Menstruation Symptoms

Menstruation represents a part of the woman's menstrual cycle which includes the secretion of both blood and tissue debris from the uterus about once a month. It is common for women of child-bearing age to experience a variety of different symptoms before, during, or after their menstruation.

Common complaints include pain in the back or inner thighs, nausea, diarrhea, constipation, headaches, changes in libido, irritability, and other mood changes. Conversely, women can sometimes experience positive sensations such as relief, euphoria, invigoration, creative energy, excitement, increased libido, and more intense orgasms.

One of the frequent and uncomfortable sensations that women experience during menstruation are uterine cramps. These cramps can be divided into two distinct types of spasmodic and congestive cramps. Spasmodic cramping is caused by prostaglandins, which are chemicals that affect muscle tension. Comparatively, congestive cramping causes the body to retain fluids and salt.

Premenstrual syndrome (PMS)

PMS is a common term for a myriad of symptoms that some women experience prior to each menstruation. Some of the more frequent physical signs of PMS include acne, lumpy or tender breasts, bloating, sleep problems, food cravings, and migraines. Psychological signs of PMS might encompass mood swings, fatigue, sadness, anger, anxiety, typically when estrogen predominates, or depression, which typically occurs when there is more progesterone.

The average duration of PMS symptoms per month is about six days, with the peak severity of symptoms occurring two days before the first day of menstrual flow. Possible etiologies of the condition are fluctuating hormone levels, increased sensitivity to normal levels of estrogen and progesterone, increased aldosterone and plasma renin activity, as well as neurotransmitter abnormalities, namely, serotonin.

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A more severe and disabling end of the spectrum of premenstrual syndrome is known as premenstrual dysphoric disorder (PMDD), which occurs in an estimated 2-9% of menstruating women. Although the symptoms of PMDD can vary from woman to woman, they are relatively consistent from cycle to cycle and tend to remit during pregnancy.

PMDD is characterized by mood symptoms that result in a significant disruption of a woman's baseline level of functioning across family, social, and occupational domains. The degree of disability and disruption of the woman's quality of life reported by those with PMDD is comparable to other depressive or anxiety disorders.


Dysmenorrhea is usually divided into two categories, based on its pathophysiology. Primary dysmenorrhea, which is defined as a painful menstruation in women with normal pelvic anatomy, usually starts during adolescence. Primary dysmenorrhea often causes cramping pain in the lower abdomen that occurs just before or during menstrual bleeding in the absence of other diseases.

Secondary dysmenorrhoea is menstrual pain associated with a specific disease such as endometriosis, myomas, endometrial polyps, pelvic inflammatory disease, and the use of an intrauterine contraceptive device. Pain from secondary dysmenorrhea usually occurs earlier in the menstrual cycle and its duration is longer when compared to common menstrual cramps.

Painful Periods, Dysmenorrhea and Endometriosis

Dysmenorrhea is caused by the release of prostaglandins and leukotrienes in the menstrual fluid, which cause an increase in the uterine tone, as well as stronger and more frequent uterine contractions. Elevated vasopressin levels have been reported in women with primary dysmenorrhea. Comparatively, prostaglandins have been implicated in secondary dysmenorrhoea, albeit the accompanying pelvic disease has a dominant role in the pathophysiology of the condition.

The severity of dysmenorrhoea is associated with the duration of menstruation, younger average menarche, obesity, smoking, and alcohol consumption. Anxiety, clinically manifest depression, and the disruption of social support networks have been associated with menstrual pain. Dysmenorrhoea, especially in its severe form, is associated with a significant restriction of activity and absenteeism from school or work.


Further Reading

Last Updated: May 25, 2021

Dr. Tomislav Meštrović

Written by

Dr. Tomislav Meštrović

Dr. Tomislav Meštrović is a medical doctor (MD) with a Ph.D. in biomedical and health sciences, specialist in the field of clinical microbiology, and an Assistant Professor at Croatia's youngest university - University North. In addition to his interest in clinical, research and lecturing activities, his immense passion for medical writing and scientific communication goes back to his student days. He enjoys contributing back to the community. In his spare time, Tomislav is a movie buff and an avid traveler.


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