Premenstrual stress syndrome

Premenstrual Stress Syndrome (PMS, also called Premenstrual Stress, Premenstrual Tension Syndrome, 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
A few have posited that PMS might be a socially constructed disorder. In 1989 Cathy McFarland reported that although study participants recalled feeling worse during the two weeks preceding their ovulation and menses than during the intermenstrual period or menstruation, the daily record of the women's moods showed little variation over the course of their cycle. For some PMS sufferers, placebo drugs may work as well as pharmaceuticals in providing relief. If a "mere social construct" hypothesis has been seriously suggested, however, it deservedly remains little known, less accepted, and controversial. Even serious and objectively-established health conditions can be powerfully affected by placebos, leading to modern requirements of placebos in well-designed therapeutic trials. The "mere social construct" idea is substantially undercut by demonstrations of the significant role of neurotransmitters, particularly serotonin levels, in the causation and treatment of PMS symptoms. Recent Swedish studies and scholarly reviews show a strong correlation between self-reported emotional distress in women with premenstrual dysphoriais and levels in their brains of a serotonin precursor measured objectively by Positron emission tomography (PET). The convincing and consistent effectiveness of SSRIs (but not other antidepressants) as treatment for premenstrual dysphoriais in placebo-controlled trials again reveals a neurochemical basis, independent of placebo effects, for Premenstrual dysphoric disorder, further rebutting the "mere social construct" hypothesis.