The first time a woman I will call Helen visited my office she told me she didn't know whether she was in the right place, maybe she should be talking to a psychiatrist instead of a gynecologist. She worked as a librarian and, befitting her position, Helen was an even-tempered, gentle, introspective person. Yet every month, approximately seven or eight days before her menstrual period began, she became "demonic," which is her word. She had tremendous difficulty coping with her life because everything, from the weather to a teenage boy who wanted reference books to the inflection in her husband's voice, seemed to irritate her.

Helen had already been divorced once, because after four years her previous husband had considered her to be "unreasonable and unbearable." She was afraid she might lose her second husband and also her job. It wasn't just her personality that underwent a transformation. Helen suffered physically, too, and for this she had taken many sick days. But what could she do? A pulsating headache gave her double vision, and sometimes she Couldn't even lie down and close her eyes because an accompanying backache was only relieved if she sat in a straight-back chair for a while. All in all, she could hardly get through a day at home, much less at work.

"It's like being possessed," she said. "I know it's going to happen every month. I try to control my mind and my body, but the force is too much for me. I feel schizophrenic, as if I'm doomed. But then my period starts, and two days into it, I'm fine. I can't understand why the world looked so bleak, why my husband seemed so impossible, why I didn't like my job. Usually when I tell doctors about my pattern, they advise me to slow down. I know I'm not going to be cured by taking it easy with a vacation or meditation, or any of the two dozen suggestions I've received, so I'm here with you. My problem is physical, I think." It is-physical, hormonal, and real.

Helen's suffering is shared by many women who experience what a growing number of doctors are finally willing to recognize as premenstrual syndrome. The symptoms, which begin anywhere from two to fourteen days before menstruation and last until the onset of, or a couple of days into, the bleeding, combine to form a formidable list of debilitations. Tiredness, irritability, depression, tension, hypersensitivity, headache, backache, weight gain, nausea, heaviness in the abdomen and legs, asthma, sinusitis, and even epilepsy have appeared during the course of the premenstrual syndrome. Cramps, which were the focus of Chapter Three, usually begin at or near the onset of menstruation. They are widespread, rooted in specific causes, and separate from the premenstrual syndrome.

In a study conducted at The Johns Hopkins University School of Medicine, Dr. Nelson H. Hendler, professor of psychiatry, wrote that the syndrome affects an estimated 10 to 15 percent of female adults. And in her book Once a Month, Dr. Katharina Dalton, the physician most responsible for pioneering and advancing premenstrual syndrome research, writes that there are over 5.5 million American women afflicted monthly. A woman may be spared the severe Dr.-Jekyll-and-Mr.-Hyde metamorphosis that Helen endured every month, but during premenstrual days most women feel some physical changes, no matter how slight.

The leaders of the women's movement originally felt that more progress for women could be made if they denounced the idea that the onset of menstruation changed a woman's fitness or psychological outlook. However, you cannot recognize the premenstrual syndrome and ignore the fact that a woman's physical changes can sometimes affect her mind as well as her body. Perhaps the way to equality these days is to understand hormonal fluctuations and to support research into treatments to alleviate the symptoms that turn work days into sick days.

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Women's Health