An innovative approach to understanding PMS

with Tilia Linthout, Co-Founder of Anticoncept! and master student at Ghent University

Aunt Flow

It's no news that menstrual health, contraception and its impact on well-being are far too under-researched. That's why we can't talk about it enough! This is also the opinion of Tilia Linthout, who is currently conducting research on premenstrual syndrome (PMS).

Hi Tilia, it's great to talk to you again, thanks for taking the time. We met in the context of our shared interest in menstrual health (research). Can you briefly introduce yourself and tell a little about what you're doing at the moment?

Yes, of course! I'm Tilia and I'm currently writing my master thesis on emotional expression, PMS, and contraception. There's actually a heavy-hearted story of how I got interested in menstrual health and all related topics, because a friend of mine passed away from pulmonary embolism due to not being informed about risks of contraception, which is why my friends and I started a movement called Anticoncept! to spread awareness about hormonal contraception and its effects, and we're trying to be as accurate as possible because we feel like there is not always enough factual information out there.  

Was it easy for you to find someone who could supervise this topic for your research? 

I was able to choose this topic from a list and was immediately curious to learn more about the scientific side of PMS and how to analyze contraception. Fortunately, I found a supervisor (doctoral student Mitchel Kappen from GHEP Lab at the University of Ghent) who works with facial coding, which we now use to study emotional expression. To do this, we use facial expressions. This is a nice implicit measure because with facial expressions, we get the “true” reaction. You can’t really hide how you feel there, the facial muscles just do their thing, even if you’re not aware of it. In our study, we use images that are supposed to evoke a certain affective reaction. On the basis of these innovative video analyses, we thus try to read those facial expressions of people with and without PMS as a reaction to the stimuli. We will also analyze contraception as a part of this master thesis.

By analyzing contraception, you mean analyzing its impact on certain aspects, right?

Exactly, and it will probably be exploratory because there aren't many sources to draw on yet. As for the PMS part, we are comparing people with PMS versus no PMS, on the basis of their answers on a verified PMS screening tool (so no clinical diagnosis). We're very interested in the results, but I can’t tell much about this yet. 

Sounds interesting! For those who don’t know, can you briefly explain what PMS is?

PMS stands for premenstrual syndrome, and there are basically two phases in the menstrual cycle: the follicular phase and the luteal phase. During the luteal phase, which is also called the premenstrual phase, many menstruators experience physical symptoms such as bloating and breast tenderness, as well as emotional and behavioral symptoms. These three groups of symptoms together form the premenstrual symptoms. The tricky part is that there are no uniform criteria. There are 3 institutions that propose PMS criteria: the American College of Obstetrics and Gynecologists (ACOG) criteria, the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, and the criteria of the World Health Organisation (WHO), so it is difficult for many menstruators to figure out if they have premenstrual symptoms and to find help. 


And for the DSM criteria, it's only recently been added to the catalog of criteria, is that correct? 

Exactly, the most severe form of PMS (PMDD) has been recognized as an official clinical disorder since the latest version of the DSM. And I was surprised to see that many PMS studies were very old. Although there were really interesting studies, many of them were not picked up, but I feel that there is a new trend in recent years where PMS is getting more attention. 


This is my observation as well and there are more and more studies on the social impact of PMS.

I think it’s a bit of both, the pathological side and the social effects. What I find really interesting, is that PMS seems to be influenced by culture. This is potentially very important for understanding attitudes and taboos concerning menstruation, but since the research is still very much in its infancy, I don't think there is a sufficient base to make conclusions about that. I think it would be very interesting if researchers dig deeper into the topic of menstruation as a cultural/social phenomenon, including also the non-Western countries.


That’s probably the tricky part about self-assessment of PMS. If people are unaware of the menstrual cycle, they probably don’t see that their symptoms follow a pattern. How do you think this research could be used to bring this knowledge into society?

That’s a difficult thing, and that’s why I find your work so important, bridging that gap between research and applying that knowledge. I look up to that, and aspire to do the same. In the end, this question is important for all fundamental research.


That’s a good point, and thank you for your nice words! I think you do the same with your project Anticoncept! Your instagram account has a lot of followers and you're doing a great job raising awareness and providing people with knowledge about contraception. 

You're right, and recently we got the great news that we are invited to the Flemish parliament. It’s great to see that so many people support it. Our goal is to spread awareness and information about contraception and menstruation. It’s nice to be on the change-making side and I hope it will have a lasting impact, even though it will probably be too hard to make actual legal changes. What I do have to say is that when women approach us and tell us that it’s great that finally someone is addressing this, it often gives me a very double feeling, because it’s great to help these women and to make sure they are heard, but there should be other institutions that fill the lack of knowledge and resources about such an important topic. Why is that not done? In the end, we are just people who are interested in it and we get a bigger responsibility than we actually aimed for. We always have to stress that we are not medical experts. Luckily, we hear from a lot of doctors and gynecologists that more and more women are coming to them with questions about contraception. I think it’s extremely important to find a good doctor or gynecologist who can inform you and who understands the importance of a good dialogue between doctor and patient.