Blog of the Society for Menstrual Cycle Research
An Oklahoma City news program prepared this investigation about health risks of Bayer’s best-selling birth control pill, YAZ, with dramatic personal stories. The video cannot be embedded here, but you can watch it and read the news story here.
Previous commentary and reporting about YAZ at re:Cycling: The Next YAZ, What’s Up with YAZ?, and The Future of YAZ. For more about YAZ, see the reporting of our friend, Holly Grigg-Spall, at Sweetening the Pill.
Some of you may recall that in my book, Capitalizing on the Curse, I argued that the addition of PMDD to the DSM-IV and the re-branding of fluoxetine HCI as Sarafem are linked. It was no coincidence that pharmaceutical manufacturer Eli Lilly sought a unique FDA approval for Sarafem as treatment for PMDD just as the patent on Prozac, also composed of fluoxetine HCI, was about to expire. Eli Lilly initially secured the patent for Sarafem until 2007, and it is no longer the only FDA-approved treatment for PMDD.
Lilly must be in need of a new way to keep milking the cash cow. How fortunate that new research suggests that Prozac can relieve garden-variety PMS as well. A neuroscientist at the University of Birmingham presented research last week at the British Science Festival that asserts a 2mg daily dose of fluoxetine in the week before menstruation could alleviate PMS. She tested it for three years on rats. Of course, rats don’t actually experience PMS, so they were “induced to have PMS-like symptoms”.
Every time I read another article about new treatments for PMS, I remember Joan Chrisler’s comments about over-diagnosis of PMS and PMDD (which are both associated with high levels of relationship and family stress): “We’re conditioned to want a pill. Instead of something you might need more, like a nap or a divorce, or the ERA.”
There have been a couple of stories in the press recently touting a study by Joanna Spencer and colleagues suggesting that PMDD may be genetic. I had a cursory look through the paper and read the article. Changes in dendritic branching of neurons in the limbic system across the menstrual cycle, owing to changes in estrogen, has been well documented in the female mice and rat. Additionally, changes in neuronal activity and accompanying receptor activity is also well document during periods of hormone change, again in the female mice and rat models. Individual differences in how this change occurs and the fact that it can be linked to differences in genes make sense. It seems that Spencer et al., have identified one of probably many genes that mediates these differences. This is not the first time that a gene of this kind has been identified or implicated. For example, Susan Girdler at Chapel Hill has done some interesting work on PMDD and suggests a genetic i.e., differing protein response to a hormone, difference in response to progesterone that might, in part, explain symptoms associated with PMDD.
The fact that Spencer et al., found a relationship to anxious behavior does not say anything conclusively about PMS or PMDD. It only states that if you have this variant then your levels of anxiety may change as estrogen fluctuates.
The news article is exploiting the findings from the Spencer study to construct a simplistic view of varying responses to hormone change within and across women. I suppose the author of the news article thought it might be interesting to examine the debate on whether or not there is a “clinically disordered” state during the luteal phase of the menstrual cycle in some women and whether it should be recognized officially. While it may do this, it also perpetuates misunderstandings and stereotypes about women’s hormones and their emotional states.
Amber Steele is a graduate student at the University of Cambridge with a biomedical background. She is writing a thesis is on wellbeing over the menstrual cycle and how it relates to hormonal “biomarkers” cortisol and progesterone.
A new study published in a recent issue of Women & Therapy finds problems with the diagnostic criteria for PMDD. No surprise – feminist psychologists, researchers within the Society for Menstrual Cycle Research, and many others have repeatedly criticized the concept of PMDD as a mental illness related to menstruation for these and other reasons.
Supposedly, PMDD occurs in 3% to 8% of menstruating women. There is a host of problems with how this is determined, including varying means of defining and applying the DSM-IV criteria for PMDD across studies, but I’ll spare you that litany here. If PMDD is truly an illness related to the menstrual cycle, the criteria should be sex-specific; that is, only those capable of menstruating should meet the diagnosic criteria (the research implicitly assumes everyone is cissexual and that all non-pregnant women of reproductive age menstruate and no men do – let’s set that aside for now).
To test the sex-specificity of the criteria for PMDD, the researchers created two versions of the assessment tools they used to determine its presence: one version included sex-specific terms like menstruation, menstrual cycle, and premenstrual symptoms, while the other version substituted sex-neutral terms such as experiences and symptoms.
Lo and behold, women who completed the sex-specific diagnostic tools met the provisional criteria for PMDD at a significantly higher rate (20%) than women who completed the sex-neutral diagnostic assessment (8%). And 4.1% of men completing the sex-neutral assessment also met the criteria for PMDD. There was no statistically significant difference in the number of women and number of men meeting the criteria when sex-neutral language was used. The researchers tentatively conclude,
Therefore, these data suggest that PMDD may not be a premenstrual disorder per se. PMDD may instead reflect general cyclical changes in mood, and in women sometimes these changes occur during or near menstruation.
So this little study is far from being the last nail in the coffin PMDD deserves. But it’s a start.
