I have terrible mood swings about four or five days before my period starts. Is there anything I can do to control these mood swings? I don't have any control over my emotions on those days, and it causes great stress at home and at work. Please help!

--Cathie

This sounds like classic premenstrual syndrome (PMS), now called Premenstrual Dysphoric Disorder (PMDD) by my psychiatrist colleagues. PMS affects about a third of all women and can cause a variety of physical, psychological and behavioral changes, including mood swings. We don't completely understand PMS, so effective treatment can be difficult. Still, many women find relief with a variety of therapies. Some of these therapies (such as calcium, magnesium, St. John's wort, and Prozac) are supported by scientific research; others are merely supported by anecdotal evidence based upon the experience of many women and physicians.

Some vitamins and minerals that appear to be helpful are B-6 (50 mg, one to two times per day); calcium (1,000-1,500 mg per day); magnesium (325-750 mg per day); zinc (15-25 mg daily); and vitamin E (400-800 IU daily). As for herbs, evening primrose, flaxseed or borage oil capsules provide essential fatty acids that can help with both physical and emotional symptoms. Evening primrose oil is widely used to alleviate premenstrual breast tenderness. Herbs such as chamomile or valerian root can ease tension, but take valerian only at bedtime as it can be pretty sedating. Dandelion leaf is a good diuretic and can be used for severe fluid retention.

St. John's wort (Hypericum) is widely used in Europe for the treatment of PMS, and it has been shown to be effective. I recommend 300 mg of a standardized preparation daily, increasing to 300 mg three times per day from about cycle day 10 until the start of your period. (The first day of a period counts as Day 1 of a new cycle.) This seems to be the most effective regimen in my patients, although some women need to use the higher amounts every day, and others only need to use the higher dosage from just before ovulation (which occurs about Day 14) until menses.

Exercise and diet are also essential in treating PMS. Regular aerobic exercise improves moods and relieves depression; it also helps with bloating and cramps. Frequent, small high-carbohydrate meals also improve mood by elevating serotonin levels in the brain. It is important to eat complex carbohydrates such as vegetables and whole grains rather than simple carbohydrates such as cookies and candy. Available over-the-counter is a special carbohydrate drink called "PMS Escape"; it is effective and convenient, but it is also more expensive than eating a whole-wheat bagel. Avoid alcohol, simple sugars and excess fat.

If these measures fail, or if your emotional symptoms are especially severe, talk to your doctor about whether you might benefit from one of the SSRI antidepressants. Medications such as Prozac and Zoloft are very effective in treating PMS. In fact, in most studies, they are one of the very few treatments shown over and over again to provide statistically significant improvement.

A final important point -- not all moodiness in women is PMS. Medical conditions (such as thyroid problems and diabetes) and psychiatric illnesses (such as depression) can share many of the same symptoms. If your symptoms continue to be bothersome, you may want to discuss the options that I have mentioned with your doctor. Otherwise, please see your doctor.