Menstruation is the shedding of the uterine lining (endometrium).

It occurs on a regular basis at a very young age, maturation, in females of certain mammal species, until menopause. Physical experience In most females, various physical changes are brought about by natural fluctuations in hormone levels during the menstrual cycle, and by muscle contractions (menstrual cramping) involving the uterus that can precede or accompany menstruation. Some may notice water retention, changes in sex drive, fatigue, breast tenderness, or nausea. Breast swelling and discomfort may be caused by water retention during menstruation.[8] Usually, such sensations are mild, and some people notice very few physical changes associated with menstruation. A healthy diet, reduced consumption of salt, caffeine and alcohol, and regular exercise are often effective in controlling these physical changes.[9] The sensations experienced vary from person to person and from cycle to cycle. Painful menstrual cramps Many women experience painful uterine cramps during menstruation. The muscles of the uterus, and abdominal muscles surrounding the uterus, contract spasmodically to push the menstrual fluid out of the uterus. The contractions are produced by the tissue lining the uterus, which is believed to release an excess of fatty acids called prostaglandins that stimulate the muscles, leading to contractions. This is called primary dysmenorrhea. Primary dysmenorrhea usually begins within a year or two of menarche. It may continue until menopause, but many people find that their symptoms of dysmenorrhea gradually subside after their mid-20s. If the pain occurs between menstrual periods, or lasts longer than the first few days of the period, it is called secondary dysmenorrhea. Symptoms of dysmenorrhea may become debilitating in some people. It is unknown why this occurs in some people and not others. Severe symptoms may include pain spreading to hips, lower back and thighs, nausea and frequent diarrhea or constipation. Treatments target excess prostaglandin, using anti-prostaglandin medications or oral contraceptives. Nonsteroidal antiinflammatory drugs (NSAIDS), such as over-the-counter ibuprofen and naproxen, may ease symptoms. Emotional and psychological experience Some women experience emotional disturbances associated with their menstruation. These range from the irritability, to tiredness, or "weepiness" (i.e. easily provoked tearfulness). A similar range of emotional effects and mood swings is associated with pregnancy.[10] The prevalence of PMS is estimated to be between 3%[11] and 30%. More severe symptoms of anxiety or depression may be signs of Premenstrual Syndrome. Rarely, in

individuals susceptible to psychotic episodes, menstruation may be a trigger (menstrual psychosis). Premenstrual Syndrome In some cases, stronger physical and emotional or psychological sensations may become debilitating, and include significant menstrual pain (dysmenorrhea), migraine headaches, and severe depression. Dysmenorrhea, or severe uterine pain, is particularly common for adolescents and young females (one study found that 67.2% of girls aged 1319 suffer from it).[13] This phenomenon is called Premenstrual Syndrome. More severe symptoms may be classified as Premenstrual Dysphoric Disorder (PMDD).