Blog of the Society for Menstrual Cycle Research

Complicated Emotions

September 4th, 2013 by Heather Dillaway

Rocky emotions at menopause? // Photo courtesy of Heather Dillaway

Anyone who has ever loved anyone and existed in any kind of intimate relationship, or raised a kid, or negotiated with their parent as their parent ages knows that you can both love someone and also be very frustrated — even feel like hating them — at the very same time. You can love someone while simultaneously being extremely frustrated by her or him.
These same complicated love-hate emotions seem very present at perimenopause and menopause. The more I listen to middle-aged women talk and the more I see the media around menopause, the more I realize this. Feminist scholars have often stressed that menopause is not solely a negative transition and that women can find the transition positive at times. At the very least we’ve found that women feel indifferent or mixed about menopause, even if they don’t feel positive about the transition. BUT feeling positive or indifferent about reaching menopause (i.e., being happy to reach a certain period of life) is completely different from living with perimenopause. The signs and symptoms of perimenopause and menopause (e.g., hot flashes, night sweats, insomnia, irregular bleeding, etc.) can be grueling, and to discount that means telling women that their everyday feelings are not real. Especially when one thinks about the uncertainty women feel when they don’t know how long perimenopause will last (and when menopause will finally arrive), it is important to think about the very real and very negative feelings women might have even if they are happy overall about making this reproductive transition. Feelings of negativity might also come from women’s thoughts about what menopause means for their fertility if they’ve had trouble conceiving (“After all I’ve been through, now I have to go through this?”) or what menopause means about aging (“Should I worry about aging now? What is coming next for me?”). Even if women are glad to be done with monthly periods, they might still be fearful of aging or mourn their fertility in some way. Women who have decided not to have kids might feel that it’s unfair to have to go through menopause when they didn’t even use their reproductive capacities, even if they are glad to finally be rid of periods. To not acknowledge these complicated emotions is to discount the complicated life courses that women lead. At any life stage we think about what has happened before and what will happen next, and our thoughts about both the past and the future affect how positive we can be about the present. Automatically this means we will have complicated emotions as we make life stage transitions.
Thinking about the road ahead, I know that I’m going to be like every other middle-aged woman. I’m going to love and hate perimenopause and menopause. Just like I’ve loved and hated all other reproductive events in my life. It’s too bad we don’t talk about this stuff more openly, because complicated emotions are actually fairly commonplace. At home. At work. In all of the arenas of everyday life. If we acknowledged this more fully ahead of time, we might be better off as we go through our life stage transitions. Transitions might still be rocky and rough, but at least we’d know it’s normal to have these emotions.

Menopausal Junk

February 28th, 2013 by Heather Dillaway

In response to my last blog entry about Helena Bonham Carter, Paula Derry commented that we treat menopause as a “junk category,” tossing in any symptom we can’t explain or don’t want to attribute to anything else. So true. In fact, Anne Fausto-Sterling said this long ago about menopause – that tons of symptoms were attributed to menopause when in fact only hot flashes really had a link to this life stage. BUT, we keep on attributing anything and everything to menopause.

    Photo by Flickr user Caterina // Creative Commons 2.0

  • Gaining weight at midlife? Must be menopause.
  • Sad or angry at midlife? Must be menopause.
  • Hairy at midlife? Must be menopause.
  • Dry at midlife? Must be menopause.
  • Blurry eyes at midlife? Must be menopause.
  • Headaches at midlife? Must be menopause.
  • Big boobs at midlife? Must be menopause.
  • Constipated at midlife? Must be menopause.
  • Have a symptom you can’t explain at midlife? Must be menopause.
  • Turned 50? Must be menopause. (Yes, see, it’s ridiculous.)

And the list goes on. And on. And on.

Okay, so, yes, menopause is a junk category because symptoms (junk) are just thrown in and declared “menopausal” (“perimenopausal”) at every turn. Just like when women go to the doctor and are given pregnancy tests no matter what their symptoms (“must be pregnant”). Ah, the fun of the reproductive life course.

BUT, I would say that there is another kind of “junk” that I see at menopause. I’ve interviewed menopausal women for 12 years now, and one of the hardest things is separating out menopause from all the other things (junk) going on in women’s lives as they make this transition. It is so hard to figure out what menopause really is and what it really means for women because it is surrounded by so much other “junk” at midlife. When you ask women about how they feel about menopause, they tell you but they also contextualize how they feel by telling you about:

  • their kids (the kids that live with them and the ones that have left)
  • their partners (current ones, ex-partners, and ones they wish they had)
  • their jobs (the ones they hate and the ones they care about)
  • their friends (the ones who support them and the ones who don’t)
  • their aging parents (and how hard it is to take care of them)
  • their worries about future aging
  • their doctors (good and bad)
  • their youth
  • their aches and pains
  • their bodies (the parts they like and don’t like)
  • their history of menstruation and other reproductive experiences…

You get the picture.
You have to wade through all of this to understand menopause. Sometimes it feels like junk clogging up their lives and clogging up the path to figuring out what menopause is really like. At the end of the day menopause is such a narrow part of most middle-aged women’s lives, but it is tied in with so much other midlife stuff that it’s hard to separate out. When you ask women about menopause, it’s sort of like asking someone, “How are you?”, on one of their busiest days. The answer you get back is surrounded and dictated by the junk in their lives and, unless you understand that going in, it might seem like menopause itself is a junk-filled process. But maybe it’s not. Despite all the news articles that predict new symptoms and conditions at menopause, and despite all of the midlife contexts that surround menopause, maybe menopause itself is very simple if we can weed out everything that’s not really menopause… What do YOU think?

Is PMS Overblown? That’s What Research Shows

October 24th, 2012 by Elizabeth Kissling

If PMS is a myth, then what on earth can we blame for all the lady-rage?

Photo by Flickr user dearbarbie // CC 2.0

You may have seen the article in The Star or The Globe and Mail or The Atlantic about the recently published research review by a team of medical researchers who assert that “clear evidence for a specific premenstrual phase-related mood occurring in the general population is lacking.” Judging from the headlines and the online comments, this proposition is surprisingly controversial–probably because the headlines were frequently misleading, suggesting the findings are much broader than they are. Some online commenters are especially angry, insulting the intelligence and methods of the researchers, proclaiming that of course hormones affect moods, as does menstrual pain, citing examples of their own or their wives’ experience.

But Sarah Romans, MB, M.D.; Rose Clarkson, M.D.; Gillian Einstein, Ph.D.; Michele Petrovic, BSc and Donna Stewart, M.D., DPsych–the five medical scholars who reviewed all the extant studies of PMS based on prospective data–did not claim in the now-infamous Gender Medicine review study that PMS does not exist, or that hormones do not affect emotion or mood. The variety of research methods used in other studies prevented them from conducting a meta-analysis–a statistical technique that allows researchers to pool results of several studies, thus suggesting greater impact–so the authors instead looked at such study characteristics as sample size, whether the data was collected prospectively or retrospectively (that is, at the time of occurrence or recalled from memory), whether participants knew menstruation was the focus of the study and whether the study looked at only negative aspects of the menstrual cycle. Although their initial database searches yielded 646 research articles dealing with the menstrual cycle, PMS, emotions, mood and related keywords, only 47 studies met their criteria of daily prospective data collection for at least one full cycle.

When the authors scrutinized these studies, they found that, taken together, there is no basis for the widespread assumption in the U.S. that all (or even most) menstruating women experience PMS. In fact, only seven studies found “the classic premenstrual pattern” with negative mood symptoms experienced in the premenstrual phase only. Eighteen studies found no negative mood associations with any phase of the menstrual cycle at all, while another 18 found negative moods premenstrually and during another phase of the menstrual cycle. In other words, the symptoms these women experienced were not exclusively premenstrual, making the label inaccurate. Four other studies found negative moods only in the non-premenstrual phase of the cycle.

So let’s be fair, angry online commenters (and careless journalists): The researchers aren’t telling you menstrual pain is all in your head, or that your very real period pain won’t affect your mood. Sarah Romans did tell James Hamblin of The Atlantic,

The idea that any emotionality in women can be firstly attributed to their reproductive function—we’re skeptical about that.

Rightly so–feminists have been saying this for decades. Feminist critiques of PMS as a construct point to both the ever-increasing medicalization of women’s lives and the dismissal of women’s emotions, especially anger, by attributing them to biology.

Part of what makes PMS difficult to study, and difficult to talk about, is the multiple meanings of the term. In the research literature, there are more than 150 symptoms–ranging from psychological, cognitive and neurological to physical and behavioral–attributed to PMS. There is no medical or scientific consensus on its definition or its etiology, which also means there is no consensus on its treatment.

In everyday language, its meaning is even more amorphous. Some women and girls use PMS to mean any kind of menstrual pain or discomfort, as well as premenstrual moodiness. Some men and boys, as well as some girls and women, use it to diminish a woman’s or girl’s emotions when they disagree with her, or want to dismiss her opinions, or are embarrassed by her feelings.

Even researchers are influenced by entrenched cultural meanings. Romans and her colleagues observed that none of the 47 studies analyzed variability in positive mood changes, which they attribute to biases of the researchers. Many women have reported anecdotally that they feel more energetic, more inspired or other positive feelings during their premenstrual phase, but this is seldom studied or regarded as a “syndrome.” Romans and colleagues note that most measures of menstrual mood changes only assess negative changes, so even if positive changes are occurring, researchers are missing them. They also cite research indicating that both women and men tend to attribute negative experiences to the menstrual cycle, especially the premenstrual phase, and positive experiences during the premenstrual phase to external sources.

Romans and her colleagues do not deny the existence of menstrual pain, or even the existence of PMS. What their study shows is that very few women experience cyclic negative mood changes associated with the premenstrual phase of their ovulatory cycle. PMS is not widespread, and the authors are careful to distinguish it from premenstrual dysphoric disorder (PMDD), which is rarer still. As Gillian Einstein, one of the researchers, told the Toronto Star, “We have a menstrual cycle and we have moods, but they don’t necessarily correlate.” She did not add, but I will, that it it is unfair and unreasonable to assume that every woman’s moods should be attributed to her menstrual cycle and to refuse to take her feelings seriously.

Cross-posted at Ms. blog.

Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.