Sex Roles (2013) 68:132150 DOI 10.

1007/s11199-011-9977-5

ORIGINAL ARTICLE

PMS as a Gendered Illness Linked to the Construction and Relational Experience of Hetero-Femininity
Jane M. Ussher & Janette Perz

Published online: 12 April 2011 # Springer Science+Business Media, LLC 2011

Abstract The majority of research conducted to date on premenstrual distress has focused on heterosexual women. Drawing on research with lesbian and heterosexual selfdefined PMS (premenstrual syndrome) sufferers and their partners, we argue that this negates the role played by hetero-patriarchal constructions of both femininity and premenstrual change in the lived experience of premenstrual distress. Negative constructions of PMS and over-responsibility within the home, commonly found in heterosexual relationships, exacerbate distress and result in women being pathologised premenstrually. Conversely, support and understanding offered by partners, more common in lesbian relationships, reduces guilt and selfpathologisation, allowing women to engage in coping strategies premenstrually, such as taking time out to be alone, or engage self-care. These patterns of relational negotiation of womens premenstrual change can be contextualised within broader cultural representations of hetero-normativity, which provide the context for gendered roles and coping. Keywords Premenstrual syndrome (PMS) . Heterofemininity . Gendered role . Constructionist . Lesbian

Introduction Premenstrual Dysphoric Disorder (PMDD) is an archetypal example of normal female experience being positioned as
J. M. Ussher (*) : J. Perz Health Services and Outcomes Research Group, School of Psychology, University of Western Sydney, Locked Bag1797, Penrith South DC, Sydney, NSW 2751, Australia e-mail: j.ussher@uws.edu.au

mad, resulting in women taking up (or being given) a psychiatric diagnosis, with consequences for how their behaviour is subsequently judged. PMDD sits in the Diagnostic and Statistical Manual of the American Psychiatric Association, DSM-4 (American Psychiatric Association 2000), officially categorising premenstrual mood or behaviour change as pathology (see Cosgrove and Caplan 2004; Ussher 2006). At the time of writing, a mood disorders work group is accumulating evidence as to whether PMDD should be included in DSM-5 (Fawcett 2009, p.1). Manifested by a range of psychological and physical symptoms, including anxiety, tearfulness, irritability, anger, depression, aches and pains, or bloating, it is estimated that between 13% and 19% of women in North America, Western Europe, and Australia experience clinically significant symptoms that could meet a PMDD diagnosis each month (Halbreich et al. 2003), with around 75% meeting the diagnosis of Premenstrual Syndrome (PMS) the same conglomeration of symptoms, but experienced to a lesser degree (Steiner and Born 2000). This means that three quarters of women of reproductive age in these specific cultural contexts could be deemed mad once a month, as PMS is also widely accepted as a pathological condition. PMDD was included in the DSM-4 in the face of widespread feminist opposition, on the basis that there is no validity in PMDD as a distinct mental illness (Cosgrove and Caplan 2004). Many feminist critics have argued that premenstrual change is a normal part of womens experience, which is only positioned as PMDD or PMS because of negative cultural constructions in North America, Western Europe and Australia of the premenstrual phase of the cycle as a time of psychological disturbance and debilitation (e.g. Chrisler and Caplan 2002; Chrisler and Levy 1990; Rittenhouse 1991; Rodin 1992; Ussher 2006).

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In contrast, in cultures such as Hong Kong (Chang et al. 1995), China (Yu et al. 1996), or India (Chaturvedi and Chandra 1991; Hoerster et al. 2003), where menstruation is invariably positioned as a natural event, women report premenstrual water retention, pain, fatigue, and increased sensitivity to cold, but rarely report negative premenstrual moods, or PMS. This has led to the conclusion that culture shapes the physical and psychological changes that are deemed to be symptoms, meaning that PMS and PMDD are deemed culture bound syndromes (Chrisler and Caplan 2002). It has also been argued that the appearance of PMS and PMDD follows unprecedented changes in the status and roles of women in contexts such as North America, Western Europe and Australia (Johnson 1987; Martin 1987), with the cultural belief that women are erratic and unreliable premenstrually serving to legitimate attempts to restrict womens access to equal opportunities (Chrisler and Caplan 2002). Indeed, belief in the negative influence of premenstrual raging hormones has been used to prevent women being employed as pilots (Parlee 1973), physicians, and presidents (Figert 2005), which casts doubt on the reliability of all women occupying positions of responsibility. It is the regimes of knowledge (Rose 1996, p.11) within bio-psychiatry which position premenstrual change as pathology (Cosgrove 2000) and which provide the discursive context wherein women are diagnosed as a PMS sufferer (Ussher 2003b, p.136). This is reinforced by depictions within popular culture in North America, Western Europe and Australia of the reproductive body as abject and needing to be controlled, and of menstruation as site of madness, badness, and debilitation (Figert 2005; Laws 1990; Ussher 2006). The premise behind PMS and PMDD, that subjectivity, mood, and bodily experience should be consistent and constant, reflects a modernist position which conceptualises identity as rational and unitary, with deviation from the norm as sign of illness (Ussher 2003b). This stands in contrast with the acceptance of change as a normal part of daily existence, and of menstruation as a natural event, in contexts such as China, Hong-Kong and India. Equally, hegemonic constructions of idealised femininity in North American, Western European and Australian culture place particular emphasis on women being calm and in control, with deviations from this norm being positioned as pathology (Chrisler 2008; Ussher 2006). Research conducted in such contexts has demonstrated that when this is combined with negative constructions of menstruation, this leads to women engaging in practices of self-surveillance, monitoring moods and behaviour in relation to often unrealistic ideals (Ussher 2004b), and blaming themselves, or their bodies, for transgressions (Koeske and Koeske 1975). Women come to anticipate negative premenstrual change (Brooks

et al. 1977) and thus take up the subject position PMS sufferer , through a process of subjectification (Ussher 2003b, 2004a), reporting feeling out of control as a primary symptom (Chrisler 2008, p.1; Ussher and Perz 2010, p.440). This emphasis on the constructed nature of PMS and within PMDD within feminist social constructionism could, however, be read as negating agency, the existence of premenstrual distress, and other material aspects of womens lives that may be associated with self diagnosis as a PMS sufferer. This is problematic, as premenstrual change is not simply a discursive construction. There is convincing evidence that many women experience embodied and psychological change, accompanied by an increased sensitivity to emotions, or to external stress, during the premenstrual phase of the cycle (Sabin Farrell and Slade 1999; Ussher and Wilding 1992). There is also a growing body of research reporting an association between relationship strain and premenstrual symptomatology, suggesting that problems in relationships may be associated with many womens premenstrual distress (Coughlin 1990; Kuczmierczyk et al. 1992; Siegel 1986; Steege et al. 1988) and that relationship satisfaction can deteriorate premenstrually (Brown and Zimmer 1986; Clayton et al. 1999; Frank et al. 1993; Ryser and Feinauer 1992; Stout and Steege 1985). Direct expression of emotion has been found to be lower in relationships where women report PMS (Kuczmierczyk et al. 1992), which increases the likelihood of premenstrual change being experienced or viewed as problematic. Conversely, effective communication between couples has been associated with lower levels of premenstrual distress (Schwartz 2001; Smith-Martinez 1995; Welthagen 1995). Many women also report that PMS has an impact on their partners and their children (Halbreich et al. 2003; Robinson and Swindle 2000), and that the responsibilities of childrearing and domestic responsibilities are associated with premenstrual distress (Coughlin 1990; Ussher 2003a, 2004b; Ussher and Perz 2010). However, these findings are not at odds with a constructivist analysis if we acknowledge that PMS is both a constructed and a lived experience (see Cosgrove 2000), with the materiality of premenstrual change discursively constructed and experienced as PMS or PMDD in particular socio-cultural contexts, and premenstrual distress developing in the context of womens lives, in particular the context of their intimate relationships. The majority of research conducted to date on the construction and experience of premenstrual distress has focused on heterosexual women. This has either been by explicit intention, or by omission, as women who take part in research on PMS are generally not asked about their sexual orientation, or the gender of their intimate partner. In this article we argue that this omission acts to

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negate the role played by hetero-patriarchal constructions of both femininity and premenstrual change, and the experience of gendered roles in heterosexual relationships, in the construction and lived experience of premenstrual distress. PMS has previously been described as a gendered phenomenon (Figert 1995; Markens 1996), with frustration or anger associated with the self-renunciating role of wife and mother that is repressed for 3 weeks of the month through self-silencing being expressed premenstrually and then dismissed as PMS (Rodin 1992; Ussher and Perz 2010). However, this self-renunciation and self-silencing is not simply an enactment of a feminine gendered role, it is an enactment of hetero-femininity, where women are expected to put the needs of their male partner and children first, or risk relationship loss (Jack 1991). The use of belittling or demeaning constructions of PMS on the part of men has also been reported to be common in North America, Western Europe and Australia (Koch 2006; Laws 1983; Sveinsdottir et al. 2002), reinforcing a gendered power imbalance where menstruating women are positioned as dangerous or dysfunctional (Ussher 2006). In these cultural contexts, the responses of male partners to premenstrual change has been found to be particularly influential, with partner support being associated with lower levels of distress in women, and lack of support with higher levels of distress (Cortese and Brown 1989; Ussher 2003a; Ussher et al. 2007). Indeed, in couples where men demonstrated empathy, understanding and awareness, marital satisfaction was also higher, and womens coping with premenstrual distress more effective (Frank et al. 1993), which has lead to the conclusion that partners act as moderators of symptoms (Jones et al. 2000). In this article we will argue that women are more likely to receive this support and empathy if their intimate partner is a woman, resulting in more effective coping and lower premenstrual distress. In formulating this argument, we draw on the findings of our research which compared the experiences of heterosexual and lesbian women who self-defined as a PMS-sufferer, as well as a number of their partners, living in Australia (for reports of other aspects of this research and details of the methodology see MooneySomers et al. 2008; Perz and Ussher 2006, 2009a; Ussher 2011; Ussher and Perz 2008; Ussher et al. 2007). This program of mixed-method research examined subjective experiences of premenstrual change, and the negotiation of PMS in the context of relationships. Interviews were conducted with 60 women aged 2248 (average age 34) who presented as experiencing PMS, and 23 of their partners, 10 women and 13 men (average age 39). Most women were partnered (80%), with 66% currently in an intimate relationship with a man and 33% currently in a relationship with a woman. Half the women interviewed

reported having children (47%), with heterosexual women more likely to have children (60%) than lesbian women (25%). The majority of participants were AngloAustralian, in full-time education, part-time or full-time employment, and were resident in an urban location in Australias largest city. As is described in the original report of the data (all of the ensuing quotations are reported in Ussher 2011), all of the women interviewed described PMS in the same way, as being characterised by heightened premenstrual irritability, intolerance of others and oversensitivity. Women described themselves premenstrually using terms such as irritable, cranky, short-tempered, snappy, confrontational, having a short fuse, bitey, impatient, grumpy, stroppy, frustrated, stressed, annoyed or teary. The trigger for these emotions was always inter-subjective, either the actions of others, or the pressure of demands and responsibilities in relation to others. As Gillian (heterosexual) told us, people around me just cheese me off more (laugh) so whatever Ive felt about them, if they do something that I dont like, Ill react more. The heterosexual women interviewed reported significantly higher premenstrual distress and less effective coping, as well as higher depression and anxiety (Perz and Ussher 2009b). There was also a clear difference between constructions of PMS adopted in heterosexual and lesbian relationships, which had implications for womens lived experience of premenstrual change. Negative constructions of PMS on the part of a womans partner and absence of support were common in heterosexual relationships, which exacerbated distress and resulted in women being pathologised premenstrually. Conversely, support and normalisation of premenstrual change were found in all of the lesbian relationships, allowing women to engage in coping strategies premenstrually, such as taking time out to be alone, or engage self-care, and thus to avoid self-pathologisation as mad or bad premenstrually. These differences were tied to gendered roles and the constructions of femininity adhered to by women and their partners, as well as differences in communication and conflict resolution within heterosexual and lesbian relationships. We will begin by examining an overarching theme PMS as a relational experience , wherein women positioned PMS as irritation, intolerance and insensitivity in reaction to others, or as a response to relational demands. We then turn to a secondary theme that described partner reactions to premenstrual change, consisting of accounts of rejection and absence of support, associated with pathologisation and absence of relational communication; and accounts of support, understanding and conflict avoidance, associated with greater acceptance of premenstrual change.

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PMS as a Relational Experience All the Relational Pinches come up at That Time: Premenstrual Irritation with Partners As described in the original research (Ussher 2011), women were interviewed about how they would describe themselves when they had PMS, then asked to describe a typical experience. Womens partners were positioned as the major focus of irritation, across both heterosexual and lesbian relationships. Mistakes that would normally be tolerated were described as becoming a source of conflict, such as when Fiona (heterosexual) reacted with anger when her husband destroyed her clothes when doing the washing: you know, your husband put some washing through and, you know, destroyed your clothes so even when people are doing the right thing, its still the wrong thing at that time of the month. Other women talked of being less intolerant of their partners foibles premenstrually, such as when Elaine (heterosexual) described her husband as a bit of a hoarder and a collector, and 3 weeks of the month that does not bother me. However, when premenstrual, Elaine said it bothers me a lot and I want to throw everything out, to put everything into plastic bags and dump it on his desk [laughs]. Descriptions of irritation triggered by apparently minor incidents could also be interpreted as deeper feelings of hurt or frustration, as Melanie (heterosexual) told us in relation to her husband: Little things like if Im tired and hell have the TV up too loud or something and Ill ask him to turn it down and he wont listen, and I ask him again or something and then I lose it and I go on and on and on about it.I become really angry and Ill sort of almost go overboard and Ill say You dont care about me! And If you cared about me youd know! Bella (heterosexual) said of her husband The guy cant do or say anything right when she is premenstrual. She described herself as just highly sensitive and picky on him, giving as examples, I dont like the shirt youre wearing or Gee, you know, arent we ever going to have the money to do up this bloody house. Feeling uncared for, or feeling angry because planned renovations were not underway, were substantive issues not raised during the 3 weeks of the month when Melanie or Bella were not premenstrual. This was common in the accounts from women in heterosexual relationships. As Joyce (heterosexual) said, everything comes up at that time, yeah. Everything that might just be a slight pinch normally comes up at the PMT time and its intensified. Approximately half of the women in heterosexual relationships (but none of the lesbians) gave accounts of self-sacrifice and self-silencing in relation to their

partner for 3 weeks of the month, and then finding this more difficult, or speaking out, when they have PMS. Thus Caitlin (heterosexual) described herself as facilitating and accommodating for most of the month and then being a little bit more assertive touchy saying what I think, instead of being so nice when she was premenstrual. Nadia (heterosexual) wondered whether it was her true feelings that are coming out more at a time like that. These accounts of PMS could be characterised as a rupture in womens self-silencing, where the feminine ideal of caring compliance is replaced by anger and assertiveness (Perz and Ussher 2006; Ussher 2004b; Ussher and Perz 2010). High levels of self-silencing (as assessed by Jacks (1991) Silencing the Self Scale (STSS)) were reported by women who took part in this study, with significantly higher rates reported by heterosexual women (Ussher and Perz 2010), in particular the inhibition of thoughts and feelings to avoid relationship conflict and loss (silencing the self, Jack and Dill, 1992, p.98) and behaving in a compliant manner to live up to female role imperatives whilst feeling angry inside (the divided self, Jack and Dill, 1992, p.98). This self-silencing was significantly associated with depression and anxiety (Perz and Ussher 2006; Ussher and Perz 2010), which confirms previous reports of a relationship between self-silencing and depression in women (Duarte and Thompson 1999; Jack 1991, 1999). Jack has argued that women repress their anger and self-silence, in an attempt to maintain connection with others, under the mistaken belief that anger is inevitably destructive to relationships (Jack 2001). However, there is consistent evidence that the open expression of anger and disagreement within intimate couple relationships leads to greater relationship satisfaction in the long-run, whereas couples who avoid conflict are the least satisfied (Jack 1991). Indeed Gottman and Krokoff, in a detailed analysis of the role of communication and relationship satisfaction in heterosexual relationships conclude that wives should confront disagreement and not be overly compliant, fearful and sad but should express anger, because it is women who generally raise and manage marital disagreements (Gottman and Krokoff 1989, p.51). In an attempt to explain the expression of premenstrual anger within relationships, it has been argued this is the only time that some women express legitimate marital conflicts (Stout and Steege 1985), allowing themselves to be angry because as they can attribute anger to their hormones (McDaniel 1988), a phenomenon described as a redeployment of the reproductive body to meet womens emotional needs (Elson 2002). This implicitly suggests a calculated decision on the part of women to express anger and use PMS as an a vehicle for expressing anger (Hammond 1988). However, as has been previously reported in research conducted in North America (Cosgrove

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and Riddle 2003) and the U.K. (Ussher 2003a; Ussher et al. 2000), for all of the women we interviewed the expression of premenstrual irritation or anger was invariably followed by guilt and self-criticism, suggesting that self-positioning as a PMS sufferer is not serving to allow women to get away with bad behaviour. So Rachel (heterosexual) told us you feel horrible about it the next week it makes you feel sick and Stephanie (lesbian) said she feels really upset and angry with herself afterwards. This criticism extends beyond premenstrual behaviour to womens view of themselves, as Joyce (heterosexual) said my perception of me (premenstrually) is lousy because I feel pretty lousy about myself, why would anybody want to be on side with me? Each of these women was exhibiting what Casey (lesbian) described as her inner critic, the surveillant, judging, self which is most vigilant when women express anger or discontent within intimate relationships. This is because the expectation of care for others, and the emphasis on emotional maintenance, is invariably translated into an ethic of responsibility, where women are positioned (and position themselves) as bearing full responsibility for relationships (Jack 1991; O'Grady 2005). This can result in women experiencing guilt and over-concern for maintaining relationships, in particular those with partner and children, which leads to the feeling, in Grimshaws words, that not upsetting people must always be given priority (Grimshaw 1986, p.196). Indeed, for the majority of the women interviewed, both lesbian and heterosexual, it is the impact of their premenstrual moods on others that stands at the centre of this self-castigation, as Leah, who was in a heterosexual relationship, commented, I feel remorse, because its like, Oh, Im really sorry, because Ive visibly hurt somebodys feelings and I dont like to do that, thats not who I am as a mature loving person. As was evident in Leahs comments, above, many of the heterosexual women, (approximately one third; but only one tenth of the lesbian women), positioned PMS as something separate from themselves, as not me, or as the PMS self, as has also been reported in previous research conducted in North America and the U.K. (Cosgrove 2000; Lee and Sasser-Coen 1996; Ussher 2004b; Ussher et al. 2000): It wasnt me, the persons, fault, it was the hormonal stuff (Tracy, lesbian); Im another personality (Kylie, heterosexual); I want to pretend to myself that Im an intelligent person who knows whats happening in todays world and be well presented in everything. Then I have this thing for a few days when Im not necessarily that person (Susannah, heterosexual). In each of these instances women are adopting the cultural construction of the reproductive body as sign of the monstrous feminine (Ussher 2006, p.32), in this instance as cause of premenstrual irrational-

ity or anger. At the same time, they are escaping selfblame for expressing anger by disavowing or masking it (Jack 2001) through positioning anger as an out-of-control pathology, rather than accepted as a legitimate reaction or response to the circumstances of their lives, in particular their gendered roles. I Just Want You All to Stop Putting Demands on Me: Burden of Care and Responsibility Caring for others is central to feminine subjectivity, and as such, is a gendered process (Hollway 2006). These caring responsibilities, manifested through mothering and managing a home, were positioned as a source of premenstrual distress by the majority of interviewees who had dependent children, confirming previous North American research reports that women with high levels of premenstrual distress are more likely to have children (Cortese and Brown 1989). As Merrin (heterosexual) told us, the major thing that I probably notice is that I get most irritated about the burden of care type activities, which tend to weigh most heavily on me. She described this as the coming home and the doing the dinner, particularly after a day of paid work, and the home work, the cleaning up, the school notes, whatever else needs to be done. Sophie (lesbian) described being angry premenstrually because she wished her children would clean the room and take the rotten sandwiches from under the bed, rather than expecting her to do both. Kylie (heterosexual) described her anger being triggered by an argument between her younger children they were fighting over my sons Bob the Builder spoon and I just said right and I snapped it in half and said noones having it and that was it. I regretted it later on, of course. Other women described PMS as a time when they werent able to give emotionally to their children. Elaine (heterosexual) told us that her children want me to sit there and chat with them at night, but premenstrually I dont want to sit there and chat to them. Its almost fake. Im not there. Im not there so its better if I, I feel remove myself from it than not giving the hundred percent. All of the heterosexual women who expressed anger or irritation towards their children reported guilt and selfremorse for doing so. Thus Katie told us that she felt so bad, and Rachel that she felt really horrible, about being irritated with their children premenstrually, and Elaine felt terrible for not being calm and nurturing. However, rather than questioning why women become irritable or overwhelmed by their children once a month, perhaps we should acknowledge the fact that these same women repress their reactions to arguments, noise, mess, disobedience, lack of help in the home, whinging, tardiness in getting ready for school or doing homeworksome of the triggers reported in our interviewsfor the remaining 3 weeks.

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Indeed, when we look to the materiality of the mothering role, combined with the pre-dominant cultural representation of the mother as ever-bountiful, ever-giving, (and) self-sacrificing (Bassin et al. 1994, p.2), womens irritation is not surprising. Unrealistic expectations are placed upon mothers, that require the patience of a saint, in the words of one of our intervieweesyet premenstrual changes in vulnerability or tolerance make it difficult for her to retain a saintly demeanour. The contrast between the reality of the demands of the mothering role, and idealised cultural constructions of motherhood, has been recognised by many feminists to be a cause of depression for women (Berggren-Clive 1998; Mauthner 2010). Mauthner argues that postpartum depression arises out of the discrepancy (women) experience between the mother they want to be and the mother they feel they are (Mauthner 2010, p.470) and Rich has eloquently described the self-castigation that invariably follows maternal anger, drawing on her own experiences (Rich 1977). The same could be said of women who report PMS. Indeed, womens premenstrual inability to enact an ideal of perfect motherhood can also be a source of premenstrual distress, with irritation or anger towards children being positioned as a pathology. As Lillian (heterosexual) told us, you try to live up to this expectation that the world gives you that you're supposed to be super-mum and superwoman and if you don't live up to that expectation life's very tough .I expect perfection and when I dont get it I get cranky. Maybe thats a contributing factor. Demands from partners could also be experienced as problematic premenstrually. Melanie (heterosexual) said that she found things more difficult and demanding if we have to do something together, but if she did try and push myself to be there for him, saying to herself come on youve got to do this, the consequence was that I get quite sort of angry within myself and sometimes I get angry at him. Constructions of femininity and the structure of the family within hetero-patriarchy are centrally implicated in these accounts. In heterosexual relationships, women are expected to take the major responsibility for caring and domestic tasks, and invariably do so (Feeney 2002; Meleis and Lindgren 2002), particularly in the presence of children, where women do 70% of the unpaid caring and housework, even if they are working full-time (Western et al. 2007). It has been argued that parenthood crystallizes gendered divisions of labour (Feeney 2002, p. 413), with the fact that women mother described as the fundamental organizational feature of the sex-gender system (Chodorow 1978, p.41). Chodorow argued that it is basic to the sexual division of labor and generates a psychology and ideology of male dominance as well as an ideology about womens capacities and nature (Chodorow 1978, p.41). In a study of

150 U.S. women, Coughlin (1990) reported that women with a career and childrearing responsibilities reported the highest levels of premenstrual distress. These are women who typically have little time for themselves, undertaking a double-day of home responsibilities following a day of paid work, and who find themselves irritated or angry premenstrually. Many of our interviewees explicitly acknowledged these pressures. For example, as Maggie (heterosexual) said when I go on holidays and I have PMS, I actually feel a little bit better than when Im working all the time. This was because she had respite from her normal routine, where Ive got to come home and Ive got to take kids to sport, then Ive got to cook dinner, and stuff. Being on holiday didnt mean that Maggie did not experience premenstrual changes, but she had more space to cope because youre a bit more relaxeda bit more aware. This confirms previous North American findings that daily life stresses, or perception of such stresses, are a strong predictor of premenstrual distress (Deuster et al. 1999; Fontana and Pontari 1994). It was thus unsurprising to find that the most common means of coping with premenstrual change reported by interviewees was the desire to take time out from responsibilities, or from being with others. As Jill (heterosexual) said solitude is wonderful, being by yourself, doing your own thing, which allowed her to avoid all the demands being made of her, be it sort of work related, personal related, family, relations, whatever, and Helena (lesbian) told us I'm more likely to want to be on my own because I dont feel like having people in my face. This is reminiscent of the room of ones own that Virginia Woolf identified as so important to womens creativityas well as their sanity (Woolf 1957), described more recently as an essential health promoting resource for women (Forssen and Carlstedt 2006, p.175). All of our lesbian interviewees described taking time out for themselves premenstrually as an unquestioned right that they exercised without difficulty. As Nancy commented I can just say I actually dont give a fuck about anyone else but myself right now and Ill be self indulgent and precious and thats alright. Simone described having a bath in order to just have the time on my own, to remind me that everythings not going to fall apart, everythings okay and allow herself down time. In contrast, half of the heterosexual women interviewed described the desire for time out or solitude at home remaining as such, a desire. Anna is a typical example, 42 years old, married for 12 years, and with three children, aged 4, 8 and 10. She told us Its very hard to say, Im just taking time out for myself, or I need a slower pace, or, you know, I dont care if its your soccer presentation, Im not coming (laugh). This inability to take time for herself was partly a result of Anna positioning anything thats based around you personally as self-

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indulgent. As she told us, when you work full-time, and youve got three kids, you literally have to pretend youre going to the toilet to have some time to yourself. Whilst the materiality of family responsibilities was partly the issue here, as was the case with most of the heterosexual women we interviewed, Annas own self-policing of how she should behave was also a factor: You feel guilty just saying, Im taking the afternoon off. In fact, I cant remember the last time I did that. Because theres always a million things that youve got to do. And theres always things that you feel you should do, you know, rightly or wrongly. In a similar vein, many heterosexual women who did manage to take time out experienced guilt because of this. As Lillian commented, my husband will just say to me go off and do something for yourself but when I go and do that. I'll be sitting there thinking oh I've got this to do at home I've that to do at home this to do at home and like you just never relax and that's really bad. Anna and Lillian are engaging in self-surveillance (Foucault 1979), judging their own needs in relation to the discursive constructions of woman as responsible, selfrenunciating, and always able to offer unlimited care and attention to others (Ussher 2004b)the best mother or best worker , in Annas words. When women are in the premenstrual phase of the cycle, living up to these ideals can feel more difficult, as the woman feels vulnerable, or finds juggling multiple responsibilities more taxing (Sabin Farrell and Slade 1999), which can cause distress, which gets attributed to PMS. Whilst motherhood may have been central to many women s feelings of over-responsibility and selfjudgement premenstrually, it is not mothering per se that is the issue hereas women in lesbian relationships who were mothers did not report the same difficulties in negotiating sharing of the burden of care with their partner. For example, Sophia described how she could defer parental responsibilities to her partner premenstrually I can say, Look, Im not dealing with that right now. You can go and talk to [partner] about it. Similarly, June described her partner smoothing tensions with her children, a common focus of her premenstrual irritation. Ill just say, Im about to get my period, so Im tired, or Ive been cranky with the kids shes supportive about it. The key issue here is the response of Sophia and Junes partners, who were willing to take responsibility for the children, as has been reported in previous North American research on lesbian couples (Goldberg 2010a). This is where the difference between lesbian and heterosexual womens accounts was most evidentin the responses of partners to premenstrual change or distress (Ussher and Perz 2008; Ussher et al. 2007).

Partner Responses to Premenstrual Change and Distress He Says its All in My Head: Heterosexual Womens Accounts of Rejection and Lack of Support from Male Partners The majority of women interviewed wanted their partners to recognise that premenstrual change was real, to empathise, understand, and not to judge. Thus Jackie (heterosexual) said she wanted a bit more of an understanding that its real acceptance that its not just laziness. However, half of the heterosexual women told us that their partners did not accept the legitimacy of premenstrual change, as Jill commented, he just cant get his head around what PMS ishe says its all in my head which irritates me more than anything else. Similarly, Melanie said I think they think its just all in your head. They dont realise that its actually like for me. Communication about premenstrual change can facilitate partner understanding and empathy (Jones et al. 2000; MooneySomers et al. 2008). However, approximately one third of the heterosexual women interviewed reported that there was no discussion with their partner of premenstrual change, or PMS, or of the ways in which the woman would like to be supported at this time. For example, Celia never named herself as having PMS to her partner because I dont want to trivialise some of the issues that come up during this time by saying, Oh, its just that I had PMT. Even if women do attempt to explain premenstrual change or distress, many are pessimistic about mens ability to understand. As Judith commented, I have tried to explain it over the last couple of yearssince weve had children (laugh) but its like talking to a brick wall. So I dont think many men really comprehend what happens. Other heterosexual women did not attempt to seek support from their partners because they believed that their needs would not be met. Rachel described her feelings of hopelessness at the possibility of receiving support, indeed, of the possibility of even imagining support, from her husband. My expectations of him have all gone over the years. I dont have any expectations, I just do for myself, I look after myself because I cant get nothing from him, I havent been able to get anything from him so Ive lost all that, to even think what I might want from him. The recognition of premenstrual change is a doubleedged sword for heterosexual women, however, as partners can carry out the rhetorical accomplishment of splitting the PMS and non-PMS selfthe good and bad womanthrough adopting the negative constructions of PMS commonly reported by men (Koch 2006; Laws 1983; Sveinsdottir et al. 2002). Approximately one third of the heterosexual women interviewed described their male partners as behaving in a rejecting manner premenstrually

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not only of the womans moods, but her very self, as Gillian told us: I had a particularly bad PMT experience, and my husband, like, he wasnt my husband then, he actually got a bit frightened, he thought, Oh gosh, I dont want to marry that person, and he called our relationship off. And its funny that that happened because the PMS has been an issue throughout the whole marriage. Joan said that her male partner had got to the stage where he really wanted me to go live in another house for 2 weeks of the month, which is a bit detrimental to a marriage. She said that she felt so bad about this that it was slit your wrists time. This confirms previous North American reports that avoidance or rejection on the part of male partners exacerbates womens premenstrual distress (Cortese and Brown 1989). Blaming PMS could also mean that womens emotions are dismissed premenstrually, as Katie (heterosexual) told us men, you know they think oh, shes got her periods, so it doesnt mean anything what she says. Merrin (heterosexual) said that if Im making a complaint or Im asking for something (premenstrually), he hears that that as irritation, rather than a legitimate request. Thus rather than attending to what Im saying her partner would say oh it must be that time of the month or youre coming into your period and so, he would be more dismissive of what Merrin is asking for at that particular time. The labelling of womens emotions, requests or criticisms as PMS can thus serve to negate her needs or concerns, which has implications for power (in)balances in the relationship, and can exacerbate premenstrual distress (McDaniel 1988; Ussher 2003a). Other heterosexual women (approximately one sixth), gave accounts of their male partners overtly positioning them as mad premenstrually. Thus Elaine said, 1 day, probably 3 months ago or so he came in and said who am I talking to today? Is it schizo Elaine, nice Elaine, sexy Elaine, or cranky Elaine? The impact of this was to increase Elaines premenstrual distress. I was so premenstrual that day, and I thought thats so unnecessary. Im not that bad. In a similar vein, Joanne told us that her male partner saying I dont know who Im talking to when she was premenstrual made her feel like a paranoid schizophrenic. Annas male partner was more overt in his view that she needed psychiatric help premenstrually, saying: Its your shit, you go deal with it on your own,cause I have fucking had enough and I cant deal with this shit. get a therapist to sort it fucking out, I dont care what it is. On the website PMSBuddy, where men share stories about their partner s PMS, (as well as being warned by a monthly email of when PMS will occur), we see similar examples of women being positioned as mad or bad

premenstrually (Ussher 2011, pp.175176). Yosho asked for advice from other men with the following post: My girl goes NUTS when she's about to have her period nothing I do is right and everything I do sets her off. Any suggestions??? Please help! (Yosho 2009). The responses were: A fucking pussy. tell her to stop being a bitch. you dont like it. go sleep at a friends house for the week. guarantee youll only have to do this once And dump her for the uglyist chick you can find, and let everyone know that you would rather hump a cow, than live with her one more second. In a similar vein, Rui posted the following: My best friend always said that PMS is bad but the most truthful thing he has ever stated is: "you should never trust an animal that bleeds for 5 days and does not die" (Rui 2009). These men are not aberrations. They are reproducing negative cultural discourses about the monstrous femininethe premenstrual mad/bad woman who must be contained, controlled or rejected (Ussher 2006). These discursive representations are not simply misogynistic fantasy. They are part of the intersubjective context wherein women construct and experience premenstrual change. It has been argued that the intersubjective context plays a constitutive role in all forms of psychopathology (Stolorow and Atwood 1992, p.3), because, in the words of Steven Mitchell, the mind is composed of relational configurations(and) experience is understood as constructed through interaction (Mitchell 1988, pp.34). Whilst we may question the status of PMS as psycho-pathology, it is clear that women who are told that they are mad or bad premenstrually are more likely to adopt this subject position, and see themselves and their emotions in such a manner. Womens Self-Pathologisation The heterosexual women who described their male partners as critical, lacking understanding or unsupportive, were more likely to self-pathologise, describing themselves as crazy, (Susannah, Joan and Stephanie), out of control (Melanie), a nut case, absolute psycho or Schizo (Sandra), mad (Stephanie), out of my mind, Ive lost the plot, or a complete loony (Joanne), or off my tree (Caroline), when they were premenstrual. Some heterosexual women also overtly positioned the premenstrual self as monstrous, describing themselves as scary (Susannah), a bitch (Nadia), a demon (Bella), or like Jekyll and Hyde (Jackie), as has previously been reported in research conducted with women in the U.K. (Ussher et al. 2000) and North America (Cosgrove and Riddle 2003). For a number of the heterosexual interviewees (approximately one tenth), this was also associated with feeling unequal or inadequate in the relationship. Thus Susannah told us that her partner

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would say most of the time I really, really love you but when you have these days youre a very difficult girl, which made her feel like a bit of a child and kind of patronised. Joanne said, I felt horrible, and I felt angry because I was apologising for something that I really couldnt do that much about .... and it made me feel inadequateI felt like a really bad person, like Id committed a crime (laugh) that I needed to say sorry for. Benjamin (1999) argued that the absence of recognition can lead to distress and the experience of the self as not existing, as is evidenced by womens responses to their partner s withdrawal or rejection premenstrually. Benjamin argues thatwhen the other does not survive and aggression is not dissipated it becomes almost exclusively intrapsychic (Benjamin 1999, p.192). This provides further explanation for self-pathologisation of women whose partners do not recognise their premenstrual vulnerability or distress, and who cant hold this distress through offering support. The woman turns inward for an explanation of her experience of negative premenstrual mood, be it anger or anxiety, and blames her body for her premenstrual state, rather than looking to her social or relational context. This can serve to protect her view of her relationship as good, in the same way that a biomedical model which positions PMS as embodied illness allows women to position premenstrual negative affect as not me, and thus avoid an assault on the self (Ussher 2003b). However, it also ensures that relational issues, and other discursive or material factors which may precipitate womens distress, are not addressed. Jack (1991) described similar patterns of relating in North American couples where the woman was diagnosed with depression, where the husband would describe the woman as a bother, and reject her need for physical or emotional support. She described this as the essence of inequality: one person governs the relationship and the other persons feelings are ignored (Jack 1991, p.47). In the case of many Australian heterosexual women reporting PMS, approximately two thirds of our interviewees, inequality was also marked by the absence of practical support, particularly for those with dependent children, where receiving help in the home premenstrually could alleviate their care giving burden and allow them to take time out to engage in self-care. Thus Jill told us even if he said Is there anything I can do? as simple as that, which to me is not much to ask do you want me to cook dinner shed be happy. Olivia said that what she wanted was help with the house-work somehow manoeuvring life around so that I dont have to do a thing, or that at least I feel like hes contributing, and the kids are contributing. Thus, whilst many heterosexual women, particularly those with children, positioned anger or irritation about burden of care as a premenstrualsymptom, we could reframe it as a legitimate

response to lack of partner support in the home. This is reminiscent of a cartoon described by Figert, of an obviously worn out woman holding a screaming child and telling her husband (sitting in the lounge chair and reading the paper) that this is stress, not PMS (2005, p.110). Figert concludes that we need a return to a menstrual hutand its monthly release from traditional womens roles of cooking, cleaning and family dutiesa release from responsibility that remains an impossible fantasy for the majority of heterosexual women. This raises the question: how do these heterosexual women tolerate the disparity between their needs and the reality of partner support? Based on a study of British womens intimate relationships, Coward (1993) has argued that women have a tendency to idealise their male partners, denying the reality of failures within the relationship, as a way of defending themselves against disappointment and potential relationship breakdown. This was evident in accounts of many of the Australian heterosexual women we interviewed, one quarter of the sample, where descriptions of their partners lack of support were juxtaposed with idealising statements such as: hes a lovely guy, dont get me wrong (Jill); he is good to me I would be hard pressed to find another man like him (Lillian); hes fantastic, hes a wonderful husband and I love him to death (Elaine). These rhetorical strategies act to further reinforce the positioning of the premenstrual woman as problematic and her emotions as unreasonable, a vicious cycle that acts to pathologise women. At the same time, premenstrual change was not without consequences for womens partners, confirming previous reports that the greatest impact of PMS is on social and family functioning (Halbreich et al. 2003; Robinson and Swindle 2000). Many of the men we interviewed gave accounts of experiencing distress themselves, with Kylies partner Craig telling us sometimes I do think Geez I hate this life, Chris saying that Lillians mood swings just puts the whole family on edge, and Sarahs partner Amir commenting that sometimes its hard for me because if its directed at me, Im not really sure why she has to be so angry. Lesbian partners also gave accounts of premenstrual mood or behaviour change exacting consequences on the relationship, or on themselves. As Helen told us, when talking of her partner Pip, if she gets cranky about something and at me, its not pleasant. Or as Casey said about her partner I find it very hard to be around her when shes in that zone. And I have to work very hard at not reacting to it. So actually having a bit of separateness is actually a healthy thing for both of us. There was also acknowledgement that having two women with PMS could be difficult. As Ellen said being with a woman during the time just makes it entirely exhausting and difficult, and far more complex than I ever thought it would bewhen one is withdrawing, the other ones wanting more of an outward

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impact or somethingso its two opposites coming together which causes a lot of discomfort. All of these accounts support previous North American and British research which suggests that partners play a significant role in the construction and lived experience of premenstrual distress. Negative reactions to premenstrual change on the part of a womans partner can exacerbate distress, and result in the women being pathologised premenstrually (Cortese and Brown 1989; Perz and Ussher 2009a; Sveinsdottir et al. 2002; Ussher 2003a). The materiality of lack of support, legitimated by cultural constructions of hetero-femininity, can make it difficult for women to absolve themselves of responsibilities, and can increase anger and irritation at inequalities in the relationship (Jack 2001). And womens premenstrual anger, as well as their partner s inability (or unwillingness) to discuss and understand premenstrual change can impact on the relationship itself, which can also increase womens distress (as well as that of her partner) (Brown and Zimmer 1986; Frank et al. 1993; Schwartz 2001). Conversely, partner support and empathy can reduce guilt and selfblame associated with premenstrual change, allowing women to engage in coping strategies premenstrually, such as taking time out to be alone, or engage self-care, as outlined below. A Dance of Moving In and Out: Relational Support Alleviates Premenstrual Distress Understanding and Acceptance All of the lesbian women interviewed, but only one third of the heterosexual women, gave accounts of supportive partners, and emphasised the positive influence that this had on their premenstrual distress. Understanding and acceptance of premenstrual change, was a key feature of this support, as Shea (lesbian) commented: In terms of the responseits just really understanding and I guess supportive Like, its not that big an issue that it becomes an issueits just like, This is how Im feeling. Thats okay. Similarly, Linda told us, Im extremely lucky that Helen [her partner] is an extremely understanding person and so I get what I need at that time. In this vein, making an attribution of mood or behaviour change to PMS was experienced as a positive thing, as Pip (lesbian) commented its almost as though its a relief theres a reason for it. Sarah (heterosexual) described how her partner s recognition of PMS made him feel more relieved, because he thinks that maybe it wasnt that bad, or that there was something else on top. She said that he worries quite a lot about you know, like how happy I am or how unhappy I am and is glad to know Im not there forever, I guess, Im not in that stage of unhappiness forever.

In these instances PMS was invariably named, but in a non-judgemental manner. This recognition functioned to protect the relationship, because irritability and moodiness could be positioned as not something personal, or something which would have a major impact upon the relationship. This is analogous to findings from other areas of health research, such as cancer, where avoidance of communication about the illness within couples is associated with less effective coping, higher levels of distress, and lower marital satisfaction (Badr et al. 2008; Manne et al. 2006; Zunkel 2002). In the context of premenstrual distress, partner recognition also meant that women did not enter into a spiral of increasing distress in response to partner rejection or pathologisation, and were more likely to engage in effective coping, such as taking time for self-care or avoidance of conflict. Avoidance of Conflict Women who portrayed their relationship context as supportive also described their partner reacting to premenstrual expressions of anger or irritation with a calm, non-reactive response, so that discussions would not escalate into an argument. Joyce (heterosexual) described herself as very fortunate to have a husband whos prepared to deal with it and has learnt the subtleties. She described their interactions premenstrually as almost like a dance of moving in and out where her husband would think okay, give her some space now, be tender now, and well talk at a better time on this issue. This meant that Joyce could express issues of concern, and they would work on it in a calmer time. Similarly, Bec (lesbian) described her partner as a very laid back person who reacted to Becs premenstrual anger by saying why are you bringing this up like this and then saying youre PMT-ing arent you? Maybe we should talk about this later. A number of the partners interviewed (one third of the men, but three quarters of the women) also gave accounts of being aware of not aggravating their premenstrual partner, avoiding contentious issues, or not taking things personally at this time. Hayley, who was Ashleys female partner told us that around period time I will usually be extremely flexible and dont do things that I know are going to annoy her. Sheridans partner Elspeth adopted a similar strategy, saying If you pick it early enough thats when you, sort of, quickly, say, deflect the situation, diffuse the situation or say, All right, why dont you have a bath? Sean, who was Merrins male partner, said I just basically keep, fly low then. Dont try and aggravate the situation. A number of the men interviewed also gave accounts of learning to give the woman space through removing themselves when she was premenstrual, in order to avoid conflict. Thus, Bill, Olivias partner, said Theres

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a time of the month where were not going to get along. And its best for me to just hide in the garage or the shed. Likewise, Gary, Bellas partner, described himself as trying to tiptoe around her a bit give her a bit of space, saying Its a good time to be out doing a bit of gardening. Whilst this could be experienced by a woman as withdrawal, and could thus be detrimental to the relationship (Gottman and Krokoff 1989), many partners were motivated by awareness of the womans need for time for herself premenstrually, and actively facilitated this, as is evidenced by Lucians account of his partner Carmen: She likes comfort food, chocolates, yes, so um, cherry ripe, shell sit down have a coffee, or Ill take Elizabeth [their daughter] out for awhile. But I go to bed early and she has time after I go to bed, to herself, she likes to do her craft and shell get very adamant and say I dont care about the dishes tonight, Im going to do craft you say okay (laughs) it isnt hard for me. Denise described her partner Stephanie as saying I just want to be on my own, which Denise thought was fine, encouraging her to go to her own room or potter in the garden to anything that helps her resolve it, thats my preference. Similarly, Jocelyn described her partner Deborahs support: Ive got a really big garden that I maintain and I like to take myself out there I do like to be a little more alone around that time.shes very understanding, maybe does a little bit of housework on those days, ah, doesnt expect too much from me at those times. This allowed women to engage in self-care premenstrually, inhabiting the metaphorical room of ones own which is recognised as an important health resource for women (Forssen and Carlstedt 2006), as noted above. Reassurance and Support Other partners provided physical reassurance, exemplified by Alices account of her husband having just walked over and hugged me when she was being angry with him premenstrually, which allowed her to realise that it was unreasonable anger (that) had come out of nowhere. Maggie said that when she cried premenstrually her husband usually comes and gives me a cuddle, and says oh, dont worry about it, its that time of the month. Her partner Dave told us I just try and be as nice as possible. You know, try and offer a bit of physical comfort by trying to give her a hug or a cuddle and just to tell her that I love her and Look, its not the be-all and end-all. No point ruining everything over one comment I've made. Sheridan said her female partner would go off and make me a tea, or remember little things that are going to comfort me, practical things. Casey was typical of the lesbian women,

in describing mutual support and reassurance being offered premenstrually: When Im in those zones, if its the weekend, Im more than happy to stay at home and just with the DVD and put music on and just kind of be in my own bubble. And be in the zone. I cant affect anyone. [partner] can be very, um, accommodating around, you know, baths and you know, going out and getting good food, and putting DVDs on, and just kind of really that real pampering stuff which, um, makes a huge difference. And I can do the same for her. All of the lesbian women described being able to absolve themselves of responsibility for household tasks premenstrually, if they needed to, with the support of their partner. For example, Jocelyn said that her partner was very understanding, and that shed do the housework on those days (and) doesnt expect too much from me. Bec described worrying about household finances when she was premenstrual, and her female partner saying dont worry about it, Ill fix it up and well work it out later. In contrast, only a small proportion of the heterosexual women, approximately one sixth, who asked for practical support in the home received it if they asked for it, or reported that they were supported by their partners in not taking on their usual responsibilities, as Jackie told us, Hes accepting. Like, he doesnt say Oh, the house is a messIf hes upset about it, hell help clean it up. He wont be happy about it. But it wont be a big issueWhen I havent cooked the dinner, I havent washed uphe helps out as well. Its something we do together. Only one of the men we interviewed, Gary, Bellas partner, talked of helping around the house because the demands seem to build up, (so) that she probably cant cope as much, and puts more onto me. Others, such as Sean, Merrins husband, showed an awareness of their partner s desire for practical support, but didnt give it without being asked, as is evidenced by the comment I think probably I should work a bit harder perhaps when I think about it really, when I know that shes like that [giggles] perhaps do something like cook the dinner . The majority of women with supportive partners told us that their partner had learnt to cope with premenstrual changes over time, in ways that helped to alleviate premenstrual distress. As Maggie said, my husbands pretty good now. At first, when we got married it was pretty dreadful, but I usually say now that these 2 weeks are coming up before my period and so now things are a lot better and Bella said Ive had to educate Gary [her partner]. When I push you away you dont have to leave me, you know, that can actually hurt me more. I need you

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to sit down and hold me. Communication was central to the development of understanding on the part of partners, confirming North American and South African research reports that effective couple communication is associated with lower levels of premenstrual distress (Schwartz 2001; Smith-Martinez 1995; Welthagen 1995). As Jocelyn (lesbian) commented weve discussed this over a long time and she doesnt get involved in any of the impatience and it actually works. Lesbian interviewees also positioned their partners as supportive because of being a woman, as Linda said because Lorna [partner] is female, I suppose that makes her a little bit more understanding, and Ashley told us having a female partner, I think, just makes all the difference. because I think they understand. Women Normalising Premenstrual Change Confirming previous North American research on premenstrual change in women with positive attitudes to menstruation (Lee 2002), none of the Australian women who reported having supportive partners (all of the lesbian and one third of the heterosexual interviewees) adopted a stance of self-pathologisation, or used derogatory terms to describe themselves premenstrually, such as mad, loony-tune, bitch, monstrous-mummy or Jekyll and Hyde , terms which are commonly found in North American and British womens accounts of PMS (Cosgrove and Riddle 2003; Ussher 2002), as well as in unsupportive relationship contexts in the present study, as noted above. There was also less evidence of guilt and self-blame in these interviewee accounts, and very few accounts of feeling out of control premenstrually, as premenstrual change was accepted as a normal part of a womans experience, even if it was not necessarily a pleasant experience for a woman or her partner. As one of the women, Helena (lesbian), told us I would just go with it and go, Oh look, in 2 days (laugh) this will be fine (laugh). Similarly, Amy (heterosexual) said I just keep plodding along and Janice (heterosexual) said you just hang on for a couple of days. This does not mean that premenstrual mood change is necessarily embraced, but it is not positioned as an illness or sign of madness, rather, as something that a woman accepts as part of being a woman. Having a supportive partner was not a necessary requisite for women adopting this position in relation to premenstrual change, however all those who reported a supportive relationship context did so, with some women (one tenth) embracing premenstrual change, experiencing it as a positive thing. For example, Sophia (lesbian) told us, sometimes you can really connect with some deeper energies that are going on, which can be really exciting and invigorating. Mm. So sometimes you can really channel it.

Even the difficult feelings that emerge premenstrually can have positive consequences, allowing women to tune into their premenstrual mood, paying attention to the issues that make them sad, anxious or angry. Nina (heterosexual) talked of getting sadder at that time of the month, with the grief associated with her mother s recent death coming to the fore, which helps her to deal with things moreit helps me put things into perspective. If a particular feeling keeps emerging each month, it could mean that the issue means something to the woman, as Olivia (heterosexual) decided, after much reflection on her cyclical changes, Ive been repressing things for years just saying, Oh, its just PMS. Thats bullshit. You need to look at it and say, Well, if I keep feeling this way, about this particular issue, at this time of the month then, its got to mean something. Thus, rather than being PMS, a problem tied to the body, Olivias symptoms could be conceptualised as an emergence of emotions that are repressed during the rest of the month, either because the feelings are too difficult to face, or because she does not want to rock the boat in her relationship by being angry. Attending to these feelings allows Olivia to address them, as well as any underlying issues that are causing her distress. These accounts confirm previous North American and Indian research reports that a substantial number of women report positive aspects of premenstrual change, if they are given the opportunity to do so (Alagna and Hamilton 1986; Chaturvedi and Chandra 1990; Lee 2002; Stewart 1989). Premenstrual change is thus not inevitably constructed or experienced as a negative, pathological conditionit can be normalised, or even embraced, transforming unwantedness into wantedness (Lee 2002, p.30).

Discussion This analysis clearly documents the complexity of the construction and lived experience of PMSa disorder that is said to affect 75% of women in North America, Western Europe and Australia (Halbreich et al. 2003; Steiner and Born 2000). Rather than being a pathology that occurs within the woman, meriting psychiatric diagnosis and bio-medical management, PMS can be conceptualised as a gendered experience located in medical and cultural discourse about premenstrual change and (hetero) femininity; the context of womens lives; and womens negotiation of somatic and psychological change as symptoms of a disorder: a material-discursive-intrapsychic phenomenon (Ussher 2000, 2011). Cultural representations of PMS are similar in Australia to those found in North America and Western Europe: premenstrual change is positioned as a bio-medical pathology, and the premenstrual

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woman is constructed as potentially mad, bad or dangerous (Ussher 2006). Representations of menstruation are also similar in Australia (Finch 1993; Raftos et al. 1998), North America (Johnston-Robledo et al. 2007; Lee and Sasser-Coen 1996), and Western Europe (Laws 1990; Treneman 1988): positioned as a matter of hygiene, or as something that is shameful and expected to be invisible. The wider availability of positive cultural representations of menstruation, and the acceptance and non-pathologisation of premenstrual change, is a plausible explanation for the finding that PMS is rarely reported in contexts such as Hong Kong, China, or India (Chang et al. 1995; Chaturvedi and Chandra 1991; Hoerster et al. 2003). However, our research suggests that acceptance and non-pathologization can also operate in a cultural context where negative attitudes to menstruation and premenstrual change are more ubiquitous (see Chrisler and Caplan 2002; Ussher 2006), strongly influenced by the construction of PMS adhered to by a woman and her partner, as well as by relationship dynamics associated with the negotiation of premenstrual experiences. Negative constructions of PMS on the part of a womans partner can exacerbate distress, and result in the women being positioned as inadequate or mad premenstrually (Cortese and Brown 1989; Perz and Ussher 2009a; Sveinsdottir et al. 2002; Ussher and Perz 2008; Ussher et al. 2007). Absence of support can also make it difficult for women to absolve themselves of responsibilities, and can increase anger and irritation at inequalities in the relationship, that comes to be positioned as PMS because of negative cultural constructions of the reproductive body. However, the converse is also truesupport and understanding offered by partners can reduce guilt and self-blame in women who experience premenstrual change, as well as acting to facilitate self-care (Perz and Ussher 2006; Ussher et al. 2007). This confirms the findings of previous North American quantitative research that has examined the association between relationship tension and PMS, where women who report premenstrual symptoms also report higher levels of relationship dissatisfaction or difficulties (Coughlin 1990; Frank et al. 1993; Ryser and Feinauer 1992; Winter et al. 1991; Wright 1986), leading to the suggestion that PMS is not an individual problem, but a relational issue (Ryser and Feinauer 1992), and that family or couples therapy may be an appropriate form of intervention (Frank 1995; Jones et al. 2000). All of this previous PMS research has focused on heterosexual couples, obscuring the gendered nature of the negotiation of premenstrual change within relationships. In our research, premenstrual relationship conflict and absence of support was more commonly reported by heterosexual women, in comparison to lesbians, supporting our argument that constructions of femininity within hetero-patriarchy, and the experience of gendered roles in heterosexual

relationships, are centrally implicated in the construction and lived experience of premenstrual distress. In the Australian lesbian couples interviewed, there were no accounts of relationship conflict or tension escalating premenstrually because of a womans partner rejecting or dismissing her, or her partner actively engaging in conflict, a theme found in previous North American and British research on heterosexual womens experiences of PMS (Cortese and Brown 1989; Ussher 2003a). This is not to suggest that lesbian partners are passive in the face of premenstrual irritation or intemperance, but rather, that they are more likely to adopt a positive and conciliatory mode of communication which serves to diffuse conflict and offer support. That a number of women partners had boundaries associated with unacceptable behaviour also suggested that dealing with premenstrual distress is the subject of a complex negotiation between two women, which requires emotion work (Duncombe and Marsden 1998, p.211) from both parties, in managing their own feeling states and those of their partner. In all of the women interviewed this emotion work was not described as a burden, but as part of being in a committed relationship, in contrast to many heterosexual womens accounts, as well as PMSBuddy posts, where premenstrual emotions are described as too much work by their male partners (Ussher et al. 2007). Whilst only a small proportion of heterosexual women gave accounts of supportive partners, these positive accounts contradict the belief held by many of our women that men cant understand. It is clearly possible for men to be supportive and respectful towards their partners premenstrually, which can facilitate a reduction in distress, and avoidance of the escalation of conflict, or the spiral of guilt and self blame which many women engage in. Communication about premenstrual change between couples appears to be central to mens recognition and understanding (Mooney-Somers et al. 2008; Schwartz 2001; Welthagen 1995), which can be assisted by mens involvement in monitoring of their partner s premenstrual change (Frank et al. 1993; Jones et al. 2000). This suggests that the involvement of male partners in therapeutic interventions for premenstrual distress may be beneficial (Jones et al. 2000), acting to inform men about the nature and course of premenstrual change, as well as engaging their involvement in strategies of support for their partner. The differences we observed between lesbian and heterosexual relationships can be explained in a number of ways. Lee has argued that menstruation helps to produce the body and the woman as cultural entities (Lee 1994, p.343), with menarche representing entrance into womanhood, through a process of (hetero)sexualisation (p.343) of the female body. We would extend this analysis to argue that the relational negotiation of premenstrual change reflects the ways in which heterosexual

Sex Roles (2013) 68:132150

145

women are inserted, and insert themselves, into the hierarchical ordering of the sexual (Lee 1994, p.344), through the positioning of premenstrual change as pathology, and the absence of support from male partners when women are experiencing premenstrual distress. This is part of the construction and experience of gender within heteropatriarchy, following the assumption that gender, and the gendering of power, both constructs and affects couple relationships (Laird 2000). Supporting this view, previous North American research has reported that premenstrual distress is associated with femininity, with more feminine women reporting higher levels of distress (Cosgrove and Riddle 2003). Conversely, lesbians have been reported to be less likely to conform to the traditional feminine gender role (see Bailey and Zucker 1995; Smith and Stillman 2002), or will knowingly enact a feminine (or femme) role as gendered performance, in order to challenge traditional gendered and heterosexual boundaries (Hiestand and Levitt 2005), or as a reflection of desire (Goldberg 2010b). This demonstrates that gender is not something that we are, but something that we do (Butler 1990), a performance that is invariably negotiated differently outside of the constraints of the heterosexual matrix, as different role expectations, opportunities and constraints apply, reflecting and reinforcing balances (and imbalances) in status and power (Goldberg 2010b, p.32). For example, greater egalitarianism, manifested as highly flexible decision making and household arrangements (Green et al. 1996, p.197), and innovation and adaptability in dealing with both relational needs and domestic tasks (Connolly 2005, p.270), has been observed in North American research on lesbian relationships. As a result, lesbian couples are more likely to share household responsibilities (Balsam et al. 2008; Matthews et al. 2003; Schneider 1986) and to report an egalitarian power balance within the relationship (Eldridge and Gilbert 1990), when compared to heterosexual couples. This was reflected in the absence of ideals of (hetero)femininity being used in a self-policing manner, and the egalitarian relationship structure described by the Australian lesbian couples in our research, which meant that there were few accounts of lesbians feeling over-burdened by emotional or practical responsibilities in the home premenstrually, and becoming angry or irritable as a result. There was also an absence of self-castigation for wanting to be alone, or for needing support, as lesbian interviewees were able to resist the self-policing inherent in the (hetero)feminine caring role (O'Grady 2005). This gendered non-adherence has previously been linked to the greater instrumentality, combined with expressiveness, that has been found in North American research on lesbian, in comparison to heterosexual,

relationships (Kurdek 1987), with lesbian couples reported to demonstrate a greater capacity for mutual empathy, empowerment and relational authenticity (Mencher 1990). It has been suggested that similarity in gender role may benefiting women by allowing them to empathize with each other (Metz et al. 1994), a view which is supported by the accounts of premenstrual empathy on the part of Australian lesbian interviewees in the current study. Lesbian couples have also been reported to experience with open exploration of feelings, empathic attunement to non-verbals, negotiation, and the conscious avoidance of contempt (Connolly and Sicola 2006), working more harmoniously (Roisman et al. 2008), being more likely using a positive tone (Gottman et al. 2003), and making more effort (Metz et al. 1994), when resolving difficulty or conflict. In this vein, Metz et al. (1994) have argued that if women are generally more likely to be cautious, scrutinize themselves, or worry more about a male partner s reactions, or if they have concerns about being substantially understood by a man, then women may be more self-assured when addressing conflict with another woman (p.304). This may be of particular relevance in coping with distress associated with the reproductive body, where women expect a female partner to be more able to understand their premenstrual experience than a male partner, because of the assumption of corporeal similarity, as was reflected in the accounts in our research on PMS. Raising matters of disagreement could also be experienced as less threatening to the relationship, providing explanation for the lower level of self-silencing in lesbian women in our research (Ussher and Perz 2010), and the greater acceptance of premenstrual emotions on the part of lesbian partners. This can have significant implications for womens psychological wellbeing. In our research, women in lesbian relationships reported lower levels of depression and anxiety and higher levels of premenstrual coping than women in heterosexual relationships (Perz and Ussher 2009b). These findings are not unique to PMS. In other areas of womens reproductive health, such as peri-natal depression (Ross 2005) and menopause (Winterich 2003), women in lesbian relationships also report lower levels of distress. At the same time, there is a growing body of North American research reporting that lesbian relationships are experienced as more satisfying than heterosexual relationships (Balsam et al. 2008; Green et al. 1996; Kurdek 2003; Metz et al. 1994), with predictors of this satisfaction being greater emotional companionship (Metz et al. 1994), greater liking, trust and equality (Kurdek 2003), cohesion and flexibility (Green et al. 1996), as well as intimacy, equity and autonomy (Schreurs and Buunk 1996). As there is considerable evidence that relationship dissatisfaction and discord are primary predictors of womens mental health

146

Sex Roles (2013) 68:132150 Acknowledgements This study was funded by a Discovery grant from the Australian Research Council, DP0558831 An examination of the development, experience and construction of premenstrual symptoms. Thanks are offered to Emily May, Margaret Boulos, Julie Mooney-Somers, Lee Shepard, Helen Vidler and Michelle RhyderObid for research support and assistance.

(Anderson et al. 1999), with women in discordant relationships found to be at high risk of mental health problems (Brown et al. 1986), including premenstrual distress (Coughlin 1990; Frank et al. 1993; Ryser and Feinauer 1992; Winter et al. 1991; Wright 1986), this provides further explanation for the lesbian-heterosexual differences found in our research. The absence of children in the majority of lesbian relationships may be put forward as an explanation for differences between heterosexual and lesbian couples, as the burden of family responsibility falls disproportionately on heterosexual women after having children (Metz et al. 1994). However, accounts of unsupportive relationships, over-responsibility and self-silencing associated with PMS, have been reported by heterosexual women with and without children in previous North American and British Research (Cosgrove and Riddle 2003; Ussher 2003a, 2004b), suggesting presence of children is not sufficient explanation for premenstrual distress. Equally, North American researchers have reported that lesbian couples are less likely to adopt gendered divisions of labour even if they do have children (Goldberg 2010a), and have been reported to rate relationship satisfaction very highly compared to child-free lesbian couples (Koepke et al. 1992). Lesbians who are non-birth mothers have been found to contribute equally to child-care tasks, with the couple actively working to minimize inequality in the parenting role (Goldberg and Perry-Jenkins 2007). In our research, whilst we did not observe a difference between lesbian couples with and without children, the number of lesbian parents was too small for generalisations to be made. Further research is needed to explore this issue further, systematically examining the construction and experience of premenstrual distress in couples with and without children, in both heterosexual and lesbian relationships. As the social and legal acceptance of same sex relationships varies across cultures, this also needs to be examined across different cultural contexts. In conclusion, this analysis reinforces the positioning of PMS as an inter-subjective phenomenon, and draws attention to the influence of discourses of heteronormativity in Australian womens premenstrual experience, in particular, the influence on distress, coping and self-pathologisation. The differences we found between lesbian and heterosexual couples reinforce the need for the inclusion of a heterogeneous range of relationship types in all future research examining PMS, a research area which has previously focused exclusively on heterosexual women. This will provide further exploration of the role of hetero-patriarchal constructions of femininity and premenstrual change, as well as the impact of gendered roles, in the construction and relational experience of premenstrual distress.

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