A review of studies carried out by researchers at the University of Toronto, and published in Gender Medicine magazine, says the link between negative moods and menstrual cycles is tenuous at best.
The largely female team, led by New Zealander Dr Sarah Romans, examined 47 studies from between 1971 and 2007 and concluded the results “failed to provide clear evidence in support of the existence of a specific premenstrual negative mood syndrome”.
It is not the first time a study has reached this conclusion. In 1994, Australian psychologist Elizabeth Harding argued that premenstrual syndrome (PMS) was a state of chronic negative effect – a perpetual state of unhappiness due to a lack of support and poor coping skills.
Harding asked 101 employees at the University of Melbourne to keep a diary over two consecutive cycles and found no association between mood and cycle.
“These women need to learn coping skills and basics like relaxation,stress management and assertiveness training,” she said.
Romans agrees. “There is this troublesome tendency if a woman is distressed, anxious or depressed to automatically think there’s a hormonal explanation for it, not to think it might be something happening in her life such as her work or home life,” she says.
She suggests factors such as health and relationship issues, or a lack of support, might play a part.
Psychologist Dr Lyn Shand has seen countless women presenting with PMS at her practice in Victoria, and says the idea that it might be a myth is “absolute rubbish”.
She also knows from first-hand experience. “I would be perfectly rational, then for three days every month I’d change,” she says.
“I charted it for years. Not every woman experiences it and some get it for longer than others, but it definitely exists.”
Shand says that because there is a hormonal explanation for PMS – it is linked to a dip in progesterone that happens around menstruation – it is ridiculous to say it doesn’t exist.
Studies have also shown that progesterone can reduce anxiety.
“Women with low progesterone before their cycle are more likely to suffer PMS, postnatal depression and menopause problems,” Shand says.
She took natural progesterone – “Not the synthetic progestin because it has a different chemical make-up” – for years and saw her PMS disappear.
“There isn’t much research on it in Australia, but plenty has been done in the US and UK,” she says. “Taking 400mg of natural progesterone a day can fix PMS and shows it’s a very real problem caused by a hormonal imbalance in some women. Not all, but some.”
She agrees that added stresses can exacerbate symptoms.
“Your body produces progesterone in the ovaries and adrenal gland. If you’re stressed it produces less than usual, making PMS worse,” she says.
Gynaecologist Dr Elizabeth Farrell, a founding director of Jean Hailes for Women’s Health, says the biggest flaw in the University of Toronto review is the studies it included.
“It’s very difficult to obtain scientific evidence about moods and menstruation,” she says. “The way a study is carried out determines whether it carries any weight or not. The gold standard is a randomised, placebo-controlled study. Only three of the 47 studies were truly randomised studies.”
Farrell points out that eight of the studies had only 20 subjects, 15 only 50, and some included men so their moods could be compared with the women’s.
“The review compared studies that used different methods of analysis and there was a lack of different socio-demographic group characteristics,” she says.
She also says many participants were told it was a menstrual study, which may have affected their responses, and the researchers requested a minimal data collection of one month. Harding’s research included two cycles.
“You can’t determine whether PMS exists on the evidence of one or two cycles,” Farrell says. “Women say sometimes they experience PMS and sometimes they don’t. The evidence presented in this review is not tight enough. Besides, if you look at the percentage results, how can you say PMS doesn’t exist?”
The results showed 14.9 per cent of respondents showed a link between mood and the premenstrual phase, and 38.3 per cent showed negative moods associated with other parts of the menstrual cycle.
“So more than 50 per cent of women experience negative moods associated with their cycle,” Farrell says.
Dr Steve Hambleton, president of the Australian Medical Association, also expresses doubt about the standard of the studies reviewed.
“Researchers differ in their criteria,” he says. “Some are strict, others more lenient. The results depend on how you analyse a study and what is included and excluded.”
But he is concerned the PMS label may be used to ignore other problems a woman may have.
“If a woman dismisses her feelings as PMS, other conditions could be missed,” he says. “If feelings of depression and anxiety are interfering with your life, you need to see someone.”
What you’re saying on Facebook
“No clear evidence? Is that a joke? I get migraines and moodiness every month like clockwork.”
“I always start to feel moody and wonder why I’m so snappy all of a sudden. Then, two days later, I get
“I’m moody when I’m moody and that can be any time.”
“[The study is] just another way to make women feel bad.”
“The mood swings are very real, though stress and lack of sleep make them worse, so maybe if these two things weren’t an issue, women would find PMS side effects were less?”