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How many people here have heard of PMS?
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Everybody, right?
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Everyone knows that women
go a little crazy
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right before they get their period,
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that the menstrual cycle throws them
onto an inevitable hormonal roller coaster
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of irrationality and irritability.
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There's a general assumption
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that fluctuations in reproductive hormones
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cause extreme emotions
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and that the great majority of women
are affected by this.
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Well I am here to tell you
that scientific evidence says
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neither of those assumptions is true.
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I'm here to give you the good news
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about PMS.
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But first, let's take a look
at how firmly the idea of PMS
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is entrenched in American culture.
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If you examine newspaper
or magazine articles,
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you'll see how widely assumed it is
that everyone gets PMS.
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In an article in the magazine Red Book
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titled "You: PMS Free,"
readers were informed
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that between 80 to 90 percent
of women suffer from PMS.
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LA Muscle Magazine warned its readers
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that 40 to 50 percent of women
suffer from PMS,
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and that it plays a major role
in women's mental and physical health,
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and a couple of years ago,
even the Wall Street Journal
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ran an article on calcium
as a treatment for PMS,
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asking its female readers,
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"Do you turn into a witch every month?"
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From all these articles, you would think
there must be a mountain of research
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verifying the widespread nature of PMS.
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However, after five decades of research,
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there's no strong consensus
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on the definition, the cause,
the treatment,
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or even the existence of PMS.
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As most commonly defined by psychologists,
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PMS involves negative behavioral,
cognitive, and physical symptoms
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from the time of ovulation
to menstruation.
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But here's where it gets tricky:
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over 150 different symptoms
have been used to diagnose PMS,
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and here are just a few of those.
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Now, I want to be clear here:
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I'm not saying women don't get
some of these symptoms.
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What I'm saying is that
getting some of these symptoms
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doesn't amount to a mental disorder,
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and when psychologists
come up with a disorder
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that's so vaguely defined,
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the label eventually becomes meaningless.
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With a list of symptoms
this long and wide,
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I could have PMS, you could have PMS,
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the guy in the third row here
could have PMS,
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my dog could have PMS.
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Some researchers said
you had to have five symptoms.
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Some said three.
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Other researchers said that symptoms
were only meaningful
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if they were highly disturbing to you,
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but others said minor symptoms
were just as important.
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For many years, because
there was no standardization
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in the definition of PMS,
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when psychologists tried
to report prevalence rates,
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their estimates ranged
from five percent of women
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to 97 percent of women,
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so at the same time almost no one
and almost everyone had PMS.
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Overall, the weaknesses in the methods
of research on PMS have been considerable.
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First, many studies asked women
to report their symptoms retrospectively,
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looking to the past and relying on memory,
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which is known to inflate reporting of PMS
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compared to what's called
prospective reporting,
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which involves keeping
a daily log of symptoms
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for at least two months in a row.
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Many studies also exclusively focused
on white, middle class women,
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which makes it problematic
to apply study findings
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to all women.
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We know there's a strong
cultural component to the belief in PMS
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because it's nearly unheard of
outside of Western nations.
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Third, many studies failed
to use control groups.
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If you want to understand
the specific characteristics
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of women who have PMS,
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we need to be able to compare them
to women who don't have PMS.
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And finally, many different types
of questionnaires were used
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to diagnose PMS, focusing
on different symptoms,
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symptom duration, and severity.
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To do reliable research on any condition,
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scientists must agree
on the specific characteristics
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that make up that condition
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so they're all talking
about the same thing,
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and with PMS, this has not been the case.
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However, in 1994,
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the Diagnostic and Statistic Manual
of Mental Disorders,
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known as the DSM, thankfully
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-- it's also the manual
for mental health professionals --
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they redefined PMS as PMDD,
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Premenstrual Dysphoric Disorder.
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And dysphoria refers to
a feeling of agitation or unease.
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And according to these new DSM guidelines,
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in most menstrual cycles in the last year,
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at least five of 11 possible symptoms
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must appear in the week
before menstruation starts;
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the symptoms must improve
once menstruation has begun;
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and the symptoms must be absent
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the week after menstruation has ended.
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One of these symptoms must come
from this list of four:
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marked mood swings, irritability,
anxiety, or depression.
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The other symptoms could come
from the first slide
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or from those on the second slide,
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including symptoms like
feeling out of control
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and changes in sleep or appetite.
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The DSM also required now
that the symptoms
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should be associated with
clinically significant distress.
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-- there should be some kind
of disturbance in work
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or school or social relationships --
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and that symptoms and symptom severity
should now be documented
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by keeping a daily log
for at least two cycles in a row.
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And finally, DSM required that
the emotional disturbance
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should be more than simply an exacerbation
of an already existing disorder.
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So scientifically speaking,
this is an improvement.
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We now have a limited number of symptoms,
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and a high impact on functioning
that's required,
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and the reporting and timing of symptoms
have both become very specific.
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Well, using this criteria
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and looking at most recent studies,
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we see that on average,
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three to eight percent of women
suffer from PMDD.
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Not all women, not most women,
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not the majority of women,
not even a lot of women:
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three to eight percent.
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For everyone else, variables
like stressful events or happy occasions
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or even day of the week
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are more powerful predictors of mood
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than time of the month,
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and this is the information
the scientific community has had
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since the 1990s.
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In 2002, my colleagues and I
published an article
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describing the PMS and PMDD research,
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and several similar articles have appeared
in psychology journals.
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the questions is, why hasn't this
information trickled down to the public?
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Why do these myths persist?
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Well, certainly the onslaught
of messages that women receive
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from books, TV, movies, the Internet,
that everyone gets PMS
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go a long way in convincing them
it must be true.
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Research tells us that the more
a woman believes that everyone gets PMS,
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the more likely she is
to erroneously report that she has it.
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Let me tell you what I mean
by "erroneously."
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You might ask her, "Do you have PMS?"
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and she says yes,
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but then, when you have her
keep a daily log
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of psychological symptoms for two months,
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no correlation is found
between her symptoms
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and time of the month.
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Another reason for the persistent
of the PMS myth
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has to do with the narrow boundaries
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of the feminine role.
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Feminist psychologists like Joan Chrisler
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have suggested that taking on
the label of PMS allows women
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to express emotions that would otherwise
be considered un-ladylike.
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The near universal definition
of a good woman
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is one who is happy, loving,
caring for others,
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and taking great satisfaction
from that role.
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Well, PMS has become a permission slip
to be angry, complain, be irritated,
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without losing the title of good woman.
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We know that the variables
in a woman's environment
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are much more likely to cause her
to be angry than her hormones,
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but when she attributes anger to hormones,
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she's absolved
of responsibility or criticism.
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"Oh, that's not who she is.
It's out of her control."
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And while this can be a useful tool,
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it serves to invalidate women's emotions.
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When people respond to a woman's anger
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with the thought, "Oh,
it's just that time of the month,"
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her ability to be taken seriously
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or affect change is severely limited.
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So who else benefits from the myth of PMS?
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Well, I can tell you that treating PMS
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has become a profitable,
thriving industry.
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Amazon.com currently offers
over 1,900 books on PMS treatment.
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A quick Google search
will bring up a cornucopia
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of clinics, workshops, and seminars.
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Reputable Internet sources
of medical information
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like WebMD or the Mayo Clinic
list PMS as a known disorder.
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It's not a known disorder,
but they list it.
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And they also list the medications that
physicians have prescribed to treat it,
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like anti-depressants or hormones.
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Interestingly, though, both websites
say that the success of medication
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in treating PMS symptoms
vary from woman to woman.
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Well, that doesn't make sense.
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If you've got a distinct disorder
with a distinct cause,
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which PMS is supposed to be,
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then the treatment should bring
improvement for a great number of women.
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This has not been the case
with these treatments,
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and FDA regulations say that
for a drug to be deemed effective,
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a large portion of the target population
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should see clinically
significant improvement.
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So we have not had that at all
with these so-called treatments.
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However, the financial gain
of perpetuating the myth
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that PMS is a common mental disorder
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and is treatable
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is quite substantial.
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When women are prescribed
drugs like anti-depressants or hormones,
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medical protocol requires that they have
physician follow up every three months.
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That's a lot of doctor visits.
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Pharmaceutical companies
reap untold profits
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when women are convinced
they should take a prescribed medication
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for all of their child-bearing lives.
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Over the counter drugs like Midol
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even claim to treat PMS symptoms
like tension and irritability,
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even though they only contain
a diarrhetic, a pain reliever,
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and caffeine.
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Now, far be it from me to argue
with the magical powers of caffeine,
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but I don't think reducing tension
is one of them.
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Since 2002, Midol has marketed
a Teen Midol to adolescents.
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They are aiming at young girls early,
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to convince them that everyone gets PMS
and that it will make you a monster,
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but wait, there's something
you can do about it:
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take Midol and you will be
a human being again.
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In 2013, Midol took in 48 million dollars
in sales revenue.
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So while perpetuating the myth of PMS
has been lucrative for some,
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it comes with some serious
adverse consequences for women.
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First, it contributes
to the medicalization
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of women's reproductive health.
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The medical field has a long history
of conceptualizing
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women's reproductive processes
as illnesses that require treatment,
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and this has come at many costs,
including excessive Cesarian deliveries,
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hysterectomies, and prescribed
hormone treatments
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that have harmed rather than enhanced
women's health.
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Second, the PMS myth also contributes
to the stereotype of women
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as irrational and over-emotional.
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When the menstrual cycle is described
as a hormonal roller coaster
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that turns women into angry beasts,
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it becomes easy to question the competence
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of all women.
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Women have made tremendous strides
in the workforce,
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but still there's a miniscule number
of women at the highest echelons
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of fields like government or business,
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and when we think about
who makes for a good CEO or senator,
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someone who has qualities like rationality,
steadiness, competence come to mind,
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and in our culture, that sounds more
like a man than a woman,
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and the PMS myth contributes to that.
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Psychologists know that
the moods of men and women
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are more similar than different.
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One study followed men and women
for four to six months
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and found that the number
of mood swings they experienced
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and the severity of those mood swings
were no different.
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And finally, the PMS myth
keeps women from dealing
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with the actual issues
causing them emotional upset.
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Individual issues like
quality of relationship
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or work conditions
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or societal issues like racism or sexism
or the daily grind of poverty
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are all strongly related to daily mood.
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Sweeping emotions under the rug of PMS
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keeps women from understanding
the source of their negative emotions,
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but it also takes away the opportunity
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to take any action to change them.
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So the good news about PMS
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is that while some women get some symptoms
because of the menstrual cycle,
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the great majority don't
get a mental disorder.
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They go to work or school,
take care of their families,
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and function at a normal level.
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We know the emotions and moods
of men and women
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are more similar than different,
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so let's walk away from
the tired old PMS myth
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of women as witches
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and embrace the reality
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of high emotional
and professional functioning
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the great majority of women
live every day.
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Thank you.
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(Applause)