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Conjoint Monitoring of Symptoms of Premenstrual Syndrome: Impact on Marital Satisfaction

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Beth Frank
Beth Frank
Beth Frank
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David N. Dixon at Ball State University
David N. Dixon
Hanus J. Grosz
Hanus J. Grosz
Hanus J. Grosz
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Abstract

30 women who met criteria for late luteal phase dysphoric disorder (premenstrual syndrome [PMS]) were randomly assigned to either a control group or a conjoint monitoring group. Following 3 mo of prospective charting to confirm the existence of PMS, the control group women continued to monitor menstrual cycle symptoms, while the conjoint monitoring group involved both the wife and the husband in charting cyclic symptoms. A 2 (control vs conjoint monitoring) × 2 (pretest vs posttest) multivariate analysis of variance (MANOVA) with 9 dependent variables from the Marital Satisfaction Inventory (MSI) revealed significant effects. Follow-up analyses showed that MSI scores predicted group membership (treatment or control) and that the conjoint monitoring treatment resulted in significantly greater improvement on specific MSI scores (Global Distress, Affective Communication, Problem-Solving Communication, Disagreement About Finances, and Sexual Dissatisfaction) than in the wives-only condition. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Journal of Counseling Psychology
1993,
Vol. 40, No. 1, 109-114
Copyright 1993 by the American Psychological Association, Inc.
0022-0167/93/S3.00
Conjoint Monitoring of Symptoms of Premenstrual Syndrome:
Impact on Marital Satisfaction
Beth Frank, David N. Dixon, and Hanus J. Grosz
Thirty women who met criteria for late luteal phase dysphoric disorder (premenstrual syndrome
[PMS]) were randomly assigned to either a control group or a conjoint monitoring group.
Following 3 months of prospective charting to confirm the existence of PMS, the control group
women continued to monitor menstrual cycle symptoms, while the conjoint monitoring group
involved both the wife and the husband in charting cyclic symptoms. A 2 (control vs. conjoint
monitoring) X 2 (pretest
vs.
posttest) multivariate analysis of variance with 9 dependent variables
from the Marital Satisfaction Inventory (MSI) revealed significant effects. Follow-up analyses
showed that MSI scores predicted group membership (treatment or control) and that the conjoint
monitoring treatment resulted in significantly greater improvement on specific MSI scores (Glo-
bal Distress, Affective Communication, Problem-Solving Communication, Disagreement About
Finances, and Sexual Dissatisfaction) than in the wives-only condition.
Premenstrual syndrome (PMS) is the cyclic patterning of
changes in somatic, psychological, behavioral, interactional,
and cognitive functioning in conjunction with the luteal
(prior to menses), or premenstrual, phase of the menstrual
cycle (Rubinow et al., 1986). This temporal patterning of
symptom changes can assist mental health professionals in
diagnosing PMS (Neimeyer & Graham-Kosch, 1988). Cur-
rently, PMS is termed late luteal phase dysphoric disorder
in the appendix to the revised catalog of psychiatric disor-
ders of the Diagnostic and Statistical Manual of Mental
Disorders (3rd ed., rev.; DSM-III-R; American Psychiatric
Association, 1987). Despite the fact that there is controversy
over PMS as a useful diagnostic category (e.g., Caplan,
1991),
women continue to seek treatment for relief of pre-
menstrual symptoms (e.g. Gise, Lebovits, Paddison, &
Strain, 1990) and to use the term for attributional explana-
tions of their experiences (e.g., McFarlane & Williams,
1990).
The conceptual framework for this study was derived
from family systems theory and marital therapy. In systems
theory, the family is viewed as "an organizationally open,
adaptive, and information-processing system" (Stuart, 1980,
p.
32). Also, "marriage can be described as an organized
system characterized to some degree by wholeness and cir-
cularity" (Nichols & Everett, 1986, p. 79). The family unit's
functioning can be affected by changes in its various
subsystems and is particularly affected by the marital
subsystem.
Beth Frank and David N. Dixon, Department of Counseling
Psychology and Guidance Services, Ball State University; Hanus J.
Grosz, Independent Practice, Indianapolis, Indiana.
An earlier version of this article was presented in August 1990
at the 98th Annual Convention of the American Psychological
Association, in Boston.
We thank Betty Gridley for her statistical consultation on this
project.
Correspondence concerning this article should be addressed to
David N. Dixon, Department of Counseling Psychology and Guid-
ance Services, Ball State University, Muncie, Indiana 47306.
With the event of a family member's illness or distress,
the function of interchange and exchange in marriage is
often altered (Brown & Zimmer, 1986). Litman (1974) and
Olsen (1970) found that illness in an individual creates a
family crisis in which other family members are influenced
by the health disruption of that individual. Indeed, a wom-
an's PMS may affect the marital subsystem as well as the
entire family system.
Other studies have reported marital and family disruption
attributable to premenstrual symptoms. Keye, Hammond,
and Strong (1986) compared 68 women who experienced
premenstrual symptoms with a similar control group of 34
women without premenstrual symptoms. The authors used
the Locke-Wallace Marital Adjustment Scale and reported
that in comparison with the control group, women with
premenstrual symptoms had a greater degree of marital
unhappiness.
In another study by Stout and Steege (1985), 100 women
were administered a psychological battery of tests, includ-
ing the Short Marital Adjustment Scale, during the follicular
(prior to ovulation) phase of the menstrual cycle. Of the 100
women in the study, 82 were involved in ongoing relation-
ships.
Forty-two percent of the women reported marital
distress and premenstrual outbursts, often involving valid
marital issues that couples had been unable to address
productively at other times during the women's menstrual
cycle.
Brown and Zimmer (1986) evaluated personal and family
sequelae of premenstrual symptoms. In their study, women
and men completed a questionnaire prior to an evening
lecture on PMS. The authors found recurrent negative fam-
ily themes, including increased conflict, decreased family
cohesion, and disrupted communication among family
members. Also of interest were the 76% of male respon-
dents reporting that their lives were moderately to greatly
disrupted by their partner's premenstrual symptoms.
Many of these earlier studies failed to accurately define
PMS populations and relied on retrospective reports of pre-
menstrual symptoms as the only inclusion criteria for pre-
menstrual research (Gise et al., 1990; McFarlane & Will-
109
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
... Furthermore, participants in the studies mentioned were informed on the goals of the study before taking part in the study, usually the goals were defined as: analyzing the impact of PMS on the relationship. As described by Giblin [27] and Frank, Dixon and Grosz [28], solely focusing on the PMS symptoms and conjoint monitoring of symptoms by both partners can lead to an improvement of the reported marital satisfaction. The authors consider an increase in empathy, understanding and awareness of the way PMS can affect a relationship due to a conjoint monitoring as reasons for that phenomenon. ...
... We collected daily (and weekly) data on marital satisfaction, "shared good experiences" and frequency of arguments throughout one complete woman's cycle from both partners. According to the suggestions by Frank, Dixon and Grosz [28], we kept the initial information on the goal of the study to a minimum, so that the participants were only informed they are taking part in a study on marital dynamics. Data concerning the female cycle and the PMS symptoms were only collected at the last day of the study. ...
... Our result clearly contradicts the findings by Ryser and Feinauer [25], who found a decrease in satisfaction for both men and women in PMS relationships similarly in the luteal phase. Most likely, the fact that the participants in the Ryser et al. study were informed of the study topic, in contrast to ours, influenced their focus of attention and thus, lead to differences in their perception and the ratings of their own satisfaction, as predicted by Frank, Dixon and Grosz [28]. ...
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... Notable is the absence of blame and his statement that PMS " can't be helped, " which is unlike the accounts presented earlier in this analysis. The present findings, in combination with previous research (Frank, 1995; Frank, Dixon, & Grosz, 1993; Ussher & Perz, 2013a), contest discourses in popular culture that position all men as insensitive to women's premenstrual needs and experiences. Rather, such findings suggest that at least some men are capable of engaging in practices intended to help women to cope with negative premenstrual changes. ...
... Also, men's accounts of providing support to their partners premenstrually contest notions of traditional masculinity wherein men are positioned as incapable of being sensitive (Allen, 2007). The present findings, in conjunction with previous research, suggest that awareness and understanding of women's premenstrual changes may help some men to be more empathetic to women, and may as well facilitate a positive construction of women's premenstrual changes (Frank et al., 1993; Koch, 2006; Mansfield, Koch, & Gierach, 2003; Ussher & Perz, 2013b). However, most men in the present study appeared to struggle to make sense of women's premenstrual experiences. ...
Representations of PMS and Premenstrual Women in Men's Accounts: An Analysis of Online Posts from PMSBuddy.com
Article
Full-text available
  • Jul 2014
Representations of premenstrual syndrome (PMS) in Western scientific and popular discourse construct premenstrual change as a disorder and portray premenstrual women as out-of-control, emotionally unstable, and dangerous. Previous research has suggested that the adoption of such constructions of PMS by male partners can have a deleterious influence on women’s experiences of premenstrual distress. However, few studies to date have examined constructions of PMS and the function of such constructions within men’s talk. Representations of PMS and premenstrual women in men’s accounts in the online discussion forum PMSBuddy.com, which appeared between September 2008 and February 2009, were analyzed through a thematic discourse analysis. The majority of accounts positioned negative premenstrual change as a hormonal disorder, an excuse, or a nuisance. Some men described themselves as victimized by their premenstrual partners, and positioned their experiences as unfair and undeserved. A small portion of men talked positively about premenstrual women and emphasized the importance of providing support. These findings suggest that it is important to recognize that PMS is constructed and experienced in a relational context. Cultural and relational constructions of PMS can influence both men and women’s experiences of premenstrual change.
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... For example, Cortese and Brown (1989) and Rundle (2005) reported that the coping responses of male partners predicted women's premenstrual symptom severity, with high levels of premenstrual distress associated with a partner's avoidance, fear, or anger, and low levels of distress associated with reassurance and support. Previous research has also reported that women who report PMS also report higher levels of relationship dissatisfaction or difficulties (Coughlin, 1990; Frank et al., 1993) and that over-responsibility within family relationships is a major source of conflict at this time (Ussher, 2003b). Women and their partners have also been reported to evaluate their relationship more negatively in the premenstrual phase, suggesting that some couples are not simply distressed, but rather, are distressed in the luteal phase of the cycle (Ryser and Feinauer, 1992). ...
... Rather than being unmentionable , PMS was acknowledged to be an issue, allowing concerns that were raised premenstrually to be discussed in a calm manner after the event. This provides a detailed qualitative case illustration that confirms previous quantitative research that reported that couple communication is beneficial in facilitating coping with premenstrual distress (Frank et al., 1993), as it is with other health problems (e.g. Gottman and Krokoff, 1989; Manne et al., 2006). ...
Pathology or source of power? The construction and experience of Premenstrual Syndrome (PMS) within two contrasting cases.
Article
Full-text available
  • Jun 2014
This research examines the construction and experience of premenstrual syndrome (PMS) in the context of intimate couple relationships, through examination of two contrasting cases analysed using thematic decomposition of narrative interviews. Judith and her male partner pathologised premenstrual change, constructing the premenstrual self as out of control, and the epitome of the ‘monstrous feminine’. Judith reported feeling over-burdened and uncontrollably angry premenstrually, associated with relationship issues and absence of partner recognition or support. In contrast, Sophia normalised premenstrual change, challenging the association between PMS and the construction of woman as deviant or dysfunctional. Sophia reported heightened energy and creativity premenstrually, and engaged in self-care supported by her woman partner. These cases demonstrate that premenstrual distress is an intersubjective experience, with constructions and material practices within relationships providing the context for premenstrual women being positioned as pathological and needing to be contained, or conversely, as sensitive and needing support.
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... This burdersome condition is commonly observed in adolescent girls and young women with prevalence rates between 58.1 to 92.3% among university students (Acikgoz et al., 2017;Hussein Shehadeh and Hamdan-Mansour, 2018). PMS is associated with substantial functional impairment comparable to that observed in dysthymia (Kues et al., 2016) and may lead to impaired work productivity (Chawla et al., 2002;Halbreich et al., 2003) and interfere with marital relationships (Frank et al., 1993), family/homemaking functions (Kuczmierczyk et al., 1992), hobbies and social activities (Heinemann et al., 2010), thereby decreasing health-related quality of life (Farrokh-Eslamlou et al., 2015). Furthermore, PMS is also an important predictor of perinatal depression (Studd and Nappi, 2012;Buttner et al., 2013;Roomruangwong et al., 2016;Stoner et al., 2017). ...
Lowered Plasma Steady-State Levels of Progesterone Combined With Declining Progesterone Levels During the Luteal Phase Predict Peri-Menstrual Syndrome and Its Major Subdomains
Article
Full-text available
  • Oct 2019
Background It is unknown whether lowered steady state levels of sex hormones coupled with changes in those hormones during the menstrual cycle are associated with premenstrual syndrome (PMS). Objective To examine associations between levels of progesterone and oestradiol during the menstrual cycle and PMS considering different diagnostic criteria for PMS. Methods Forty-one women aged 18–45 years with a regular menstrual cycle completed the Daily Record of Severity of Problems (DRSP) for all 28 consecutive days of the menstrual cycle. Blood was sampled at days 7, 14, 21, and 28 to assay oestradiol and progesterone. Results We developed a new diagnosis of peri-menstrual syndrome, which is characterized by increased DRSP severity in pre and post-menstrual periods and increased scores on the major DRSP dimensions, i.e., depression, physio-somatic symptoms, breast tenderness and appetite, and anxiety. This new diagnosis performed better than classical diagnoses of PMS, including that of the American College of Obstetricians and Gynecologists (ACOG). Lowered steady state levels of progesterone, when averaged over the menstrual cycle, together with declining progesterone levels during the luteal phase predict severity of peri-menstrual symptoms. Steady state levels of oestradiol and declining oestradiol levels during the cycle are also related to DRSP severity although most of these effects appeared to be mediated by progesterone. Conclusion A significant increase in menstrual-cycle related symptoms can best be conceptualized as “peri-menstrual syndrome” and may result from insufficient progesterone production (relative corpus luteum insufficiency), which, in part may result from lowered oestradiol production indicating suboptimal pre-ovulatory follicular development.
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... The monthly conflict associated with PMS has been linked to deterioration of relationships and to divorce (Graze et al. 1990), although the wide variety of outside factors to be considered make demonstration of causality difficult. The preferential direction of PMS towards partners is suggested by the fact that conjoint monitoring of PMS symptoms within a relationship improves marital satisfaction (Frank et al. 1993). Consequently, it does appear that PMS symptoms are more extreme in the home, that animosity is directed at partners, and that marital dissatisfaction peaks during the luteal phase for PMS sufferers. ...
Were there evolutionary advantages to premenstrual syndrome?
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Premenstrual syndrome (PMS) affects up to 80% of women, often leading to significant personal, social and economic costs. When apparently maladaptive states are widespread, they sometimes confer a hidden advantage, or did so in our evolutionary past. We suggest that PMS had a selective advantage because it increased the chance that infertile pair bonds would dissolve, thus improving the reproductive outcomes of women in such partnerships. We confirm predictions arising from the hypothesis: PMS has high heritability; gene variants associated with PMS can be identified; animosity exhibited during PMS is preferentially directed at current partners; and behaviours exhibited during PMS may increase the chance of finding a new partner. Under this view, the prevalence of PMS might result from genes and behaviours that are adaptive in some societies, but are potentially less appropriate in modern cultures. Understanding this evolutionary mismatch might help depathologize PMS, and suggests solutions, including the choice to use cycle-stopping contraception.
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The uterine-chemokine-brain axis: menstrual cycle-associated symptoms (MCAS) are in part mediated by CCL2, CCL5, CCL11, CXCL8 and CXCL10
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Objective: To examine associations between chemokines and menstrual cycle associated symptoms (MCAS). Methods: Forty-one women completed the Daily Record of Severity of Problems (DRSP) rating scale during 28 consecutive days of the menstrual cycle. MCAS is diagnosed when the total daily DRSP score during the menstrual cycle is > 0.666 percentile. We assayed plasma CCL2, CCL5, CCL11, CXCL8, CXCL10, EGF, IGF-1, and PAI-1 at days 7, 14, 21 and 28 of the menstrual cycle. Results: CCL2, CCL5, CCL11 and EGF are significantly higher in women with MCAS than in those without. Increased CCL2, CXCL10, CXCL8, CCL11 and CCL5 levels are significantly associated with DRSP scores while CCL2 is the most significant predictor explaining 39.6% of the variance. The sum of the neurotoxic chemokines CCL2, CCL11 and CCL5 is significantly associated with the DRSP score and depression, physiosomatic, breast-craving and anxiety symptoms. The impact of chemokines on MCAS symptoms differ between consecutive weeks of the menstrual cycle with CCL2 being the most important predictor of increased DRSP levels during the first two weeks, and CXCL10 or a combination of CCL2, CCL11 and CCL5 being the best predictors during week 3 and 4, respectively. Discussion: The novel case definition “MCAS” is externally validated by increased levels of uterus-associated chemokines and EGF. Those chemokines are involved in MCAS and are regulated by sex hormones and modulate endometrium functions and brain neuro-immune responses, which may underpin MCAS symptoms. As such, uterine-related chemokines may link the uterus with brain functions via a putative uterine-chemokine-brain axis.
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Premenstrual Dysphoric Disorder
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EpidemiologyDefinitionAssessment / MeasurementTheories / ModelsCharacteristics of Women with PMDD / PMSEffects of PMDD / PMSAttributions of Symptoms to the Menstrual CycleTreatment for PMDD / PMSSummaryReferences
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Evaluation of the relative efficacy of a couple cognitive-behaviour therapy (CBT) for Premenstrual Disorders (PMDs), in comparison to one-to-one CBT and a wait list control: A randomized controlled trial
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Conjoint monitoring of symptoms of premenstrual syndrome: Impact on marital satisfaction.
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30 women who met criteria for late luteal phase dysphoric disorder (premenstrual syndrome [PMS]) were randomly assigned to either a control group or a conjoint monitoring group. Following 3 mo of prospective charting to confirm the existence of PMS, the control group women continued to monitor menstrual cycle symptoms, while the conjoint monitoring group involved both the wife and the husband in charting cyclic symptoms. A 2 (control vs conjoint monitoring) × 2 (pretest vs posttest) multivariate analysis of variance (MANOVA) with 9 dependent variables from the Marital Satisfaction Inventory (MSI) revealed significant effects. Follow-up analyses showed that MSI scores predicted group membership (treatment or control) and that the conjoint monitoring treatment resulted in significantly greater improvement on specific MSI scores (Global Distress, Affective Communication, Problem-Solving Communication, Disagreement About Finances, and Sexual Dissatisfaction) than in the wives-only condition.
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