Premenstrual stress syndrome

From Wikipedia, the free encyclopedia

**Pre-menstrual Syndrome**
*Classifications and external resources*
ICD-10	N943
ICD-9	625.4

"PMS" redirects here. For other uses, see PMS (disambiguation).

Pre-menstrual Syndrome (PMS, also called Pre-menstrual Stress, Pre-menstrual 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.

Some estimates say that PMS occurs 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.

1 Diagnosis and treatment
2 Alternative Views
3 References
4 External links

[edit] Diagnosis and treatment

Diagnosis of PMS 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. Exercise will help reduce depression and anxiety symptoms. Keeping a symptom diary will help cure 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^{[citation needed]}. There is some clinical evidence that these do indeed remedy the symptoms of PMS.<ref>Webster DE, Lu J, Chen SN, Farnsworth NR, Wang ZJ. (2006). "Activation of the mu-opiate receptor by Vitex agnus-castus methanol extracts: Implication for its use in PMS.". J Ethnopharmacol: –.</ref><ref>Huntley AL, Ernst E (2003 Sep-Oct). "A systematic review of herbal medicinal products for the treatment of menopausal symptoms". Menopause 10 (5): 465 –76.</ref> <ref>Hardy ML (2000 Mar-Apr). "Herbs of special interest to women". J Am Pharm Assoc (Wash) 40 (2): 234–42.</ref> Herbal treatments may work by stimulating the pituitary gland, or by effects on dopamine or opioid receptors. A good dose of vitamin B6 is also believed to assist with the symptoms, although care should be taken when increasing your vitamin B6 intake, such as taking it with other B vitamins and watching for symptoms of overdose.

[edit] Alternative Views

It has been suggested that PMS might be a socially constructed disorder. Evidence supporting this view comes from medical trials that show placebo drugs may work as well as pharmaceuticals in providing relief. Other medical evidence shows that there is no difference between hormonal levels of sufferers and non-sufferers<ref>Capitalizing on the Curse. Elizabeth Kissling. 2006, Lynne Rienner Publishers.</ref>. However, social construct hypotheses remain controversial.

Supporters of PMS's medical validity are supported by placebo drug's effectiveness in even serious and objectively-established health conditions. They further claim support from the non-disputed status of a more serious but similar problem, Premenstrual Dysphoric Disorder. In women with PMDD studies have shown a correlation between self-reported emotional distress and levels of a serotonin precursor as measured by Positron emission tomography (PET).<ref>http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=16515859&query_hl=2&itool=pubmed_docsum | Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria.</ref> PMDD also has a consistent treatment record with SSRIs, when compared with placebos. <ref>http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=10471170&query_hl=1&itool=pubmed_docsum </ref>

However, supporters of PMS as a social construct do not dispute PMDD's medical status. Rather, they believe PMS and PMDD to be unrelated issues, one a product of brain chemistry, the other a product of a hypochondriatic culture. There has not been enough debate between the two views to come to any sound conclusion.

A less controversial middle view holds that, while PMS is a reality for some women, it is over- and mis-diagnosed in many cases. A variety of problems, such as chronic depression, infections, and outbursts of frustration can be mis-diagnosed as PMS if they happen to coincide, or even if they don't coincide, with the premenstrual period. Often, says this theory, PMS is used as an excuse for outbursts of socially unacceptable behavior such as rage or sadness, even when it is not the cause.<ref>Capitalizing on the Curse. Elizabeth Kissling. 2006, Lynne Rienner Publishers.</ref>