There have been days, weeks even, some women say, when they felt they were out of control. When they'd cry for no reason, and scream at their kids over nothing; when they couldn't get out of bed because of depression or heart-racing anxiety or overwhelming fatigue.
But they couldn't explain why -- and they couldn't put a name to their symptoms -- until, finally, they recognized the cyclic pattern of premenstrual syndrome, or PMS, and sought treatment.
"I was a raging looney-tune," confessed Cindy Richardson, 39, of Carroll County, whose mood swings sent her into weeping fits for no reason.
"I thought I was losing my grip," said Susan Orthaus, a 38-year-old Towson nurse who used to wake up at night with heart pounding and hands sweating.
One of those closet ailments that no one talked about in the days when "menstruation" was treated like a four-letter word, PMS is now defined as physical, emotional and behavioral changes that occur, month after month, during the weeks between ovulation and menstruation -- caused by hormonal changes -- and strike with a severity that interferes with normal life.
And, in recent years, the syndrome, incurable except by menopause, has been at the receiving end of increased efforts ** to treat it in a variety of ways, from drugs to nutritional manipulations to behavioral management:
* There's a new PMS Center in Towson, directed by a psychiatrist and an internist-endocrinologist, and staffed by a clinical social worker, a psychiatric nurse and an educator, where the emphasis is on education in nutrition, physiology and stress reduction.
* There's a 3 1/2 -year-old PMS support group in the Women's Resource Center at Greater Baltimore Medical Center, where women get the company -- and coping tips -- of others like themselves.
* There are also area physicians who devote a part of their practice to helping women who feel their lives go out of control for a good part of every month.
But the attention to the syndrome has come at a price. There's something so Roseanne Barr-ish about the nasty-woman-with-PMS jokes. Something mean-spirited in the report that a Male Premenstrual Victims Association, with MPMVA T-shirts, was founded in Oregon.
Something that roused troubling echoes of the "raging hormones" argument against women's equality when a female surgeon from Virginia arrested for driving under the influence and attempting to assault police officers was acquitted in June, after her lawyer argued that the Breathalyzer test was inaccurate and that her abusive behavior could have been caused by PMS.
Irritability, rage, even violence are, in fact, among the more than 150 symptoms associated with PMS according to Dr. Samuel Smith, an obstetrician-gynecologist, who sees five or six new PMS patients each month, usually on referral from other physicians.
"I've seen patients who threaten suicide, who are violent toward their husbands or abusive to their children," says Dr. Smith, who is also director of reproductive endocrinology-fertility at the hospital.
"A patient like that should be managed by a psychiatrist as well as a gynecologist," he says.
Fluid retention, breast tenderness, swelling of the feet and fingers, headaches, bizarre appetite, food cravings, extreme fatigue, insomnia, substance abuse, difficulty in concentrating, weepiness, depression, mood swings and anxiety attacks are also on the symptom list.
About 90 percent of women in the childbearing years are uncomfortably aware that they're premenstrual, but not so uncomfortable that they think they can't cope.
But in a sizable minority -- possibly 20 to 40 percent of women aged 15 to 50 -- the symptoms escalate to the severity of a syndrome; and in 3 or 4 percent, the ferocity of the symptoms is such that the woman poses a danger to herself or others, according to Dr. Smith.
But what women complain about most are the emotional and behavioral aspects. "They say, 'I'm angry, I'm out of control, I'm depressed, I cry and laugh and don't know why -- and that's not like me,' " reports Dr. Gay Guzinski, chief of outpatient obstetrics and gynecology at the University of Maryland Medical Center and director of the PMS Evaluation Program there.
"One [woman] came right out and said she could eat a box of chocolate chip cookies and four sandwiches at a sitting," says Betsy Fleming-Rice, the educator at the PMS Center, which opened in July and has already taken a group of eight women through the eight-hour program. They've also said they feel like witches, like Jekyll and Hyde.
Those symptoms can be charted; in fact, most people who treat PMS require that women do so, on a special symptom calendar. The onset of menstruation is Day 1; ovulation usually occurs around Day 14. PMS symptoms, by definition, follow ovulation, and remit after menstruation begins, although some women continue to feel uncomfortable for another few days.