late luteal phase dysphoric disorder
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pre·men·stru·al syn·drome (PMS),
About 80% of menstruating women aged 25-40 experience some symptoms of PMS with at least some menstrual cycles, and 5-10% have severe emotional symptoms associated with impairment in domestic, occupational, or social functioning, identified as premenstrual (or late luteal phase) dysphoric disorder. A specific biologic cause has not been identified. Reported abnormalities in serotonin metabolism have led to the hypothesis that in women with PMS the normal hormonal fluctuations of the menstrual cycle interact with a neurotransmitter dysregulation to trigger mood and anxiety symptoms. Serotonergic antidepressants (for example, citalopram, fluoxetine, paroxetine, and sertraline) or alprazolam often suppress emotional symptoms when administered continuously or cyclically. Calcium supplementation, reducing caffeine and salt intake, regular exercise, and a diet high in complex carbohydrates may help to minimize physical symptoms. In severe cases, suppression of menses with danazol, leuprolide, or nafarelin may be justified.