Abstract
D.Litt. et Phil.
Although PMS has been described almost since the beginning of the written history of
medicine, it is still not completely understood. There are many theories about its causation
and treatment, and a proliferation of symptoms are ascribed to it. The prevalence of PMS in relation to the total population is still unknown, because premenstrual symptoms or a
combination of these range from almost 25% to 100% amongst women. Furthermore,
different criteria for the assessment of the prevalence of PMS are used by different
researchers.
Researchers are in agreement, however, that no single definition for PMS exists. Some
women experience mainly psychological symptoms, while others present predominantly
physical symptoms. Very little is known of the prognosis of the natural history of PMS.
The precise causes of menstrually-related distress is not known, although much has been
written about the role that nutrition plays in PMS. A direct relationship has not been identified between individual levels of, and changes in, oestrogen and progesterone alone, and the reported psychological, behavioural and physical changes associated with the cycle. Certain observable behaviours are associated with the premenstrual phase of the cycle, such as aggressive and illness behaviour.
An important aspect is the link between premenstrual changes and psychopathology,
especially mood disorders. Many researchers report a positive association between
premenstrual changes and mood disorders, especially depressive disorders. Women
suffering from depressive disorders are reported to frequently experience a premenstrual
exacerbation of symptoms and a deterioration in functioning. Most studies have found that
women report both psychological and somatic symptoms. The psychological symptoms are, owever, more commonly reported and have also been found to be more distressing for women.
In respect of aetiological theories, the literature shows a major subdivision between the
biological causes and the psychological basis. Potential causes, according to a biological
approach include abnormalities in gonadal steroids, excessive fluid retention, hypoglycemia, abnormalities in prostaglandin metabolism, allergy to endogenous hormones and endogenous opiate withdrawal. Research results in each of these areas are conflicting and conclusions reached are speculative. Most psychological aetiologies originate from the psychoanalytical school and include a rejection or resentment of the feminine role, as well as a repressed wish for a child. At present, the psychoanalytical theories have not been supported by controlled studies and, therefore, still remain speculative. The uncertainty of the causes of PMS is reflected in the numerous treatments proposed in the literature. A review of the literature shows that treatment for PMS is generally given indiscriminately for a divergent group of symptoms, without regard for the fact that growing evidence suggests that the Syndrome is made up of a variety of distinct, but related, symptoms.
A girl's first menstruation is a developmental milestone with psychological and physiological concomitants. Adolescents of both sexes tend to view menstruation negatively. Many adolescents associate menstruation with dysmenorrhea. Studies have shown that up to 91% of girls report dysmenorrhea, and it is also the leading cause of recurrent short-term school absenteeism among adolescent girls. Dysmenorrhea cannot be ignored, as it leads to a loss in self-esteem, with all the accompanying problems. If an adolescent does not get help with her PMS symptoms, she may be negatively affected.
The purpose of the present study was to cross-culturally investigate the psychological
concomitants of the premenstrual symptomatology in adolescent girls. Four hypotheses were tested: In an analysis of symptoms associated with PMS, a single factor reflecting will emerge to account for a significant percentage of the variance observed;
Dysmenorrhic adolescents will experience a greater number of negative premenstrual
symptoms than non-dysmenorrhic adolescents; Adolescents experiencing a number of negative premenstrual symptoms will report lower self-esteem; Adolescents of different cultural groups will report PMS symptoms that are IV commensurate with their culturally-based health beliefs. In order to test these hypotheses, one hundred and twenty five adolescent girls of all race groups, between 13 and 18 years of age, who were not taking any contraceptive, participated in the study. The Premenstrual Assessment Form (PAF) and the Index of Self-Esteem (ISE) were used. Physical and emotional discomfort emerged as two clear interpretable factors. It would appear that for this sample, PMS is not a unitary phenomenon, but consists of dual factors which are depended on cultural expectations. By observing dysmenorrhic and nondysmenorrhic adolescent girls, it was found that dysmenorrhic girls manifested a significantly higher degree of low mood and loss of pleasure, "endogenous" depressive features, lability, "atypical" depressive features, hysteroid features, hostility and anger, social withdrawal, anxiety, impulsivity, organic mental features, general physical discomfort, water retention, autonomic physical changes, fatigue, impaired social functioning, impaired miscellaneous mood and behaviour changes and miscellaneous physical changes than non-dysmenorrhic
girls. Non-dysmenorrhic girls showed a significantly higher degree of well-being when
compared with dysmenorrhic girls.
Thus, the present study supported the findings of previous research which suggested that
dysmenorrhic girls will experience more negative premenstrual symptoms than nondysmenorrhic girls.
In respect of self-esteem, girls reporting a number of negative premenstrual symptoms were found to have a lower self-esteem than those reporting fewer negative premenstrual
symptoms. In respect of culture, it was found that culture seemed to play a role in the girls' perceived experiences of PMS.
The present study indicates that adolescent girls do experience many negative symptoms
and, if these are not adequately dealt with, they may adversely affect them in adulthood.