It's a tricky problem.
A lot of women for a lot of years have liked simply to pretend that it doesn't exist. It's not quite nice to talk about it in the first place. And then there's a kind of feeling that it's not properly feminist to admit to it. It is not always easy for today's woman to accept the idea of being physiologically subject to sex-linked forces that can turn a perfectly rational, intelligent, sensible woman into a suicidal wreck, or a raging harpy, or both.
Doctors, by and large, have been very little help over the years -- "There, there, dear, it's what comes with being a woman . . . you've just got to pull yourself together. . . ." Maybe a Valium here or a sedative there . . .
And when doctors did speak out it; was in the tone of Dr. Edgar Berman, Hubert Humphrey's physician who in 1970 suggested (in jest, he claimed afterward) that women were unfit for high positions of leadership because of their "raging hormonal crises." The fact that his conclusion, joke or no, was nonsense beclouded the fact that, endocrinologically speaking, there was some substance to his position, ill-timed, intemperate and heavy-handed as his statements were.
The Greek Semonides set the tone for linking fickleness and women 2,500 years ago, comparing woman to the sea: "Often it lies calm and innocent and still . . . then it will go wild and turbulent . . . this woman's disposition is just like the sea's . . ."
"Whoever she was," sighs Virginia Cassara, "she was probably a victim of premenstrual syndrome. And that is a lot of the problem, men since the 6th century B.C. making generalizations about all women on the basis of some women some of the time.
"Premenstrual Syndrome [PMS] is a disorder," says Cassara. "It is not inherently part of being a woman."
Cassara speaks on firm ground. She suffered from an assortment of physical and emotional ailments for some 12 years before she ever even connected them to her menstrual cycle.
Once she did, she started looking for something more than a there-there-dear approach.
Premenstrual syndrome is characterized by any one or more or all of these symptoms:
Bloating, swelling and tenderness of breasts, fatigue, acne, constipation.
Emotional crises: ill temper, crying jags, depression, even paranoia, panic or anxiety attacks, uncontrollable rages and sometimes uncontrollable acts during those rages.
Headaches, especially migraines.
Cravings: for sweet things or for salty.
Often PMS is mild, so mild that women may not even suspect their transient discomfort or discontent is linked to their menstrual cycle. Sometimes it is quite severe. Some recent studies have linked PMS to an incidence of child abuse. In England, Dr. Katharina Dalton, probably the preeminent authority today on PMS, recently published a study of three young women, all convicted repeatedly for criminal acts ranging from theft to murder. Dr. Dalton's study, in the prestigious medical journal Lancet, showed that the crimes were committed only when the women were premenstrual.
Even with severe cases a woman may fail to note the connection to her cycle. PMS may come on as much as two weeks before a period and may continue throughout. Or it may not. Meticulous record keeping is often the only way to establish a link. Not recognizing the syndrome for what it is, says Cassara, can be part of the syndrome itself.
In France and some other countries PMS is recognized now as a defense or at least a mitigating circumstance in certain crimes.
And although stress and difficult psychological situations can make PMS worse, modern medical evidence suggests that its causes are physiological, not psychological. And PMS can continue sometimes for years after menopause or after a woman has a hysterectomy.
Although its exact causes have not been pinpointed in all cases, there is increasingly wide acceptance of PMS as something real, somatic rather than psychological, and there are beginning to be serious scientific efforts for treatment, some of which already hold real promise.
Dr. Dalton has written two books, Once A Month, for lay readers, and The Premenstrual Syndrome and Progesterone Therapy, which outlines her work in more technical terms and is designed mainly for health professionals.
Virginia Cassara heard about Dalton's work in England and, after futile visits to some 20 doctors here, found relief in the London clinic where much of the work on PMS has focused in the past three decades.
Cassara was treated with natural progesterone, the hormone secreted by women to prepare the uterus for the fertilized egg. Dalton's thesis is that most PMS is provoked by a progesterone deficiency.
Cassara found immediate relief -- and a long-term career. Cassara and a colleague, Julie Egger, both social workers, started PMS Action, Inc., near Madison, Wis., as an informational-activist group for both patients and doctors, many of whom either do not know of work on PMS or misunderstand it. PMS Action informs, counsels and will even accompany a woman to her doctor if she wants; Dalton's books and other materials can be ordered through the organization.
More recently, Harvard psychiatrist-neuro-endocrinologist Ronald V. Norris has opened, near Boston, probably the first PMS clinic in this country.
Dr. Norris has an investigational permit to use natural progesterone in suppository form, the method Dalton has found most successful, but which is not yet approved by the FDA for use in this country. (Both Norris and Cassara emphasize, however, that synthetic progesterone, called progestogen, available in this country for contraceptive and other uses, is not effective in PMS, and may even make it worse.)
Natural progesterone is approved in injectable form, says Cassara, and her group has been encouraging its use as a rectal spray.
Norris, who has been treating women for PMS since 1968, opened his private clinic last April and has already seen womem from all the country. One Maryland woman, he says, came to hil following two psychiatric hospitalizations. "We are virtually certain her problem is PMS."
Norris stresses that before a PMS diagnosis can be made, other physical and psychological possibilities must be ruled out, so a comprehensive examination, mental and physical, must be made before any treatment is begun. He hopes to demonstrate the effectiveness (and safety) of the progesterone suppository.
For women with milder symptoms, some success has been seen with the use of Vitamin B-6 or by taking diuretics to ease premenstrual bloating. Valium is regarded as a "cop-out" treatment and is probably ineffective to boot. Norris hopes to hold a major PMS symposium in Boston this summer with Dr. Dalton present.
Meanwhile, it should be reassuring to the estimated 40 percent of women who have PMS to one degree or another that "Despite what they've been told," as Norris puts it, "they don't have housewife syndrome and they're not suffering because they're competing too hard in a man's world."