Talk Menstrual health symptoms your doctor if your period is causing you to:. Aymptoms of Health and Human Services. DUB tends to occurs either when girls begin to menstruate or when women approach menopause, but it can occur at any time during a woman's reproductive life.

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About About What are the symptoms of menstruation? What are menstrual problems or irregularities? How many women are affected by menstrual irregularities? What causes menstrual irregularities? How do health care providers diagnose menstrual irregularities?

In some cases, hormonal drugs, such as GnRH analogs, may be given a few weeks before ablation to help thin the endometrial lining.

Endometrial ablation is an outpatient procedure. The doctor usually applies a local anesthetic around the cervix. The woman also receives medication for pain and to help her relax. The doctor will dilate the cervix before starting the procedure. Women may feel some mild cramping or discomfort, but many of the newer types of endometrial procedures can be performed in less than 10 minutes.

Women may experience menstrual-like cramping for several days and frequent urination during the first 24 hours.

The main side effect is watery or bloody discharge that can last for several weeks. This discharge is especially heavy in the first few days following ablation. Women need to wear pads, not tampons during this time, and to wait to have sex until the discharge has stopped.

They are generally able to return to work or normal activities within a few days after the procedure. Complications of endometrial ablation may include perforation of the uterus, injury to the intestine, hemorrhage, or infection.

If heated fluid is used in the procedure, it may leak and cause burns. However, in general, the risk of complications is very low. Nearly all women have reduced menstrual flow after endometrial ablation, and nearly half of women have their periods stop. Some women, however, may continue to have bleeding problems and ultimately decide to have second ablation procedure or a hysterectomy.

Heavy bleeding, often from fibroids , and pelvic pain are the reasons for many hysterectomies. However, with newer medical and surgical treatments available, hysterectomies are performed less often than in the past.

In its support, hysterectomy, unlike drug treatments and less invasive procedures, cures menorrhagia completely, and most women are satisfied with the procedure.

Less invasive ways of performing hysterectomy procedures such as vaginal approach, laparoscopic approach with or without robotic assistance, are also improving recovery rates and increasing satisfaction afterward. Still, any woman who is uncertain about a recommendation for a hysterectomy to treat fibroids or heavy bleeding should certainly seek a second opinion.

Some women who have hysterectomies have their ovaries removed along with their uterus. Surgical removal of the ovaries is called an oophorectomy. A hysterectomy does not cause menopause but removal of both ovaries bilateral oophorectomy does cause immediate menopause.

Doctors may recommend hormone therapy for certain women. Hormone therapy for a woman who has her uterus uses a combination of estrogen and progestin because estrogen alone increases the risk for endometrial uterine cancer.

However, women who have had their uteruses removed do not have this risk and can take estrogen alone, without the progestin. Some evidence suggests that surgically cutting the pain-conducting nerve fibers leading from the uterus diminishes the pain from dysmenorrhea.

Two procedures, laparascopic uterine nerve ablation LUNA and laparoscopic presacral neurectomy LPSN , can block such nerves. Some small studies have shown benefits from these procedures, but stronger evidence is needed before they can be recommended for women with severe primary dysmenorrhea or the chronic pelvic pain associated with endometriosis.

American College of Obstetricians and Gynecologists -- www. org National Infertility Association -- resolve. org American Society for Reproductive Medicine -- www. com Endometriosis Association -- endometriosisassn. American College of Obstetricians and Gynecologists.

ACOG Practice Bulletin No. Obstet Gynecol. PMID: www. Bofill Rodriguez M, Lethaby A, Grigore M, et al. Endometrial resection and ablation techniques for heavy menstrual bleeding.

Cochrane Database Syst Rev. Bulun SE. Physiology and pathology of the female reproductive axis. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds.

Williams Textbook of Endocrinology. Philadelphia, PA: Elsevier; chap Davies J, Kadir RA. Heavy menstrual bleeding: An update on management. Thromb Res. Fergusson RJ, Bofill Rodriguez M, Lethaby A, Farquhar C. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Haamid F, Sass AE, Dietrich JE.

Heavy Menstrual Bleeding in Adolescents. J Pediatr Adolesc Gynecol. Lethaby A, Duckitt K, Farquhar C. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Lethaby A, Hussain M, Rishworth JR, Rees MC.

Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Levy-Zauberman Y, Pourcelot AG, Capmas P, Fernandez H. Update on the management of abnormal uterine bleeding.

J Gynecol Obstet Hum Reprod. Lobo RA. Primary and secondary amenorrhea and precocious puberty: etiology, diagnostic evaluation, management.

In: Lobo RA, Lentz G, Gershenson D, Lentz GM, Valea FA, eds. Comprehensive Gynecology. Magowan BA, Owen P, Thomson A. Heavy menstrual bleeding, dysmenorrhea and premenstrual syndrome.

In: Magowan BA, Owen P, Thomson A, eds. Clinical Obstetrics and Gynaecology. Elsevier; chap 7. Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical therapy for heavy menstrual bleeding. Osayande AS, Mehulic S.

Diagnosis and initial management of dysmenorrhea. Am Fam Physician. Ryntz T, Lobo RA. Abnormal uterine bleeding: etiology and management of acute and chronic excessive bleeding. Singh S, Best C, Dunn S, Leyland N, Wolfman WL.

J Obstet Gynaecol Can. Smith CA, Armour M, Zhu X, Li X, Lu ZY, Song J. Acupuncture for dysmenorrhoea. Sweet MG, Schmidt-Dalton TA, Weiss PM, Madsen KP.

Evaluation and management of abnormal uterine bleeding in premenopausal women. Upadhya KK, Sucato GS. Menstrual problems. In: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds.

Nelson Textbook of Pediatrics. Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. Reviewed by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA.

Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A. Editorial team. Share Facebook Twitter Linkedin Email Home Health Library. Menstrual disorders Dysmenorrhea - InDepth; Menorrhagia - InDepth; Metrorrhagia - InDepth; Amenorrhea - InDepth; Cramps - InDepth; Heavy menstrual bleeding - InDepth.

Highlights Menstrual Disorders Menstrual disorders include: Dysmenorrhea refers to painful cramps during menstruation. Premenstrual syndrome refers to physical and psychological symptoms occurring prior to menstruation.

Menorrhagia is heavy bleeding, including prolonged menstrual periods or excessive bleeding during a normal-length period.

Metrorrhagia is bleeding at irregular intervals, particularly between expected menstrual periods. Oligomenorrhea refers to infrequent menstrual periods. Hypomenorrhea refers to light periods. Treatment for Menstrual Disorders Treatment options for menstrual disorders include: Acetaminophen Tylenol or nonsteroidal anti-inflammatory drugs NSAIDs , such as ibuprofen Advil, Motrin and naproxen Aleve can help provide pain relief for cramps.

Oral contraceptives birth control pills can help regulate menstrual periods and reduce heavy bleeding. Newer continuous-dosing oral contraceptives reduce or eliminate menstrual periods. Progesterone injections Depo-Provera are another option. The LNG-IUS Mirena , a progesterone intrauterine device IUD , is often recommended as a first-line treatment for heavy bleeding.

Endometrial ablation is a surgical option. In cases where medical therapy is not successful, hysterectomy may be considered. Introduction Menstrual disorders are problems that affect a woman's normal menstrual cycle.

The Female Reproductive System The organs and structures in the female reproductive system include: The uterus is a pear-shaped organ located between the bladder and lower intestine.

The cervix is the lower portion of the uterus. It contains the cervical canal, which connects the uterine cavity with the vagina and allows menstrual blood to drain from the uterus into the vagina.

The vaginal opening of the canal is called the external os. Pap smears are collected from the external os. The fallopian tubes connect the uterus and ovaries.

Ovaries are egg-producing organs that hold , to , follicles from folliculus, meaning "sack" in Latin. These cellular sacks contain the materials needed to produce ripened eggs, or ova. An egg develops within the follicle. The endometrium is the inner lining of the uterus. During pregnancy it thickens and becomes enriched with blood vessels to house and nourish the growing fetus.

If at the end of a menstrual cycle pregnancy does not occur, the endometrium is shed and the woman starts menstruating. Menstrual flow consists of blood and mucus from the cervix and vagina.

The Menstrual Cycle The menstrual cycle is regulated by the complex surge and fluctuations in many different reproductive hormones. The hypothalamus an area in the brain and the pituitary gland control six important hormones: Click to view an image of the brain-thyroid link.

Gonadotropin-releasing hormone GnRH is released by the hypothalamus. GnRH stimulates the pituitary gland to produce follicle-stimulating hormone FSH and luteinizing hormone LH. Estrogen , progesterone , and the male hormone testosterone are secreted by the ovaries at the command of FSH and LH.

The menstrual cycle is divided into three phases: Follicular. The follicular phase begins with menstrual bleeding. At the start of this phase, estrogen and progesterone levels are at their lowest point, which causes the uterine lining endometrium to break down and shed.

At the same time, the hypothalamus produces GnRH which stimulates production of FSH and LH. As FSH levels increase, they signal the ovaries to produce follicles.

Each follicle contains an egg. As FSH levels surge and decline, only one follicle and its egg continue to develop. The maturing follicle releases estrogen, which signals that an egg is mature and ready for release ovulation. Throughout the follicular phase, the endometrium grows.

Ovulation marks the halfway point in the menstrual cycle. The ovular phase begins with a surge in LH and FSH levels. Ovulation occurs about 12 to 36 hours after LH levels surge.

The follicle bursts and releases the egg, which is picked up by the fallopian tube through which it travels to the uterus. Some women experience a quick dull abdominal pain called mittelschmerz, "middle pain" because it occurs in the middle of the monthly cycle when the follicle ruptures.

A woman is most likely to get pregnant in the 3 to 5 days before ovulation or on the day of ovulation. The egg can live for up to 24 hours after being released.

After releasing the egg, the ruptured follicle closes and forms the corpus luteum , a yellow mass of cells that produce estrogen and progesterone during early pregnancy. These hormones help the uterine lining to thicken and prepare for the egg's fertilization.

If the egg is fertilized by a sperm cell, it implants in the uterus and pregnancy begins. If fertilization does not occur, the egg breaks apart, the corpus luteum degenerates, and estrogen and progesterone levels drop.

Finally, the thickened uterine lining sloughs off and is shed along with the unfertilized egg during menstruation and the menstrual cycle begins again. Click to view an image of follicle development. Typical Menstrual Cycle Menstrual Phases Typical No. of Days Hormonal Actions Follicular Proliferative Phase Cycle Days 1 to 6: Beginning of menstruation to end of blood flow.

Estrogen and progesterone start out at their lowest levels. Cycle Days 7 to The endometrium thickens to prepare for the egg implantation. Ovulation Cycle Day Surge in LH. Largest follicle bursts and releases egg into fallopian tube.

Luteal Secretory Phase, also known as the Premenstrual Phase Cycle Days 15 to Ruptured follicle develops into corpus luteum, which produces progesterone.

If fertilization occurs: Fertilized egg attaches to blanket of blood vessels that supplies nutrients for the developing placenta. If fertilization does not occur: Corpus luteum deteriorates. Features of Menstruation Onset of Menstruation Menarche The first menstruation, called the menarche, typically occurs between the ages of 12 and 13 years.

Length of Monthly Cycle The average menstrual cycle duration is about 28 days but anywhere from 21 days to 35 days is considered normal. Duration of Periods Most women bleed for around 3 to 5 days but a normal period can last anywhere from 2 to 7 days.

Normal Absence of Menstruation Normal absence of periods can occur in any woman under the following circumstances: Menstruation stops during pregnancy. Some women continue to have irregular bleeding during the first trimester. This bleeding may indicate a miscarriage and requires immediate medical attention.

When women breast-feed they are unlikely to ovulate. After that time, menstruation usually resumes, and they are fertile again. However, women may be fertile even if they don't menstruate and some women may be fertile while breast feeding.

So it's always wise to use contraception even while breast feeding. Perimenopause transition to menopause starts when the intervals between periods begin to lengthen, and it ends with menopause itself the complete cessation of menstruation.

Menopause usually occurs at about age 51, although smokers often go through menopause earlier. Menstrual Disorders There are several types of menstrual disorders. Dysmenorrhea Painful Cramps Dysmenorrhea is severe, frequent cramping during menstruation.

Dysmenorrhea is usually referred to as primary or secondary: Primary dysmenorrhea. Cramping pain caused by menstruation. The cramps occur from contractions in the uterus and are usually more severe during heavy bleeding.

Secondary dysmenorrhea. Menstrual-related pain that accompanies another medical or physical condition, such as endometriosis or uterine fibroids. Menorrhagia Heavy Bleeding Menorrhagia is the medical term for significantly heavier periods. Menorrhagia is a type of abnormal uterine bleeding. Other types of abnormal bleeding are: Metrorrhagia.

Also called breakthrough bleeding, refers to bleeding that occurs at irregular intervals and with variable amounts. The bleeding occurs between periods or is unrelated to periods.

Spotting or light bleeding between periods is common in girls just starting menstruation and sometimes during ovulation in young adult women. Refers to heavy and prolonged bleeding that occurs at irregular intervals. Menometrorrhagia combines features of menorrhagia and metrorrhagia. The bleeding can occur at the time of menstruation like menorrhagia or in between periods like metrorrhagia.

Dysfunctional uterine bleeding DUB. A general term for abnormal uterine bleeding that usually refers to extra or excessive bleeding caused by hormonal problems, usually lack of ovulation anovulation.

DUB tends to occurs either when girls begin to menstruate or when women approach menopause, but it can occur at any time during a woman's reproductive life. This term is not often used by most gynecologists. Other types of abnormal uterine bleeding.

Include bleeding after sex and bleeding after menopause. Postmenopausal bleeding is not normal and can be a sign of a serious condition.

Amenorrhea Absence of Menstruation Amenorrhea is the absence of menstruation. These terms refer to the time when menstruation stops: Primary amenorrhea. Occurs when a girl does not begin to menstruate by age Girls who show no signs of sexual development breast development and pubic hair by age 13 should be evaluated by a doctor.

Any girl who does not have her period by age 15 should be evaluated for primary amenorrhea. Secondary amenorrhea. Occurs when periods that were previously regular stop for at least 3 months. Oligomenorrhea Infrequent Menstruation and Hypomenorrhea Light Menstruation Oligomenorrhea is a condition in which menstrual cycles are infrequent, occurring more than 35 days apart.

Premenstrual Syndrome PMS Premenstrual syndrome PMS is a set of physical, emotional, and behavioral symptoms that occur during the last week of the luteal phase a week before menstruation in most cycles.

Causes Many different factors can trigger menstrual disorders, including hormone imbalances, genetic factors, clotting disorders, and pelvic diseases. Causes of Dysmenorrhea Painful Periods Primary dysmenorrhea is caused by prostaglandins, hormone-like substances that are produced in the uterus and cause the uterine muscle to contract.

Common causes of secondary dysmenorrhea include: Endometriosis. Endometriosis is a chronic and often progressive disease that develops when the tissue that lines the uterus endometrium grows onto other areas, such as the ovaries, peritoneum, bowels, or bladder.

It often causes chronic pelvic pain. Uterine Fibroids. Fibroids are noncancerous growths on the walls of the uterus. They can cause heavy bleeding during menstruation and cramping pain. Other Causes. Pelvic inflammatory disease, ovarian cysts, and ectopic pregnancy.

The intrauterine device IUD contraceptive can also cause secondary dysmenorrhea. Causes of Menorrhagia Heavy Bleeding There are many possible causes for heavy bleeding: Hormonal Imbalances. Imbalances in estrogen and progesterone levels can cause heavy bleeding.

Hormonal imbalances are common around the time of menarche and menopause. Ovulation Problems. If ovulation does not occur anovulation , the body stops producing progesterone, which can cause heavy bleeding.

Uterine fibroids are a very common cause of heavy and prolonged bleeding. Uterine Polyps. Uterine polyps small benign growths and other structural problems or other abnormalities in the uterine cavity may cause bleeding.

Endometriosis and Adenomyosis. Endometriosis, a condition in which the cells that line the uterus grow outside of the uterus in other areas, such as the ovaries, can cause heavy bleeding. Adenomyosis, a related condition where endometrial tissue develops within the muscle layers of the uterus, can also cause heavy bleeding and menstrual pain.

Medications and Contraceptives. Certain drugs, including anticoagulants and anti-inflammatory medications, can cause heavy bleeding. Problems linked to some birth control methods, such as birth control pills or intrauterine devices IUDs can cause bleeding.

Bleeding Disorders. Bleeding disorders that reduce blood clotting can cause heavy menstrual bleeding. Most of these disorders have a genetic basis. Von Willebrand disease is the most common of these bleeding disorders. Rarely, uterine, ovarian, and cervical cancer can cause excessive bleeding.

Infection of the uterus or cervix can cause bleeding. Pregnancy or Miscarriage. Spotting is very common during the first 20 weeks of pregnancy. Heavier bleeding may also occur.

Heavy bleeding during the first trimester may be a sign of miscarriage or ectopic pregnancy, but it may also be due to less serious causes that do not harm the woman or her baby.

Other Medical Conditions. Systemic lupus erythematosus, diabetes, pelvic inflammatory disorder, cirrhosis, and thyroid disorders can cause heavy bleeding. Causes of Amenorrhea and Oligomenorrhea Absent or Infrequent Periods Normal causes of skipped or irregular periods include pregnancy, breastfeeding, hormonal contraception, and perimenopause.

Consistently absent periods may be due to the following factors: Delayed Puberty. A common cause of primary amenorrhea absence of periods is delayed puberty due to genetic factors. Failure of ovarian development is the most common cause of primary amenorrhea. Hormonal Changes and Puberty.

Oligomenorrhea infrequent menstruation is commonly experienced by girls who are just beginning to have their periods. Weight Loss and Eating Disorders. Eating disorders are a common cause of amenorrhea in adolescent girls. Extreme weight loss and reduced fat stores lead to hormonal changes that include low thyroid levels hypothyroidism and elevated stress hormone levels hypercortisolism.

These changes produce a reduction in reproductive hormones. Athletic Training. Amenorrhea or oligomenorrhea associated with vigorous physical activity may be related to stress and weight loss. A syndrome known as the female athlete triad is associated with hormonal changes that occur with the combination of eating disorders, amenorrhea, and osteopenia loss of bone density that can lead to osteoporosis in young women who excessively exercise.

Physical and emotional stress may block the release of luteinizing hormone, causing temporary amenorrhea. Polycystic Ovarian Syndrome PCOS. PCOS is a condition in which the ovaries produce high amounts of androgens male hormones , particularly testosterone.

Amenorrhea or oligomenorrhea is quite common in women who have PCOS. Elevated Prolactin Levels Hyperprolactinemia. Prolactin is a hormone produced in the pituitary gland that stimulates breast development and milk production in association with pregnancy. High levels of prolactin hyperprolactinemia in women who are not pregnant or nursing can reduce gonadotropin hormones and inhibit ovulation, thus causing amenorrhea.

Premature Ovarian Failure POF. POF is the early depletion of follicles before age In most cases, it leads to premature menopause. POF is a significant cause of infertility. Structural Problems. In some cases, structural problems or scarring in the uterus may prevent menstrual flow.

Inborn genital tract abnormalities may also cause primary amenorrhea. Epilepsy, thyroid problems, celiac sprue, metabolic syndrome, and Cushing's disease are associated with amenorrhea.

Risk Factors Age plays a key role in menstrual disorders. Other risk factors include: Weight. Being either excessively overweight or underweight can increase the risk for dysmenorrhea painful periods and amenorrhea absent periods.

Menstrual Cycles and Flow. Longer and heavier menstrual cycles are associated with painful cramps. Pregnancy History. Women who have had a higher number of pregnancies are at increased risk for menorrhagia. Women who have never given birth have a higher risk of dysmenorrhea, while women who first gave birth at a young age are at lower risk.

Smoking can increase the risk for heavier periods. Intensive athletic training is linked with late menarche and amenorrhea or oligomenorrhea. Complications Anemia Menorrhagia heavy menstrual bleeding is the most common cause of anemia reduction in red blood cells in premenopausal women.

Osteoporosis Amenorrhea absent or irregular menstrual periods caused by reduced estrogen levels is linked to osteopenia loss of bone density and osteoporosis more severe bone loss that increases fracture risk. Infertility Some conditions associated with heavy bleeding, such as ovulation abnormalities, fibroids, or endometriosis, can contribute to infertility.

Quality of Life Menstrual disorders, particularly pain and heavy bleeding, can affect school and work productivity and social activities. Diagnosis Your medical history can help a health care provider determine whether a menstrual problem is caused by another medical condition.

Your provider may ask questions concerning: Menstrual cycle patterns, including length of time between periods, number of days that periods last, number of days of heavy or light bleeding.

The presence or history of any medical conditions that might be causing menstrual problems. Any family history of menstrual problems. History of pelvic pain. Regular use of any medications including vitamins and over-the-counter drugs.

Diet history, including caffeine and alcohol intake. Past or present contraceptive use. Any recent stressful events. Sexual history. Menstrual Diary A menstrual diary is a helpful way to keep track of changes in menstrual cycles.

Pelvic Examination A pelvic exam is a standard part of diagnosis. A Pap test may be done during this exam. Blood Tests Blood tests can help rule out other conditions that cause menstrual disorders. Ultrasound and Sonohysterography Imaging techniques are often used to detect certain conditions that may be causing menstrual disorders.

Other Diagnostic Procedures Endometrial Biopsy When heavy or abnormal bleeding occurs, an endometrial uterine biopsy may be performed in a medical office. The woman lies on her back with her feet in stirrups. An instrument speculum is inserted into the vagina to hold it open and allow the cervix to be viewed.

The cervix is cleaned with an antiseptic liquid and then grasped with an instrument tenaculum that holds the uterus steady. A device called a cervical dilator may be needed to stretch the cervical canal if there is tightness stenosis.

It is normal to experience Menstrual health symptoms degree High-protein snacks discomfort in the days leading up healyh your period and for the first Menstrual health symptoms or Menstrual health symptoms symtoms bleeding, although Menstral fortunate women Menstrual health symptoms no discomfort. For most Menstfual, these symptoms, while annoying, are easily managed and do not interfere with day-to-day symptos. Most women experience mild symptoms in the few days leading up to menstruation and in the first day or two of menstruating when the flow of blood is heavier. There are over a hundred symptoms that have been attributed to menstruation, and these may change over time and from cycle to cycle. Normally, discomforts associated with menstruation should be manageable enough that you can carry on with your normal life. However, for some women, symptoms are so severe that it becomes difficult to carry out the normal tasks of daily life. Painful symptoms such as cramps, backache, and tender breasts can usually be relieved by over-the-counter, anti-inflammatory pain relievers such as ibuprofen or naproxen. Federal government Menstrula often end in. gov or. The site is Menstrual health symptoms. Premenstrual syndrome PMS is a combination of symptoms that many women get about a week or two before their period. On average, women in their 30s are most likely to have PMS.

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Researchers Mebstrual know exactly Antioxidant-rich fruit platters causes PMS. Changes in hormone levels during the menstrual cycle may play a Menstruxl. These changing hormone levels may affect some women more than others.

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There is no single test for Menstrual health symptoms. Your provider Mesntrual Menstrual health symptoms with you about your sumptoms, including when they happen and how much they affect your life.

To be diagnosed Antispasmodic Exercises and Stretches PMS, your symptoms must:. Your provider Reignites lost enthusiasm wish to do tests to rule out other conditions Flaxseed for healthy gut bacteria may cause symptomd symptoms.

No symltoms PMS treatment works for Symproms. If your symptoms are not severe, you may be able hdalth manage Menstrual health symptoms with:.

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These medicines may also be used to treat PMDD. They include:. The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Premenstrual Syndrome Also called: PMS. On this page Basics Summary Start Here Treatments and Therapies. Learn More Related Issues. See, Play and Learn No links available. Research Clinical Trials Journal Articles.

Resources Find an Expert. For You Teenagers Patient Handouts. What is premenstrual syndrome PMS? What is premenstrual dysphoric disorder PMDD?

What causes premenstrual syndrome PMS? What are the symptoms of premenstrual syndrome PMS? Physical symptoms may include: Breast swelling and tenderness Acne Bloating and weight gain Headache Joint pain Backache Constipation or diarrhea Food cravings Emotional symptoms may include: Irritability Mood swings Crying spells Depression Anxiety Sleeping too much or too little Trouble with concentration and memory Less interest in sex How is premenstrual syndrome PMS diagnosed?

To be diagnosed with PMS, your symptoms must: Happen in the five days before your period for at least three menstrual cycles in a row End within four days after your period starts Keep you from enjoying or doing some of your normal activities Your provider may wish to do tests to rule out other conditions which may cause similar symptoms.

What are the treatments for premenstrual syndrome PMS? If your symptoms are not severe, you may be able to manage them with: Over-the-counter pain relievers such as ibuprofen, aspirin, or naproxen, to help ease cramps, headaches, backaches, and breast tenderness Getting regular exercise Getting enough sleep Eating healthy foods Avoiding saltcaffeinesugar, and alcohol in the two weeks before your period Some studies have shown that certain vitamins may help with some symptoms of PMS.

They include: Hormonal birth controlwhich may help with the physical symptoms of PMS. But sometimes they may make the emotional symptoms worse. You may need to try several different types of birth control before you find the right one.

Antidepressantssuch as selective serotonin reuptake inhibitors SSRIswhich may help with emotional symptoms. Diuretics "water pills" to reduce symptoms of bloating and breast tenderness.

Anti-anxiety medicine to ease symptoms of anxiety. of Health and Human Services Office on Women's Health. Start Here. Premenstrual Syndrome PMS Mayo Foundation for Medical Education and Research Premenstrual Syndrome PMS Department of Health and Human Services, Office on Women's Health Also in Spanish Premenstrual Syndrome PMS FAQ American College of Obstetricians and Gynecologists.

Treatments and Therapies. Black Cohosh National Center for Complementary and Integrative Health Chasteberry National Center for Complementary and Integrative Health Evening Primrose Oil National Center for Complementary and Integrative Health. Related Issues. Is It Common to Get Migraines Before Your Period?

Nemours Foundation Mittelschmerz Mayo Foundation for Medical Education and Research Also in Spanish Premenstrual Dysphoric Disorder PMDD American Academy of Family Physicians Premenstrual Dysphoric Disorder PMDD : Different from PMS?

Mayo Foundation for Medical Education and Research Also in Spanish Water Retention: Relieve This Premenstrual Symptom Mayo Foundation for Medical Education and Research Also in Spanish.

Clinical Trials. gov: Premenstrual Syndrome National Institutes of Health. Article: Mediating effect of suicidal ideation in the association between child abuse Article: The potential role of the orexin system in premenstrual syndrome.

Article: Association of menopausal symptoms and menopausal quality of life with premenstrual Premenstrual Syndrome -- see more articles. Find an Expert. Department of Health and Human Services, Office on Women's Health Also in Spanish Find an Ob-Gyn American College of Obstetricians and Gynecologists.

Menstrual Period: Premenstrual Syndrome PMS and Premenstrual Dysphoric Disorder PMDD Boston Children's Hospital Also in Spanish PMS, Cramps, and Irregular Periods Nemours Foundation Also in Spanish Premenstrual Syndrome PMS Department of Health and Human Services, Office on Women's Health Why Do I Feel Depressed When I Have My Period?

Nemours Foundation. Patient Handouts. Premenstrual breast changes Medical Encyclopedia Also in Spanish Premenstrual dysphoric disorder Medical Encyclopedia Also in Spanish Premenstrual syndrome Medical Encyclopedia Also in Spanish Premenstrual syndrome - self-care Medical Encyclopedia Also in Spanish.

: Menstrual health symptoms

Breadcrumb	Other Concerns Resources Français Other SOGC sites Sex and U HPV Pregnancy Info Menopause SOGC. HHS Non-Discrimination Notice Language Assistance Available Accessibility Privacy Policy Disclaimers Freedom of Information Act FOIA USA. Some evidence suggests that surgically cutting the pain-conducting nerve fibers leading from the uterus diminishes the pain from dysmenorrhea. The LNG-IUS Mirena , a progesterone intrauterine device IUD , is often recommended as a first-line treatment for heavy bleeding. These hormones work together to prepare a women's body for pregnancy. Normal Absence of Menstruation Normal absence of periods can occur in any woman under the following circumstances: Menstruation stops during pregnancy.
Actions for this page	Light or scanty flow is also common in the first years after menarche and before menopause. When girls first menstruate they often do not have regular cycles for several years. Even healthy cycles in adult women can vary by a few days from month to month. Periods may occur every 3 weeks in some women, and every 5 weeks in others. Flow also varies and can be heavy or light. Skipping a period and then having a heavy flow may occur; this is most likely due to missed ovulation rather than a miscarriage. Premenstrual syndrome PMS is a set of physical, emotional, and behavioral symptoms that occur during the last week of the luteal phase a week before menstruation in most cycles. The symptoms typically do not start until at least day 13 in the cycle, and resolve within 4 days after bleeding begins. Women may begin to have premenstrual syndrome symptoms at any time during their reproductive years, but it usually occurs when they are in their late 20s to early 40s. Once established, the symptoms tend to remain fairly constant until menopause, although they can vary from cycle to cycle. Many different factors can trigger menstrual disorders, including hormone imbalances, genetic factors, clotting disorders, and pelvic diseases. Primary dysmenorrhea is caused by prostaglandins, hormone-like substances that are produced in the uterus and cause the uterine muscle to contract. Prostaglandins also play a role in the heavy bleeding that causes dysmenorrhea. Secondary dysmenorrhea can be caused by a number of medical conditions. Common causes of secondary dysmenorrhea include:. Fibroid tumors may not need to be removed if they are not causing pain, bleeding excessively, or growing rapidly. Normal causes of skipped or irregular periods include pregnancy, breastfeeding, hormonal contraception, and perimenopause. Skipped periods are also common during adolescence, when it may take a while before ovulation occurs regularly. Consistently absent periods may be due to the following factors:. If the ovaries produce too much androgen hormones such as testosterone a woman may develop male characteristics. This ovarian imbalance can be caused by tumors in the ovaries or adrenal glands, or polycystic ovarian disease. Virilization may include growth of excess body and facial hair, amenorrhea loss of menstrual period and changes in body contour. Age plays a key role in menstrual disorders. Girls who start menstruating at age 11 or younger are at higher risk for severe pain, longer periods, and longer menstrual cycles. Women who are approaching menopause perimenopause may also skip periods. Occasional episodes of heavy bleeding are also common as women approach menopause. Anemia Menorrhagia heavy menstrual bleeding is the most common cause of anemia reduction in red blood cells in premenopausal women. A blood loss of more than 80 mL per menstrual cycle can eventually lead to anemia. Most cases of anemia are mild. Nevertheless, even mild-to-moderate anemia can reduce oxygen transport in the blood, causing symptoms such as fatigue, lightheadedness, and pale skin. Severe anemia that is not treated can lead to heart problems. Amenorrhea absent or irregular menstrual periods caused by reduced estrogen levels is linked to osteopenia loss of bone density and osteoporosis more severe bone loss that increases fracture risk. Because bone growth is at its peak in adolescence and young adulthood, losing bone density at that time is very dangerous and early diagnosis and treatment is essential for long-term health. Osteoporosis is a condition characterized by progressive loss of bone density, thinning of bone tissue, and increased vulnerability to fractures. Osteoporosis may result from disease, dietary or hormonal deficiency, or advanced age. Regular weight-bearing exercise and strength training, and calcium and vitamin D supplements, can reduce and even reverse loss of bone density. Some conditions associated with heavy bleeding, such as ovulation abnormalities, fibroids, or endometriosis, can contribute to infertility. Many conditions that cause amenorrhea, such as ovulation abnormalities and PCOS, can also cause infertility. Irregular periods from any cause may make it more difficult to conceive. Sometimes treating the underlying condition can restore fertility. In other cases, specific fertility treatments that use assisted reproductive technologies may be needed. Menstrual disorders, particularly pain and heavy bleeding, can affect school and work productivity and social activities. Your medical history can help a health care provider determine whether a menstrual problem is caused by another medical condition. For example, non-menstrual conditions that may cause abdominal pain include appendicitis, urinary tract infections, ectopic pregnancy, and irritable bowel syndrome. Endometriosis and uterine fibroids may cause heavy bleeding and chronic pain. A menstrual diary is a helpful way to keep track of changes in menstrual cycles. You should record when your period starts, how long it lasts, and the amount of bleeding and pain that occurs during the course of menstruation. Blood tests can help rule out other conditions that cause menstrual disorders. For example, your provider may test thyroid function to make sure that low thyroid hypothyroidism is not present. Blood tests can also check follicle-stimulating hormone, estrogen, and prolactin levels. Women who have menorrhagia heavy bleeding may get tests for bleeding disorders. If women are losing a lot of blood, they should also get tested for anemia. Imaging techniques are often used to detect certain conditions that may be causing menstrual disorders. Imaging can help diagnose fibroids, endometriosis, or structural abnormalities of the reproductive organs. Ultrasound is a painless procedure and is the standard imaging technique for evaluating the uterus and ovaries. It can help detect fibroids, uterine polyps, ovarian cysts and tumors, and obstructions in the urinary tract. Ultrasound uses sound waves to produce an image of the organs. Transvaginal sonohysterography uses ultrasound along with a probe transducer placed in the vagina. Sometimes saline salt water is injected into the uterus to enhance visualization. When heavy or abnormal bleeding occurs, an endometrial uterine biopsy may be performed in a medical office. This procedure can help identify abnormal cells, which suggest that pre-cancer or cancer may be present. It may also help the doctor decide on the best hormonal treatment to use. The procedure is done without anesthesia, or local anesthetic is injected. Hysteroscopy is a procedure that can detect the presence of fibroids, polyps, or other causes of bleeding. Hysteroscopy may be done either in an office or operating room setting and requires no incisions. The procedure uses a slender flexible or rigid tube called a hysteroscope, which is inserted into the vagina and through the cervix to reach the uterus. A fiber-optic light source and a tiny camera in the tube allow the health care provider to view the cavity. The uterus is filled with saline or carbon dioxide to inflate the cavity and provide better viewing. This can cause cramping. Hysteroscopy is non-invasive, but many women find the procedure painful. The use of an anesthetic spray, such as lidocaine or an oral agent, such as a NSAID can help prevent pain from this procedure. Other complications include excessive fluid absorption, infection, and uterine perforation. The procedure is used to take samples of the tissue, and to relieve heavy bleeding in some instances. Diagnostic laparoscopy, an invasive surgical procedure, is used to diagnose and treat endometriosis , a common cause of dysmenorrhea. Laparoscopy normally requires a general anesthetic, although the patient can go home the same day. The procedure involves inflating the abdomen with gas through a small abdominal incision. A fiber optic tube equipped with small camera lenses the laparoscope is then inserted. The health care provider uses the laparoscope to view the uterus, ovaries, tubes, and peritoneum lining of the pelvis. Dietary Factors Dietary adjustments, starting about 14 days before a period may help some women with certain mild menstrual disorders, such as cramping. The general guidelines for a healthy diet apply to everyone; they include properly hydrating, eating plenty of whole grains, fresh fruits and vegetables, and avoiding saturated fats and commercial junk foods. Limiting salt sodium may help reduce bloating. Limiting caffeine, sugar, and alcohol intake may also be beneficial. Women who have heavy menstrual bleeding can sometimes become anemic. Eating iron-rich foods can help prevent anemia. Iron found in foods is either in the form of heme or non-heme iron. Heme iron is better absorbed than non-heme iron. There are two forms of supplemental iron: ferrous and ferric. Ferrous iron is better absorbed and is the preferred form of iron tablets. Ferrous iron is available in three forms: ferrous fumarate, ferrous sulfate, and ferrous gluconate. Depending on the severity of your anemia , as well as your age and weight, your doctor will recommend a dosage of 60mg to mg of elemental iron per day. This means taking 1 iron pill 2 to 3 times each day. Applying a heating pad to the abdominal area, or soaking in a hot bath, can help relieve the pain of menstrual cramps. Change tampons every 4 to 6 hours. Avoid scented pads and tampons; feminine deodorants can irritate the genital area. Douching is not recommended because it can destroy the natural bacteria normally present in the vagina. Bathing regularly is sufficient. NSAIDs block prostaglandins, the substances that increase uterine contractions. They are effective painkillers that also help control the inflammatory factors that may be responsible for heavy menstrual bleeding. Among the most effective NSAIDs for menstrual disorders are ibuprofen Advil, Motrin, Midol PMS and naproxen Aleve , which are both available over-the-counter, and mefenamic acid Ponstel , which requires a doctor's prescription. Long-term daily use of any NSAID can increase the risk for gastrointestinal bleeding and ulcers, so it is best to just use these drugs for a few days during the menstrual cycle. Acetaminophen Tylenol is a good alternative to NSAIDs, especially for women with stomach problems or ulcers. Some products Pamprin, Premsyn combine acetaminophen with other drugs, such as a diuretic, to reduce bloating. Oral contraceptives OCs , commonly called birth control pills or "the Pill," contain combinations of an estrogen and a progesterone in a synthetic form called progestin. The estrogen compound used in most combination OCs is estradiol. There are many different progestins, but common types include levonorgestrel, drospirenone, and norgestrel. A four-phasic OC that contains estradiol and the progesterone dienogest, has been shown in small trials as effective for treatment of heavy menstrual bleeding. OCs are often used to regulate periods in women with menstrual disorders, including menorrhagia heavy bleeding , dysmenorrhea severe pain , and amenorrhea absence of periods. They also protect against ovarian and endometrial cancers. Standard OCs usually comes in a pill pack with 21 days of "active" hormone pills and 7 days of "inactive" placebo pills. Extended-cycle also called "continuous-use" or "continuous-dosing" oral contraceptives aim to reduce or eliminate monthly menstrual periods. These OCs contain a combination of estradiol and the progestin levonorgestrel, but they use extending dosing of active pills with 81 to 84 days of active pills followed by 7 days of inactive or low-dose pills. Some types of continuous-dosing OCs use only active pills, which are taken days a year. Common side effects of combination OCs include headache, nausea, bloating, breast tenderness, and bleeding between periods. The estrogen component in combination OCs is usually responsible for these side effects. In general, today's OCs are much safer than OCs of the past because they contain much lower dosages of estrogen. However, all OCs may increase the risk for migraine, stroke, heart attack, and blood clots. The risk is highest for women who smoke, who are over age 35, or who have a history of heart disease risk factors such as high blood pressure or diabetes or past cardiac events. Women who have certain metabolic disorders, such as polycystic ovary syndrome PCOS , are also at higher risk for the heart-related complications associated with these pills. Some types of combination OCs contain progestins, such as drospirenone, which have a higher risk for causing blood clots than levonorgestrel. Progestins synthetic progesterone are used by women with irregular or skipped periods to restore regular cycles. They also reduce heavy bleeding and menstrual pain, and may protect against uterine and ovarian cancers. Progestin-only contraceptives may be a good option for women who are not candidates for estrogen-containing OCs, such as smokers over the age of Short-term treatment of anovulatory bleeding bleeding caused by lack of ovulation may involve a to day course of an oral progestin on days 16 to 25 or 5 to Medroxyprogesterone Provera is commonly used. An intrauterine device IUD that releases progestin can be very beneficial for menstrual disorders. In the United States, a levonorgestrel-releasing intrauterine system, also called an LNG-IUS, is sold under the brand name Mirena. It is the only IUD approved by the FDA to treat heavy menstrual bleeding. The LNG-IUS remains in place in the uterus and releases the progestin levonorgestrel for up to 5 years, therefore being considered as a good long-term options. After the LNG-IUS is inserted, there may be heaver periods initially. However, periods become short eventually with little to no blood flow. For many women, the LNG-IUS completely stops menstrual periods. Common side effects may include cramping, acne, back pain, breast tenderness, headache, mood changes, and nausea. The LNG-IUS may increase the risk for ovarian cysts, but such cysts usually cause no symptoms and resolve on their own. Women who have a history of pelvic inflammatory disease or who have had a serious pelvic infection should not use the LNG-IUS. Depo-Provera also called Depo or DMPA uses the progestin medroxyprogesterone acetate, which is administered by injection once every 3 months. Most women who use Depo-Provera stop menstruating altogether after a year. Depo-Provera may be beneficial for women with heavy bleeding, or pain due to endometriosis. Women who eventually want to have children should be aware that Depo-Provera can cause persistent infertility for up to 22 months after the last injection, although the average is 10 months. Weight gain can be a problem, particularly in women who are already overweight. Women should not use Depo-Provera if they have a history of liver disease, blood clots, stroke, or cancer of the reproductive organs. Depo-Provera should not be used for longer than 2 years because it can cause loss of bone density. Gonadotropin releasing hormone GnRH agonists are sometimes used to treat severe menorrhagia. GnRH agonists block the release of the reproductive hormones LH luteinizing hormone and FSH follicular-stimulating hormone. As a result, the ovaries stop ovulating and no longer produce estrogen. GnRH agonists include the implant goserelin Zoladex , a monthly injection of leuprolide Lupron Depot , and the nasal spray nafarelin Synarel. Several new oral GnRH antagonists elagolix and relugolix are available. They have similar action of the ovaries as the GnRH agonists. Such drugs may be used alone or in preparation for procedures used to destroy the uterine lining. They are not generally suitable for long-term use. Commonly reported side effects, which can be severe in some women, include menopausal-like symptoms. These symptoms include hot flashes, night sweats, changes in the vagina, weight change, and depression. The side effects vary in intensity depending on the GnRH agonist. They may be more intense with leuprolide and persist after the drug has been stopped. The most important concern is possible osteoporosis from estrogen loss. Women should not take these drugs for more than 6 months. Add-back therapy, which provides doses of estrogen and progestin that are high enough to maintain bone density but are too low to offset the beneficial effects of the GnRH agonist, may be used. GnRH treatments may increase the risk for birth defects. Women who are taking GnRH agonists should use non-hormonal birth control methods, such as the diaphragm, cervical cap, or condoms. Danazol Danocrine is a synthetic substance that resembles a male hormone. It suppresses estrogen, and therefore menstruation, and is occasionally used sometimes in combination with an oral contraceptive to help prevent heavy bleeding. It is not suitable for long-term use, and due to its masculinizing side effects it is only used in rare cases. GnRH agonists have largely replaced the use of danazol. Adverse side effects include facial hair, deepening of the voice, weight gain, acne, and reduced breast size. Danazol may also increase the risk for unhealthy cholesterol levels and it may cause birth defects. Tranexamic acid Lysteda is a newer medication for treating heavy menstrual bleeding and the first non-hormonal drug for menorrhagia treatment. Tranexamic acid is given as a pill. It is an anti-fibrinolytic drug that helps blood to clot. The FDA warns that use of this medication by women who take hormonal contraceptives may increase the risk of blood clots, stroke, or heart attacks. This drug should not be taken by women who have a history of venous thromboembolism. Women with heavy menstrual bleeding, painful cramps, or both have surgical options available to them. Most procedures eliminate or significantly affect the possibility for childbearing, however. Hysterectomy removes the entire uterus while endometrial ablation destroys the uterine lining. Women should be sure to ask their doctors about all medical options before undergoing surgical procedures. In endometrial ablation, the entire lining of the uterus the endometrium is removed or destroyed. For most women, this procedure stops the monthly menstrual flow. In some women, menstrual flow is not stopped but is significantly reduced. Endometrial ablation significantly decreases the likelihood a woman will become pregnant. However, pregnancy can still occur and this procedure increases the risks of complications, including miscarriage. Women who have this procedure must be committed to not becoming pregnant and to using birth control. Sterilization after ablation is another option. A main concern of endometrial ablation is that it may delay or make it more difficult to diagnose uterine cancer in the future. Postmenopausal bleeding or irregular vaginal bleeding can be warning signs of uterine cancer. Women who have endometrial ablation still have a uterus and cervix, and should continue to have regular Pap smears and pelvic exams. Endometrial ablation used to be performed in an operating room using electrosurgery with a resectoscope a hysteroscope with a heated wire loop or roller ball. Laser ablation was another older procedure. These types of endometrial ablation have largely been replaced by newer types of procedure that do not use a resectoscope. The newer procedures can be performed either in an operating room or a doctor's office. They include:. In preparing for the ablation procedure, the doctor will perform an endometrial biopsy to make sure that cancer is not present. If the woman has an intrauterine device IUD , it must be removed before the procedure. In some cases, hormonal drugs, such as GnRH analogs, may be given a few weeks before ablation to help thin the endometrial lining. Endometrial ablation is an outpatient procedure. The doctor usually applies a local anesthetic around the cervix. The woman also receives medication for pain and to help her relax. The doctor will dilate the cervix before starting the procedure. Women may feel some mild cramping or discomfort, but many of the newer types of endometrial procedures can be performed in less than 10 minutes. Women may experience menstrual-like cramping for several days and frequent urination during the first 24 hours. The main side effect is watery or bloody discharge that can last for several weeks. This discharge is especially heavy in the first few days following ablation. Women need to wear pads, not tampons during this time, and to wait to have sex until the discharge has stopped. They are generally able to return to work or normal activities within a few days after the procedure. Mood symptoms are only present for a specific period of time, during the luteal phase of the menstrual cycle. Symptoms emerge one to two weeks before menses and resolve completely with the onset of menses. Women with PMDD should experience a symptom-free interval between menses and ovulation. Therefore, it is important for patients to be carefully evaluated for the presence of an underlying mood disorder in order to develop the best treatment plan. Watch these videos about PMDD: The Biology behind PMDD Oral Contraceptive relief for PMDD. Or read these articles about PMDD research at UNC: Oral Contraceptives May Ease Suffering of Women with Severe PMS Study finds hereditary link to premenstrual depression. Back to Top. Menopause is defined as the permanent cessation of the menses. Perimenopause is defined as the transitional period from normal menstrual periods to no periods at all. At this time menstrual periods gradually lighten and become less frequent. For example:. Make sure you get advice from a qualified and experienced health practitioner, such as a herbalist, naturopath or Chinese medicine practitioner , before using complementary therapies. And always tell your GP doctor if you are taking any complementary medicines. Many women feel they benefit from other therapies, such as cognitive behavioural therapy CBT , acupuncture and massage. For more detailed information, related resources, articles and podcasts, visit: jeanhailes. This page has been produced in consultation with and approved by:. Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional. The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website. Skip to main content. Reproductive system - female. Home Reproductive system - female. Premenstrual syndrome PMS. Actions for this page Listen Print. Summary Read the full fact sheet. On this page. What is premenstrual syndrome PMS? Symptoms of PMS What causes PMS?
What is PMDD?	Symptooms more information about Muscle-building nutrition, call the OWH Menstrual health symptoms at or sympgoms out the Menstrual health symptoms resources from other organizations:. Abnormal uterine bleeding: etiology and management of acute and chronic excessive bleeding. Get enough sleep. If the tampon is inserted correctly, you should not be able to feel it inside you. Endometrial ablation used to be performed in an operating room using electrosurgery with a resectoscope a hysteroscope with a heated wire loop or roller ball.
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)	Some medical conditions Menstrual health symptoms affect Menstryal menstrual cycle, including polycystic ovarian disease, uterine healtg, and endometriosis. Was this page sym;toms Bloch, M. Nemours Foundation Mfnstrual Mayo Menstrual health symptoms Low-carb and body composition Medical Education and Research Also in Spanish Premenstrual Dysphoric Disorder PMDD American Academy of Family Physicians Premenstrual Dysphoric Disorder PMDD : Different from PMS? These are the most common conditions that overlap with PMS. It's estimated that as many as 3 of every 4 menstruating women have experienced some form of premenstrual syndrome.
Premenstrual Syndrome | PMS | PMS Symptoms | MedlinePlus	For many women, the Turmeric face masks completely stops Menstruql periods. Premenstrual dysphoric disorder: a healgh for Menstrual health symptoms treating practitioner. Menstrual health symptoms dysphoric disorder: burden of illness and treatment update. Patient Handouts. Some women report feeling the symptoms of premenstrual syndrome PMS. Some types of continuous-dosing OCs use only active pills, which are taken days a year.

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First period signs and symptoms - MENSTRUAL CYCLE 101!