With a history of working for women’s health in Auckland, New Zealand, Marjorie discusses her involvement in running a special clinic for premenstrual syndrome (PMS), working to find ways to help each individual woman’s needs.
Can you explain what Premenstrual syndrome is?
Premenstrual syndrome refers to the symptoms you get in the luteal phase (the last part) of the cycle, before the period comes. The experiences of women is hugely varied as are the symptoms. With that in mind, the clinic was set up and run by a multi-disciplinary team; a doctor, a nurse and a psychologist to help those women who struggled.
How did the clinic run?
The initial appointment would involve asking the women to talk about their history; when they started their periods, what their periods were like, any changes over time and what their symptoms were. A focus was on understanding why they thought they had PMS. We would give them a symptom chart to fill out over the course of 3 months so as to see what patterns occurred.
What would you then offer women in terms of support or solutions?
Well, there’s no magic, but there are ways to manage it better.
The psychologist decided it could be beneficial to work in a group so she and I would run sessions one evening a week that mostly focused on group cognitive behaviour therapy. This encourages awareness of how you think about something and trying to approach it more rationally.
If you have quite severe symptoms at this point in your cycle such as feeling depressed, anxious, having low self-esteem and feeling unable to cope then we’d look at specific elements. What can’t you cope with, turn it around and change the thinking behind it. It’s a very helpful tool which a lot of people do subconsciously. By managing it, you’re going to manage your life around that time. For example, you might not want to get married the week before your period starts.
In a room with about ten to twenty women they would all have different things that would help them manage. For some women going on the combined or contraceptive pill worked quite well, or at least gave them the edge to manage better. Other women would get a lot of bloating, feeling heavy and puffy, so the doctor may subscribe a diuretic during that last part of the cycle. St Johns wart works very well for some women, as do anti depressives and vitamin D.
Some women felt better when they didn’t have a bleed, some felt better if they did have a bleed, some people had painful periods and getting good pain control before the period started would help, because they wouldn’t get so anxious about what they were about to go through. My experience from talking with these women proves that it’s very complicated and very individual.
During the time you have worked, have you witnessed a change in the way women understand their PMS
Yes. A good move forward has been to give women more choice, and control over their own bodies, demystifying the experiences we go through. I think there were a few women who had struggled for years, not knowing who to tell and at a loss of what to do.
For example, there was a woman in her late forties, who had started to feel worse and worse pre menstrually. And I asked her how she felt about not having children, and her eyes welled up. There was the truth, that she was getting older and therefore closer to menopause meaning children were becoming less of a possibility. It was a mourning thing. Mourning the loss of her fertility. And I think this happens to quite a few women. I suggested grief counselling, as it’s a grieving process and a big deal. However, once she had realised her situation she could make sense of it, and she was ok again. This highlights for me how interesting and real PMS is.
Therefore, the treatment always has to be acceptable. There’s no point saying your PMS will go away if you cut your right arm off. If you don’t want to do something one way then it is important to find how else can we help find a choice which you find acceptable.
In our hunter gatherer days it was all about survival but now we have leisure time and careers and all these other expectations that could be an added factor. Women’s lives are very complicated, and their roles are multiple, you’re a wife, a mother, a girlfriend, a daughter; you have certain feelings of obligation. It’s complicated, and you may have to negotiate your way through, making certain decisions to make sure people don’t get hurt or complain. That is the complexity of the 21st century. Hence why conversations about how to take care of yourself and people becoming more mindful helps.
Can you expand on the idea of “modern woman”, in what ways have our cycles changed?
What we know about menstrual cycles in homo sapians times (due to the fact there are still hunter gathers in the world today), is that if you live that kind of life style, your periods start later as your development is slower. And you’re likely to become pregnant very quickly after starting your periods. You won’t have periods while you’re pregnant, nor while you’re fully breast feeding, which can be one or two years, maybe longer. Then you have another period or two until you become pregnant again. This means the number of periods in a woman’s life is far less than in a modern woman’s life.
From the experiences you’ve had over the course of so many years, what’s been the most important thing you‘ve learnt or would like to change, raise awareness of?
I think one big thing for me lately, has been what women understand about their bodies, and how to educate them, particularly if they’re from another culture. Cultural beliefs, traditions, family expectations are all wrapped up in how we view our bodies, deeming what would be acceptable and what wouldn’t. And I suppose my awareness of this has come more from my experience of working with women coming for a pre-surgical consultation. Witnessing the number of women who really didn’t understand parts of their body and what was happening to it. You need to be told a number of times to understand, helping to unpack certain beliefs. Using pictures, clear diagrams, seemed to do the trick.
Another important factor was how to establish a rapport with someone. Focusing the attention on creating a good relationship and talking together, as sometimes the problem isn’t what it’s perceived to be, it may be something else but to get there you have to spend the time. If the person is from another culture that can be more difficult, the challenge of talking through a translator can be difficult. Pantomiming can work sometimes, making people laugh and relax a bit more. Because building that rapport can be a therapeutic relationship in itself. And I think it can be the key to a lot of these other situations, of what woman find themselves in to do with their normal physiology.
Marjorie A. in conversation with Bethany Burgoyne
Illustration by Bethany Burgoyne