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PMS Or Perifollicular Phase Euphoria? Public Health Faculty Publications School of Public Health 1988 PMS or Perifollicular Phase Euphoria? Mary Guinan University of Nevada, Las Vegas, [email protected] Follow this and additional works at: https://digitalscholarship.unlv.edu/ community_health_sciences_fac_articles Part of the Medicine and Health Commons, Obstetrics and Gynecology Commons, and the Women's Health Commons Repository Citation Guinan, M. (1988). PMS or Perifollicular Phase Euphoria?. Journal of the American Medical Women’s Association, 43 91-92. Reston, VA: https://digitalscholarship.unlv.edu/community_health_sciences_fac_articles/61 This Article is protected by copyright and/or related rights. It has been brought to you by Digital Scholarship@UNLV with permission from the rights-holder(s). You are free to use this Article in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Article has been accepted for inclusion in Public Health Faculty Publications by an authorized administrator of Digital Scholarship@UNLV. For more information, please contact [email protected]. WOMEN'S HEALTH PMS or Perifollicular Phase Euphoria? Mary E. Guinan, MD, PhD taglandin excess, prolactin effect, woman ever be president if she were and multiple other guesses including, still menstruating? Had she ever had What I am going to say about pre­ of course, psychosomatic origins. PMS? Was she likely to start World menstrual syndrome (PMS) has little Suggested treatments include estro­ War III if, as president, she was out scientific basis; however, this is not gen, progesterone, vitamins, nutri­ of control because of PMS? I had unusual in the field ofPMS. Much of tional supplements, a prolactin inhib­ never experienced premenstrual the information on PMS published in itor, and psychotherapy. None of symptoms, and I never really knew medical journals is so lacking in sci­ these treatments have proved con­ any women who did. Therefore, I entific method that it would make vincingly more effective than place­ simply just didn't believe in PMS. many scientists (including myself) hoes in well-designed trials. Then in the early 1980s, I was at a cry in despair. Why is it that so little is known about PMS? First of all, there is no How could a scientist be suffering from something so agreement on what PMS is. If inves­ unscientific? Although I clearly had symptoms described tigators are referring to different sets as PMS, I refused to believe that I was out of control or of symptoms, how can studies be capable of killing, beating, or other violent behavior. comparable? In fact, they are not. Not only are the symptoms different, but the timing of symptoms is differ­ PMS has been a no-win situation local AMW A branch meeting talk­ ent, Some studies describe symptoms for women, according to Anne Faus­ ing to a friend about occasional that occur 7 to 10 days before the to-Sterling.1 In the past if women insomnia I was experiencing. I had onset of menses, while others include complained about symptoms related never had insomnia before in my life, symptoms that begin 14 days before to menses, they were often diagnosed and I was surprised and puzzled the onset of menses and continue for as neurotic. With the advent of the about being up one night every so 7 days after onset. This definition women's movement, women became often when I felt so wound up I suggests that women may have more assertive, insisting that their couldn't sleep. My friend replied that PMS-related symptoms during 21 symptoms were real. More attention. she thought it might be PMS. I was days of a 28-day cycle. I don't want was paid to PMS, especially in the shocked that she accepted the PMS to believe this-and I don't have media. Several legal cases emerged theory. Several of the other physi­ to-because little scientific evidence in which women charged with mur­ cians at the meeting chimed in to say exists to either support or refute this der or child abuse tried to use PMS that they themselves experienced hypothesis. as a defense, implying that PMS so PMS and occasionally diagnosed it in Symptoms both physical and emo­ affected them they were unable to their patients. I couldn't accept it. tional are attributed to PMS, with control their behavior. Then feminist Subsequently, I kept track of my most women having a combination. voices were heard pleading for cau­ insomnia bouts and found that they Symptoms include anxiety, depres­ tion in assuming that women may not occurred between 24 and 36 hours sion, tension, labile emotions, irrita­ be in control of their behavior several preceding onset of menses. I was bility, difficulty in concentrating, days each month, an idea consistent forced to reevaluate my position. I increased energy, decreased energy, with the old "raging hormone" theo­ reviewed all published books and food cravings, headache, weight ry that cyclic hormone changes make articles I could find through a Med­ gain, fluid retention, insomnia, women unreliable, unpredictable, line search. What a mishmash they breast swelling and tenderness, and and incapable of assuming important were. How could a scientist be suffer­ increased or decreased appetite. jobs. This is a myth that women have ing from something so unscientific'? These symptoms alone are not specif­ been trying to disprove for at least a Although I clearly had symptoms ic for PMS; the diagnosis depends on century. Now comes PMS to say it's described as PMS, I refused to their cyclical occurrence in relation­ actually true. What a dilemma. believe that I was out of control and ship to menses. The cause of these When I first heard about PMS in capable of killing, beating, or other varied symptoms has not been estab­ the 1970s, I was sure that this was violent behavior. But how could I be lished-if indeed there is only one just another variant of the raging sure? I certainly wasn't an unbiased cause. Suggested causes include hormone theory perpetuated by those observer. Was I deluding myself? estrogen excess, progesterone defi­ who wanted to keep women out of How could I possibly answer these ciency, vitamin B6 deficiency, pros- positions of power. How could a questions objectively? I interviewed May I June 1988 91 all my close family and friends. None American Psychiatric Association? of them could recall my showing In a recent revision of the Diagnostic WE'RE FIGHTING FOR signs of violent behavior. I decided to and Statistical Manual of Mental YOUR LIFE keep my symptoms to myself. Disorder (DSM III), despite the lack I recently encountered a most of scientific evidence and the strong American Heart intriguing theory of PMS. In Under­ opposition from respected psychiat­ Association standing Your Body, Every Wom­ ric, psychologic, and public health an's Guide to Gynecology and organizations,3 the APA decided to Health/ an anonymous gynecologist include PMS (with some caveats) says, "Another way of thinking under the designation "late luteal about the PMS emotional patterns phase dysphoria." Now someone has my patients describe is that women to tell them that the problem should tend to be abnormally pleasant and really be named "perifollicular phase nice three weeks out of four. They euphoria" (PPE), for the three weeks fail to experience or express normal of every month that women are annoyances and anger a great deal of unnaturally nice and accommodating the time, and are dismayed when because of high levels of naturally these emotions surface during pre­ occurring endorphins. This PPE the­ menstrual days." This is a wonderful ory has biologic plausibility and at theory guaranteed to make most least as much validity as the other PMS sufferers feel much better. And theories embraced by experts in the the cause of this abnormal euphoria field. I hope all AMWA members during those three weeks is an excess will lobby the APA to have this of endorphins, naturally occurring problem put in its proper perspective. opiate-like substances manufactured Let's get the word out and encourage in the brain. Sudden decreases in the Perifollicular Phase Euphoria endorphin levels may result in with­ Support Group in your area. drawal-like symptoms-the same symptoms described for PMS: ten­ References sion, anxiety, and irritability. I am I. Fausto-Sterling A: Myths of Gen­ entranced by this theory. The prob­ der. New York, Basic Books, 1985. 2. Stewart F, Guest F, Stewart G, et al: lem isn't premenstrual symptoms as Understanding Your Body: Every YOU'VE COME we thought, these are normal. It's the Woman's Guide to Gynecology and other three weeks that we women Health. New York, Bantam, 1987, A LONG WAY, BABY. PMS sufferers are abnormal, being p 551. nice, flexible, calm, loving creatures 3. Braude M: Update: DSM-111 diag­ nosis debate. JAmMed Wom Assoc YOU'VE QUIT. because we are addicted to our own 1988;43:30. naturally occurring endorphins. Congratulations. You've But how are we going to tell the kicked a habit that's not styl· ish - it's foolish. Studies have shown that smoking is Pill/Cyst Link? a major risk factor of heart disease. Yet, unfortunately, James C. Cail!ouette, MD, an obstetrician/gynecologist in Pasadena, more women are smoking California, believes there may be a link between low-dose phasic contra­ now than ever before. ceptive pills and the development of functional ovarian cysts. Dr. Cail­ And as the Surgeon Gen­ louette published an anecdotal report of seven cases from his practice in eral pointed out, cigarette the August 1987 American Journal of Obstetrics and Gynecology.
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