Premenstrual stress syndrome

Premenstrual Stress Syndrome (PMS, also called Premenstrual Stress, Premenstrual Tension, PMT, Premenstrual Syndrome, Periodic Mood Swing) is stress which is a physical symptom prior to the onset of menstruation. PMS should not be confused with dysmenorrhea, which refers to pain or cramps during menstruation.

PMS is exceedingly common, occurring in 75% of women of reproductive age during their lifetime. A more severe form of PMS is premenstrual dysphoric disorder (PMDD). This occurs in about 5% of women. Both are characterized by symptoms of mood swings, depression, anxiety and irritability that occur prior to menses, usually in the two week period between ovulation and menses. It is often accompanied by physical symptoms such as bloating and cramping.

Diagnosis and treatment
Diagnosis of PMDD differentiation from clinical depression and anxiety disorders.

Treatment usually begins with lifestyle modification. Reducing caffeine, sugar, and sodium intake may help. Supplements of vitamin B6 and calcium carbonate have been shown to help alleviate some symptoms; calcium carbonate should be taken in doses of 1200 milligrams a day. Exercise will help reduce depression and anxiety symptoms. Keeping a symptom diary will help cue sufferers to exacerbating and relieving strategies.

Prescription treatments include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). While commonly described as the selective serotonin reuptake inhibitors, several drugs of this class (such as fluoxetine) have been demonstrated to increase the bioavailability of the neurosteroid allopregnanolone by altering the metabolic favorability of the reaction.

Traditional herbal treatments include Vitex (Chasteberry), Evening primrose (Oenothera Biennis), red clover and black cohosh. There is some clinical evidence that these do indeed remedy the symptoms of PMS. Herbal treatments may work by stimulating the pituitary gland, or by effects on dopamine or opioid receptors.

Controversial views
In a 1989 study of menstruating women, Cathy McFarland and colleagues discovered that study participants recalled feeling worse during the two weeks preceding ovulation and menses than the intermenstrual period or during menstruation. However, the daily record of the women's moods suggested that their actual mood varied very little over the course of their cycle.

Other studies have shown that for many PMS sufferers, placebo drugs work just as well as pharmaceuticals in providing relief. A controversial and not widely-accepted theory holds that PMS may be a socially constructed disorder.