“Enhancing Mental Health Practice: Investigating Premenstrual Symptomatology and

Effective Screening Approaches for Mental Health Social Workers “or

"Unveiling Premenstrual Symptoms: Enhancing Mental Health Practice through
Investigating Symptomatology and Effective Screening Approaches for Mental Health
Social Workers,"

Chapter 1: Introduction

Abstract

1.1 Introduction and Background

Women [and those who menstruate- see below] may experience a diverse range of
premenstrual experiences, characterized by a variety of signs and symptoms (Saglam,
Yesildere, & Orsal, 2020). Among these experiences, Premenstrual Syndrome (PMS)
occursthe most frequently during reproductive years and is characterised by a collection of
emotional, physical, and behavioural symptoms, which disappear few days after the onset
of menstruation(Siegel, 1987a; Jarvis, Lynch, & Morin, 2008; Barry, 2016).Although
symptoms are often mild, 5-8% have moderate to severe symptoms that can cause
significant distress or functional impairment. (Gudipally & Sharma, 2022).

As Johnson points out, “a connection between the physiology of the menstrual cycle and
behavioral change has been noted since the early medical writings of Hippocrates around
400 B.C. and of Soranus in the second century A.D." (Delaney et al., 1999; Johnson, 1987 as
cited in Hall, 1994). Hippocrates linked menstrual cycle disorders to hysteria, a condition
thought to be caused by a "wandering uterus." The uterus was believed to move internally
in response to the lunar phases, which coincided with the menstrual cycle length of 28 days
(Rodin, 1992).

Around 420 BCE, the Corpus Hippocraticum used the term "hysteria" to describe a range of
female diseases that were believed to be caused by animate or inanimate wombs, referring
to the idea that the uterus (womb) can be thought of as either devoid of life (inanimate) or
possessing life (animate) (Reynolds, 2018).

Hippocrates described some physical and psychological manifestations of hysteria in his

work "On Virgins" (VIII.466-70 Littré. G):

"For later the blood collects in the womb in preparation to flow out"..."because of its
abundance, rushes up to the heart and to the lungs; and when these are filled with blood,
the heart becomes sluggish, and then, because of the sluggishness, numb, and then, because
of the numbness, insanity takes hold of the woman... When these places are filled with
blood, shivering sets in with fevers. They call these 'erratic fevers.' When this is the state of
affairs, the girl goes crazy because of the violent inflammation, and she becomes murderous
because of the decay and is afraid and fearful because of the darkness."
"The girls try to choke themselves because of the pressure on their hearts; their will,
distraught and anguished because of the bad condition of the blood, forces evil on itself. In
some cases, the girl says dreadful things"... "When this person returns to her right mind,
women give to Artemis various offerings, especially the most valuable of women's robes,
following the orders of oracles, but they are deceived. The fact is that the disorder is cured
when nothing impedes the downward flow of blood" (Diotima Project, n.d., para. 349).

***Subtitle needed here**

In this dissertation, the term 'women' refers to individuals who experience menstruation, in
line with the language commonly used in the existing literature on Premenstrual Syndrome
(PMS). It is important to note that this terminology is chosen to maintain consistency with
the original authors and the broader body of literature.
However, it is crucial to acknowledge that not all people who menstruate may identify as
women. Gender identity is diverse and can extend beyond the binary notion of male and
female. Some individuals who menstruate may identify as non-binary, genderqueer, or have
other gender identities (Rydström, 2020). By using the term 'women' in this dissertation, it is
not meant to exclude or invalidate the experiences of individuals who menstruate and do
not identify as women. Rather, it is a reflection of the existing language used in the
literature and the terminology employed by the original authors.

Despite being the most common disorder at reproductive age (Zendehdel & Elyasi, 2018),
PMS remains an under-researched area within the field of mental health social work,
representing an important gap in our understanding of women's health and well-being
(Siegel, 1987a). Although the precise aetiology of Premenstrual Syndrome (PMS) is unclear,
it is believed that hormonal fluctuations throughout the menstrual cycle play a significant
role (Severino & Moline, 1995; Mayo & Joseph, 1999).Research has acknowledged the
impacts of the menstrual cycle on the emotional state and cognitive functioning of some
women (Lazarov, 1982; Farage, Osborn, & MacLean, 2008; Birtchnell & Floyd, 1974).
Premenstrual syndrome (PMS) is characterized by symptoms such as irritability, mood
swings, anxiety, and depression, which are experienced during the cycle's luteal phase
(Kappen et al., 2022; Hoyer et al., 2013). These symptoms can impact cognitive abilities,
such as memory, attention, and executive function. However, the severity and
manifestation of PMS can vary among women and may not be consistent from one cycle to
the next (Le, Thomas, & Gurvich, 2020). Although the precise aetiology of Premenstrual
Syndrome (PMS) is unclear, it is believed that hormonal fluctuations throughout the
menstrual cycle play a significant role (Severino & Moline, 1995; Mayo & Joseph,
1999).Research by Siahbazi(citation needed here!) has highlightedthe multidimensional nature of
premenstrual syndrome (PMS) and its significant impact on women's quality of life. The study found
that PMS can affect women in physical, psychological, behavioural, and family-social ways, leading to
a decreased quality of life. The author emphasizes the need for a more holistic approach to women's
healthcare that considers the various dimensions of PMS and addresses each person’s unique needs.
Building upon understanding the widespread impact of premenstrual symptoms, the study
conducted by Tschudin, Hantsoo, and colleagues (2022; 2022) utilized quantitative data
from the "Flo" app, an application designed for tracking menstrual cycles and symptoms. In
addition, their research specifically relied on self-recorded data collected from app users,
providing a large sample size and real-time insights into the experiences of women with
premenstrual symptoms.To analyze the data, the researchers examined the frequency and
severity of premenstrual symptoms reported by app users. They utilized a sample of
238,114 app users from 140 countries. Using statistical analysis techniques, they identified
patterns and associations between symptoms and different phases of the menstrual cycle.
This approach provided insights into the impact of premenstrual symptoms on women's
daily lives.Using the "Flo" app data enabled the researchers to draw meaningful conclusions
about the prevalence and effects of premenstrual symptoms. In addition, by utilizing a
quantitative approach and employing statistical analysis, the study provided valuable
insights into the magnitude and patterns of symptoms experienced by women worldwide.
The study's findings shed light on the prevalence and effects of these symptoms,
contributing to a broader understanding of their significance in women's lives.

1.2 Aims and objectives.

Mental health social workers play a critical role in supporting individuals with mental health
concerns, including those who experience PMS-related symptoms. However, little is known
about how mental health social workers perceive and address PMS within their practice.

The aim of this research is to explore the intersection between PMS and mental health
social work. Specifically, this study will seek to (1) determine the scope and depth of the
[scholarly?] literature on PMS within mental health social work, (2) understand how PMS is
discussed within the literature of the wider social work profession and examine what mental
health social workers can learn from this, (3) analyse what studies of mental health social
workers reveal about the way they perceive PMS and if/how they incorporate it into their
mental health assessments, and (4) assess which interventions by mental health social
workers to better screen for PMS are most effective and/or approach the issue from a
holistic perspective.

Overall, this research aims to shed light on the current understanding and practice of mental
health social workers regarding PMS and to identify potential strategies to improve the
identification and treatment of PMS-related symptoms within mental health social work
practice. This research aims to contribute to a more comprehensive understanding and
practice of mental health social workers regarding Premenstrual Syndrome (PMS). By
identifying strategies to improve the identification and treatment of PMS-related symptoms
in their approach, this study seeks to empower mental health social workers to provide
inclusive and practical support to all people who experience PMS-related symptoms. In
addition, the findings of this research could enhance the well-being and mental health
outcomes of individuals affected by PMS.
This review aims to explore the effects of Premenstrual Symptomatology on mental health
and if it is appropriate for mental health social workers to screen premenstrual symptoms
during mental health assessments. To achieve this aim, the following objectives were set:
 To determine the scope and depth of the literature on Premenstrual Symptoms
within mental health social work.

 To understand how Premenstrual Symptoms are discussed within the literature of

the wider social work profession and examine what mental health social workers
can learn from this.

 To analyse existing studies of what mental health social workers reveal about the
way they perceive Premenstrual Symptoms and if/how they incorporate it into
their mental health assessments.

 To identify the most effective interventions employed by mental health social

workers for screening premenstrual symptoms, including those that approach the
issue holistically and offer comprehensive support to those affected. This
objective seeks to identify approaches that can aid in systematically evaluating
premenstrual symptoms' psychological and psychiatric impact.

1.3 Conceptual Framework

Grant and Osanloo (2014) emphasise the often-misunderstood importance of the

theoretical framework in the research process, particularly for doctoral students completing
their dissertations. They suggest that without a theoretical framework, the organisation and
vision of a study remain ambiguous. In contrast, including a theoretical framework in the
research plan gives the dissertation study strength and structure, allowing for a well-
organised flow from one chapter to the next. The writers utilise the metaphor of a
"blueprint" to show how the theoretical framework directs the dissertation.

To improve the recognition and management of PMS-related symptoms in the context of

mental health social work practice, I aim to develop a thorough understanding, strengthen
the validity of my findings, and identify practical strategies by incorporating different
theoretical frameworks into my research on the knowledge of Premenstrual Syndrome
(PMS) among mental health social workers. According to Anfara Jr and Mertz (2014, p. 114),
"Using multiple theories can help 'have a greater breadth'." With this strategy, I plan to
create a more functional and inclusive support network for people with PMS.

Explain why I am using multiple theoretical frameworks.

The limitations of the linearity assumption in premenstrual syndrome (PMS) research are
discussed by Walker (1995). The dominant linearity model presupposes a one-way causal
relationship between variables and the onset of PMS symptoms. As a result, there is now an
emphasis on categorising women as having PMS or not and looking for a single component
separating the two groups. However, the diversity of PMS experiences needs to be
adequately represented by this linear method.

Walker asserts that interactive biopsychosocial models, which consider how social,
psychological, and biological aspects interact, may provide a more thorough explanation of
PMS. These models consider the differences in symptoms across women and within
menstrual cycles, the impact of social variables on the cycle, the disruption of mood and
circadian rhythms, and the synchronised changes in the body's physiological and
neurochemical systems during the menstrual cycle. Researchers can go beyond linear
presumptions and get deeper insights into the complex nature of PMS by utilising
interactive biopsychosocial models (Walker, 1995).

In addition to the biopsychosocial model, social constructionism theory will be considered.

According to Conrad and Barker (2010), social constructionism emphasises how language,
symbols, and shared meanings are used to socially construct issues like health and illness.
Applying social constructionism can help explore how PMS is conceptualized and discussed
within mental health social work and the broader social work profession. It can look at how
language, cultural assumptions, and societal discourses about PMS affect how those with
the condition experience and perceive their condition (Lorber & Moore, 2002).

Bronfenbrenner (2000) put forth ecological systems theory that emphasises the various
systems—the microsystem, mesosystem, ecosystem, and macrosystem—that interact and
impact a person's growth and well-being. Analysing the multiple contexts and systems that
influence people with PMS, such as family, school, community, and broader societal
influences, can be achieved by using ecological systems theory. It can help shed light on
broader social and environmental factors that influence how people with PMS experience
their condition and can guide the creation of all-encompassing interventions.

Intersectionality theory will also be considered as it acknowledges the multiple intersecting

social identities and experiences of privilege and oppression that people have (Hawkey &
Ussher, 2022). Applying intersectionality can aid in examining the connections between the
experience of PMS and mental health and variables like race, ethnicity, socioeconomic
status, and sexual orientation. It can help people from different marginalised groups better
understand the difficulties they face and direct the creation of inclusive and culturally
sensitive methods for addressing PMS in mental health social work.

How many theoretical frameworks I can use in my dissertation?

1.4 Methodology
Barry, L., 2016. Social workers' knowledge of premenstrual syndrome (PMS) and
premenstrual dysphoric disorder (PMDD): implications for assessment practices with
mothers (Doctoral dissertation, Memorial University of Newfoundland).

Birtchnell, J. and Floyd, S., 1974. Attempted suicide and the menstrual cycle—a negative
conclusion. Journal of Psychosomatic Research, 18(5), pp.361-369.

Bronfenbrenner, U., 2000. Ecological systems theory. Oxford University Press.

Conrad, P. and Barker, K.K., 2010. The social construction of illness: Key insights and policy
implications. Journal of health and social behavior, 51(1_suppl), pp.S67-S79.

Farage, M.A., Osborn, T.W. and MacLean, A.B., 2008. Cognitive, sensory, and emotional
changes associated with the menstrual cycle: a review. Archives of gynecology and
obstetrics, 278, pp.299-307.
From Cycle to Syndrome and Back Again: A Social Work Response to PMS

Grant, C. and Osanloo, A., 2014. Understanding, selecting, and integrating a theoretical
framework in dissertation research: Creating the blueprint for your “house”. Administrative
Issues Journal, 4(2), p.4.

Gudipally, P. R., & Sharma, G. K. (2022). Premenstrual Syndrome. In: StatPearls [Internet].
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JARVIS, C.I., LYNCH, A.M. and MORIN, A.K., 2008. Management Strategies for Premenstrual
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Walker, A., 1995. Theory and methodology in premenstrual syndrome research. Social
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