Expert and Patient Descriptions of Premenstrual Syndrome, 2019-2020

King, Sally (2023). Expert and Patient Descriptions of Premenstrual Syndrome, 2019-2020. [Data Collection]. Colchester, Essex: UK Data Service. 10.5255/UKDA-SN-855486

PMS (Premenstrual Syndrome) diagnostic guidelines prioritise psychological symptoms, but the clinical reason for doing so remains unclear. Studies show that they are not necessarily the most commonly experienced, nor uniquely determining, nor most disruptive of the (100+) known premenstrual symptoms.

The main aim of this research was to explore how and why certain premenstrual symptoms achieve relative prominence over others, by examining 'expert' clinical constructions of PMS, alongside the experiences and perspectives of 'PMS sufferers'.

The research uses a mixed-methods approach, comparing quantitative epidemiological data with those derived from qualitative interviews with sixteen of the world’s top PMS experts (biomedical and critical academics) and twelve self-identified PMS sufferers.

The main finding was that persistent gender and racial myths associated with the 17th Century concept of ‘hysteria’ are unintentionally reproduced in contemporary expert and lay descriptions of cyclical symptoms. In turn, the disproven yet persistent idea that the female reproductive body (first the womb, now the ‘female sex hormones’) causes debilitating negative emotions, positions women as biologically prone to irrational behaviours (including the exaggeration, fabrication, or imagination of symptoms and other distressing experiences).

Such gender myths appear to contribute to the arbitrary clinical separation, prioritisation, and medicalisation of typically mild emotional premenstrual changes, and dismissal of/ disbelief in much more common experiences of debilitating abdominal pain. Black and other racialised ethnicity patient participants appeared to be subject to even higher levels of disbelief in their symptoms than White cisgender women, further demonstrating how gender and race myths may intersect and compound discriminatory beliefs and practices.

Another major finding was that educational resources (from high school biology to specialist gynaecological physiology textbooks) reduce the menstrual cycle to ‘hormonal changes’. By omitting key physiological events, the most likely cause of cyclical symptoms (systemic inflammation) has been obscured for the past 100 years. This has directly contributed to the unintentional reproduction and perpetuation of gender myths as well as ‘bad science’- in terms of the conflation of symptom correlation with (hormonal) causation.

Hundreds of clinical PMS studies have tried but failed to prove a causal relationship between any (female sex or other) hormones and cyclical symptoms. Tellingly, such contradictory findings were positioned by the biomedical PMS experts as evidence of the ‘mysterious’ nature of the female reproductive body rather than suggestive of alternative aetiological explanations. In sociological terms, it appears that a metaphorical linguistic/ conceptual association between ‘women’ and ‘hormones’ in the natural sciences (first identified by Nancy Leys Stepan in 1986), has severely limited the ability of biomedical researchers and clinicians to account for premenstrual experiences in any other terms.

Crucially, by quoting these biomedical discourses rather than directly engaging with reproductive physiology or the available epidemiological data, the expert feminist critical health scholars also unintentionally reproduced the same gender myths in their descriptions of PMS as a socially constructed diagnostic label. This discovery has significant implications for feminist (and other critical) methodologies and theories more widely, given their historical aversion to engaging with biology due to the harm caused by reductionist ‘justifications’ for the inferior political position of oppressed populations.

Data description (abstract)

The collection consists of 28 participant (pseudonyms used) interview transcripts (13 biomedical PMS experts, 3 critical health PMS experts, and 12 self-identified PMS patients from the UK and North America). Methodology overview and associated documents have been uploaded including: ethical clearance, participant information form, consent form, demographic background survey, data management plan, participant interview schedules, Transcription notation, Discursive device notation, coding tree. Analysis data and associated documents include the review of reproductive physiology content, overview of study implications, overview of main findings and original contribution to the literature, NVIVO analysis, symptom lists.

Data creators: