Premenstrual Syndrome Subjects Research Articles

Efficacy and Tolerability Evaluation of a Nutraceutical Composition Containing Vitex agnus-castus Extract (EVX40™), Pyridoxine, and Magnesium in Premenstrual Syndrome: A Real-World, Interventional, Comparative Study.

Background Pre-menstrual syndrome (PMS) is a condition associated with altered hormone levels during the menstrual phase of females and is characterised by physical, emotional, and behavioural symptoms that have a negative impact on the quality of life of females. The symptoms of PMS may vary between individuals, but the major complication is pain, especially during menstrual days. The current treatment strategy involves the use of hormonal therapies and analgesics for symptomatic relief, but these therapies have a risk of potential side effects. The use of herbal and nutraceutical supplements in PMS conditions is increasing due to their long-term safety and proven efficacy. The current real-world study aimed to evaluate the efficacy and tolerability of Ezedayz® tablets containing Vitex agnus-castus extract (EVX40™), vitamin B6, and magnesium in PMS subjects. Methodology A real-world, open-label study was conducted involving 64 participants with varied severity of PMS symptoms. Participants were categorised into Group A (N=23) receiving standard therapies, Group B (N=20) receiving Ezedayz®tablets, or Group C (N=21) receiving standard and Ezedayz®therapy. Standard therapies were provided as per physician supervision, and Ezedayz® tablets were given for 90 days. All subjects were evaluated on core symptoms of PMS like menstrual backache, menstrual cramps, joint or muscle pain, and headache using the numerical rating scale (NRS), and quality-of-life (QoL) was evaluated using a QoL questionnaire. A spontaneous reporting methodology was used to evaluate the tolerability of the therapies provided. Statistical analysis was performed as per the statistical plan. A p-value of <0.05 was considered statistically significant. Results Out of 64 participants, five were lost to follow-up, and the data of 59 participants were included in the final analysis. All groups showed improvement in all evaluated parameters, but Group B and Group C showed greater improvement at the end of the study in all evaluated parameters. The quality-of-life assessment revealed greater improvement in Group B and Group C participants compared to Group C in all evaluated QoL parameters. No serious side effects were observed in any subjects. Conclusion The results of the current study conclude that the nutraceutical composition of Vitex agnus-castus extract, vitamin B6, and magnesium is effective in reducing the severity of PMS symptoms and improving the quality of life of PMS subjects. The nutraceutical therapy provided greater relief from PMS symptoms compared to standard therapy alone, and this effect was augmented when the nutraceutical therapy was provided in combination with standard therapies. Similarly, the improvement in quality-of-life parameters was greater in subjects treated with nutraceuticals alone or in combination therapy. Despite the limitations of the study, the results of the current study are promising, and the nutraceutical composition (Ezedayz®) can be effectively used in clinical settings to control symptoms and improve the quality of life of PMS patients.

Beneficial Role of Calcium in Premenstrual Syndrome: A Systematic Review of Current Literature.

Since premenstrual syndrome (PMS) is one of the most common and debilitating disorders in women, risk factor modification is an urgent health priority. Therefore, this systematic review aimed to summarize and discuss the outcomes of observational and interventional studies in humans regarding the relationship between Calcium and PMS. PubMed, Scopus, ISI web of sciences and Google scholar were searched up to January 2019 to identify relevant studies. The Newcastle-Ottawa and Jadad scales were used for quality assessment. A total of 14 studies (8 interventional and 6 observational) met our inclusion criteria. Majority of the studies showed that not only serum calcium levels are lower in PMS subjects, but also calcium supplementation could significantly improve the incidence of PMS and its related symptoms. This systematic review suggests a beneficial role for calcium in PMS subjects. However, in order to draw a firm link between calcium and PMS, further dose-response clinical trials with larger sample size and better methodological design are warranted.

The Association Between Serum Magnesium and Premenstrual Syndrome: a Systematic Review and Meta-Analysis of Observational Studies.

A number of studies have assessed the association between serum magnesium (Mg) and premenstrual syndrome (PMS) in different population, but the findings have been inconclusive. Herein, we systematically reviewed available observational studies to elucidate the overall relationship between Mg and PMS. PubMed, Cochrane's library, ScienceDirect, Scopus, Google Scholar, and ISI web of science databases were searched for all available literature until January 2019 for studies evaluating the association between Mg and PMS. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of observational studies. A total of 13 studies out of 196 met our inclusion criteria and were included in our systematic review and meta-analysis. There were no associations between serum magnesium and PMS (WMD - 0.04; 95% CI, - 0.14 to 0.06; P = 0.46) during follicular or serum/erythrocyte magnesium (WMD - 0.37; 95% CI, - 1.01 to 0.27; P = 0.25)/(WMD - 0.04; 95% CI, - 0.10 to 0.03; P = 0.26) and during luteal phase except for the sub-group of studies done outside of the US in which recent association became significant and means that serum Mg is lower in PMS subjects. According to what have been discussed, although our study did not show any significant association between serum/erythrocyte Mg and PMS except for serum Mg in luteal phase in the sub-group of studies done outside of the USA, heterogeneity between studies should be taken into accounts when interpreting these results. Additional well-designed clinical trials should be considered in future research to develop firm conclusions on the efficacy of magnesium on PMS.Registration number: CRD42018114473 .

Neuropsychological function in relation to dysmenorrhea in adolescents

ObjectiveHormonal variations during the menstrual cycle may affect emotional regulation. We aimed to investigate the association between dysmenorrhea (the severe abdominal pain and cramps associated with menstruation) and cognitive abilities, emotional function and sleep patterns in adolescent girls. Moreover, we evaluated the frequency of premenstrual syndrome (PMS) in our population and then divided them into 4 groups: subjects with only PMS; subjects with only dysmenorrhea; individuals with both PMS and dysmenorrhea and normal subjects. Study designIn this cross sectional study, 897 adolescent girls who had entered menarche were recruited. Of these, 35.9% had only dysmenorrhea, 14.9% had only PMS, 32.7% had both PMS and dysmenorrhea while 16.5% had no PMS and/or dysmenorrhea (Normal). We assessed the tests for cognitive, emotional function and sleep patterns were compared for these groups. ResultsIndividuals in the dysmenorrhea group had significantly higher depression, aggression, insomnia, daytime sleepiness and sleep apnea scores compared to normal controls and the PMS group, but did not have significantly different cognitive ability (P value <0.05). These differences were strongly correlated to pain intensity (P<0.001). However, there were no significant differences between those with only PMS and control subjects with regard to cognitive ability, emotional function and sleep pattern tests. ConclusionsDysmenorrhea is highly prevalent among adolescents and appears to be associated with depressive mood, a tendency to aggressive behavior and sleep disorders among adolescent girls.

The Association between the Risk of Premenstrual Syndrome and Vitamin D, Calcium, and Magnesium Status among University Students: A Case Control Study.

Background: Premenstrual syndrome (PMS) is one of major health problems in childbearing age women. Herein, we compared the nutritional status of vitamin D, calcium (Ca) and magnesium (Mg) in young students affected by PMS with those of normal participants. Methods: This study was conducted on 62 students aged 20‒25 yr in the city of Abadan (31 PMS cases and 31 controls). All participants completed four or more criteria according to the Utah PMS Calendar 3. Age, height, body mass index (BMI), serum Ca, Mg and vitamin D levels and a 24-hour food recall questionnaire were recorded. Results: Vitamin D serum levels were lower than the normal range in the two groups. The odds ratios (CI 95%) of having PMS based on serum Ca and Mg concentrations were 0.81(0.67 – 0.89) and 0.86 (0.72 – 0.93), respectively. Based on serum levels, 855 of all participants showed vitamin D deficiency and more than one-third of the PMS cases were Mg deficient (P<0.05). In addition, there were signifi­cant differences in dietary intake of Ca and Mg, and potassium but not vitamin D in the two groups. Dietary intakes of Ca and Mg were quite below the recommendation in all participants. Conclusion: Vitamin D, Ca and Mg nutritional status are compromised in PMS subjects. Because PMS is a prevalent health problem among young women, it merits more attention regarding improvement of their health and nutritional status.

Menstrual and circadian variations in time perception in healthy women and women with premenstrual syndrome

A time production test was performed in seven normal females and seven females with premenstrual syndrome (PMS). We used a time production test for six time intervals (6, 12, 24, 36, 48, 60 s). Time production tests were performed at 08:00, 14:00 and 20:00 h in the follicular, early luteal and late luteal phases (LLP), respectively. The results are as follows. (1) Normal females showed diurnal variations in time production only in the follicular phase (FP). In this phase, they overproduced time at 08:00 h suggesting that the interval clock in normal females was slowest in the morning. (2) Normal females showed menstrual variations in time production only at 20:00 h. They overproduced time in the LLP suggesting that the interval clock in normal females was slowest in the LLP. (3) Neither diurnal nor menstrual variation was found in PMS subjects at any menstrual stage or at any time of the day. These results suggest that the interval timing system in normal females is under the control of ovarian steroid hormones and the circadian clock, but the control of ovarian steroid hormone or the circadian clock does not operate in PMS subjects.

Insulin-like growth factor-1 and insulin-like growth factor-binding protein-3 in women with premenstrual syndrome

Objective: To determine whether women with premenstrual syndrome (PMS) have aberrations of the GH axis as has been demonstrated in individuals with depression. Design: Prospective trial. Setting: Department of Obstetrics and Gynecology, University of California, Los Angeles. Patient(s): After prospective screening, 32 healthy women with PMS and 32 asymptomatic controls completed the study. Intervention(s): Subjects completed a daily PMS symptom diary and a Beck Depression Inventory. They underwent phlebotomy 5 days and 12 days after the LH midcycle surge, which was identified with the use of a urinary LH detection kit. Main Outcome Measure(s): Serum levels of insulin-like growth factor-1 (IGF-1), insulin-like growth factor-binding protein-3 (IGFBP-3), E 2, and progesterone. Result(s): Levels of IGF-1, IGFBP-3, E 2, and progesterone did not differ between women with prospectively documented PMS and control subjects. Conclusion(s): Premenstrual syndrome and affective disorder share common symptoms and possibly a common cause. Biochemical markers such as alterations in the somatotropic system often are associated with major depression. Levels of IGF-1 and IGFBP-3 did not differ between women with PMS and control subjects, supporting the concept that PMS and endogenous depression are biologically distinct entities.

Pituitary–adrenal hormones and testosterone across the menstrual cycle in women with premenstrual syndrome and controls

Background: Premenstrual syndrome (PMS) is a cyclic mood disorder, widely believed, yet not conclusively shown, to be of endocrine etiology. This study examines basal levels of several hormones reported, albeit inconsistently, to differ in women with PMS compared with controls. Methods: Subjects (10 PMS patients and 10 controls) had their blood drawn for one full menstrual cycle. Subjects’ mood and behavioral symptoms were assessed by daily self-ratings and objective ratings. Plasma was assayed for total and free testosterone (T), β-endorphin (β-EP), adrenocorticotropic hormone (ACTH), and cortisol. Results: No differences were observed between the PMS and control groups for β-EP, ACTH, or cortisol. PMS subjects had significantly lower total and free T plasma levels with a blunting of the normal periovulatory peak, a finding that may be epiphenomenal to age. Conclusions: This study does not confirm previous reports of abnormalities in plasma levels of either ACTH or β-EP in women with PMS; it also fails to replicate a previous observation of high free T levels in women with PMS. These results are not supportive of a primary endocrine abnormality in PMS patients.

Progesterone metabolite allopregnanolone in women with premenstrual syndrome

To evaluate the anxiolytic 3alpha-5alpha-reduced progesterone metabolite allopregnanolone in the luteal phase of the menstrual cycle in women with premenstrual syndrome (PMS) and controls. Thirty-five women with prospectively documented PMS and 36 controls were evaluated. Serum progesterone and allopregnanolone levels were measured on days 19 and 26 of the cycle as determined by urinary LH detection kits. Analysis of variance and Student t tests were used to analyze the data. Allopregnanolone levels were significantly lower on day 26 in the PMS group than in controls (3.6 +/- 0.8 versus 7.5 +/- 1.3 ng/mL; P < .04). Significant differences in the ratio of the metabolite to progesterone also were noted, with a smaller ratio in the PMS subjects (0.9 +/- 0.3 versus 3.2 +/- 1.3 ng/mL; P < .05). There were no significant differences between the PMS and control groups with respect to serum progesterone levels. Subjects with PMS manifested lower levels of the anxiolytic metabolite allopregnanolone in the luteal phase when compared with controls. Diminished concentrations of allopregnanolone in women with PMS may lead to an inability to enhance gamma aminobutyric acid-mediated inhibition during states of altered central nervous system excitability, such as ovulation or physiologic or psychological stress. The lowered metabolite levels could contribute to the genesis of various mood symptoms of the disorder, such as anxiety, tension, and depression.

Cognitive functioning in premenstrual syndrome

To evaluate cognitive functioning in women with premenstrual syndrome (PMS) and controls during the follicular and luteal phases of the menstrual cycle. Thirty women with PMS and 31 controls were selected on the basis of psychiatric interview and prospective daily diary recordings. Subjects were tested on two occasions, follicular (days 8-10) and luteal (days 24-26), using complex tasks consisting of measures validated previously for the assessment of "executive" frontal-lobe functions. Tests were counterbalanced for order across subjects. The Beck Depression Inventory scores were significantly different between the groups and across time (P < .001). Women with PMS had a mean luteal phase Beck score of 13.3 consistent with mild-to-moderate premenstrual depression. There were no statistically significant score differences in tests for attention, memory, cognitive flexibility, and overall mental agility. The evaluation of our preliminary data with 30 PMS subjects and 31 controls indicated a very small effect size (.02). To detect an effect size this small (if in fact one exists) with a power of .8 would require a sample of more than 1000 subjects per group. Our sample of women with PMS failed to demonstrate objective evidence of diminished cognitive performance, despite subjective feelings of inadequacy.

The association of menstrual migraine with the premenstrual syndrome.

To investigate the comorbidity of premenstrual syndrome (PMS) and menstrual migraine, the Menstrual Distress Questionnaire (MDQ) was prospectively administered for two consecutive menstrual cycles to 22 patients with menstrual migraine, 12 cases with migraine without aura and 15 patients with PMS. MDQ scores varied throughout the menstrual cycle in each patient group, the wider changes being shown by patients with PMS. Fourteen menstrual migraine patients and 4 migraine without aura patients achieved diagnostic criteria for PMS over two menstrual cycles. In these patients MDQ scores did not differ from PMS sufferers at any stage of the menstrual cycle. The premenstrual increase of each cluster of PMS symptoms was identical in menstrual migraine and PMS subjects with the exception of negative affect. We suggest that PMS symptoms should be taken into account in the IHS diagnostic criteria for menstrual migraine.

Serum levels of androgens are higher in women with premenstrual irritability and dysphoria than in controls

Serum levels of progesterone, total testosterone, free testosterone, androstendione (A2), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS), 17-OH-progesterone (17-OHP), and sex hormone binding globulin (SHBG) were measured in the follicular phase, around ovulation, and in the luteal phase of 11 women with severe premenstrual irritability and dysphoria and in 11 age-matched controls with no premenstrual complaints. Serum levels of free testosterone were significantly higher in the subjects with premenstrual syndrome (PMS) than in the controls in the luteal phase ( p<0.01), the follicular phase ( p<0.05), and around ovulation ( p<0.01). DHEA levels were significantly higher in the PMS subjects, as compared to controls, around ovulation ( p<0.05), while 17-OHP levels were higher in the PMS women in the luteal phase ( p<0.05). With respect to the other steroids measured, as well as SHBG, no differences between PMS subjects and controls were found. These results indicate a possible involvement of androgens in the pathophysiology of premenstrual irritability and dysphoria.

Interactions between stress and performance during the menstrual cycle in relation to the premenstrual syndrome

Abstract Differences between self-diagnosed premenstrual syndrome (PMS) sufferers and non-sufferers (both oral contraceptive users and normally cycling subjects) on performance, state, and reaction to mild stress at premenstrual or intermenstrual stages of the cycle were examined. All subjects reported increases in arousal and stress in the premenstrual phase but there was a significantly greater increase in reported arousal in the premenstrual phase in PMS subjects than in non-PMS subjects. There were no differences between subject groups on performance during the cycle, or on reaction to stress: for all subjects semantic processing on a word matching test improved premenstrually. No differences were found between pill and non-pill subjects. PMS subjects scored significantly higher on the Neuroticism scale of the EPI than non-PMS subjects, and were significantly more ‘A’ typed in personality on a Framingham A/B personality scale. It is suggested that a multivariate model is adopted for menstrual cycle re...

Mood‐related self‐schemata and mood‐congruity effects in autobiographical memory: A study of women with premenstrual syndrome

AbstractEveryday autobiographical memory and mood interactions were explored in a small clinical sample of women with premenstrual syndrome (PMS) and a matched control group. Subjects kept daily records of memorable events for two consecutive menstrual cycles. Two recognition memory tests were given after a one‐cycle delay. Mood, or affect, was self‐assessed retrospectively over a week, at the end of each day during data collection and at testing, and when events occurred. Women with PMS were more depressed and more negative (angry) than positive (experiencing bursts of energy) in their daily moods than controls. Memory accuracy was poorer overall for PMS than control subjects, although no direct effects of menstrual cycle phase on memory were found. Instead, mood affected memory indirectly through moodrelated self‐schemata which subsequently mediated mood‐congruity effects. Memory accuracy for events experienced in negative mood states and associated with negative affective reactions was higher for PMS subjects when tested in negative mood states than for controls. No group differences were found on events associated with positive affect or positive daily moods when mood state at the time of testing was also positive. Women with PMS processed information selectively from negative events and events experienced in negative moods compared to controls. Negative events and negative moods appeared to interfere with remembering for control subjects. Women in the control group appeared to be biased towards selectively remembering positive events and events experienced on days when their mood states were relatively positive.

Diagnosis of premenstrual syndrome by a simple, prospective, and reliable instrument: The calendar of premenstrual experiences

To establish a quantitative method for the diagnosis of premenstrual syndrome (PMS), a simple prospective inventory, the calendar of premenstrual experiences, was constructed. The validity and reliability of this instrument were assessed by administering it throughout two consecutive ovulatory cycles to 36 rigidly screened women with PMS and to 18 controls. To establish concurrent validity, scores on behavioral items were correlated with simultaneously obtained scores on lengthier, well-validated psychiatric inventories designed to measure depression rather than PMS, the Beck Depression Inventory and the Profile of Mood States. The results showed that the calendar of premenstrual experiences luteal phase score distinguished PMS women from controls correctly in 104 of 108 cycles, with a 2.8% false-negative rate and no false positives when used for two consecutive cycles. An upper limit follicular phase score was observed beneath which all PMS and normal control subjects fell, suggesting that a higher score is not consistent with PMS. Correlation coefficients of calendar item scores with Profile of Mood States scale scores were 0.58 for tension, 0.51 for depression, 0.46 for anger, 0.61 for fatigue, and 0.57 for confusion (P less than .0001 for all correlations). The correlation of the calendar depression item with the Beck Depression Inventory score was 0.56 (P less than .0001). The test-retest reliability of the calendar given in the same phase of two consecutive menstrual cycles was high (r = 0.78, P less than .0001). We conclude that this instrument is a valid, reliable, and practical PMS inventory, applicable to clinical and some research settings.

Alteration of 5-HT uptake by plasma fractions in the premenstrual syndrome

The effects of plasma and an aqueous plasma fraction from patients with premenstrual syndrome (PMS) and control subjects on the uptake of 5-hydroxytryptamine (5-HT) in washed human platelets and rat forebrain synaptosomes were studied. Pre- and postmenstrual samples of unextracted plasma from the control group significantly enhanced platelet uptake of 5-HT. In contrast, an aqueous fraction following extraction of the plasma with organic solvents caused a dose-dependent decrease of 5-HT uptake. Plasma obtained from patients with PMS caused less stimulation of 5-HT uptake compared to plasma from the control group. The aqueous fraction of premenstrual plasma from patients tended to inhibit 5-HT uptake to a greater extent than a similar plasma fraction from controls. The inhibition of 5-HT uptake was associated with an increase in Km. Aqueous plasma fractions from both groups also inhibited 5-HT uptake in brain synaptosomes. However, there were no significant differences between groups. The results of the platelet study suggest that there may be quantitative differences in the plasma concentration of endogenous factors that affect 5-HT uptake between patients with PMS and control subjects and that such differences may explain the previously reported alteration of platelet 5-HT uptake and content associated with PMS symptoms.

Effect of nutrient intake on premenstrual depression

We examined the occurrence and coincidence of depressed mood and excessive carbohydrate intake in 19 patients who claimed to suffer from severe premenstrual syndrome and in nine control subjects, all as inpatients, during the early follicular and late luteal phases of their menstrual cycles. Mood was assessed with the Hamilton Depression Scale and an addendum that evaluated fatigue, sociability, appetite, and carbohydrate craving. Calorie and nutrient intakes were measured directly. The subjects with premenstrual syndrome significantly increased calorie intake during the late luteal phase (from 1892 +/- 104 to 2395 +/- 93 kcal, mean +/- SEM); carbohydrate intake increased by 24% from meals and by 43% from snacks. Protein intake failed to change, whereas intake of fat, a fixed constituent of all of the test foods, rose in proportion to calorie intake. The Hamilton Depression Scale and addendum scores rose from 2.0 +/- 0.5 to 21.2 +/- 0.8 (Hamilton Scale) and from 0.5 +/- 0.5 to 10.2 +/- 0.6 (addendum) among subjects with premenstrual syndrome during the luteal phase but failed to change among the controls (2.1 +/- 0.8 to 2.4 +/- 0.8, and 0.4 +/- 0.3 to 0.6 +/- 0.3). Consumption of a carbohydrate-rich, protein-poor evening test meal during the late luteal phase of the menstrual cycle improved depression, tension, anger, confusion, sadness, fatigue, alertness, and calmness scores (p less than 0.01) among patients with premenstrual syndrome. No effect of the meal was observed during the follicular phase or among the control subjects during either phase. Because synthesis of brain serotonin, which is known to be involved in mood and appetite, increases after carbohydrate intake, premenstrual syndrome subjects may overconsume carbohydrates in an attempt to improve their dysphoric mood state.

Tryptophan loading test in premenstrual syndrome

SummaryAn oral tryptophan loading test (SOmg/kg) was performed in both women with premenstrual syndrome and controls. In controls at all sampling intervals, and the premenstrual syndrome subjects in the follicular and mid-luteal phases, tryptophan loading consistently increased whole blood serotonin levels. By contrast, during the late luteal phase, in subjects with premenstrual syndrome there was a decrease in blood serotonin.

Skin conductance and heart rate in women with premenstrual syndrome.

This study investigated the effects of the menstrual cycle phase on certain components of autonomic arousal and task performance. Premenstrual syndrome (PMS) women and matched controls (non-PMS) were tested both premenstrually and postmenstrually. The conditions selected were a) the presentation of 10 tones, b) a proofreading performance task, and c) a word-association learning task. Skin conductance and heart rate were continuously monitored. No significant effects were found on baseline physiological measures, or on proofreading or word-association performance. A significant point in cycle effect for skin conductance and HR orienting response to the tones was found showing smaller HR and skin conductance responses postmenstrually. Several significant PMS classifications by point in menstrual cycle interactions were found. These indicated that, paradoxically, the non-PMS subjects showed higher spontaneous skin conductance responding during the word association task and higher skin conductance responses to tones prior to menses. While in contrast, PMS subjects yielded higher responding on the same measures postmenstrually. On stress ratings, PMS subjects reported experiencing more stress postmenstrually. Results are discussed in terms of the possible role of expectancy factors and inaccurate self-monitoring.

Circulatory failure of capillary origin: Moon, Virgil H.: J. A. M. A. 114: 1312, 1940

We examined the occurrence and coincidence of depressed mood and excessive carbohydrate intake in 19 patients who claimed to suffer from severe premenstrual syndrome and in nine control subjects, all as inpatients, during the early follicular and late luteal phases of their menstrual cycles. Mood was assessed with the Hamilton Depression Scale and an addendum that evaluated fatigue, sociability, appetite, and carbohydrate craving. Calorie and nutrient intakes were measured directly. The subjects with premenstrual syndrome significantly increased calorie intake during the late luteal phase (from 1892 ± 104 to 2395 ± 93 kcal, mean ± SEM); carbohydrate intake increased by 24% from meals and by 43% from snacks. Protein intake failed to change, whereas intake of fat, a fixed constituent of all of the test foods, rose in proportion to calorie intake. The Hamilton Depression Scale and addendum scores rose from 2.0 ± 0.5 to 21.2 ± 0.8 (Hamilton Scale) and from 0.5 ± 0.5 to 10.2 ± 0.6 (addendum) among subjects with premenstrual syndrome during the luteal phase but failed to change among the controls (2.1 ± 0.8 to 2.4 ± 0.8, and 0.4 ± 0.3 to 0.6 ± 0.3). Consumption of a carbohydrate-rich, protein-poor evening test meal during the late luteal phase of the menstrual cycle improved depression, tension, anger, confusion, sadness, fatigue, alertness, and calmness scores (p < 0.01) among patients with premenstrual syndrome. No effect of the meal was observed during the follicular phase or among the control subjects during either phase. Because synthesis of brain serotonin, which is known to be involved in mood and appetite, increases after carbohydrate intake, premenstrual syndrome subjects may overconsume carbohydrates in an attempt to improve their dysphoric mood state.