with women in a non-PMS group with regard to emotion regulation strategies and trait meta-mood dimensions. Based on the results of an interview and screening tool, a total of 252 female college students were assigned to two groups including 126 women with PMS and 126 non-PMS women. Participants completed the Emotion Regulation Questionnaire (ERQ) and Trait Meta-Mood Scale (TMMS). The results showed that the women with PMS scored significantly higher on suppression (d= 2.35) and lower on reappraisal (d=0.50), emotional clarity (d=0.64) and emotional repair (d =0.81) compared to non-PMS women. Women with PMS had trouble regulating their emotions and didn’t use trait meta-mood strategies adaptively. The findings of our study could help both researchers and clinicians better understand some of the psychological difficulties experienced by women with PMS, and therefore explore and deliver effective interventions. Keywords Emotion regulation · Trait meta-mood · Premenstrual syndrome · Reappraisal · Suppression · Emotional attention · Emotional clarity · Emotional repair
... Тим не менше, хворі на ПМС мають високий рівень особистої тривожності, емоціональної лабільності, станів, пов'язаних з агресією, депресією або апатією, прояви яких можуть бути достатньо виражені для того, щоб зумовити значні труднощі в соціальній та професійній діяльності цих осіб [4][5][6]. ПМС, як біопсихосоціальний фактор, вимагає подальшого поглибленого вивчення [8,12]. ...
Article
Background: Premenstrual symptoms affect a significant number of women throughout their reproductive years. There is evidence that adapting and maintaining healthy lifestyle behaviours can improve these symptoms; however, the effectiveness of multiple behaviour change interventions remain largely untested. Aim: This study aims to test feasibility of a 12-week multiple health behaviour change (MHBC) intervention for university students suffering from premenstrual symptoms. Methods: A sequential mixed-method approach will explore the feasibility of a MHBC intervention to reduce premenstrual symptoms in female university students aged 18–35 years. In phase 1, a parallel three-group randomised pilot trial will be conducted among Australian students. Group 1 will receive the full intervention, while Groups 2 and 3 will receive either the period tracking application, or health behaviour change intervention, respectively. The second phase of the study will include semi-structured interviews and thematic analysis to gain an in-depth understanding of participants’ perceptions of the acceptability, appropriateness, usefulness, and sustainability of the intervention and its components (Group 1 participants only). Discussion: The results will inform whether a subsequent fully powered trial is feasible and provide a deeper understanding of the impact of premenstrual symptoms on university student's health and wellbeing. Moreover, the semi-structured interviews will provide insight into the acceptability, appropriateness, usefulness, and sustainability of the intervention in this population group. Conclusion: This study based on Bandura's social cognitive theory will examine the feasibility of a 12-week MHBC intervention for young women suffering from premenstrual symptoms.
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On Zhihu, China’s biggest social network platform for knowledge sharing, young male users are invited to put forward their experiences and suggestions on how to alleviate their partner’s menstrual pain. By means of thematic analysis and critical discourse analysis, this present study concentrates on the (un)supportive discourses of male netizens on dysmenorrhea and their implying gender ideologies. It finds out that Chinese young men to a certain extent have broken the restraint of traditional gender norms by offering tangible, emotional, and informational support for their partners. However, this kind of idealized male tenderness is still embedded in the problematic gender relations, and is a form of gender performativity informed by consumerism, neoliberalism, and the Confucian tradition. Moreover, a few discourses featuring male levity and misogyny indicate the dual nature of knowledge-sharing social networks, which imbue hidden gender issues with visibilities on the one hand and reproduce gender inequity on the other.
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Offering new perspectives on motherhood, distinguished contributors from a variety of fields look at the conflicting positions on motherhood within the feminist movement; draw on psychoanalysis to grapple with mothers' profoundly ambivalent feelings toward their children; discuss how advances in medicine influence the meaning of motherhood; and examine how representations of mothers in art, film, literature, the social and behavioral sciences, and historical writing have affected women. "The significant contribution of this collection of essays is its repeated re-presentation of the mother as a fully bodied, real, complex person, a subject in her own right, both liberated and oppressed by the demands of birthing and rearing children."-Bonnie J. Miller-McLemore, Cross Currents
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Volunteers (N = 59) who met both NIMH and an adjusted DSM-III-R criteria for moderate to severe Late Luteal Phase Dysphoric Disorder or premenstrual syndrome (PMS) were administered the Coping Inventory for Stressful Situations (CISS) intermenstrually and premenstrually in counterbalanced order. Participants reported significant increases in emotion-oriented coping and significant decreases in task, avoidance, and social diversion-oriented coping premenstrually. Results provide more specific understanding of the coping style changes which occur during PMS and, contrary to previous research, suggest that PMS stress may impact women in a manner which makes them less likely to use social support in coping. Utilization of coping knowledge is suggested for therapists with clients who report difficulties resulting from PMS.
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Woman's Relationship with Herself explores the relationship women have with themselves and demonstrates how this relationship is often dominated by debilitating practices of self-surveillance. Employing Foucault's notion of panoptical power, Helen O'Grady illuminates the link between this kind of self-surveillance and the broader mechanisms of social control, arguing that these negative practices prevent women from enjoying a satisfying, affirming relationship with themselves. Cultural factors that render women vulnerable to dissatisfying self-relations are identified and analysed and, drawing on the insights of Foucault, feminism and narrative therapy, the possibilities for developing a more empowering relationship with the self are examined. This innovative contribution to feminist debates about gender and the self will be of interest to students and researchers in social psychology, feminist psychology, mental health studies and gender studies, and to practitioners in psychological therapies and counselling psychology.
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Originally published in 1989, Reclaiming Reality still provides the most accessible introduction to the increasingly influential multi-disciplinary and international body of thought, known as critical realism. It is designed to "underlabour" both for the sciences, especially the human sciences, and for the projects of human emancipation which such sciences may come to inform; and provides an enlightening intervention in current debates about realism and relativism, positivism and poststucturalism, modernism and postmodernism, etc. Elaborating his critical realist perspective on society, nature, science and philosophy itself, Roy Bhaskar shows how this perspective can be used to undermine currently fashionable ideologies of the Right, and at the same time, to clear the ground for a reinvigorated Left. Reclaiming Reality contains powerful critiques of some of the most important schools of thought and thinkers of recent years-from Bachelard and Feyerabend to Rorty and Habermas; and it advances novel and convincing resolutions of many traditional philosophical problems. Now with a new introduction from Mervyn Hartwig, this book continues to provide a straightforward and stimulating introduction to current debates in philosophy and social theory for the interested lay reader and student alike. Reclaiming Reality will be of particular value not only for critical realists but for all those concerned with the revitalization of the socialist emancipatory project and the renaissance of the Marxist theoretical tradition. Roy Bhaskar is the originator of the philosophy of critical realism, and the author of many acclaimed and influential works including A Realist Theory of Science, The Possibility of Naturalism, Scientific Realism and Human Emancipation and Dialectic: The Pulse of Freedom. He is an editor of the recently published Critical Realism: Essential Readings and is currently chair of the Centre for Critical Realism.