The monthly malady: a history of premenstrual suffering.

In 1931, in a paper presented to the New York Academy of Medicine, Robert T Frank called attention to "a large group ofwomen" who were subject to "premenstrual tension". Their "intense personal suffering", he claimed, far surpassed those "varying degrees of discomfort", which preceded the onset of menstruation in normal women. Restlessness, irritability, a feeling like "jumping out of their skin" combined with various somatic complaints.' In the same year, the psychoanalyst Karen Horney published a paper on "premenstrual mood swings", on the irritability and anxiety, the listlessness, self-depreciation, or even outright depression, which many women experienced in the days preceding menstruation, linking them to strongly rejected fantasies of motherhood.2 After World War II, such notions were widely popularized under the new term "premenstrual syndrome" (PMS), which referred more explicitly to the mix of emotional, behavioural and somatic symptoms that Frank had already pointed out.3 Since then, PMS has spawned numerous medical and sociological studies and created a flourishing market for advice literature and medical help. The nature, prevalence and etiology of PMS remain a matter of intense debate.4 Various causes have been proposed, ranging from hormone or electrolyte imbalances to the somatization of emotional conflict, but no consensus is in sight, and it has even been argued that there are several distinct premenstrual syndromes.5 Definitions tend to be correspondingly general and vague. In current clinical terminology, "PMS" refers to any unspecified periodical somatic, psychological or behavioural disorder