If you're a woman, you may be more familiar with the premenstrual syndrome than you'd like to be. But do you know when a problem period indicates that a visit to your doctor is in order?

For most women, menstrual cycles last between 21 and 35 days, with a period of three to seven days. However, many women experience variations in the length, timing, and symptoms of their cycles, and menstrual disorders are often to blame. Up to 85 percent of women with regular cycles experience at least one menstrual disorder symptom before their periods.

Premenstrual Syndrome and Premenstrual Dysphoric Disorder (PMDD):

When premenstrual symptoms become a monthly fact of life, the condition is called premenstrual syndrome, or PMS. PMS symptoms range from emotional upheaval, such as irritability and sadness, to physical effects such as cramping and breast tenderness. A certain number of women, about 5 percent, experience emotional and physical symptoms so severe that they have problems managing daily life. This is called PMDD (premenstrual dysphoric disorder).

Why PMS occurs, and why some women experience it to a greater degree than others, is unknown, says Steven Sondheimer, MD, a professor of obstetrics and gynecology at the University of Pennsylvania in Philadelphia. "There are some recent hints that there is a genetic predisposition. It's a function of certain hormones and their impact on receptors in the brain that might be different from one person to another."

A predisposition that runs in families is the most likely explanation for why some women are more susceptible to PMS or PMDD, and why some women's PMS symptoms are more severe, notes Dr. Sondheimer.

Amenorrhea and Dysmenorrhea: Missing and Painful Periods

Amenorrhea means that you have missed one or more periods when you were expecting to have them. There are a number of reasons for missing periods, including:

• Pregnancy
• Excessive exercise
• Sudden weight change
• Not eating enough
• Stress
• Illness
• Medication side effects
• Hormonal abnormalities

Missing your period for three or more months is considered abnormal (unless you're pregnant). If you skip periods often or have not had one for more than three months, contact your doctor.

Severe pain during your period, so much so that it can impair your quality of life is called dysmenorrhea. The pain may be due to endometriosis, which occurs when uterine lining tissue grows outside of the uterus, or you have fibroids, benign growths that can appear anywhere on the uterus. Your doctor can recommend medications, pain management techniques, or surgery that will help.

For some, the physical pain and emotional stress are severe enough to affect their daily lives. Regardless of symptom severity, the signs and symptoms generally disappear within four days after the start of the menstrual period for most women.

But a small number of women with premenstrual syndrome have disabling symptoms every month. This form of PMS is called premenstrual dysphoric disorder (PMDD).

PMDD signs and symptoms include depression, mood swings, anger, anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension.

Exactly what causes premenstrual syndrome is unknown, but several factors may contribute to the condition:

• Cyclic changes in hormones. Signs and symptoms of premenstrual syndrome change with hormonal fluctuations and disappear with pregnancy and menopause.
• Chemical changes in the brain. Fluctuations of serotonin, a brain chemical (neurotransmitter) that's thought to play a crucial role in mood states, could trigger PMS symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.
• Depression. Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms

For many women, lifestyle changes can help relieve PMS symptoms. But depending on the severity of your symptoms, your doctor may prescribe one or more medications for premenstrual syndrome.

The success of medications in relieving symptoms varies among women. Commonly prescribed medications for premenstrual syndrome include:

• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others — have been successful in reducing mood symptoms. SSRIs are the first line treatment for severe PMS or PMDD. These medications are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can ease cramping and breast discomfort.
• Diuretics. When exercise and limiting salt intake aren't enough to reduce the weight gain, swelling and bloating of PMS, taking water pills (diuretics) can help your body shed excess fluid through your kidneys. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS.
• Hormonal contraceptives. These prescription medications stop ovulation, which may bring relief from PMS symptoms.

Premenstrual syndrome (PMS) is the emergence of periodic one or more symptoms of symptoms before menstruation and in the first few days of menstruation.

Risk factors:
A woman can get PMS with or without the risk factors listed below. The chances are greater in women who have many risk factors.

1. Lifestyle is one of the series of factors that affect the health of people.
2. Smoking raises the risk of getting PMS. Activities like smoking, and junk food intake are factors associated with lifestyle.
3. PMS is more common in women of reproductive age and in women who are White.
4. Women with a personal or family history of mental health problems are more likely to get PMS. Examples are depression and postpartum depression.
5. Women who are overweight or obese are at higher risk of PMS.
6. PMS is more common in women who have had a stressful event happen in the past year.
7. PMS is more common in women who have had physical, sexual, or emotional trauma.

Symptoms
Tension or anxiety,Poor concentration,Depressed mood,Mood swings and irritability or anger,Crying spells,Trouble falling asleep (insomnia),Appetite changes and food cravings,Social withdrawal,Bloated tummy,Tender breasts,Joint pain,Swollen hands and feet
Conditions
Physical and emotional symptoms,Premenstrual dysphoric disorder (PMDD)
Drugs
Over-the-counter pain relievers like Ibuprofen, Naproxen and Aspirin to lessen physical symptoms, such as cramps, headaches, backaches, and breast tenderness,Antidepressants,Diuretics (water pills),Anti-anxiety medicine

A healthy lifestyle is the first step to managing premenstrual syndrome (PMS). For many women, lifestyle approaches are often enough to control symptoms.

The following is an example of lifestyle modification advice.
1. Drink plenty of fluids (water or juice, not soft drinks, alcohol or other beverages with caffeine) to help reduce bloating, fluid retention, and other symptoms.
2. Eat frequent small meals, leave no more than 3 hours between snacks, and avoid overeating.
3. Eat a balanced diet with extra whole grains, vegetables, and fruit and less or no salt and sugar.
4. A health care provider may recommend nutritional supplements such as vitamin B6, calcium, and magnesium.
5. Get regular aerobic exercise throughout the month to help reduce the severity of PMS symptoms.

The success of medications in relieving symptoms varies among women. Commonly prescribed medications for premenstrual syndrome include:
1. Nonsteroidal anti-inflammatory drugs (NSAIDs)- They are taken before or at the onset of the menstrual period, NSAIDs such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can ease cramping and breast discomfort.
2. Antidepressants- Selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft), and others — have been successful in reducing mood symptoms. SSRIs are the first-line treatment for severe PMS or PMDD.
3. Diuretics- When exercise and limiting salt intake aren't enough to reduce the weight gain, swelling, and bloating of PMS, taking diuretics can help your body shed excess fluid through your kidneys. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS.
4. Hormonal contraceptives- These prescription medications stop ovulation, which may bring relief from PMS symptoms.

Symptoms
Tension or anxiety,Poor concentration,Depressed mood,Mood swings and irritability or anger,Crying spells,Trouble falling asleep (insomnia),Appetite changes and food cravings,Social withdrawal,Bloated tummy,Tender breasts,Joint pain,Swollen hands and feet
Conditions
Physical and emotional symptoms,Premenstrual dysphoric disorder (PMDD)
Drugs
Over-the-counter pain relievers like Ibuprofen, Naproxen and Aspirin to lessen physical symptoms, such as cramps, headaches, backaches, and breast tenderness,Antidepressants,Diuretics (water pills),Anti-anxiety medicine