Physical symptoms may include:

• Breast engorgement and tenderness

• Abdominal bloating

• Constipation or diarrhea, nausea, vomiting

• Acne

• Headache

• Alcohol intolerance

• Fluid retention and weight gain

• Clumsiness

• Crampy pain in the lower abdomen

• Joint or muscle pain

Emotional symptoms may include

• Anxiety and panic attacks

• Insomnia

• Change in sexual interest and desire

• Irritability

• Depression and crying spells

• Lethargy and fatigue

• Mood swings ranging from bursts of creative energy to anger/paranoia

• Inability to concentrate and some memory loss

• Increased appetite with specific food cravings (especially salt and sugar)

• Withdrawal and trouble in relationships with family and friends

Symptoms vary from person to person. If you think you have PMS, try keeping track of your symptoms for several menstrual cycles. You can use a calendar to note which symptoms you are having on which days of your cycle, and how bad the symptoms are. If you seek medical care for your PMS, having this kind of record is helpful. 

If your symptoms of PMS are not reduced with lifestyle modifications, consult you health care provider. Certain antidepressants called SSRIs (selective serotonin -reuptake inhibitors) help with depression, fatigue and relationship problems during the premenstrual time period. Anti-anxiety medications are sometimes prescribed. For very severe symptoms, a gonadotropin-releasing hormone agonist (GnRH) is sometimes prescribed. These medications suppress ovulation and hormonal fluctuations that produce PMS. For some individuals, oral contraceptives may help prevent PMS symptoms. Occasionally diuretics, which increase urination, are prescribed to reduce bloating, food craving and breast tenderness. All the above medications can have serious side effects and should be prescribed only under a health provider' care and management. 

Three to eight percent of people who menstruate suffer from a very severe form of premenstrual syndrome known as premenstrual dysphoric disorder that seriously impacts their daily life. PMDD is a severe, disabling form of PMS. In PMDD, the main symptoms are mood disorders such as depression, anxiety, tension, and persistent anger or irritability. These severe symptoms lead to problems with relationships and carrying out normal activities. People with PMDD usually also have physical symptoms, such as headache, joint and muscle pain, lack of energy, bloating and breast tenderness. You must have at least five of the typical symptoms to be diagnosed with PMDD. The symptoms must occur during the two weeks before your period and go away when bleeding begins. Research has shown that SSRIs can help many people with PMDD. Commonly prescribed medications to treat PMDD include, Zoloft and Sarafem. 

If you experience severe menstrual cramps and pain along with your periods, you could have dysmenorrhea. Dysmenorrhea can also be classified as either primary or secondary. Primary dysmenorrhea takes place when you experience severe menstrual cramps caused by abnormal or rigorous uterine contractions as a result of a chemical imbalance in the body (particularly prostaglandin and arachidonic acid - both chemicals which control the contractions of the uterus).

Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis (a condition in which tissue that looks and acts like endometrial tissue becomes implanted outside the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity . This can often result in internal bleeding, and pelvic pain. Other possible causes of secondary dysmenorrhea include pelvic inflammatory disease (PID), uterine fibroids, infection, tumors, or polyps in the pelvic cavity, or abnormal pregnancies such as miscarriages, ectopic pregnancies. 

Diagnosis begins with a trained provider, typically your gynecologist, who will evaluate your medical history and perform a complete physical examination including a pelvic examination. A diagnosis of dysmenorrhea can only be certain when your gynecologist rules out other menstrual disorders, medical conditions, or medications that may be causing or aggravating the condition. In addition to this there are diagnostic procedures to detect if you have dysmenorrhea. An ultrasound can be used through a technique called sonography which includes using high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. A magnetic resonance imaging (MRI) could also be used to detect dysmenorrhea. An MRI is a diagnostic procedure that uses a combination of large magnets, radio-frequencies, and a computer to produce detailed images of organs and structures within the body. In some cases your gynecologist could opt to do a laparoscopy which is a minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, your gynecologist can often detect abnormal growths. Also, a hysteroscopy could be performed. A hysteroscopy is a visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) which is inserted through the vagina. 

Heavy periods or long periods are referred to as menorrhagia. During menorrhagia there is excessively heavy or prolonged uterine bleeding, which may be caused by medical problems or hormone imbalances.

In a normal menstrual cycle, there is a balance between estrogen and progesterone, two hormones in the body. These hormones regulate the buildup of the endometrium (uterine lining of blood and tissue), which is shed each month during menstruation. Menorrhagia can occur because of an imbalance between estrogen and progesterone. As a result of the imbalance, the endometrium keeps building up. When it is eventually shed, there is heavy bleeding.

Menorrhagia is commonly treated using oral contraceptives which can lead to lighter flows that occur more regularly. If you smoke, then your provider may recommend that you try injectable forms of progestin to regulate and lighten your cycle. An example of this could include Depo-Provera.