What counts as a premenstrual symptom? Patient and expert health professional perspectives on PMS (Premenstrual Syndrome)

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. Does such medical knowledge/ practice simply reflect and perpetuate the myth of the irrational female?

The main aim of this research is 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'. It builds on the work of Prof. Jane M Ussher, in particular, whose research examines the gendered factors underlying the psychological symptoms of PMS, and identity in relation to the reproductive body.

Just as Ussher went on to develop an effective gender-centred psychological treatment for PMS, it is hoped that this research will also directly contribute to the integration of research and clinical practice. Especially in relation to the diagnosis and treatment of PMS, and associated female-prevalent conditions, such as; anxiety, asthma, chronic fatigue syndrome, depression, IBS (Irritable Bowel Syndrome), and migraine.

This study will address the following interrelated themes and questions:
- Premenstrual symptoms and identity. How do patients/clinicians (experience), explain, and categorise premenstrual changes/symptoms? How do patients associate PMS with their identity (or not), particularly in relation to gender, health, competence, rationality, and (reproductive) anatomy? In general terms, how do clinicians describe patients with PMS?

- Contested and stigmatised 'illnesses'. How do patients/clinicians compare PMS to other illnesses e.g. menstrual migraine, or Chronic Fatigue Syndrome? How do patients/clinicians account for the selective criteria used to diagnose PMS? How do patients/clinicians understand, or reveal, that PMS is a stigmatised or contested illness?

- Social influences in the construction of medical knowledge and practice. How do medical texts, training resources, and diagnostic/treatment guidelines define premenstrual symptoms, across a range of geographical and historical contexts? How does the gender, medical specialism, or age of a clinician affect the criteria used to diagnose PMS?

There is an inherent contradiction in arguments made about PMS: There is compelling evidence that positions it as a socially constructed 'illness' that serves to undermine the rational and political status of all 'women', but when some women (or transgender men) really do experience cyclical premenstrual symptoms, their experiences can in turn be undermined through medical/societal disbelief in their 'biological' validity (Martin, 1980).

By seeking to explore 'what counts' as a premenstrual symptom, and by asking this question of both expert medical professionals and 'PMS sufferers', this study hopes to examine this tension around what differentiates a menstrual cycle-related change from a symptom of ill health. As far as I am aware, this will be the first PMS study to include the perspectives of medical professionals, and to explicitly ask expert and lay participants to define, and explain, diagnostic criteria (from their personal perspective, rather than as defined elsewhere).

Feminist theorists have already shown how supposedly 'objective' scientific knowledge in this area can actually be highly subjective, and influenced by societal beliefs about gender roles. Likewise, this research project hopes to determine if the current clinical focus on the psychological elements of PMS is based on the lived experience of premenstrual symptoms, or simply reflects and perpetuates a societal myth - the 'naturally' irrational (or hysterical) female.