“Mary is really bitchy today; she must be on the rag.” Comments like this are all too common, and are misguided. In her new book, Robyn Stein DeLuca dispels the myths about how hormones affect women’s moods and mental health, myths that have contributed to unequal treatment of women. Junk science supported the myths; good science debunks them.
Women have historically been considered inferior to men, and those attitudes have only recently begun to change. Women have physiological experiences that men don’t have. Menstruation, pregnancy, and menopause are all accompanied by changing hormone levels. It is commonly believed that these changing hormones can make women moody, irrational, emotional, depressed, angry, and sometimes even crazy. That belief has been used as an excuse to put women down and discriminate against them. That belief is wrong. Robyn Stein DeLuca explains why in her new book The Hormone Myth: How Junk Science, Gender Politics and Lies About PMS Keep Women Down. She reviews some of the junk science that seemed to support the belief and the good science that has revealed it to be a myth:
The evidence is clear: for the great majority of women, changes in hormones caused by reproductive events don’t cause mental disorders.
I can remember reading, a while back, that a woman should never be president because her judgment couldn’t be trusted during her periods. And just recently, a conservative commentator questioned the wisdom of appointing Sonia Sotomayor to the Supreme Court, saying:
Let’s hope that the key conferences aren’t when she’s menstruating or something, or just before she’s going to menstruate. That would really be bad. Lord knows what we would get then.
That concern was doubly ridiculous, since she was at an age where she was not likely to still be menstruating.
Today women are treated more equally than ever before, but the idea that hormones cause mental instability is still pervasive. As I was reading this book, I happened to read something in another book, American Fire, by Monica Hesse, that reinforced it. She reports that German scientists studying arson in the late 1700s believed (based on anecdotal evidence and prurient wishful thinking) that most fires were set by young peasant women; they attributed it to puberty and the trauma of menstruation. “Fire starting was an illness of tragic, hysterical, impoverished women who lacked coping skills and were victims of the unpredictability of female biology.” And in a novel I was reading, when a pregnant woman is accused of forgetting something, she calls herself a “pregnant airhead.”
Numerous studies have evaluated the impact of the menstrual cycle on skills like spelling, writing, memory, academic performance, arithmetic, spatial tasks, factory performance, judgment, and social skill such as detecting others’ mood from facial expressions. They have shown that menstruation had no impact on any of these skills, and some studies even showed improved performance during menstruation.
Dr. Oz says 85% of women have at least one symptom of premenstrual syndrome (PMS). DeLuca points out that having only one symptom of lung cancer (a cough?) doesn’t mean you have lung cancer. One website claims that 30-40% of women have PMS symptoms severe enough to impair their daily functioning. Some sources say PMS symptoms can last as long as 14 days every month: half of a woman’s life! Women accused of homicide have been acquitted with a PMS defense.
But no strong consensus exists on the definition, the cause, the treatment, or even the existence of PMS. The research on PMS suffers from fatal flaws. More than 150 different symptoms have been included in the definition, so that pretty much anyone would qualify. DeLuca lists five reasons PMS research was wrong: retrospective reporting, no standardization, homogeneity of researchers and subjects, problems with timing, and not using control groups. Today it is more properly called “premenstrual dysphoric disorder,” and only 3-8% of women qualify. For most women, other variables like stressful events, happy occasions, or even the day of the week are more predictive of mood than hormone levels.
DeLuca explores the many reasons for the persistence of the PMS myth, including the profit motive. Medications are widely used, including Sarafem and herbal medicines; Midol is marketed to teens and is a $48 million dollar business. And women gain social benefits from attributing anger or irritability to their PMS. Blaming hormones is easy; taking responsibility is hard.
Pregnant women report that they feel like their abilities to remember and stay focused are impaired, but there is no consistent evidence for a decline in cognitive abilities. Some women report mood swings, crying spells, etc.; but most women experience a stable emotional state, and there are many other reasons for pregnant women to be upset that have nothing to do with hormones. “When a pregnant woman becomes angry or forgetful, calling it baby brain also delegitimizes the actual cause” and avoids dealing with the real problems. If she is feeling overwhelmed and stressed, her hormones are not to blame. Jobs are affected by employers’ misconceptions about performance during pregnancy and by the belief that women won’t return to work after childbirth (75% do). The myths contribute to income inequality based on the belief that women can’t do the same work because of their ability to reproduce.
Three different postpartum conditions are often lumped together in the public mind: postpartum blues, postpartum depression, and postpartum psychosis. Hormones play a role in the fleeting postpartum blues that only last a week, but their role in serious postpartum depression and psychosis is negligible. Four percent of women with postpartum psychosis attempt to hurt or kill their children. Irresponsible media reports falsely blame hormones, and even attribute depression four years after childbirth to hormonal changes that are no longer present. Recognizing that it’s not the hormones will help women get proper treatment for depression and hospitalization for psychosis. As for the baby blues, women with newborn babies would benefit from sympathy, support, and concrete help, the kinds of things that were provided by extended families in the past.
Menopause is a modern illness, a normal life change that has been demonized and medicalized. Attitudes about menopause are largely culturally determined: women in Greece, Mexico, and India view it positively, especially where older women are valued. The myth is that menopause makes women sick, ugly, and unpleasant. One influential book called it “the horror of this living decay.” The disease model says that it is a hormone deficiency disease that needs to be treated with medication. There are physical symptoms like hot flashes, but for most women it is a time of happy thriving. The upsides: no more periods, no worries about pregnancy, a time to evaluate and reprioritize, freedom to focus on self, permission to be wise and assertive. Many menopausal women do report depression, but rather than blaming hormones, we should consider the bigger picture: midlife challenges and situational factors.
Hormone replacement therapy (HRT) is big business. Hormones were once prescribed indiscriminately to “keep women young,” but recognition of the risks has limited HRT to brief periods and minimal doses. Bioidentical hormones are big business too. Advocates like Suzanne Somers make exaggerated claims for their benefits, but the FDA doesn’t recognize the designation “bioidentical,” and there is no evidence that they are safer or more effective than conventional hormone replacements. They are prepared in compounding pharmacies, many of which have had serious quality control problems.
Why do hormone myths persist?
If women believe the myth but don’t experience the symptoms, they think they are the exception to the rule. We are flooded with a tsunami of information about the myth. The hormone myths are a form of gender policing. The myths provide an excuse for poor behavior. They give women permission to be angry or emotionally unavailable. They justify special treatment by others. Social inequalities are justified by assuming that men and women are fundamentally different psychologically and behaviorally because of their different reproductive systems; we are trapped by biology. Gender stereotypes hurt men, too.
How can we defend against the myths?
DeLuca offers a series of tools to combat the myths as well as an appendix showing how to recognize junk science. She concludes:
By embracing and promoting the truth, that reproductive hormones are not related to women’s mental health in any significant way, we can hail the reality that is clear to see: in all ways, most of us function at very high levels throughout our lives. This is the powerful truth about women.
This article was originally published in the Science-Based Medicine Blog.