Katharina Dalton, 87; First Doctor to Define, Treat PMS

Dr. Katharina Dalton, a pioneering British gynecologist and endocrinologist who coined the term “premenstrual syndrome” and advocated treating both PMS and postpartum depression with natural progesterone, has died. She was 87.

Dalton, whose work proved as intriguing in the courtroom as in the doctor’s office, died Sept. 17 in Poole, England, of unspecified causes.

Dalton became involved in the treatment of PMS in 1948, when, as a pregnant 32-year-old medical student, she realized her monthly migraine headaches had disappeared. Consulting with endocrinologist Dr. Raymond Greene, she concluded that the headaches could be attributed to a deficiency in the hormone progesterone, which drops before menstruation but soars during pregnancy.

After further clinical study, Dalton, along with Greene, published the theory in British medical journals in 1953 -- first using the term “premenstrual syndrome,” or PMS.

Dalton, who treated numerous women after setting up her own practice, concluded that PMS was a cyclical hormonal illness occurring in the 14 days following ovulation, with the most severe symptoms evident during the final four days before menstruation. In direct conflict with the views of many of her male colleagues, Dalton said the symptoms were more physical than psychological and included migraine headaches, asthma, epilepsy, skin lesions, laryngitis, irritability, fatigue and depression.

In addition to her patients, she studied teenage schoolgirls, the mothers of abused children and women confined to prison for serious crimes, including murder. Her research showed that during times of severe PMS, students’ academic performance dipped and women were more likely to abuse their children or commit crimes.

From historic anecdotes, she even concluded that Queen Victoria suffered from PMS, as indicated by reports of the monarch’s monthly screaming and throwing objects at her husband, Prince Albert.

Dalton advocated treatment with natural progesterone -- which she said could be obtained from sweet potatoes -- administered through injections or suppositories. The substance differs from synthetic progestogen used in contraceptive and post-menopausal therapy pills.

She also concluded that a decline in progesterone following childbirth caused the so-called “baby blues” and could be corrected with an injection of the hormone for the mother immediately after giving birth.

Dalton estimated that at least 30% of women suffer PMS severely enough to affect their lives, and that a third of those require progesterone. Lesser symptoms, she said, could be treated by dietary means -- such as eating starchy food every three hours. Only about 1% of women, she said, become violent enough to commit crimes, although half of crimes committed by women she studied took place during the PMS period.

As for postpartum depression, Dalton said in a 1988 seminar at Western Medical Center in Santa Ana, about half of new mothers suffer a mild form, indicated by moodiness and bouts of crying. About 10%, she said, suffer severe symptoms such as personality changes and anxiety.

Only about three in 1,000 mothers, she said, reach the stage of postpartum psychosis -- involving hallucinations and thoughts of suicide or even the killing of a newborn child.

Dalton’s research led her to court as an expert witness defending women accused of crimes such as being drunk and disorderly and murder. She first testified in a British court in 1979 and over the next 25 years appeared in about 50 trials.

By showing that a defendant had committed the crime while suffering from PMS, she supported defense claims of diminished responsibility -- in many cases helping win acquittal, probation or reduced charges and sentences.

American lawyers were quicker to accept Dalton’s research than American doctors. They began using the defense in U.S. courts a few years after British barristers, especially to defend mothers accused of killing their infants.

In 1957, Dalton opened the world’s first PMS clinic at London’s University College Hospital and directed it for more than 30 years.

Nearly 25 years later, a similar clinic was established in the U.S. by psychiatrist and neuroendocrinologist Ronald V. Norris in Reading, Mass.

Dalton’s research remained controversial for decades, particularly in the U.S., where mostly male medical practitioners believed premenstrual symptoms stemmed from a psychological rather than physical cause, and where feminist leaders adamantly opposed any suggestion that women were emotionally unstable once a month.

Naysayers criticized Dalton for basing her conclusions on observation of patients, or clinical evaluation, rather than on basic endocrine research. Saying placebos could often relieve premenstrual symptoms, they also dismissed her insistence on natural progesterone.

“Some of you,” Dalton told medical personnel at a Santa Monica hospital during a 1982 tour to share her research with American doctors, “may feel that I’ve got tunnel vision, that I can just see progesterone when I look into the PMS picture. In my practice, it is simply that I have found this to be the most effective.”

Born Katharina Kuipers in London to Dutch parents, she first became a chiropodist treating foot ailments. But widowed with an infant son when her first husband, Wilfred Thompson, was killed in World War II, she enrolled in medical school at the Royal Free Hospital, the only medical school of London’s 12 then admitting women.

She later became the first female president of the general practice section of the British Royal Society of Medicine.

Dalton’s second husband, the Rev. Tom Dalton, died in 1992. She is survived by her four children, Michael, Thomas, Wendy and Maureen, and five grandchildren.