Many women experience a range of physical and emotional symptoms before they menstruate. This premenstrual stress, also commonly known as PMS, is often manifested by tension or anger in their relationships. Some women may feel so angry at their partner that they want to leave them.
In a study recently published in the journal PLoS ONE, we found a woman’s partner can help decrease PMS symptoms, rather than exacerbating them. Our study showed couples counselling reduced symptoms of moderate to severe premenstrual symptoms and improved relationship satisfaction.
Around 40% of women report moderate to severe premenstrual stress in the three to four days before their period. The most common symptoms are irritability, anger and depression, sometimes accompanied by tiredness, back pain and headaches.
These symptoms result from a combination of hormonal changes and life stress. Their severity is influenced by the coping strategies women adopt and their relationship context. Women who acknowledge premenstrual change, engage in self-care and ask for support are less likely to experience extreme premenstrual stress.
When we interview women who experience PMS, it’s common to hear they are dissatisfied by elements of their relationship – whether it is the emotional support they receive at home, or the dishes left in the sink at the end of the day.
For women who suffer from moderate to severe premenstrual stress, these issues can be left to simmer for three weeks of every month, when they are able to be repressed or ignored. But during that one week, when women feel more sensitive or vulnerable, it can all become too much.
How therapy helps
We already know that one-on-one therapy can reduce symptoms of premenstrual stress. The focus is on helping the woman understand the origins of her symptoms and develop coping strategies. These might include taking time-out for self-care, avoiding conflict, expressing needs for support, and reducing life stress.
While medical treatment, such as antidepressant SSRIs (selective serotonin re-uptake inhibitors), can be used to help women deal with premenstrual stress, psychological therapy is more effective in the long term. It also works in a self-help version, where women read about coping with PMS in a written manual, rather than talking to a therapist.from www.shutterstock.com
While therapy for premenstrual stress considers relationship issues, partners have generally not been directly involved in the sessions. This is a serious omission. Many men say they don’t understand PMS. They want to support their partner but don’t know what to do.
Others may avoid their partners when they have symptoms, which makes the woman feel rejected and makes the premenstrual stress worse.
Women in lesbian relationships have reported greater premenstrual support and understanding from their partner. This kind of support is associated with reduced symptoms and improved coping. Male partners who are supportive can have a similar positive effect.
Couples therapy even better
In our latest study, we compared the impacts of one-on-one and couples therapy for premenstrual distress with a control group of people on the wait list for therapy. The results indicate couple-based therapy was the most effective in improving relationships and alleviating premenstrual distress.
The study, which lasted for three years, involved 83 women who suffered from moderate to severe PMS. They were randomly divided into three groups: a one-on-one therapy group, a couples therapy group and a waiting list group. Most (95%) were in heterosexual relationships.
Women in the two therapy groups reported lower premenstrual symptoms, emotional reactions and premenstrual distress, in comparison to the wait-list control group. This confirms therapy is effective, regardless of the type.
However, the women in the couples-therapy group had significantly better behavioural coping strategies than those in the one-on-one therapy and wait-list control groups. In the couples-therapy group, 58% of women reported increased self-care and coping. This compared to 26% in the one-on-one, and 9% in the wait-list group.
Most women in the couples-therapy group (57%) reported an improved relationship with their partner. This was compared with 26% in the one-on-one therapy group and 5% of the wait-list reporting improvement.
In the couples-therapy group, 84% of women reported increased partner awareness and understanding of PMS, compared with 39% in the one-on-one therapy group and 19% in the wait-list group.
Men can be part of the solution
Following therapy sessions, women report they are less likely to “lose control” when expressing their feelings during times of PMS. They have increased awareness of the potential for relationship conflict; describe relationship tension as less problematic; and are more likely to talk to their partner about PMS and ask for support.
These improvements were evident in both therapy groups in our study. This suggests that even if women do therapy without their partner, it can still have a positive impact. The women will still learn self-care and coping strategies, develop a better understanding of PMS, and go home and tell their partner about the experiences in therapy.
However, the results of this study clearly indicate that the greatest positive impact is seen when a woman’s partner participates in the therapy sessions as well. So men may feel maligned by being “blamed” for PMS. But they can be part of the solution, rather than the cause of the problem.
Jane Ussher received funding from the Australian Research Council (ARC) for research on relationships and Premenstrual Stress (PMS), and the evaluation of couples therapy for PMS
Authors: Jane Ussher, Professor of Women's Health Psychology, Centre for Health Research, Western Sydney University