PMS as a Gendered Illness Linked to the Construction and Relational Experience of Hetero-Femininity

Abstract

The majority of research conducted to date on premenstrual distress has focused on heterosexual women. Drawing on research with lesbian and heterosexual self-defined PMS (premenstrual syndrome) sufferers and their partners, we argue that this negates the role played by hetero-patriarchal constructions of both femininity and premenstrual change in the lived experience of premenstrual distress. Negative constructions of PMS and over-responsibility within the home, commonly found in heterosexual relationships, exacerbate distress and result in women being pathologised premenstrually. Conversely, support and understanding offered by partners, more common in lesbian relationships, reduces guilt and self-pathologisation, allowing women to engage in coping strategies premenstrually, such as taking time out to be alone, or engage self-care. These patterns of relational negotiation of women’s premenstrual change can be contextualised within broader cultural representations of hetero-normativity, which provide the context for gendered roles and coping.

Full text

ORIGINAL ARTICLE
PMS as a Gendered Illness Linked to the Construction
and Relational Experience of Hetero-Femininity
Jane M. Ussher &Janette Perz
#Springer Science+Business Media, LLC 2011
Abstract The majority of research conducted to date on
premenstrual distress has focused on heterosexual women.
Drawing on research with lesbian and heterosexual self-
defined PMS (premenstrual syndrome) sufferers and
their partners, we argue that this negates the role played
by hetero-patriarchal constructions of both femininity
and premenstrual change in the lived experience of
premenstrual distress. Negative constructions of PMS
and over-responsibility within the home, commonly
found in heterosexual relationships, exacerbate distress
and result in women being pathologised premenstrually.
Conversely, support and understanding offered by partners,
more common in lesbian relationships, reduces guilt and self-
pathologisation, allowing women to engage in coping
strategies premenstrually, such as taking time out to be alone,
or engage self-care. These patterns of relational negotiation of
women’s premenstrual change can be contextualised within
broader cultural representations of hetero-normativity, which
provide the context for gendered roles and coping.
Keywords Premenstrual syndrome (PMS) .Hetero-
femininity .Gendered role .Constructionist .Lesbian
Introduction
Premenstrual Dysphoric Disorder (PMDD) is an archetypal
example of normal female experience being positioned as
mad, resulting in women taking up (or being given) a
psychiatric diagnosis, with consequences for how their
behaviour is subsequently judged. PMDD sits in the Diagnostic
and Statistical Manual of the American Psychiatric Associa-
tion, DSM-4 (American Psychiatric Association 2000),
officially categorising premenstrual mood or behaviour
change as pathology (see Cosgrove and Caplan 2004;
Ussher 2006). At the time of writing, a ‘mood disorders
work group’is “accumulating evidence”as to whether
PMDD should be included in DSM-5 (Fawcett 2009,p.1).
Manifested by a range of psychological and physical
symptoms, including anxiety, tearfulness, irritability,
anger, depression, aches and pains, or bloating, it is
estimatedthatbetween13%and19%ofwomeninNorth
America, Western Europe, and Australia experience
clinically significant symptoms that could meet a PMDD
diagnosis each month (Halbreich et al. 2003), with around
75% meeting the diagnosis of Premenstrual Syndrome
(PMS)—the same conglomeration of symptoms, but
experienced to a lesser degree (Steiner and Born 2000).
This means that three quarters of women of reproductive
age in these specific cultural contexts could be deemed
“mad”once a month, as PMS is also widely accepted as a
pathological condition.
PMDD was included in the DSM-4 in the face of
widespread feminist opposition, on the basis that there is no
validity in PMDD as a distinct mental illness (Cosgrove
and Caplan 2004). Many feminist critics have argued that
premenstrual change is a normal part of women’s experi-
ence, which is only positioned as PMDD or PMS because
of negative cultural constructions in North America,
Western Europe and Australia of the premenstrual phase
of the cycle as a time of psychological disturbance and
debilitation (e.g. Chrisler and Caplan 2002; Chrisler and
Levy 1990; Rittenhouse 1991; Rodin 1992; Ussher 2006).
J. M. Ussher (*):J. Perz
Health Services and Outcomes Research Group,
School of Psychology, University of Western Sydney,
Locked Bag1797, Penrith South DC,
Sydney, NSW 2751, Australia
e-mail: j.ussher@uws.edu.au
Sex Roles
DOI 10.1007/s11199-011-9977-5

In contrast, in cultures such as Hong Kong (Chang et al.
1995), China (Yu et al. 1996), or India (Chaturvedi and
Chandra 1991;Hoersteretal.2003), where menstruation
is invariably positioned as a natural event, women report
premenstrual water retention, pain, fatigue, and increased
sensitivity to cold, but rarely report negative premenstrual
moods, or ‘PMS’.Thishasledtotheconclusionthat
culture shapes the physical and psychological changes that
are deemed to be symptoms, meaning that PMS and
PMDD are deemed culture bound syndromes (Chrisler and
Caplan 2002). It has also been argued that the appearance
of PMS and PMDD follows unprecedented changes in the
status and roles of women in contexts such as North
America, Western Europe and Australia (Johnson 1987;
Martin 1987), with the cultural belief that women are
erratic and unreliable premenstrually serving to legitimate
attempts to restrict women’s access to equal opportunities
(Chrisler and Caplan 2002). Indeed, belief in the negative
influence of premenstrual ‘raging hormones’has been
used to prevent women being employed as pilots (Parlee
1973), physicians, and presidents (Figert 2005), which
casts doubt on the reliability of all women occupying
positions of responsibility.
It is the ‘regimes of knowledge’(Rose 1996,p.11)
within bio-psychiatry which position premenstrual change
as pathology (Cosgrove 2000) and which provide the
discursive context wherein women are diagnosed as a
“PMS sufferer”(Ussher 2003b, p.136). This is reinforced
by depictions within popular culture in North America,
Western Europe and Australia of the reproductive body as
abject and needing to be controlled, and of menstruation as
site of madness, badness, and debilitation (Figert 2005;
Laws 1990;Ussher2006). The premise behind PMS and
PMDD, that subjectivity, mood, and bodily experience
should be consistent and constant, reflects a modernist
position which conceptualises identity as rational and
unitary, with deviation from the norm as sign of illness
(Ussher 2003b). This stands in contrast with the accep-
tance of change as a normal part of daily existence, and of
menstruation as a natural event, in contexts such as China,
Hong-Kong and India. Equally, hegemonic constructions
of idealised femininity in North American, Western
European and Australian culture place particular emphasis
on women being calm and in control, with deviations from
this norm being positioned as pathology (Chrisler 2008;
Ussher 2006). Research conducted in such contexts has
demonstrated that when this is combined with negative
constructions of menstruation, this leads to women
engaging in practices of self-surveillance, monitoring
moods and behaviour in relation to often unrealistic ideals
(Ussher 2004b), and blaming themselves, or their bodies,
for transgressions (Koeske and Koeske 1975). Women
come to anticipate negative premenstrual change (Brooks
et al. 1977) and thus take up the subject position ‘PMS
sufferer’, through a process of subjectification (Ussher
2003b,2004a), reporting feeling “out of control”as a
primary symptom (Chrisler 2008,p.1;UssherandPerz
2010,p.440).
This emphasis on the constructed nature of PMS and
within PMDD within feminist social constructionism
could, however, be read as negating agency, the existence
of premenstrual distress, and other material aspects of
women’s lives that may be associated with self diagnosis
as a PMS sufferer. This is problematic, as premenstrual
change is not simply a discursive construction. There is
convincing evidence that many women experience em-
bodied and psychological change, accompanied by an
increased sensitivity to emotions, or to external stress,
during the premenstrual phase of the cycle (Sabin Farrell
and Slade 1999; Ussher and Wilding 1992). There is also
a growing body of research reporting an association
between relationship strain and premenstrual symptom-
atology, suggesting that problems in relationships may be
associated with many women’s premenstrual distress
(Coughlin 1990; Kuczmierczyk et al. 1992;Siegel1986;
Steege et al. 1988) and that relationship satisfaction can
deteriorate premenstrually (Brown and Zimmer 1986;
Clayton et al. 1999;Franketal.1993; Ryser and Feinauer
1992; Stout and Steege 1985). Direct expression of
emotion has been found to be lower in relationships where
women report PMS (Kuczmierczyk et al. 1992), which
increases the likelihood of premenstrual change being
experienced or viewed as problematic. Conversely, effec-
tive communication between couples has been associated
with lower levels of premenstrual distress (Schwartz 2001;
Smith-Martinez 1995; Welthagen 1995). Many women also
report that ‘PMS’has an impact on their partners and their
children (Halbreich et al. 2003; Robinson and Swindle
2000), and that the responsibilities of childrearing and
domestic responsibilities are associated with premenstrual
distress (Coughlin 1990;Ussher2003a,2004b;Ussherand
Perz 2010). However, these findings are not at odds with a
constructivist analysis if we acknowledge that PMS is both a
constructed and a lived experience (see Cosgrove 2000),
with the materiality of premenstrual change discursively
constructed and experienced as PMS or PMDD in particular
socio-cultural contexts, and premenstrual distress developing
in the context of women’s lives, in particular the context of
their intimate relationships.
The majority of research conducted to date on the
construction and experience of premenstrual distress has
focused on heterosexual women. This has either been by
explicit intention, or by omission, as women who take
part in research on PMS are generally not asked about
their sexual orientation, or the gender of their intimate
partner. In this article we argue that this omission acts to
Sex Roles

negate the role played by hetero-patriarchal constructions
of both femininity and premenstrual change, and the
experience of gendered roles in heterosexual relationships,
in the construction and lived experience of premenstrual
distress. PMS has previously been described as a gendered
phenomenon (Figert 1995;Markens1996), with frustration
or anger associated with the self-renunciating role of wife
and mother that is repressed for 3 weeks of the month
through self-silencing being expressed premenstrually and
then dismissed as PMS (Rodin 1992; Ussher and Perz
2010). However, this self-renunciation and self-silencing
is not simply an enactment of a feminine gendered role, it
is an enactment of hetero-femininity, where women are
expected to put the needs of their male partner and
children first, or risk relationship loss (Jack 1991). The
use of belittling or demeaning constructions of PMS on
thepartofmenhasalsobeenreportedtobecommonin
North America, Western Europe and Australia (Koch
2006;Laws1983;Sveinsdottiretal.2002), reinforcing a
gendered power imbalance where menstruating women are
positioned as dangerous or dysfunctional (Ussher 2006).
In these cultural contexts, the responses of male partners
to premenstrual change has been found to be particularly
influential, with partner support being associated with
lower levels of distress in women, and lack of support with
higher levels of distress (Cortese and Brown 1989;Ussher
2003a; Ussher et al. 2007). Indeed, in couples where men
demonstrated empathy, understanding and awareness,
marital satisfaction was also higher, and women’scoping
with premenstrual distress more effective (Frank et al.
1993), which has lead to the conclusion that partners act as
‘moderators’of symptoms (Jones et al. 2000). In this
article we will argue that women are more likely to receive
this support and empathy if their intimate partner is a
woman, resulting in more effective coping and lower
premenstrual distress.
In formulating this argument, we draw on the findings
of our research which compared the experiences of
heterosexual and lesbian women who self-defined as a
“PMS-sufferer”, as well as a number of their partners,
living in Australia (for reports of other aspects of this
research and details of the methodology see Mooney-
Somers et al. 2008;PerzandUssher2006,2009a;Ussher
2011; Ussher and Perz 2008;Ussheretal.2007). This
program of mixed-method research examined subjective
experiences of premenstrual change, and the negotiation of
PMS in the context of relationships.Interviews were
conducted with 60 women aged 22–48 (average age 34)
who presented as experiencing PMS, and 23 of their
partners, 10 women and 13 men (average age 39). Most
women were partnered (80%), with 66% currently in an
intimate relationship with a man and 33% currently in a
relationship with a woman. Half the women interviewed
reported having children (47%), with heterosexual women
more likely to have children (60%) than lesbian women
(25%). The majority of participants were Anglo-
Australian, in full-time education, part-time or full-time
employment, and were resident in an urban location in
Australia’s largest city.
As is described in the original report of the data (all of
the ensuing quotations are reported in Ussher 2011), all
of the women interviewed described “PMS”in the same
way, as being characterised by heightened premenstrual
irritability, intolerance of others and oversensitivity.
Women described themselves premenstrually using terms
such as “irritable”,“cranky”,“short-tempered”,“snappy”,
“confrontational”,havinga“short fuse”,“bitey”,“impa-
tient”,“grumpy”,“stroppy”,“frustrated,”“stressed,”
“annoyed”or “teary”. The trigger for these emotions was
always inter-subjective, either the actions of others, or the
pressure of demands and responsibilities in relation to
others. As Gillian (heterosexual) told us, “people around
me just cheese me off more (laugh) so whatever I’ve felt
about them, if they do something that I don’t like, I’ll react
more”. The heterosexual women interviewed reported
significantly higher premenstrual distress and less effec-
tive coping, as well as higher depression and anxiety (Perz
and Ussher 2009b). There was also a clear difference
between constructions of PMS adopted in heterosexual
and lesbian relationships, which had implications for
women’s lived experience of premenstrual change. Nega-
tive constructions of PMS on the part of a woman’s
partner and absence of support were common in hetero-
sexual relationships, which exacerbated distress and
resulted in women being pathologised premenstrually.
Conversely, support and normalisation of premenstrual
change were found in all of the lesbian relationships,
allowingwomentoengageincoping strategies premen-
strually, such as taking time out to be alone, or engage
self-care, and thus to avoid self-pathologisation as mad or
bad premenstrually. These differences were tied to gen-
dered roles and the constructions of femininity adhered to
by women and their partners, as well as differences in
communication and conflict resolution within heterosexual
and lesbian relationships.
We will begin by examining an overarching theme
‘PMS as a relational experience’,whereinwomen
positioned PMS as irritation, intolerance and insensitivity
in reaction to others, or as a response to relational
demands. We then turn to a secondary theme that
described partner reactions to premenstrual change,
consisting of accounts of rejection and absence of
support, associated with pathologisation and absence of
relational communication; and accounts of support,
understanding and conflict avoidance, associated with
greater acceptance of premenstrual change.
Sex Roles

PMS as a Relational Experience
“All the Relational Pinches come up at That Time”:
Premenstrual Irritation with Partners
As described in the original research (Ussher 2011), women
were interviewed about how they would describe them-
selves when they “had PMS”, then asked to describe a
typical experience. Women’s partners were positioned as
the major focus of irritation, across both heterosexual and
lesbian relationships. Mistakes that would normally be
tolerated were described as becoming a source of conflict,
such as when Fiona (heterosexual) reacted with anger when
her husband “destroyed”her clothes when doing the
washing: “you know, your husband put some washing
through and, you know, destroyed your clothes …so even
when people are doing the right thing, it’s still the wrong
thing at that time of the month”. Other women talked of
being less intolerant of their partners’foibles premenstru-
ally, such as when Elaine (heterosexual) described her
husband as “a bit of a hoarder and a collector, and 3 weeks
of the month that does not bother me”. However, when
premenstrual, Elaine said “it bothers me a lot and I want to
throw everything out, to put everything into plastic bags
anddumpitonhisdesk[laughs].”Descriptions of
irritation triggered by apparently minor incidents could
also be interpreted as deeper feelings of hurt or
frustration, as Melanie (heterosexual) told us in relation
to her husband:
Little things like if I’m tired and he’ll have the TV up
too loud or something and I’ll ask him to turn it down
and he won’t listen, and I ask him again or something
and then I lose it and I go on and on and on about
it….I become really angry and I’ll sort of almost go
overboard and I’ll say “You don’t care about me!”
And “If you cared about me you’d know!”
Bella (heterosexual) said of her husband “The guy can’t
do or say anything right”when she is premenstrual. She
described herself as “just highly sensitive”and “picky on
him”, giving as examples, “’I don’t like the shirt you’re
wearing’or ‘Gee, you know, aren’t we ever going to have
the money to do up this bloody house’”. Feeling uncared
for, or feeling angry because planned renovations were not
underway, were substantive issues not raised during the
3 weeks of the month when Melanie or Bella were not
premenstrual. This was common in the accounts from
women in heterosexual relationships. As Joyce (heterosexual)
said, “everything comes up at that time, yeah. Everything that
might just be a slight pinch normally comes up at the PMT
time and it’sintensified”. Approximately half of the women in
heterosexual relationships (but none of the lesbians) gave
accounts of self-sacrifice and self-silencing in relation to their
partner for 3 weeks of the month, and then finding this more
difficult, or speaking out, when they “have PMS”.Thus
Caitlin (heterosexual) described herself as “facilitating and
accommodating”for most of the month and then being a
“little bit more assertive…touchy…saying what I think,
instead of being so nice”when she was premenstrual. Nadia
(heterosexual) wondered whether it was her “true feelings that
are coming out more at a time like that”.
These accounts of PMS could be characterised as a
rupture in women’s self-silencing, where the feminine ideal
of caring compliance is replaced by anger and assertiveness
(Perz and Ussher 2006; Ussher 2004b; Ussher and Perz
2010). High levels of self-silencing (as assessed by Jack’s
(1991) Silencing the Self Scale (STSS)) were reported by
women who took part in this study, with significantly
higher rates reported by heterosexual women (Ussher and
Perz 2010), in particular the inhibition of thoughts and
feelings to avoid relationship conflict and loss (“silencing
the self”, Jack and Dill, 1992, p.98) and behaving in a
compliant manner to live up to female role imperatives
whilst feeling angry inside (the “divided self”, Jack and
Dill, 1992, p.98). This self-silencing was significantly
associated with depression and anxiety (Perz and Ussher
2006; Ussher and Perz 2010), which confirms previous
reports of a relationship between self-silencing and depres-
sion in women (Duarte and Thompson 1999; Jack 1991,
1999). Jack has argued that women repress their anger and
self-silence, in an attempt to maintain connection with
others, under the mistaken belief that anger is inevitably
destructive to relationships (Jack 2001). However, there is
consistent evidence that the open expression of anger and
disagreement within intimate couple relationships leads to
greater relationship satisfaction in the long-run, whereas
couples who avoid conflict are the least satisfied (Jack
1991). Indeed Gottman and Krokoff, in a detailed analysis
of the role of communication and relationship satisfaction
in heterosexual relationships conclude that “wives should
confront disagreement and not be overly compliant, fearful
and sad but should express anger”, because it is women
who generally raise and “manage”marital disagreements
(Gottman and Krokoff 1989, p.51).
In an attempt to explain the expression of premenstrual
anger within relationships, it has been argued this is the
only time that some women express legitimate marital
conflicts (Stout and Steege 1985), allowing themselves to
be angry because as they can attribute anger to their
hormones (McDaniel 1988), a phenomenon described as a
redeployment of the reproductive body to meet women’s
emotional needs (Elson 2002). This implicitly suggests a
calculated decision on the part of women to express anger
and use PMS as an a vehicle for expressing anger
(Hammond 1988). However, as has been previously
reported in research conducted in North America (Cosgrove
Sex Roles

and Riddle 2003)andtheU.K.(Ussher2003a;Ussheret
al. 2000), for all of the women we interviewed the
expression of premenstrual irritation or anger was invari-
ably followed by guilt and self-criticism, suggesting that
self-positioning as a PMS suffererisnotservingtoallow
women to get away with ‘bad’behaviour. So Rachel
(heterosexual) told us “you feel horrible about it the next
week…it makes you feel sick”and Stephanie (lesbian)
said she feels “really upset”and “angry”with herself
afterwards. This criticism extends beyond premenstrual
behaviour to women’s view of themselves, as Joyce
(heterosexual) said “my perception of me (premenstrually)
is lousy because I feel pretty lousy about myself, why
would anybody want to be on side with me?”
Each of these women was exhibiting what Casey
(lesbian) described as her “inner critic”, the surveillant,
judging, self which is most vigilant when women express
anger or discontent within intimate relationships. This is
because the expectation of care for others, and the emphasis
on emotional maintenance, is invariably translated into an
ethic of responsibility, where women are positioned (and
position themselves) as bearing full responsibility for
relationships (Jack 1991; O'Grady 2005). This can result
in women experiencing guilt and over-concern for main-
taining relationships, in particular those with partner and
children, which leads to the feeling, in Grimshaw’s words,
that “not upsetting people must always be given priority”
(Grimshaw 1986, p.196). Indeed, for the majority of the
women interviewed, both lesbian and heterosexual, it is the
impact of their premenstrual moods on others that stands at
the centre of this self-castigation, as Leah, who was in a
heterosexual relationship, commented, “Ifeelremorse,
because it’s like, “Oh, I’m really sorry,”because I’ve
visibly hurt somebody’s feelings and I don’t like to do that,
that’s not who I am as a mature loving person”.
As was evident in Leah’s comments, above, many of
the heterosexual women, (approximately one third; but
only one tenth of the lesbian women), positioned PMS as
something separate from themselves, as “not me”,oras
the “PMS self”, as has also been reported in previous
research conducted in North America and the U.K.
(Cosgrove 2000; Lee and Sasser-Coen 1996; Ussher
2004b; Ussher et al. 2000): “It wasn’tme,theperson’s,
fault, it was the hormonal stuff”(Tracy, lesbian); “I’m
another personality”(Kylie, heterosexual); “Iwantto
pretend to myself that I’m an intelligent person who
knows what’s happening in today’sworldandbewell
presented in everything. Then I have this thing for a few
days when I’m not necessarily that person”(Susannah,
heterosexual). In each of these instances women are
adopting the cultural construction of the reproductive
body as sign of the “monstrous feminine”(Ussher 2006,
p.32), in this instance as cause of premenstrual irrational-
ity or anger. At the same time, they are escaping self-
blame for expressing anger by disavowing or “masking”it
(Jack 2001) through positioning anger as an out-of-control
pathology, rather than accepted as a legitimate reaction or
response to the circumstances of their lives, in particular
their gendered roles.
“I Just Want You All to Stop Putting Demands on Me”: Burden
of Care and Responsibility
Caring for others is central to feminine subjectivity, and as
such, is a gendered process (Hollway 2006). These caring
responsibilities, manifested through mothering and manag-
ing a home, were positioned as a source of premenstrual
distress by the majority of interviewees who had dependent
children, confirming previous North American research
reports that women with high levels of premenstrual
distress are more likely to have children (Cortese and
Brown 1989). As Merrin (heterosexual) told us, “the major
thing that I probably notice is that I get most irritated about
the burden of care type activities, which tend to weigh most
heavily on me”. She described this as “the coming home
and the doing the dinner, particularly after a day of paid
work, and the home work, the cleaning up, the school
notes, whatever else needs to be done”. Sophie (lesbian)
described being angry premenstrually because she wished
her children would “clean the room”and “take the rotten
sandwiches from under the bed”, rather than expecting her
to do both. Kylie (heterosexual) described her anger being
triggered by an argument between her younger children
“they were fighting over my son’sBob the Builder spoon
and I just said ‘right’and I snapped it in half and said ‘no-
one’s having it’and that was it. I regretted it later on, of
course”. Other women described PMS as a time when they
weren’t able to give emotionally to their children. Elaine
(heterosexual) told us that her children “want me to sit there
and chat with them at night”, but premenstrually “I don’t
want to sit there and chat to them. It’s almost fake. I’m not
there. I’m not there so it’s better if I, I feel remove myself
from it than not giving the hundred percent”.
All of the heterosexual women who expressed anger or
irritation towards their children reported guilt and self-
remorse for doing so. Thus Katie told us that she “felt so
bad”, and Rachel that she “felt really horrible”, about being
irritated with their children premenstrually, and Elaine “felt
terrible”for not being “calm and nurturing”. However,
rather than questioning why women become irritable or
overwhelmed by their children once a month, perhaps we
should acknowledge the fact that these same women repress
their reactions to arguments, noise, mess, disobedience,
lack of help in the home, whinging, tardiness in getting
ready for school or doing homework—some of the triggers
reported in our interviews—for the remaining 3 weeks.
Sex Roles

Indeed, when we look to the materiality of the mothering
role, combined with the pre-dominant cultural representa-
tion of the mother as “ever-bountiful, ever-giving, (and)
self-sacrificing”(Bassin et al. 1994, p.2), women’s irritation
is not surprising. Unrealistic expectations are placed upon
mothers, that require the “patience of a saint”, in the words
of one of our interviewees—yet premenstrual changes in
vulnerability or tolerance make it difficult for her to retain a
saintly demeanour.
The contrast between the reality of the demands of the
mothering role, and idealised cultural constructions of
motherhood, has been recognised by many feminists to be
a cause of depression for women (Berggren-Clive 1998;
Mauthner 2010). Mauthner argues that postpartum depres-
sion “arises out of the discrepancy (women) experience
between the mother they want to be and the mother they
feel they are”(Mauthner 2010, p.470) and Rich has
eloquently described the self-castigation that invariably
follows maternal anger, drawing on her own experiences
(Rich 1977). The same could be said of women who report
PMS. Indeed, women’s premenstrual inability to enact an
ideal of perfect motherhood can also be a source of
premenstrual distress, with irritation or anger towards
children being positioned as a pathology. As Lillian
(heterosexual) told us, “youtrytoliveuptothis
expectation that the world gives you that you're supposed
to be super-mum and superwoman and if you don't live up
to that expectation life's very tough ….I expect perfection
and when I don’t get it I get cranky. Maybe that’sa
contributing factor”. Demands from partners could also be
experienced as problematic premenstrually. Melanie (het-
erosexual) said that she found “things more difficult and
demanding if we have to do something together”, but if she
did “try and push myself to be there for him,”saying to
herself “come on you’ve got to do this”, the consequence
was that “I get quite sort of angry within myself and
sometimes I get angry at him”.
Constructions of femininity and the structure of the
family within hetero-patriarchy are centrally implicated in
these accounts. In heterosexual relationships, women are
expected to take the major responsibility for caring and
domestic tasks, and invariably do so (Feeney 2002; Meleis
and Lindgren 2002), particularly in the presence of
children, where women do 70% of the unpaid caring and
housework, even if they are working full-time (Western et
al. 2007). It has been argued that parenthood “crystallizes
gendered divisions of labour”(Feeney 2002, p. 413), with
the fact that women mother described as the “fundamental
organizational feature of the sex-gender system”(Chodorow
1978, p.41). Chodorow argued that “it is basic to the sexual
division of labor and generates a psychology and ideology of
male dominance as well as an ideology about women’s
capacities and nature”(Chodorow 1978, p.41). In a study of
150 U.S. women, Coughlin (1990)reportedthatwomen
with a career and childrearing responsibilities reported the
highest levels of premenstrual distress. These are women
who typically have little time for themselves, undertaking
a double-day of home responsibilities following a day of
paid work, and who find themselves irritated or angry
premenstrually. Many of our interviewees explicitly
acknowledged these pressures. For example, as Maggie
(heterosexual) said “whenIgoonholidaysandIhave
PMS, I actually feel a little bit better than when I’m
working all the time”. This was because she had respite
from her normal routine, where “I’ve got to come home
and I’ve got to take kids to sport, then I’ve got to cook
dinner, and stuff”. Being on holiday didn’tmeanthat
Maggie did not experience premenstrual changes, but she
had more space to cope “because you’re a bit more
relaxed…a bit more aware.”This confirms previous North
American findings that daily life stresses, or perception of
such stresses, are a strong predictor of premenstrual
distress (Deuster et al. 1999; Fontana and Pontari 1994).
It was thus unsurprising to find that the most common
means of coping with premenstrual change reported by
interviewees was the desire to take time out from
responsibilities, or from being with others. As Jill (hetero-
sexual) said “solitude is wonderful, being by yourself,
doing your own thing”, which allowed her to avoid all the
demands being made of her, “be it sort of work related,
personal related, family, relations, whatever”, and Helena
(lesbian) told us “I'm more likely to want to be on my
own…because I don’t feel like having people in my face”.
This is reminiscent of the ‘room of one’s own’that Virginia
Woolf identified as so important to women’s creativity—as
well as their sanity (Woolf 1957), described more recently
as an essential “health promoting resource for women”
(Forssen and Carlstedt 2006, p.175). All of our lesbian
interviewees described taking time out for themselves
premenstrually as an unquestioned right that they exercised
without difficulty. As Nancy commented “I can just say ‘I
actually don’t give a fuck about anyone else but myself
right now’and I’ll be self indulgent and precious and that’s
alright”. Simone described “having a bath”in order to “just
have the time on my own”,to“remind me that everything’s
not going to fall apart, everything’s okay”and allow herself
“down time”. In contrast, half of the heterosexual women
interviewed described the desire for time out or solitude at
home remaining as such, a desire. Anna is a typical
example, 42 years old, married for 12 years, and with three
children, aged 4, 8 and 10. She told us “It’s very hard to
say, ‘I’m just taking time out for myself,’or ‘I need a
slower pace,’or, you know, ‘I don’t care if it’s your soccer
presentation, I’m not coming (laugh).’” This inability to
take time for herself was partly a result of Anna positioning
“anything that’s based around you personally”as “self-
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indulgent”. As she told us, “when you work full-time, and
you’ve got three kids, you literally have to pretend you’re
going to the toilet to have some time to yourself”. Whilst
the materiality of family responsibilities was partly the
issue here, as was the case with most of the heterosexual
women we interviewed, Anna’s own self-policing of how
she ‘should’behave was also a factor:
You feel guilty just saying, “I’m taking the afternoon
off.”In fact, I can’t remember the last time I did that.
Because there’s always a million things that you’ve
got to do. And there’s always things that you feel you
should do, you know, rightly or wrongly.
In a similar vein, many heterosexual women who did
manage to take time out experienced guilt because of
this. As Lillian commented, “my husband will just say to
me ‘go off and do something for yourself’but when I go
and do that…. I'll be sitting there thinking oh I've got this
to do at home I've that to do at home this to do at home
and like you just never relax and that's really bad.”Anna
and Lillian are engaging in self-surveillance (Foucault
1979), judging their own needs in relation to the
discursive constructions of woman as responsible, self-
renunciating, and always able to offer unlimited care and
attention to others (Ussher 2004b)—the ‘best mother’or
‘best worker’,inAnna’s words. When women are in the
premenstrual phase of the cycle, living up to these ideals
can feel more difficult, as the woman feels vulnerable, or
finds juggling multiple responsibilities more taxing (Sabin
Farrell and Slade 1999), which can cause distress, which
gets attributed to PMS.
Whilst motherhood may have been central to many
women’s feelings of over-responsibility and self-
judgement premenstrually, it is not mothering per se that
is the issue here—as women in lesbian relationships who
were mothers did not report the same difficulties in
negotiating sharing of the burden of care with their
partner. For example, Sophia described how she could
defer parental responsibilities to her partner premenstrually
“Icansay,‘Look, I’m not dealing with that right now. You
can go and talk to [partner] about it.’” Similarly, June
described her partner smoothing tensions with her children,
a common focus of her premenstrual irritation. “I’ll just say,
‘I’m about to get my period, so I’m…tired, or…I’ve been
cranky with the kids’…she’s supportive about it”. The key
issue here is the response of Sophia and June’spartners,
who were willing to take responsibility for the children, as
has been reported in previous North American research on
lesbian couples (Goldberg 2010a). This is where the
difference between lesbian and heterosexual women’s
accounts was most evident—in the responses of partners
to premenstrual change or distress (Ussher and Perz 2008;
Ussher et al. 2007).
Partner Responses to Premenstrual Change and Distress
“He Says it’s All in My Head”: Heterosexual Women’s
Accounts of Rejection and Lack of Support from Male
Partners
The majority of women interviewed wanted their partners
to recognise that premenstrual change was “real”,to
empathise, understand, and not to judge. Thus Jackie
(heterosexual) said she wanted “a bit more of an under-
standing that it’sreal…acceptance that it’s not just
laziness”. However, half of the heterosexual women told
us that their partners did not accept the legitimacy of
premenstrual change, as Jill commented, “he just can’t get
his head around what PMS is…he says it’s all in my head
which irritates me more than anything else.”Similarly,
Melanie said “I think they think it’s just all in your head.
They don’t realise that it’s actually like for me”. Commu-
nication about premenstrual change can facilitate partner
understanding and empathy (Jones et al. 2000; Mooney-
Somers et al. 2008). However, approximately one third of
the heterosexual women interviewed reported that there was
no discussion with their partner of premenstrual change, or
PMS, or of the ways in which the woman would like to be
supported at this time. For example, Celia never named
herself as “having PMS”to her partner because “I don’t
want to trivialise some of the issues that come up during
this time by saying, “Oh, it’s just that I had PMT.”Even if
women do attempt to explain premenstrual change or
distress, many are pessimistic about men’s ability to
understand. As Judith commented, “I have tried to explain
it over the last couple of years…since we’ve had children
(laugh) but it’s like talking to a brick wall. So I don’t think
many men really comprehend what happens”.Other
heterosexual women did not attempt to seek support from
their partners because they believed that their needs would
not be met. Rachel described her feelings of hopelessness at
the possibility of receiving support, indeed, of the possibil-
ity of even imagining support, from her husband. “My
expectations of him have all gone over the years. I don’t
have any expectations, I just do for myself, I look after
myself because I can’t get nothing from him, I haven’t been
able to get anything from him so I’ve lost all that, to even
think what I might want from him”.
The recognition of premenstrual change is a double-
edged sword for heterosexual women, however, as
partners can carry out the rhetorical accomplishment of
splitting the PMS and non-PMS self—the good and bad
woman—through adopting the negative constructions of
PMS commonly reported by men (Koch 2006;Laws
1983; Sveinsdottir et al. 2002). Approximately one third of
the heterosexual women interviewed described their male
partners as behaving in a rejecting manner premenstrually—
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not only of the woman’s moods, but her very self, as Gillian
told us:
I had a particularly bad PMT experience, and my
husband, like, he wasn’t my husband then, he actually
got a bit frightened, he thought, “Oh gosh, I don’t
want to marry that person,”and he called our
relationship off. And it’s funny that that happened
because the PMS has been an issue throughout the
whole marriage.
Joan said that her male partner had got to the stage
where “he really wanted me to go live in another house for
2 weeks of the month, which is a bit detrimental to a
marriage”. She said that she felt so bad about this that it
was “slit your wrists time”. This confirms previous North
American reports that avoidance or rejection on the part of
male partners exacerbates women’s premenstrual distress
(Cortese and Brown 1989). Blaming PMS could also mean
that women’s emotions are dismissed premenstrually, as
Katie (heterosexual) told us “men, you know they think
‘oh, she’s got her periods, so it doesn’t mean anything what
she says’”. Merrin (heterosexual) said that “if I’m making a
complaint or I’m asking for something (premenstrually), he
hears that that as irritation, rather than a legitimate request”.
Thus rather than “attending to what I’m saying”her partner
would say “‘oh it must be that time of the month’or ‘you’re
coming into your period’and so, he would be more
dismissive”of what Merrin is “asking for at that particular
time”. The labelling of women’s emotions, requests or
criticisms as “PMS”can thus serve to negate her needs or
concerns, which has implications for power (in)balances in
the relationship, and can exacerbate premenstrual distress
(McDaniel 1988; Ussher 2003a).
Other heterosexual women (approximately one sixth),
gave accounts of their male partners overtly positioning
them as mad premenstrually. Thus Elaine said, “1 day,
probably 3 months ago or so he came in and said ‘who am I
talking to today? Is it schizo Elaine, nice Elaine, sexy
Elaine, or cranky Elaine?’” The impact of this was to
increase Elaine’s premenstrual distress. “I was so premen-
strual that day, and I thought ‘that’s so unnecessary. I’m not
that bad’”. In a similar vein, Joanne told us that her male
partner saying “I don’t know who I’m talking to”when she
was premenstrual made her feel like a “paranoid schizo-
phrenic”. Anna’s male partner was more overt in his view
that she needed psychiatric help premenstrually, saying:
“It’s your shit, you go deal with it on your own,’cause I
have fucking had enough and I can’t deal with this shit….
get a therapist to sort it fucking out, I don’t care what it is.”
On the website PMSBuddy, where men share “stories”
about their partner’s PMS, (as well as being warned by a
monthly email of when PMS will occur), we see similar
examples of women being positioned as mad or bad
premenstrually (Ussher 2011, pp.175–176). ‘Yos h o’asked
for advice from other men with the following post: “My
girl goes NUTS when she's about to have her period…
nothing I do is right and everything I do sets her off. Any
suggestions??? Please help!”(Yosho 2009). The responses
were: “A fucking pussy. tell her to stop being a bitch. you
don’t like it. go sleep at a friends house for the week.
guarantee you’ll only have to do this once”And “dump
her for the uglyist chick you can find, and let everyone
know that you would rather hump a cow, than live with
her one more second”.Inasimilarvein,‘Rui’posted the
following: “My best friend always said that PMS is bad
but the most truthful thing he has ever stated is: "you
should never trust an animal that bleeds for 5 days and
does not die" (Rui 2009).
These men are not aberrations. They are reproducing
negative cultural discourses about the ‘monstrous femi-
nine’—the premenstrual mad/bad woman who must be
contained, controlled or rejected (Ussher 2006). These
discursive representations are not simply misogynistic
fantasy. They are part of the intersubjective context
wherein women construct and experience premenstrual
change. It has been argued that “the intersubjective
context”plays “a constitutive role in all forms of
psychopathology”(Stolorow and Atwood 1992,p.3),
because, in the words of Steven Mitchell, the “mind is
composed of relational configurations…(and) experience
is understood as constructed through interaction”(Mitchell
1988,pp.3–4). Whilst we may question the status of PMS
as “psycho-pathology”, it is clear that women who are told
that they are mad or bad premenstrually are more likely to
adopt this subject position, and see themselves and their
emotions in such a manner.
Women’s Self-Pathologisation
The heterosexual women who described their male partners
as critical, lacking understanding or unsupportive, were
more likely to self-pathologise, describing themselves as
“crazy,”(Susannah, Joan and Stephanie), “out of control”
(Melanie), a “nut case”,“absolute psycho”or “Schizo”
(Sandra), “mad”(Stephanie), “out of my mind”,“I’ve lost
the plot”,or“a complete loony”(Joanne), or “off my tree”
(Caroline), when they were premenstrual. Some heterosex-
ual women also overtly positioned the premenstrual self as
monstrous, describing themselves as “scary”(Susannah), “a
bitch”(Nadia), “a demon”(Bella), or like “Jekyll and
Hyde”(Jackie), as has previously been reported in research
conducted with women in the U.K. (Ussher et al. 2000) and
North America (Cosgrove and Riddle 2003). For a number
of the heterosexual interviewees (approximately one tenth),
this was also associated with feeling unequal or inadequate
in the relationship. Thus Susannah told us that her partner
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would say “most of the time I really, really love you but
when you have these days you’re a very difficult girl,”
which made her “feel like a bit of a child”and “kind of
patronised”. Joanne said, “I felt horrible, and I felt angry
because I was apologising for something that I really
couldn’t do that much about .... and it made me feel
inadequate…I felt like a really bad person, like I’d
committed a crime (laugh) that I needed to say sorry for”.
Benjamin (1999) argued that the absence of recognition
can lead to distress and the experience of the self as not
existing, as is evidenced by women’s responses to their
partner’s withdrawal or rejection premenstrually. Benjamin
argues that”when the other does not survive and aggression
is not dissipated it becomes almost exclusively intrapsy-
chic”(Benjamin 1999, p.192). This provides further
explanation for self-pathologisation of women whose
partners do not recognise their premenstrual vulnerability
or distress, and who can’t‘hold’this distress through
offering support. The woman turns inward for an explana-
tion of her experience of negative premenstrual mood, be it
anger or anxiety, and blames her body for her premenstrual
state, rather than looking to her social or relational context.
This can serve to protect her view of her relationship as
‘good’, in the same way that a biomedical model which
positions PMS as embodied illness allows women to
position premenstrual negative affect as ‘not me’, and thus
avoid an assault on the self (Ussher 2003b). However, it
also ensures that relational issues, and other discursive or
material factors which may precipitate women’s distress,
are not addressed.
Jack (1991) described similar patterns of relating in
North American couples where the woman was diagnosed
with depression, where the husband would describe the
woman as a “bother”, and reject her need for physical or
emotional support. She described this as “the essence of
inequality: one person governs the relationship and the
other person’s feelings are ignored”(Jack 1991, p.47). In
the case of many Australian heterosexual women reporting
PMS, approximately two thirds of our interviewees,
inequality was also marked by the absence of practical
support, particularly for those with dependent children,
where receiving help in the home premenstrually could
alleviate their care giving burden and allow them to take
time out to engage in self-care. Thus Jill told us “even if he
said ‘Is there anything I can do?’as simple as that, which to
me is not much to ask…do you want me to cook dinner”
she’d be happy. Olivia said that what she wanted was “help
with the house-work somehow manoeuvring life around so
that I don’t have to do a thing, or that at least I feel like he’s
contributing, and the kids are contributing”. Thus, whilst
many heterosexual women, particularly those with children,
positioned anger or irritation about burden of care as a
premenstrual’symptom’, we could reframe it as a legitimate
response to lack of partner support in the home. This is
reminiscent of a cartoon described by Figert, of “an
obviously worn out woman holding a screaming child and
telling her husband (sitting in the lounge chair and reading
the paper) that ‘this is stress, not PMS’” (2005, p.110).
Figert concludes that we need a “return to a menstrual
hut…and its monthly release from traditional women’s
roles of cooking, cleaning and family duties”—a release
from responsibility that remains an impossible fantasy for
the majority of heterosexual women.
This raises the question: how do these heterosexual women
tolerate the disparity between their needs and the reality of
partner support? Based on a study of British women’sintimate
relationships, Coward (1993) has argued that women have a
tendency to idealise their male partners, denying the reality
of failures within the relationship, as a way of defending
themselves against disappointment and potential relationship
breakdown. This was evident in accounts of many of the
Australian heterosexual women we interviewed, one quarter
of the sample, where descriptions of their partner’slackof
support were juxtaposed with idealising statements such as:
“he’s a lovely guy, don’t get me wrong”(Jill); “he is good to
me I would be hard pressed to find another man like him”
(Lillian); “he’sfantastic,he’s a wonderful husband and I love
himtodeath”(Elaine). These rhetorical strategies act to
further reinforce the positioning of the premenstrual woman
as problematic and her emotions as unreasonable, a vicious
cycle that acts to pathologise women.
At the same time, premenstrual change was not without
consequences for women’s partners, confirming previous
reports that the greatest impact of PMS is on social and
family functioning (Halbreich et al. 2003; Robinson and
Swindle 2000). Many of the men we interviewed gave
accounts of experiencing distress themselves, with Kylie’s
partner Craig telling us “sometimes I do think “Geez I hate
this life”, Chris saying that Lillian’s mood swings “just puts
the whole family on edge”, and Sarah’s partner Amir
commenting that “sometimes it’s hard for me because if it’s
directed at me, I’m not really sure why she has to be so
angry”. Lesbian partners also gave accounts of premenstru-
al mood or behaviour change exacting consequences on the
relationship, or on themselves. As Helen told us, when
talking of her partner Pip, “if she gets cranky about
something and at me, it’s not pleasant”. Or as Casey said
about her partner “I find it very hard to be around her when
she’s in that zone. And I have to work very hard at not
reacting to it. So actually having a bit of separateness is
actually a healthy thing for both of us”. There was also
acknowledgement that having two women with PMS could
be difficult. As Ellen said “being with a woman during the
time just makes it entirely exhausting and difficult, and far
more complex than I ever thought it would be…when one
is withdrawing, the other one’s wanting more of an outward
Sex Roles

impact or something…so it’s two opposites coming
together which causes a lot of discomfort”.
All of these accounts support previous North American
and British research which suggests that partners play a
significant role in the construction and lived experience of
premenstrual distress. Negative reactions to premenstrual
change on the part of a woman’s partner can exacerbate
distress, and result in the women being pathologised
premenstrually (Cortese and Brown 1989; Perz and Ussher
2009a; Sveinsdottir et al. 2002; Ussher 2003a). The
materiality of lack of support, legitimated by cultural
constructions of hetero-femininity, can make it difficult
for women to absolve themselves of responsibilities, and
can increase anger and irritation at inequalities in the
relationship (Jack 2001). And women’s premenstrual anger,
as well as their partner’s inability (or unwillingness) to
discuss and understand premenstrual change can impact on
the relationship itself, which can also increase women’s
distress (as well as that of her partner) (Brown and Zimmer
1986; Frank et al. 1993; Schwartz 2001). Conversely,
partner support and empathy can reduce guilt and self-
blame associated with premenstrual change, allowing
women to engage in coping strategies premenstrually, such
as taking time out to be alone, or engage self-care, as
outlined below.
“A Dance of Moving In and Out”: Relational Support
Alleviates Premenstrual Distress
Understanding and Acceptance
All of the lesbian women interviewed, but only one third of
the heterosexual women, gave accounts of supportive
partners, and emphasised the positive influence that this
had on their premenstrual distress. Understanding and
acceptance of premenstrual change, was a key feature of
this support, as Shea (lesbian) commented: “In terms of the
response…it’s just really understanding and I guess
supportive…Like, it’s not that big an issue that it becomes
an issue…it’s just like, ‘This is how I’m feeling. That’s
okay.’” Similarly, Linda told us, “I’m extremely lucky that
Helen [her partner] is an extremely understanding person
and so I get what I need at that time”. In this vein, making
an attribution of mood or behaviour change to “PMS”was
experienced as a positive thing, as Pip (lesbian) commented
“it’s almost as though it’s a relief there’s a reason for it”.
Sarah (heterosexual) described how her partner’s recogni-
tion of “PMS”made him feel “more relieved, because he
thinks that maybe it wasn’t that bad, or that there was
something else on top”. She said that “he worries quite a lot
about…you know, like how happy I am or how unhappy I
am”and is “glad to know I’m not there forever, I guess, I’m
not in that stage of unhappiness forever”.
In these instances “PMS”was invariably named, but in a
non-judgemental manner. This recognition functioned to
protect the relationship, because irritability and moodiness
could be positioned as ‘not something personal’,or
something which would have a major impact upon the
relationship. This is analogous to findings from other areas
of health research, such as cancer, where avoidance of
communication about the illness within couples is associ-
ated with less effective coping, higher levels of distress, and
lower marital satisfaction (Badr et al. 2008; Manne et al.
2006; Zunkel 2002). In the context of premenstrual distress,
partner recognition also meant that women did not enter
into a spiral of increasing distress in response to partner
rejection or pathologisation, and were more likely to engage
in effective coping, such as taking time for self-care or
avoidance of conflict.
Avoidance of Conflict
Women who portrayed their relationship context as sup-
portive also described their partner reacting to premenstrual
expressions of anger or irritation with a calm, non-reactive
response, so that discussions would not escalate into an
argument. Joyce (heterosexual) described herself as “very
fortunate to have a husband who’s prepared to deal with it
and has learnt the subtleties”. She described their inter-
actions premenstrually as “almost like a dance of moving in
and out”where her husband would think “okay, give her
some space now, be tender now, and we’ll talk at a better
time on this issue.”This meant that Joyce could express
issues of concern, and they would “work on it in a calmer
time”. Similarly, Bec (lesbian) described her partner as a
“very laid back”person who reacted to Bec’s premenstrual
anger by saying “why are you bringing this up like this”
and then saying “you’re PMT-ing aren’t you?…Maybe we
should talk about this later”.
A number of the partners interviewed (one third of the
men, but three quarters of the women) also gave accounts
of being aware of not aggravating their premenstrual
partner, avoiding contentious issues, or not taking things
personally at this time. Hayley, who was Ashley’s female
partner told us that “around period time I will usually be
extremely flexible and don’t do things that I know are
going to annoy her”. Sheridan’s partner Elspeth adopted a
similar strategy, saying “If you pick it early enough…that’s
when you, sort of, quickly, say, deflect the situation, diffuse
the situation or say, “’All right, why don’t you have a
bath?’” Sean, who was Merrin’s male partner, said “I just
basically keep, fly low then. Don’t try and aggravate the
situation”. A number of the men interviewed also gave
accounts of learning to give the woman space through
removing themselves when she was premenstrual, in order
to avoid conflict. Thus, Bill, Olivia’s partner, said “There’s
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a time of the month where we’re not going to get along.
And it’s best for me to just hide in the garage or the shed”.
Likewise, Gary, Bella’s partner, described himself as trying
to “tiptoe around her a bit…give her a bit of space”, saying
“It’s a good time to be out doing a bit of gardening.”Whilst
this could be experienced by a woman as withdrawal, and
could thus be detrimental to the relationship (Gottman and
Krokoff 1989), many partners were motivated by awareness
of the woman’s need for time for herself premenstrually,
and actively facilitated this, as is evidenced by Lucian’s
account of his partner Carmen:
She likes comfort food, chocolates, yes, so um, cherry
ripe, she’ll sit down have a coffee, or I’ll take
Elizabeth [their daughter] out for awhile. But I go to
bed early and she has time after I go to bed, to herself,
she likes to do her craft and she’ll get very adamant
and say ‘I don’t care about the dishes tonight, I’m
going to do craft’you say “okay”(laughs) it isn’t hard
for me.
Denise described her partner Stephanie as saying “I just
want to be on my own,”which Denise thought was “fine”,
encouraging her to “go to her own room”or “potter in the
garden”to “anything that helps her resolve it, that’smy
preference”. Similarly, Jocelyn described her partner
Deborah’s support: “I’ve got a really big garden that I
maintain and I like to take myself out there …I do like to
be a little more alone around that time….she’svery
understanding, maybe does a little bit of housework on
those days, ah, doesn’t expect too much from me at those
times”. This allowed women to engage in self-care
premenstrually, inhabiting the metaphorical ‘room of one’s
own’which is recognised as an important health resource
for women (Forssen and Carlstedt 2006), as noted above.
Reassurance and Support
Other partners provided physical reassurance, exemplified
by Alice’s account of her husband having “just walked over
and hugged me”when she was being angry with him
premenstrually, which allowed her to realise that “it was
unreasonable anger (that) had come out of nowhere”.
Maggie said that when she cried premenstrually her
husband “usually comes and gives me a cuddle, and says
‘oh, don’t worry about it, it’s that time of the month”. Her
partner Dave told us “I just try and be as nice as possible.
You know, try and offer a bit of physical comfort by trying
to give her a hug or a cuddle and just to tell her that I love
her and ‘Look, it’s not the be-all and end-all. No point
ruining everything over one comment I've made’”. Sheridan
said her female partner would “go off and make me a tea, or
remember little things that are going to comfort me,
practical things”. Casey was typical of the lesbian women,
in describing mutual support and reassurance being offered
premenstrually:
When I’m in those zones, if it’s the weekend, I’m
more than happy to stay at home and just with the
DVD and put music on and just kind of be in my own
bubble. And be in the zone. I can’t affect anyone.
[partner] can be very, um, accommodating around,
you know, baths and you know, going out and getting
good food, and putting DVDs on, and just kind of
really…that real pampering stuff which, um, makes a
huge difference. And I can do the same for her.
All of the lesbian women described being able to absolve
themselves of responsibility for household tasks premen-
strually, if they needed to, with the support of their partner.
For example, Jocelyn said that her partner was “very
understanding”, and that she’d do the “housework on those
days (and) doesn’t expect too much from me”.Bec
described worrying about household finances when she
was premenstrual, and her female partner saying “don’t
worry about it, I’ll fix it up and we’ll work it out later”.In
contrast, only a small proportion of the heterosexual
women, approximately one sixth, who asked for practical
support in the home received it if they asked for it, or
reported that they were supported by their partners in not
taking on their usual responsibilities, as Jackie told us,
He’s accepting. Like, he doesn’t say “Oh, the house is
a mess”…If he’s upset about it, he’ll help clean it up.
He won’t be happy about it. But it won’t be a big
issue…When I haven’t cooked the dinner, I haven’t
washed up…he helps out as well. It’s something we
do together.
Only one of the men we interviewed, Gary, Bella’s
partner, talked of “helping around the house”because “the
demands seem to build up, (so) that she probably can’t cope
as much, and puts more onto me”. Others, such as Sean,
Merrin’s husband, showed an awareness of their partner’s
desire for practical support, but didn’t give it without being
asked, as is evidenced by the comment “I think probably I
should work a bit harder perhaps when I think about it
really, when I know that she’s like that…[giggles] perhaps
do something like ‘cook the dinner’.”
The majority of women with supportive partners told us
that their partner had learnt to cope with premenstrual
changes over time, in ways that helped to alleviate
premenstrual distress. As Maggie said, “my husband’s
pretty good now. At first, when we got married it was
pretty dreadful, but I usually say now that these 2 weeks are
coming up before my period and so now things are a lot
better”and Bella said “I’ve had to educate Gary [her
partner]. ‘When I push you away you don’t have to leave
me, you know, that can actually hurt me more. I need you
Sex Roles

to sit down and hold me’”. Communication was central to
the development of understanding on the part of partners,
confirming North American and South African research
reports that effective couple communication is associated
with lower levels of premenstrual distress (Schwartz 2001;
Smith-Martinez 1995; Welthagen 1995). As Jocelyn (lesbian)
commented “we’ve discussed this over a long time and she
doesn’t get involved in any of the impatience and it actually
works”. Lesbian interviewees also positioned their partners
as supportive because of being a woman, as Linda said
“because Lorna [partner] is female, I suppose that makes her
a little bit more understanding, and Ashley told us “having a
female partner, I think, just makes all the difference….
because I think they understand”.
Women Normalising Premenstrual Change
Confirming previous North American research on pre-
menstrual change in women with positive attitudes to
menstruation (Lee 2002), none of the Australian women
who reported having supportive partners (all of the lesbian
and one third of the heterosexual interviewees) adopted a
stance of self-pathologisation, or used derogatory terms to
describe themselves premenstrually, such as ‘mad’,‘loo-
ny-tune’,‘bitch’,‘monstrous-mummy’or ‘Jekyll and
Hyde’, terms which are commonly found in North
American and British women’s accounts of PMS (Cosgrove
and Riddle 2003;Ussher2002), as well as in unsupportive
relationship contexts in the present study, as noted above.
There was also less evidence of guilt and self-blame in
these interviewee accounts, and very few accounts of
feeling out of control premenstrually, as premenstrual
change was accepted as a normal part of a woman’s
experience, even if it was not necessarily a pleasant
experience for a woman or her partner. As one of the
women, Helena (lesbian), told us “I would just go with it
and go, “Oh look, in 2 days (laugh) this will be fine
(laugh).”Similarly, Amy (heterosexual) said “Ijustkeep
plodding along”and Janice (heterosexual) said you “just
hang on for a couple of days”. This does not mean that
premenstrual mood change is necessarily embraced, but it
is not positioned as an illness or sign of madness, rather,
as something that a woman accepts as part of being a
woman. Having a supportive partner was not a necessary
requisite for women adopting this position in relation to
premenstrual change, however all those who reported a
supportive relationship context did so, with some women
(one tenth) embracing premenstrual change, experiencing
it as a positive thing. For example, Sophia (lesbian) told
us, “sometimes you can really connect with some deeper
energies that are going on, …which can be really exciting
and invigorating. Mm. So sometimes you can really
channel it”.
Even the difficult feelings that emerge premenstrually
can have positive consequences, allowing women to “tune
into”their premenstrual mood, paying attention to the
issues that make them sad, anxious or angry. Nina
(heterosexual) talked of getting “sadder at that time of the
month”, with the grief associated with her mother’s recent
death “coming to the fore”, which helps her to “deal with
things more…it helps me put things into perspective”.Ifa
particular feeling keeps emerging each month, it could
mean that the issue “means something”to the woman, as
Olivia (heterosexual) decided, after much reflection on her
cyclical changes, “I’ve been repressing things for years …
just saying, ‘Oh, it’s just PMS.’That’s bullshit. You need to
look at it and say, ‘Well, if I keep feeling this way, about
this particular issue, at this time of the month…then, it’s
got to mean something.’”
Thus, rather than being ‘PMS,’a problem tied to the
body, Olivia’s“symptoms”could be conceptualised as an
emergence of emotions that are repressed during the rest of
the month, either because the feelings are too difficult to
face, or because she does not want to rock the boat in her
relationship by being angry. Attending to these feelings
allows Olivia to address them, as well as any underlying
issues that are causing her distress. These accounts confirm
previous North American and Indian research reports that a
substantial number of women report positive aspects of
premenstrual change, if they are given the opportunity to do
so (Alagna and Hamilton 1986; Chaturvedi and Chandra
1990; Lee 2002; Stewart 1989). Premenstrual change is
thus not inevitably constructed or experienced as a
negative, pathological condition—it can be normalised, or
even embraced, transforming “unwantedness into wanted-
ness”(Lee 2002, p.30).
Discussion
This analysis clearly documents the complexity of the
construction and lived experience of PMS—a‘disorder’
that is said to affect 75% of women in North America,
Western Europe and Australia (Halbreich et al. 2003;
Steiner and Born 2000). Rather than being a pathology
that occurs within the woman, meriting psychiatric diagno-
sis and bio-medical management, PMS can be conceptual-
ised as a gendered experience located in medical and
cultural discourse about premenstrual change and (hetero)
femininity; the context of women’s lives; and women’s
negotiation of somatic and psychological change as ‘symp-
toms’of a disorder: a material-discursive-intrapsychic phe-
nomenon (Ussher 2000,2011). Cultural representations of
PMS are similar in Australia to those found in North
America and Western Europe: premenstrual change is
positioned as a bio-medical pathology, and the premenstrual
Sex Roles

woman is constructed as potentially mad, bad or
dangerous (Ussher 2006). Representations of menstrua-
tion are also similar in Australia (Finch 1993;Raftosetal.
1998), North America (Johnston-Robledo et al. 2007;Lee
and Sasser-Coen 1996), and Western Europe (Laws 1990;
Treneman 1988): positioned as a matter of hygiene, or as
something that is shameful and expected to be invisible.
The wider availability of positive cultural representations
of menstruation, and the acceptance and non-pathologisation
of premenstrual change, is a plausible explanation for the
finding that PMS is rarely reported in contexts such as Hong
Kong, China, or India (Chang et al. 1995; Chaturvedi and
Chandra 1991;Hoersteretal.2003). However, our research
suggests that acceptance and non-pathologization can also
operate in a cultural context where negative attitudes to
menstruation and premenstrual change are more ubiquitous
(see Chrisler and Caplan 2002;Ussher2006), strongly
influenced by the construction of PMS adhered to by a
woman and her partner, as well as by relationship dynamics
associated with the negotiation of premenstrual experiences.
Negative constructions of PMS on the part of a woman’s
partner can exacerbate distress, and result in the women being
positioned as inadequate or mad premenstrually (Cortese and
Brown 1989; Perz and Ussher 2009a; Sveinsdottir et al.
2002; Ussher and Perz 2008;Ussheretal.2007). Absence of
support can also make it difficult for women to absolve
themselves of responsibilities, and can increase anger and
irritation at inequalities in the relationship, that comes to
be positioned as PMS because of negative cultural
constructions of the reproductive body. However, the
converse is also true—support and understanding offered
by partners can reduce guilt and self-blame in women
who experience premenstrual change, as well as acting to
facilitate self-care (Perz and Ussher 2006;Ussheretal.
2007). This confirms the findings of previous North
American quantitative research that has examined the
association between relationship tension and PMS, where
women who report premenstrual symptoms also report
higher levels of relationship dissatisfaction or difficulties
(Coughlin 1990; Frank et al. 1993; Ryser and Feinauer
1992; Winter et al. 1991;Wright1986),leadingtothe
suggestion that ‘PMS’is not an individual problem, but a
relational issue (Ryser and Feinauer 1992), and that family
or couples therapy may be an appropriate form of
intervention (Frank 1995; Jones et al. 2000).
All of this previous PMS research has focused on
heterosexual couples, obscuring the gendered nature of the
negotiation of premenstrual change within relationships. In
our research, premenstrual relationship conflict and absence
of support was more commonly reported by heterosexual
women, in comparison to lesbians, supporting our argument
that constructions of femininity within hetero-patriarchy,
and the experience of gendered roles in heterosexual
relationships, are centrally implicated in the construction
and lived experience of premenstrual distress. In the
Australian lesbian couples interviewed, there were no
accounts of relationship conflict or tension escalating
premenstrually because of a woman’s partner rejecting or
dismissing her, or her partner actively engaging in conflict,
a theme found in previous North American and British
research on heterosexual women’s experiences of PMS
(Cortese and Brown 1989; Ussher 2003a). This is not to
suggest that lesbian partners are passive in the face of
premenstrual irritation or intemperance, but rather, that they
are more likely to adopt a positive and conciliatory mode of
communication which serves to diffuse conflict and offer
support. That a number of women partners had boundaries
associated with unacceptable behaviour also suggested that
dealing with premenstrual distress is the subject of a
complex negotiation between two women, which requires
“emotion work”(Duncombe and Marsden 1998, p.211)
from both parties, in managing their own feeling states and
those of their partner. In all of the women interviewed this
emotion work was not described as a burden, but as part of
being in a committed relationship, in contrast to many
heterosexual women’s accounts, as well as PMSBuddy
posts, where premenstrual emotions are described as too
much work by their male partners (Ussher et al. 2007).
Whilst only a small proportion of heterosexual women
gave accounts of supportive partners, these positive
accounts contradict the belief held by many of our women
that “men can’t understand”. It is clearly possible for men
to be supportive and respectful towards their partners
premenstrually, which can facilitate a reduction in distress,
and avoidance of the escalation of conflict, or the spiral of
guilt and self blame which many women engage in.
Communication about premenstrual change between cou-
ples appears to be central to men’s recognition and
understanding (Mooney-Somers et al. 2008;Schwartz
2001; Welthagen 1995), which can be assisted by men’s
involvement in monitoring of their partner’s premenstrual
change (Frank et al. 1993; Jones et al. 2000). This suggests
that the involvement of male partners in therapeutic
interventions for premenstrual distress may be beneficial
(Jones et al. 2000), acting to inform men about the nature
and course of premenstrual change, as well as engaging
their involvement in strategies of support for their partner.
The differences we observed between lesbian and
heterosexual relationships can be explained in a number
of ways. Lee has argued that menstruation helps to
“produce the body and the woman as cultural entities”
(Lee 1994, p.343), with menarche representing entrance
into womanhood, through a process of “(hetero)sexualisa-
tion”(p.343) of the female body. We would extend this
analysis to argue that the relational negotiation of premen-
strual change reflects the ways in which heterosexual
Sex Roles

women “are inserted, and insert themselves, into the
hierarchical ordering of the sexual”(Lee 1994, p.344),
through the positioning of premenstrual change as pathol-
ogy, and the absence of support from male partners when
women are experiencing premenstrual distress. This is part
of the construction and experience of gender within hetero-
patriarchy, following the assumption that gender, and the
gendering of power, both constructs and affects couple
relationships (Laird 2000).
Supporting this view, previous North American re-
search has reported that premenstrual distress is associ-
ated with femininity, with more feminine women
reporting higher levels of distress (Cosgrove and Riddle
2003). Conversely, lesbians have been reported to be less
likely to conform to the traditional feminine gender role
(see Bailey and Zucker 1995; Smith and Stillman 2002),
or will knowingly enact a feminine (or femme) role as
gendered performance, in order to challenge traditional
gendered and heterosexual boundaries (Hiestand and
Levitt 2005), or as a reflection of desire (Goldberg
2010b). This demonstrates that gender is not something
that we are, but something that we do (Butler 1990), a
performance that is invariably negotiated differently
outside of the constraints of the heterosexual matrix, as
different role expectations, opportunities and constraints
apply, reflecting and reinforcing balances (and imbalan-
ces) “in status and power”(Goldberg 2010b,p.32).For
example, greater egalitarianism, manifested as “highly
flexible decision making and household arrangements”
(Green et al. 1996, p.197), and innovation and adaptability
in dealing with both relational needs and domestic tasks
(Connolly 2005, p.270), has been observed in North
American research on lesbian relationships. As a result,
lesbian couples are more likely to share household
responsibilities (Balsam et al. 2008; Matthews et al.
2003; Schneider 1986) and to report an egalitarian power
balance within the relationship (Eldridge and Gilbert
1990), when compared to heterosexual couples. This was
reflected in the absence of ideals of (hetero)femininity
beingusedinaself-policingmanner,andtheegalitarian
relationship structure described by the Australian lesbian
couples in our research, which meant that there were few
accounts of lesbians feeling over-burdened by emotional
or practical responsibilities in the home premenstrually,
and becoming angry or irritable as a result. There was also
an absence of self-castigation for wanting to be alone, or
for needing support, as lesbian interviewees were able to
resist the self-policing inherent in the (hetero)feminine
caring role (O'Grady 2005).
This gendered non-adherence has previously been
linked to the greater instrumentality, combined with
expressiveness, that has been found in North American
research on lesbian, in comparison to heterosexual,
relationships (Kurdek 1987), with lesbian couples
reported to demonstrate a greater capacity for mutual
empathy, empowerment and relational authenticity
(Mencher 1990). It has been suggested that similarity in
gender role may benefiting women by allowing them to
empathize with each other (Metz et al. 1994), a view
which is supported by the accounts of premenstrual
empathy on the part of Australian lesbian interviewees in
the current study. Lesbian couples have also been reported
to experience with open exploration of feelings, empathic
attunement to non-verbals, negotiation, and the conscious
avoidance of contempt (Connolly and Sicola 2006),
working more harmoniously (Roisman et al. 2008), being
more likely using a positive tone (Gottman et al. 2003),
and making more effort (Metz et al. 1994), when resolving
difficulty or conflict. In this vein, Metz et al. (1994)have
argued that “ifwomenaregenerallymorelikelytobe
cautious, scrutinize themselves, or worry more about a
male partner’s reactions, or if they have concerns about
being substantially understood by a man, then women may
be more self-assured when addressing conflict with
another woman”(p.304). This may be of particular
relevance in coping with distress associated with the
reproductive body, where women expect a female partner
to be more able to understand their premenstrual experi-
ence than a male partner, because of the assumption of
corporeal similarity, as was reflected in the accounts in our
research on PMS. Raising matters of disagreement could
also be experienced as less threatening to the relationship,
providing explanation for the lower level of self-silencing
in lesbian women in our research (Ussher and Perz 2010),
and the greater acceptance of premenstrual emotions on
the part of lesbian partners.
This can have significant implications for women’s
psychological wellbeing. In our research, women in lesbian
relationships reported lower levels of depression and
anxiety and higher levels of premenstrual coping than
women in heterosexual relationships (Perz and Ussher
2009b). These findings are not unique to PMS. In other
areas of women’s reproductive health, such as peri-natal
depression (Ross 2005) and menopause (Winterich 2003),
women in lesbian relationships also report lower levels of
distress. At the same time, there is a growing body of North
American research reporting that lesbian relationships are
experienced as more satisfying than heterosexual relation-
ships (Balsam et al. 2008; Green et al. 1996; Kurdek 2003;
Metz et al. 1994), with predictors of this satisfaction being
greater emotional companionship (Metz et al. 1994), greater
liking, trust and equality (Kurdek 2003), cohesion and
flexibility (Green et al. 1996), as well as intimacy, equity
and autonomy (Schreurs and Buunk 1996). As there is
considerable evidence that relationship dissatisfaction and
discord are primary predictors of women’smentalhealth
Sex Roles

(Anderson et al. 1999), with women in discordant relation-
ships found to be at high risk of mental health problems
(Brown et al. 1986), including premenstrual distress
(Coughlin 1990; Frank et al. 1993; Ryser and Feinauer
1992; Winter et al. 1991; Wright 1986), this provides further
explanation for the lesbian-heterosexual differences found in
our research.
The absence of children in the majority of lesbian
relationships may be put forward as an explanation for
differences between heterosexual and lesbian couples, as
the burden of family responsibility falls disproportionately
on heterosexual women after having children (Metz et al.
1994). However, accounts of unsupportive relationships,
over-responsibility and self-silencing associated with PMS,
have been reported by heterosexual women with and
without children in previous North American and British
Research (Cosgrove and Riddle 2003; Ussher 2003a,
2004b), suggesting presence of children is not sufficient
explanation for premenstrual distress. Equally, North
American researchers have reported that lesbian couples
are less likely to adopt gendered divisions of labour even if
they do have children (Goldberg 2010a), and have been
reported to rate relationship satisfaction very highly
compared to child-free lesbian couples (Koepke et al.
1992). Lesbians who are non-birth mothers have been
found to contribute equally to child-care tasks, with the
couple actively working to minimize inequality in the
parenting role (Goldberg and Perry-Jenkins 2007). In our
research, whilst we did not observe a difference between
lesbian couples with and without children, the number of
lesbian parents was too small for generalisations to be
made. Further research is needed to explore this issue
further, systematically examining the construction and
experience of premenstrual distress in couples with and
without children, in both heterosexual and lesbian relation-
ships. As the social and legal acceptance of same sex
relationships varies across cultures, this also needs to be
examined across different cultural contexts.
In conclusion, this analysis reinforces the positioning
of PMS as an inter-subjective phenomenon, and draws
attention to the influence of discourses of hetero-
normativity in Australian women’s premenstrual experi-
ence, in particular, the influence on distress, coping and
self-pathologisation. The differences we found between
lesbian and heterosexual couples reinforce the need for
the inclusion of a heterogeneous range of relationship
types in all future research examining PMS, a research
area which has previously focused exclusively on
heterosexual women. This will provide further explora-
tion of the role of hetero-patriarchal constructions of
femininity and premenstrual change, as well as the
impact of gendered roles, in the construction and
relational experience of premenstrual distress.
Acknowledgements This study was funded by a Discovery grant
from the Australian Research Council, DP0558831 ‘An examination
of the development, experience and construction of premenstrual
symptoms’. Thanks are offered to Emily May, Margaret Boulos, Julie
Mooney-Somers, Lee Shepard, Helen Vidler and Michelle Rhyder-
Obid for research support and assistance.
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