Am I Going Crazy?
The psychological symptoms of PMS don’t always announce like a guest ringing a doorbell. PMS-related changes and behavior may be so subtle that you don’t realize happening or aren’t fully aware of the timing of your symptoms. Instead, you might dismiss your symptoms out of hand or them to other external causes.
Common psychological PMS symptoms include depression, anxiety, a feeling of helplessness, obsessive thoughts, the inability to concentrate, memory problems, and fuzzy thinking.
PMS is not only pervasive, it’s also frequently mild. Of the millions of women who experience PMS symptoms at some point their lives, only a small portion say it causes a noticeable change their behavior and an even smaller number suffer severe symptoms. This means there are a great number of women whose anxiety, lack of energy, and fatigue are mild enough that they don’t seek medical treatment for them. On the contrary, a great number of women aren’t aware that their depression, anxiety, insomnia, and memory problems may be caused by PMS. In fact, it’s not unusual for someone with PMS not even to realize she has it, until someone else—a husband, mother, sister, or friend—mentions the possibility. Remember, the majority of women are not officially diagnosed with PMS at all!
Of the 43 million to 55 million women who experience PMS symptoms annually, as many as 80 percent, or 34 million to 45 million women, experience mild symptoms that do not impact their behavior. These women are usually not diagnosed with PMS; they simply suffer from one or more PMS-related symptoms.
Ultimately, one of the best ways to determine if you have PMS-related anxiety or depression is to chart your symptoms and notice if they are cyclical. In fact, to be diagnosed as PMS, your symptoms must be tied to your menstrual cycle. When charting, note the severity of your symptoms. This will also help your doctor determine if you have PMS or some other condition. (Chapter 12 covers charting in more detail.)
Why all the fuzzy-headedness during PMS? Once again, you can blame estrogen. Estrogen affects mood but also memory, attention and language skills. For example, postmenopausal women, whose estrogen levels are low, often complain of memory and concentration problems, and the standard treatment used to relieve their symptoms is hormone replacement therapy. Indeed, a lot of what's known about estrogen's cognitive effects is the result of studies done on older, menopausal women.
Estrogen enhances communication between neurons in the hippocampus, the area in the brain that plays an important role in verbal memory.
Women with PMS also complain of cognitive symptoms such as difficulty concentrating, but there is much less research to explain why this happens. In general, though, researchers believe that estrogen induces changes in how serotonin transmits, binds, and metabolizes in the regions of the brain associated with mood and cognition. What those changes are and their implications for treating PMS are not yet clear.
Is It Culture?
On the other hand, some researchers believe that women who experience negative cognitive or psychological PMS symptoms, such as depression and anxiety, do so because of their cultural perception of PMS rather than because of any physical processes or causes. In other words, women with anxiety, depression, sleep issues, or any other psychological, cognitive, emotional, or even physical symptoms feel worse because their culture tells them PMS is supposed to include those types of symptoms. For example, there is evidence that women report different PMS symptoms or different levels of severity in their symptoms depending on where they're from, their level of education, whether they're married, or if they have children. (See Chapter 3 for a more thorough discussion of the role of culture in PMS.)
A number of researchers have looked at how women’s perceptions of PMS affect their reported symptoms. Evidence suggests there is some connection between how much women know about PMS and the degree to which they report negative symptoms.
There are also studies, such as the one conducted in 1977 researcher D. N. Ruble, that suggest women report more negative symptoms if they believe they have PMS, even when they are in different part of their menstrual cycle. Ruble told some women they were premenstrual and others that they were intermenstrual (that in the middle of their cycles), even though they were all intermenstrual. The women who believed they were premenstrual reported more negative symptoms. Another study conducted in 1999 found that women who watched a videotape describing PMS symptoms reported more severe symptoms after viewing it.
These studies suggest a few possibilities:
On some level, PMS sufferers buy into the idea that their pain is PMS-induced, instead of looking for other causes.
Once women understand there is a condition such as PMS, they pay more attention to symptoms they previously dismissed. In other words, knowing there is a genuine condition that includes their symptoms legitimizes their experience.
It is also possible that some women exaggerate their symptoms once they learn about PMS.
However, none of the studies linking PMS to culture or to about how women might exaggerate their symptoms based knowledge of PMS changes the fact that the anxiety and depression many women experience is real and affects their lives.