by Mara Altman
“You’ve had that gym membership for months now,” I added.
Dave is conflict averse, so when I bring up subjects with volatile properties, he tends to ambiguously nod or pivot the conversation. “Chinese, Mediterranean, Thai,” he read from the screen, not engaging with any of my complaints.
“I can’t have a fight by myself,” I said. “I need you to state your position.”
“Vietnamese?” he said. “You like pho.”
I was so completely not in the mood for pho at that moment, yet he was still looking at me like it was possible that somehow I might want pho. How, after four years of marriage, could he look at this face contorted in this way and think that it meant “Yes, I want pho”? After a few more empty and looming seconds, I said, “You don’t even know me!”
He sat there perplexed, his hand steady on the mouse. He looked wounded and slightly distressed. “I don’t understand,” he said after a moment. “Why are you shitting into my soul?”
I didn’t have a good answer—shitting into his soul felt so right at that moment. I had a knot in my chest—a tightly wound spool of yarn, of words—and something inside me had green-lit its unraveling.
But when he called me out—why are you shitting into my soul?—I also began to see myself from the outside. I felt like there was another me who was observing myself through a window. I could see my mouth like a little volcano, erupting with angry words, and I started to regret my intensity. I loved the dude, brows furrowed, in front of me. I wanted to rewind, to put that spool of yarn back where it came from and make everything okay.
At times like those, I pull out my calendar to see when my next period is due to start. Then I ponder how many days out—what is my window exactly?—that I’m allowed to blame my morose and erratic mood on the infamous yet possibly mythological premenstrual syndrome.
Dave put in an order for Szechuan tofu, kung pao chicken, and soup dumplings. As he flipped on the television, I tapped him on the shoulder.
“Maybe it’s PMS,” I finally said. I think that may have been my attempt at an apology.
I don’t know much about PMS—I’m not even sure it actually exists—yet I use those three letters liberally. I use them as a scapegoat for a range of homicidal impulses, gray-cloud thoughts, and potentially divorce-inducing statements. Those three letters also give me hope: If it’s my PMS making me say awful things, feel awful things, and do awful things, then it’s not actually me who’s at fault for any of it, so clearly everything will be better and back to normal in the morning. Or the next morning. Or the next next morning. Or the next next next morning. I mean, right?
Given the role PMS seemed to play in my life, looking into it felt dangerous. I know many women, myself included, who depend on PMS to rationalize a crappy day, to justify a meltdown, and very importantly, to account for why she bawled at the end of a completely predictable movie with horrible acting and no artistic merits or originality whatsoever.
So, what if I found out that PMS wasn’t real and that horrible movie actually moved me? When I told a friend I was going to research the psychological aspects of PMS, she got pissed.
“Don’t take that away from me,” she said. “I’ll fuck you up. It’s very real for me, dude. It’s a great handicap.”
I had to know, though, when I claimed that PMS made me do it, what was I saying exactly?
* * *
For a few days, I had a one-track mind. I asked every woman I ran across her views on PMS. I got as many answers as there were women I asked.
“Do you get PMS?” I asked my friend Sara.
She cocked her head to the side and said that she wasn’t sure. “You should ask Nate,” she said, referring me to her partner.
My cousin Nora said she totally gets PMS. “I cannot be trusted during that time,” she said. “I turn into a raging lunatic.” She told me that during one particularly intense episode, she left her boyfriend, who had been annoying her, at a gas station and drove away.
My friend Reyna had an optimistic twist on the monthly episode. “I loathe PMS,” she said, explaining that it makes her feel like a two-ton ball of shit that should put itself out of its own misery, “but I love that it gives me an excuse to eat hamburgers.” It’s only when her womb is about to have its bloodbaby that she feels like she finally deserves to satisfy a craving.
When I asked another friend, Mariah, she responded, “Isn’t PMS kind of like lactose intolerance and being gluten-free?”
“How do you mean?”
“Like once you hear about it,” she said, “you suddenly seem to get it.”
“I don’t know.” I shrugged. “Maybe.”
PMS seemed to have as many rumors swirling around it as the popular girl in high school does about the state of her virginity.
* * *
Once I began trying to pin down the facts about PMS, all the hearsay made a lot more sense. Even among scholars, the topic is incredibly divisive. There are as many studies proving that it exists as there are studies proving that it does not. Also, a hunch I’d had turned out to be true: The exact cause of PMS is still not known.
Kimberly Yonkers, a professor of psychiatry at Yale and the director of the Center for Wellbeing of Women and Mothers, has been researching PMS for a quarter of a century and thinks we are closer than ever to an answer, but prefaced what she said with, “Opinions vary.” She explained that the current theory is that the fluctuation of hormones—more specifically, metabolites of progesterone—cause some premenstrual women to experience withdrawal. Hormones then do not cause the mood swing; rather, the mood swing is caused by each woman’s differing sensitivity to the monthly hormonal shift. “We think some women are biologically more vulnerable to experience more severe symptoms,” she said.
There is also a premenstrual state called premenstrual dysphoric disorder (PMDD), which is more or less the supervillain version of PMS. PMDD is what happens if your PMS fell into a radioactive spill and transformed into the Joker. Each month, PMDD launches its victims into a temporary but deeply depressive abyss.
Though there is no blood test to confirm the presence of PMS, the diagnosis is calculated clinically just like depression or bipolar disorder.
“So I can’t just feel shitty and say it’s PMS?” I asked Yonkers.
“That would not be consistent with PMS.”
“Even if the shittiness I feel is right before my period?” I asked.
“Not if you haven’t charted your symptoms for several months to see if there is a pattern.”
To have legit PMS, it turns out, you’ve got to feel like crap in a very specific way. Yonkers said that you have to show a symptom or symptoms for most cycles in the year, which she considers seven out of the twelve months, and the symptom or symptoms have to be bad enough to cause a negative impact on one’s life. “A functional impairment of some sort,” she explained. “Fights with a significant other or trouble at work or school.”
The symptoms also have to fall within the right time period: They have to occur no more than two weeks before you start to bleed and subside no more than a few days after your flow begins. The timing piece of the mood swing is often misunderstood. If a woman is acting “bitchy,” an a-hole might say, “She must be on the rag.” In this case, he would be attributing her mood to the wrong issue, because PMS—namely the “premenstrual” part of “PMS”—means “before menstruation.” This person, if he’s going to say anything (which he shouldn’t), should actually be saying, “She must be pre-rag.”
Yonkers explained that only 10 to 15 percent of the population would qualify for actual clinical PMS.
PMS, by this definition, seemed too constraining for the breadth of my moods.
Soon after talking to Yonkers, I asked Dave what he thought—did he see a pattern in me?
He answered very tentatively, as if it were a trap. “There may be times when my soul is shat upon that seem to coincide with where you say you are in your cycle,” he said, “but I am not one to c
orrelate the two.”
Though PMS is an actual diagnosis, it is clear that many of us have adopted the term and, for better or worse, use it more liberally.
* * *
All the factors that added up to PMS and the diagnosis itself seemed so arbitrary. I wanted to get more clarity on the issue and figured that if I went back in time and found its origins, just like I did with sweat and vaginal odor, I would be able to better understand its significance for women today.
First I contacted Helen King, a professor of classical studies at the Open University in the UK, who specializes in ancient Greek gynecology.
“When did people first start to recognize PMS?” I asked.
King said that ancient Greeks were aware of physical changes that occurred before menstruation like breast tenderness, but they did not recognize any mood changes. “Greeks thought women were crazy, full stop,” she said. “So getting your period wouldn’t make you any more crazy.”
“Of course,” I said, “women were crazy all of the time.”
“Exactly”—she laughed—“you know, those out-of-control women!”
Then she went on to tell me things that don’t necessarily have to do with PMS, but that I have to relay to you anyway, because the information was so insane that it deserves a slight tangent.
King explained that Greeks in the fourth century BC thought that menstruation was essential to female health. “If you didn’t release the blood, you would just explode,” she said, “not literally explode, but really, you could die of suppressed menstruation.” Because of this, ancient Greeks had various methods to make women whose periods were late bleed. King shared two of her favorite recipes, which could easily double as torture techniques. “In the first, poisonous beetles were used,” King explained. Once the head, feet, and wings—the most toxic parts—were removed, a half a dozen of said beetles were wrapped in wool and then inserted up the vaginal canal. The idea was that the woman—beetles up her cooch—would experience such irritation that she would scratch at herself until she bled. “Then you could say, ‘See, she had her period!’”
Upon hearing that, I could muster only a mere “Jesus.”
“I know!” she said.
Beetles were used when the blood was stuck, but if a doctor also suspected that the uterus was floating around the body (because that’s what uteruses did back then—they floated around the body wreaking havoc like a wayward hobo searching for his next pit stop), they’d use a special technique to lure the womb back into its right spot. Once it was in its rightful location, it could then bleed.
The technique: puppy fumigation.
First, a puppy was disemboweled and stuffed with aromatics and spices. Then it was put into a jar and buried in a hole that had been prepared with hot charcoal. Finally, the rim of the jar was plastered with clay, but not before passing a straw through it and into the vagina.
“Then you sit with the vapors from the cooking puppy passing into your womb,” she said, “and this supposedly inflates your womb like a balloon and then it floats around in your body until it gets back to where it should be.”
I was full of hope when I asked this next question: “When you say ‘puppy,’ did that word mean something different back then?” I thought perhaps it could be a colloquial term for a throw pillow.
“I’m afraid it means ‘very small dog,’” King said. “That’s what it means.”
She made a really big deal out of the fact that women had authority over the straw. “They could put it as deep as they wanted,” she said. “Women didn’t usually have any control in ancient medicine.”
That’s how bad it was for women back then: Getting to decide how far up your vagina to put a straw that was spitting dead-puppy fumes was considered to be quite progressive.
After hearing about these methods, I was not surprised that ancient Grecian women were considered crazy—I’d be agitated, too, if a doctor, at any moment, could shove toxic insects up my genitals.
Clearly, some horrific practices existed in ancient Greece, but interestingly enough, there was no mention of PMS, so I jumped forward about a millennium to see if I could find something there. As with vaginal odor historians, there aren’t a ton of PMS historians, either, but it just so happens that Michael Stolberg, the medical historian at the University of Würzburg in Germany, whom I’d spoken to earlier about sweat’s sketchy past, had also spent a year of his life poring through letters, medical records, and journals from the fifteenth to nineteenth centuries in search of the origin of premenstrual suffering.
He found that depending on the notion of menstruation of the era—remember, until relatively recently we didn’t know menstruation comes from the uterus shedding its lining each month—women’s premenstrual symptoms and complaints shifted accordingly. Then Stolberg offered another complicated lens through which to glimpse PMS. “Like any disease,” he said, “people give meaning to the symptoms, and those meanings can be personal, they can be cultural, and they change with time.”
In the sixteenth century, the period—or monthly flux, as it was called—was considered to be women’s garbage-disposal system. Throughout the month, women collected bodily impurities and stored them in her uterus until, all in one go, she would flush the toxins through her crotch. Men didn’t have to worry about their toxins, because conveniently for them, they weren’t considered inherently dirty.
Our premenstrual symptoms at that time—cramps, colic, and something mysterious called “strangulation from the uterus”—were seen as validation that what we were passing was highly noxious. Think something akin to the gunk stuck to the sole of a shoe after it’s walked through Chernobyl’s nuclear sludge.
In the late sixteenth century, Stolberg told me, the idea evolved. Physicians came to believe that women suffered from an overabundance of blood. The period was a natural way of expelling the excess—it was like letting air out of an overly taut balloon. “In that time,” Stolberg said, “women felt tension all over their bodies and a sense of being overfilled.”
Headaches, for example, were considered a sign that excess blood was being collected and brought downward from the head.
In a wonderful twist, men could also suffer from similar premenstrual symptoms, because they, too, could suffer from excess blood. Because they didn’t have such a convenient orifice for the blood to exit, they had to depend on erratic nosebleeds and aggravated hemorrhoids. (Who wishes they had a vagina now?) “They, as well as women, would only feel relief upon the onset of bleeding,” explained Stolberg.
There were slight permutations on this theory until the eighteenth century, when a drastic shift occurred: The uterus itself, not the blood, became the monster. When irritated by blood, the organ would go on a rampage. The way Stolberg described it made me think of an enraged rodeo bull trying to buck off its rider. “It was an entity in its own right,” he said of the uterus, “and it could get very pissed off.”
“So let me get this right,” I said. “The uterus got angry and then took it out on the woman?”
He said it was actually more an irritation than a full-on fistfight: “The uterus got extremely irritable and irritated the whole nervous system.” It reminded me of poison ivy, the way the plant can irritate our skin, but in this scenario, the uterus was the irritant and agitated the inside of our bodies.
The premenstrual symptoms a woman experienced, which for the first time regularly began to include erratic moods, were evidence that her uterus was having a tantrum. The woman would respond to her upset uterus by becoming hysterical.
A modern version, such as in my case, I suppose would look more like a woman yelling at her husband to put the toilet seat down or tearing up at car commercials—the part where the dad hands his daughter a new set of keys and watches her wistfully drive off without him for the first time. When I cry at that part, I won’t even check my calendar. I just have to assume that my hormones are wacky. It’s the only way I can live with myself.
* * *
; After talking to Stolberg, I realized that as recently as the nineteenth century there was still no sign of the three letters—P, M, S—that we now associate with heating pads, unchecked chocolate consumption, and bitchiness. With a little more research, I discovered that by looking as far back as ancient Greece, I’d gone back way too far. My timing was so far off that it would have made just as much sense to take a time machine to the Ice Age in the hopes of killing Hitler. PMS seemed so deeply rooted in our culture that I had suspected its origin was ancient—I could easily envision Cleopatra lopping off five heads and then saying, “Sorry, y’all. PMS!”—but in reality, the term wasn’t coined until 1953 by a gynecologist named Katharina Dalton. PMS, if she were a person, would be just old enough to enjoy her senior discount at the movies.
Though PMS, as a name, stuck, it wasn’t the first time premenstrual symptoms were classified. Only a couple of decades before, in 1931, a man named Robert Frank noticed that some women—not all—lost their shit before their period. They were “reckless” and engaged in “foolish and ill considered actions.” He called this condition “premenstrual tension,” or PMT. He did some rather extreme stuff, stuff that makes puppy fumigation look kind of cute, to try to heal these women from their crazies. He thought that by decreasing their estrogen he could restore their sanity, so he tried radiating their ovaries, extracting their ovaries, and also stuffing their bodies full of male hormones.
In a later paper, a scientist would critique the latter tactic: “It occasionally happens that the dose needed to relieve symptoms is high enough to cause acne, the growth of a slight moustache, and lowering of the voice.” Menstruation, the paper also noted, often stopped.
Being one who already has a slight mustache problem, I got some serious chills.
