Recent evidence suggests that the inflammatory response, which may be triggered by hormonal fluctuations, could contribute to the mood disturbances, fatigue and physical symptoms commonly seen in PMDD and PMS.101 Barone et al102 presented elevated levels of the pro-inflammatory markers IL-8/CXCL-8 and TNF-α during the luteal phase in a PMDD group compared to controls. This evidence concerns the gene CXCL8 and premenstrual tension.