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Contents 1 What Is Menstruation? 1.1 How does it happen? 1.2 How long does menstruation last? 1.3 How much bleeding is normal? 1.3.1 Normal bleeding 1.3.2 Heavy bleeding, or menorrhagia 1.3.2.1 What Is Anemia? 1.3.2.1.1 Iron-Deficiency Anemia 1.3.2.1.2 Vitamin Deficiency, or Megaloblastic Anemia 1.3.2.1.3 Inherited/Hereditary Anemia 1.3.2.1.4 Aplastic and Other Types of Anemia 1.4 Why is my cycle so irregular? 1.5 Where the @#%! is my period? 1.5.1 Primary amenorrhea 1.5.2 Secondary amenorrhea 1.5.3 Am I pregnant? 1.6 How can I keep track of my cycle? 1.6.1 Pen and paper method, a.k.a. the old-fashioned way 1.6.2 Online cycle trackers 1.7 Can I have sex while I'm menstruating? 1.7.1 What else should I know? 1.7.2 Is it true that I don't need to use birth control if I have sex during menstruation? 1.8 Menstrual cramps, or dysmenorrhea 1.8.1 What are some symptoms of dysmenorrhea? 1.8.2 What causes dysmenorrhea? 1.8.2.1 Primary dysmenorrhea 1.8.2.2 Secondary dysmenorrhea 1.9 Spotting 1.9.1 What is spotting? 1.9.2 What causes it? 1.9.3 Should I be worried if I experience it? 1.10 Premenstrual Syndrome (PMS) 1.10.1 What is PMS? 1.10.2 What are some symptoms of PMS? 1.10.3 What causes PMS? 1.10.4 How is PMS treated? 1.11 Premenstrual Dysphoric Disorder (PMDD) 1.11.1 What is premenstrual dysphoric disorder (PMDD)? 1.11.2 What causes PMDD? 1.11.3 What are some symptoms of PMDD? 1.11.4 How is PMDD treated? 1.12 Endometriosis 1.12.1 What is endometriosis? 1.12.2 What are some symptoms of endometriosis? 1.12.3 How is endometriosis treated?

[edit] What Is Menstruation?

Menstruation is the part of a woman's menstrual cycle during which the lining of the uterus, also known as the endometrium, along with blood produced by the blood vessels within the uterus, is shed via the cervix and vagina. Women use a variety of menstrual products during this time to absorb or contain menstrual fluid.

[edit] How does it happen?

Menstruation can be divided into two phases.

The Follicular (or Proliferative) Phase

This phase begins with the first day of menstruation, and can vary somewhat in length.

According to Planned Parenthood:

The first part of the cycle, from the first day of menstruation to ovulation, may vary from 13 to 20 days in length. The length of the first part is not only different from one woman to another, but also differs in some women from month to month. It is during this critical first part of the cycle that fertilization can occur. Such common circumstances as sickness, worry, physical exertion, and even sudden changes in climate may occasionally upset a regular pattern by shortening it or extending it.

Source: "Fertility Awareness-based Methods," Planned Parenthood

After the bleeding stops, levels of Follicle-Stimulating Hormone (FSH) begin to rise, which causes several (between 10 and 20 according to Our Bodies, Ourselves, though usually only one will reach maturity -- the rest are reabsorbed by the body) follicles on the ovaries to begin maturing in order to produce eggs. FSH also triggers an increase in another hormone, estrogen (produced by the ovaries), which in turn causes an increase in the body's production of Luteinizing Hormone (LH).

During its maturation, the follicle releases the hormone estrogen, which stimulates thickening of the uterine lining, or endometrium, and increases the flow of blood to the glands there.

The Luteal (or Premenstrual) Phase

This phase typically lasts about fourteen days. According to Planned Parenthood, "[t]he second part of the cycle, from ovulation to the first day of menstruation, is about the same length in all women."

Once the follicle ruptures, releasing a mature egg, it is then referred to as the corpus luteum ("yellow body"). The corpus luteum releases another hormone called progesterone, and this hormone causes the glands in the endometrium to produce substances designed to nourish a developing embryo.

It is at this point in the menstrual cycle, after ovulation, that fertilization of an egg by male sperm cells can occur. If this does occur, the fertilized egg can implant in the thickened uterine lining.

If fertilization does not occur, the corpus luteum will continue to produce estrogen and progesterone for about twelve days. When levels of these two hormones begin to drop, the network of arteries and veins that nourish the endometrium begin to close off again. Lacking nourishment, the lining begins to slough off and the cycle begins anew. The entire lining is not shed -- some of it remains, and serves as a base for development of the next cycle's lining.

Sources:

Our Bodies, Ourselves: A New Edition for a New Era, The Boston Women's Health Collective

Menstruation 101, Tracee Cornforth, womenshealth.about.com

"Fertility Awareness-based Methods," Planned Parenthood

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[edit] How long does menstruation last?

Menstruation can last anywhere between two and eight days; the average length is four to six days. Menstruation may not last for the same number of days with every cycle, and some variation is normal.

In a larger sense of the question, menstruation lasts from menarche (pronounced men-ar-kee), or the onset of menstruation, through menopause, or the cessation of it.

According to Our Bodies, Ourselves, the average age of menarche is twelve and a half, with the normal range being between nine and eighteen; the average age of menopause is fifty, with any age from forty to fifty-five being considered normal.

Source:

Our Bodies, Ourselves: A New Edition for a New Era, The Boston Women's Health Collective

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[edit] How much bleeding is normal?

[edit] Normal bleeding

According to the Mayo Clinic, "[n]ormal menstrual flow occurs about every 28 days, lasts four to five days and produces a total blood loss of 60 to 250 milliliters (4 tablespoons to about 1 cup)."

Of course, it can be very hard to measure blood loss during menstruation. Users of menstrual cups may find it easier to measure the total amount of blood lost during menstruation, as they can keep track of how much menstrual fluid is in the cup each time it is emptied. For those who use pads or tampons, the Mansfield-Voda-Jorgensen Menstrual Bleeding Scale may be helpful in determining how heavy their bleeding is.

Mansfield-Voda-Jorgensen Menstrual Bleeding Scale Spotting. A drop or two of blood, not even requiring sanitary protection though you may prefer to use some. Very light bleeding. You would need to change the least absorbent tampon or pad one or two times per day, though you may prefer to change more frequently. Light bleeding. You would need to change a low or regular absorbency tampon or pad two or three times per day, though you may prefer to change more frequently. Moderate bleeding. You would need to change a regular absorbency tampon or pad every three to four hours, though you may prefer to change more frequently. Heavy bleeding. You would need to change a high absorbency tampon or pad every three to four hours, though you may prefer to change more frequently. Very heavy bleeding or gushing. Protection hardly works at all; you would need to change the highest absorbency tampon or pad every hour or two.

[edit] Heavy bleeding, or menorrhagia

Heavy bleeding, i.e. a six on the Mansfield-Voda-Jorgensen scale, is known as menorrhagia. There are many possible causes. Some listed by Our Bodies, Ourselves are:

• Not ovulating during a cycle (also known as anovulatory menstruation) -- this happens more frequently to women in perimenopause or menopause but can also happen to premenopausal women
• Being under severe stress
• Having a copper IUD (such as the Paragard)
• Experiencing an early miscarriage
• Having uterine fibroids or tumors

Menorrhagia is something that you should mention to your healthcare provider. Other symptoms of menorrhagia (according to the Mayo Clinic) include:

• A menstrual period lasting longer than seven days
• Large blood clots (though some blood clots are normal)
• Menstrual flow so heavy (think a 6 on the scale above) that it interferes with your regular activities
• Constant lower abdominal pain during a menstrual period
• Irregular menstrual periods
• Signs of anemia such as tiredness, fatigue, and shortness of breath

[edit] What Is Anemia?

Our Bodies, Ourselves says:

The hemoglobin molecule in red blood cells carries oxygen to every part of the body. Anemia results from a shortage of red blood cells and/or their low hemoglobin content, so that our tissues get less oxygen.

Some possible signs of anemia include:

• Fatigue
• Irritability
• Dizziness
• Memory problems
• Low body temperature
• Pale or ashen skin
• Rapid heartbeat
• Shortness of breath
• Headaches
• Numbness or coldness in hands and feet

Mild anemia may have no recognizable symptoms. Your healthcare provider can do a simple blood test (called a hematocrit) to determine whether or not you have anemia, and can help you devise a treatment plan.

There are two different types of anemia.

[edit] Iron-Deficiency Anemia

This type of anemia occurs when your body does not have enough iron. This can be caused by heavy menstrual periods, pregnancy, miscarriage, abortion, childbirth, ulcers, colon polyps, colon cancer or fibroid surgery.

Ways to prevent/treat this type of anemia:

• Adding more iron-rich foods to your diet
  • Some examples of iron-rich foods:
    • red meat
    • clams
    • spinach
    • lentils
    • baked potato with skin
    • sunflower seeds
    • cashews
    • blackstrap molasses
• Cooking in iron pots and pans
• Taking iron supplements

[edit] Vitamin Deficiency, or Megaloblastic Anemia

This type of anemia results from a lack of folic acid and/or vitamin B₁₂. This can happen to women who are pregnant, have had many children, are taking oral contraceptives, or are malnourished.

Ways to prevent/treat this type of anemia:

• Eating foods rich in folic acid and B₁₂
  • whole grains such as wheat bran
  • leafy green vegetables
  • beans and legumes
  • citrus fruits and juices
  • poultry, pork, shellfish and liver
• Taking folic acid supplements
• Taking dietary supplements such as brewer's yeast and spirulina

Some women suffer from a condition called pernicious anemia. Their bodies lack a protein called the intrinsic factor which allows the body to properly absorb B₁₂. Women with this condition may need to get monthly B₁₂ injections or take additional B₁₂ supplements.

[edit] Inherited/Hereditary Anemia

There are some forms of anemia that are inherited, such as sickle-cell anemia and thalassemia.

[edit] Aplastic and Other Types of Anemia

Aplastic anemia can also be the result of such illnesses or treatments for illnesses such as kidney disease, thyroid disease, arthritis, cancer, lupus or diseases/infections of the bone marrow, and by exposure to toxic chemicals.

Sources:

Menorrhagia (heavy menstrual bleeding) -- The Mayo Clinic

Menstrual Mysteries -- Her Body, Jan 31 2006, Newsweek

Anemia -- womenshealth.gov

Our Bodies, Ourselves: A New Edition for a New Era, The Boston Women's Health Collective

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[edit] Why is my cycle so irregular?

From Our Bodies, Ourselves:

Often we think of periods as occurring once per month. (In fact, the word "menstruation" is from the Latin mensis, for "month.") While some women's periods do occur exactly every month, other women have cycles that are longer or shorter. Some women have regular cycles (they bleed every twenty-eight or forty days, for instance), while other women have alternating long and short cycles. There are spontaneous small changes, and there can be major changes when a woman is under a great deal of stress or loses a significant amount of body fat. As you get older, or if you have a baby, you may notice more significant changes in your cycle length.

If you miss more than three periods in a row, or are experiencing symptoms consistent with amenorrhea, you should consult your healthcare provider.

Source:

Our Bodies, Ourselves: A New Edition for a New Era, The Boston Women's Health Collective

[edit] Where the @#%! is my period?

The absence of menstruation is called amenorrhea. Amenorrhea can also be characterized by extremely light, short periods.

There are two types of amenorrhea.

[edit] Primary amenorrhea

Primary amenorrhea occurs when a woman does not begin menstruating by the the age of 16. Generally speaking, if you are over the age of sixteen and have not yet begun menstruating, you should see your heathcare provider, as some of the causes of primary amenorrhea (such as hormone imbalance or ovarian problems) require medical treatment.

[edit] Secondary amenorrhea

Secondary amenorrhea refers to the cessation of menstruation after menarche. Many women experience amenorrhea at some point during their lifetime.

Some of the possible causes are:

• Pregnancy
• Menopause
• Breastfeeding
• Strenuous physical exercise
• Emotional issues
• Stress
• Recent use of hormonal birth control or emergency contraception
• Extreme dieting or anorexia
• Significant weight loss
• Drug use
• Hormonal imbalance (such as Polycystic Ovarian Syndrome, or PCOS)
• Tumors or cysts
• Chronic illness
• Malnutrition
• Thyroid disease
• Infertility

[edit] Am I pregnant?

For women of childbearing age who are sexually active, this can be a pressing concern when amenorrhea occurs.

As you can see from the previous section, there are many causes of amenorrhea besides pregnancy. However, if you are concerned that you may be pregnant, you may find that the best course of action is to purchase an at-home pregnancy test (which can be found at virtually any drugstore/pharmacy or grocery store, and at most retail outlets that sell condoms and other forms of birth control) or to visit your heathcare provider to be tested. If you are pregnant, it is best to know as early as possible in the pregnancy.

While it's natural and understandable to worry about prengnacy, it's important to keep in mind the odds of pregnancy occurring. If you are correctly using some form of birth control (either hormonal methods such as the pill or non-hormonal methods such as condoms), your odds of being pregnant are greatly reduced. Even women having completely unprotected sexual intercourse will not always become pregnant, and many people who are trying to conceive have to try for some time before becoming pregnant.

Sources:

Our Bodies, Ourselves: A New Edition for a New Era, The Boston Women's Health Collective

"Why Is My Period Late?" -- Tracee Cornforth, womenshealth.about.com

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[edit] How can I keep track of my cycle?

Many women keep track of their menstrual cycles. Some do so as part of the Fertility Awareness Method, which is a way of predicting one's fertile and non-fertile days. Other women like to keep track of their cycles simply to increase their knowledge, and to become more familiar with how their bodies work.

[edit] Pen and paper method, a.k.a. the old-fashioned way

You can use pen and paper (in the form of a calender) to track your cycle. This is a good method to use if you don't have regular internet access, or if you prefer to have a hard copy of your results. Below is a simple way to track your cycle with a regular calendar, as explained by Tracee Cornforth at About.com.

Source: "How to Make a Menstrual Cycle Calendar," Tracee Cornforth, womenshealth.about.com |}

[edit] Online cycle trackers

Or you can use one of the many free online cycle tracking programs. Like an internet email account, you can log into these sites from any computer, and keep your information private. Some to try are:

• The Cycles Page
• MyCycle
• MyMonthyCycles

[edit] Can I have sex while I'm menstruating?

The short answer is "Yes! Absolutely!"

[edit] What else should I know?

Period sex can be messy sometimes.

But don't let that stop you! Try putting down a towel to avoid staining sheets or furniture, or engaging in sex/sexual play in the shower, where a mess is easily washed away. Some women find they are able to wear Insteads (a type of menstrual cup) during penetrative vaginal sex, because they sit far enough up in the vagina that they are usually not felt during sex. Others find that they can enjoy other sexual activities (oral sex, mutual masturbation) while wearing a tampon or regular, non-disposable menstrual cup.

If you do end up with a few bloodstains, check out what VP members recommend for getting them out.

There is a broad range of feelings about period sex -- some people are totally comfortable with it, but others are not.

Many people find that menstruation does not hamper their enjoyment of sex in the slightest, and are comfortable engaging in all manner of sexual activity during menstruation. (Some people, in fact, report enjoying period sex more than sex at any other time, and some women report that orgasm helps alleviate their menstrual cramps.) Others prefer to limit their sexual activities to those they are comfortable with (for instance, some people prefer not to perform oral sex on a woman who is menstruating; others may prefer to avoid penetrative sex during menstruation), and some prefer to avoid sexual activity during menstruation altogether. These are all valid choices, and it is important to discuss them with your partner(s), to be respectful of their feelings and for them to be respectful of yours.

See what other VP members have to say about period sex!

Menstruation can increase the risk of spreading HIV during sex.

It is important to note that because of the presence of blood (which contains a higher concentration of the virus than vaginal fluid), sex during menstruation can make it easier for HIV to pass from an HIV-positive woman who is menstruating to her partner. HIV can also be spread from an HIV-positive woman to a partner when she is not menstruating, so it is important to know your partner(s)' HIV status and to be safe at all times. See our entry on Safer Sex for more information on how to be safe.

Source: "How HIV Is Spread" -- San Francisco AIDS Foundation

[edit] Is it true that I don't need to use birth control if I have sex during menstruation?

No, it is not. While women are not typically fertile while menstruating, it is possible for sperm that enters the body to remain potent for several days -- if a woman has unprotected sex while menstruating, she could ovulate later and the egg could be fertilized by sperm that remains in her body. To prevent pregnancy it is important to use birth control at all times, even during menstruation.

Note: If you are using a method of hormonal birth control correctly, you are still protected from pregnancy during your hormone-free (or placebo) week.

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[edit] Menstrual cramps, or dysmenorrhea

Cramps, or dysmenorrhea, are a very common side effect of menstruation. Many women experience menstrual cramps at some time during their life. For some women, they are merely uncomfortable; however, for others they can be extremely painful and when the occur can interfere with their usual activities.

If cramping interferes with your life for several days per month, or if you have been menstruating for more than a few years and have suddenly begun experiencing severe cramps, you should see your doctor.

[edit] What are some symptoms of dysmenorrhea?

Symptoms of dysmenorrhea can include:

• Dull or throbbing pain in your lower abdomen
• Pain that radiates to your lower back and thighs
• Nausea and vomiting
• Loose stools
• Sweating
• Dizziness

[edit] What causes dysmenorrhea?

According to the Mayo Clinic, there are two types of dysmenorrhea.

[edit] Primary dysmenorrhea

Primary dysmenorrhea is not caused by any other problem (fibroids, for example, or endometriosis. Often you can treat the cramps with simple at-home measures.

Primary dysmenorrhea is believed to be caused by prostaglandins, hormone-like substances involved in pain and inflammation. Prostaglandins are thought to cause the uterine muscle contractions that cause menstrual cramps.

Some treatments for primary dysmenorrhea include:

• OTC painkillers like ibuprofen (Advil, Motrin), naproxen (Aleve), or acetaminophen (Tylenol)
• Gentle heat, in the form of a heating pad or hot water bottle
• Hormonal birth control
• Orgasm
• Some yoga positions
• Acupuncture
• Self-care strategies such as:
  • Getting regular exercise
  • Getting adequate rest
  • Eating foods rich in omega-3 fatty acids (such as fish) or taking an omega-3 supplement (try fish or flaxseed oil capsules)
  • Taking a multivitamin that contains adequate amounts of calcium, magesium, vitamin B₆ and vitamin E
  • Limiting consumption of caffeine, carbohydrates, and red meat, and eating more fresh vegetables, whole grains, nuts/seeds, and fruit

[edit] Secondary dysmenorrhea

Secondary dysmenorrhea is dysmenorrhea that is caused by another condition. Treatment of this type of dysmenorrhea usually involves treating that underlying condition.

Some of the conditions that cause secondary dysmenorrhea include:

• Endometriosis
• Pelvic inflammatory disease (PID)
• Use of an intrauterine device (IUD)
• Uterine fibroids and uterine polyps

Treatment for secondary dysmenorrhea depends on the underlying cause.

Sources:

Our Bodies, Ourselves: A New Edition for a New Era, The Boston Women's Health Collective

The Mayo Clinic -- Menstrual cramps (dysmenorrhea)

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[edit] Spotting

[edit] What is spotting?

Spotting is light bleeding that occurs outside of normal menstruation.

[edit] What causes it?

Spotting can occur for many reasons. Spotting a few days before you are due to being menstruating is normal, as is spotting during the first few months of hormonal birth control use.

Spotting can also be a sign that you are pregnant. The Mayo Clinic has the following to say about this type of spotting, commonly called implantation bleeding:

You may notice a small amount of spotting or bleeding very early in pregnancy, about 10 to 14 days after fertilization. Known as implantation bleeding, it happens when the fertilized egg attaches to the lining of your uterus. It's usually earlier, spottier and lighter in color than a normal menstrual period, and it doesn't last long. Some women actually mistake this light bleeding for a period and don't realize they're pregnant.

If you are experiencing spotting and are concerned that you might be pregnant, you may want to purchase and take a home pregnancy test, or visit your healthcare provider for a test.

Other causes of spotting listed by the Mayo Clinic include:

Hormonal fluctuations (this is the most common cause of spotting in premenopausal women) Menstrual dysfunction Vaginal infection Tumors, polyps or fibroids of the vagina, cervix, uterus, or fallopian tubes Cervical disorders -- such as cervical ectropion, a condition common among younger women, especially young women taking birth control pills -- in which the cervical tissue becomes more suspectible to abrasion, often associated with bleeding after sexual intercourse Cancer of the uterus, cervix, vagina or vulva Some sexually transmitted diseases, such as chlamydia, gonorrhea or genital warts Vagina injury from trauma or sexual abuse Source: The Mayo Clinic -- Vaginal bleeding: What's normal, what's not?

If you are experiencing spotting that is not caused by pregnancy or hormonal birth control, you may want to schedule an appointment with your healthcare provider to discuss it. In premenopausal women, spotting most often has a benign cause (such as hormonal fluctuation), but since some of the rarer causes are conditions requiring medical treatment, a visit to your healthcare provider may be in order.

If you experience any type of vaginal bleeding or spotting before menarche (the onset of menstruation) or after menopause or total hysterectomy, you should also contact your healthcare provider.

[edit] Should I be worried if I experience it?

The cause of spotting is not likely to be anything life-threatening. As mentioned above, you should contact your healthcare provider if you cannot pinpoint a likely reason for spotting.

Source:

The Mayo Clinic -- Vaginal bleeding: What's normal, what's not?

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[edit] Premenstrual Syndrome (PMS)

[edit] What is PMS?

Premenstrual syndrome, or PMS is the phrase used to describe the negative changes some women notice several days before and sometimes several days after menstrual bleeding begins.

It should also be noted that not all feelings associated with the premenstrual phase of a woman's cycle are negative. Some women find that they feel more creative or more energetic during this time in their cycle. If you are tracking your menstrual cycle, you may want to note both positive and negative premenstrual feelings so as to keep things in perspective.

[edit] What are some symptoms of PMS?

According to the Mayo Clinic, the following symptoms are often associated with PMS:

Weight gain from fluid retention Abdominal bloating Breast tenderness Tension or anxiety Depressed mood Crying spells Mood swings and irritability or anger Appetite changes and food cravings Trouble falling asleep (insomnia) Joint or muscle pain Headache Fatigue Source: Premenstrual syndrome (PMS) -- The Mayo Clinic

Most women do not experience every single one of those problems. Those who do may be suffering from a more severe form of PMS, called premenstrual dysphoric disorder (PMDD).

[edit] What causes PMS?

It's believed that more than one factor may be responsible for PMS.

Some potential causes, according to the Mayo Clinic:

Cyclic changes in hormones Chemical changes in the brain, specifically fluctuations in serotonin levels Low levels of vitamins and minerals Salty foods Alcohol Caffeine Undiagnosed depression (this is considered more likely in cases of extreme PMS or PMDD) Source: Premenstrual syndrome (PMS) -- The Mayo Clinic

[edit] How is PMS treated?

Some treatments you can try yourself at home:

• Change your diet
  • Eat smaller and more frequent meals
  • Limit consumption of salt/salty foods, caffeine, and alcohol
  • Eat foods high in complex carbohydrates (whole grains, beans, fruits, vegetables)
  • Take a daily multivitamin (one with adequate amounts of vitamin B₆ and calcium
  • Take a supplement containing omega-3 fatty acids (try fish or flaxseed oil capsules, or straight flaxseed oil)
• Get regular exercise
• Get plenty of sleep
• Practice meditation or other relaxation exercises

Some treatments commonly prescribed by physicians are:

• OTC painkillers like ibuprofen (Advil, Motrin) or naproxen (Aleve)
• Oral contraceptives
• Antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), in cases of severe PMS that may involve untreated depression
• Medroxyprogesterone acetate (Depo-Provera), for severe PMS or PMDD; this injection may be used to temporarily stop ovulation, but can also increase some symptoms of PMS

Sources:

Premenstrual syndrome (PMS) -- The Mayo Clinic

Our Bodies, Ourselves: A New Edition for a New Era, The Boston Women's Health Collective

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[edit] Premenstrual Dysphoric Disorder (PMDD)

[edit] What is premenstrual dysphoric disorder (PMDD)?

According to the Mayo Clinic, "for some women with premenstrual syndrome, symptoms are so severe they're considered disabling. This form of PMS has its own psychiatric designation — premenstrual dysphoric disorder (PMDD). PMDD is a severe form of premenstrual syndrome with symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability and tension. A number of women with severe PMS may have an underlying psychiatric disorder."

PMDD is quite rare -- the Mayo Clinic estimates that of all menstruating women, only about eight percent have PMDD.

[edit] What causes PMDD?

Doctors are not sure what exactly causes PMDD. Some women with PMDD also have major depression, but this isn't always the case.

[edit] What are some symptoms of PMDD?

According to the Mayo Clinic, some of the symptoms of PMDD include:

Persisent sadness or depression Marked anxiety, feelings of being "keyed up" or "on edge" Mood swings often marked by periods of teariness Persistent or marked anger or irritability Decreased interest in usual activities Fatigue or lethargy A feeling of being overwhelmed or out of control Flu-like symptoms, incluing muscle aches, headaches and joint pain Changes in sleep patterns -- problems falling and staying asleep or sleeping too much Changes in appetite -- overeating, lack of appetite or specific food cravings Source: "Premenstrual dysphoric disorder (PMDD): A severe form of PMS," MayoClinic.com

You should talk with your healthcare provider if you think that you may have PMDD.

[edit] How is PMDD treated?

Because it is often associated with depression, PMDD may be treated with antidepressants, specifically SSRIs (selective serotonin reuptake inhibitors).

Other things that may help relieve PMDD:

• Getting regular exercise
• Limiting caffeine intake
• Increasing consumption of carbohydrates in the week prior to menstruation
• Taking ver-the-counter pain relievers like ibuprofen (Advil) and aspirin
• Taking calcium supplements
• Taking an herbal supplement such as chasteberry

Sources:

Premenstrual dysphoric disorder (PMDD): A severe form of PMS -- MayoClinic.com

Premenstrual syndrome (PMS) - MayoClinic.com

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[edit] Endometriosis

[edit] What is endometriosis?

Endometriosis occurs when fragments of the uterine lining, or endometrium, become implanted outside the uterus. Like the rest of the uterine lining, these fragments respond to the hormonal changes of the menstrual cycle, thickening and then sloughing off. There is nowhere for the blood shed by these fragments to go, and so it becomes trapped and can irritate and inflame the surrounding tissue.

This trapped blood can cause cysts to grow, and cysts can lead to scar tissue and adheseions -- all of which can cause pelvic pain during menstruation and at other times of a woman's cycle.

[edit] What are some symptoms of endometriosis?

• Dysmenorrhea
• General pelvic pain, lower back pain, and/or abdominal pain
• Pain beginning before and extending into your menstrual period
• Pelvic pain during ovulation, sexual intercourse, bowel movements or urination
• Heavy bleeding during menstrual periods
• Infertility

[edit] How is endometriosis treated?

There are a number of ways to treat endometriosis, ranging from pain management to surgery. It can take some time to determine which method of treatment is best for an individual sufferer.

Some of the options available are:

• Over-the-counter pain relievers like ibuprofen (Advil)
• Hormone therapy using
  • Oral contraceptives
  • Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists
  • Danazol (Danocrine)
  • Medroxyprogesterone (Depo-Provera)
• Surgery to remove endometrial tissue, scar tissue, and adhesions
• Hysterectomy (with or without removal of ovaries) -- these is an extreme option, used only in cases where no other treatment is successful

Source:

"Endometriosis," MayoClinic.com

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