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Severe Form of PMS May Have Roots in Stress

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Do you get PMS? Think it might actually be PMDD? Talk it over on WebMD's Women's Health message board, moderated by Jane Harrison-Hohner, RN, RNP. continued...

Unlike healthy women, who respond to stressful situations by increasing their body's production of a hormone called allopregnanolone, women with PMDD produce less, not more, of the hormone when stressed. Oddly enough, Girdler says women with PMDD actually have more of the hormone present in their bodies most of the time than women without PMDD, but it doesn't increase at times when it should.

"One possibility is that they have normal levels [of allopregnanolone] but they [break it down] abnormally," she says. Allopregnanolone is a substance that results from the breakdown of the sex hormone progesterone.

An early treatment idea was to give women with PMDD progesterone therapy to boost their abnormal levels, but Girdler says the studies clearly show that it doesn't work.

One thing that does work in some women is antidepressant therapy.

Last year, Sarafem became the first prescription medication approved for the treatment of PMDD. Like Prozac, which shares the same active ingredient as Sarafem, it helps to correct an imbalance of serotonin, a chemical responsible for communication between nerves in the brain. Serotonin is thought to be involved in depression.

Sarafem has also been found to reduce some physical complaints of PMDD such as bloating.

More research and more public attention is good news for PMDD sufferers who haven't been given much hope for treatment until the last decade or so, says Jean Endicott, PhD.

"I think it's a relief for many women to know it is a recognized condition, that it has biological underpinnings, and that people are trying to find something that will work," says Endicott, director of the Premenstrual Evaluation Unit at Columbia Presbyterian Medical Center, in New York. "It's moved a long way certainly from the '80s when we had virtually nothing to offer women."

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