Cramps reflect the effect of prostaglandins produced and acting in a progesterone-rich environment.
Inhibitors of prostaglandin endoperoxide synthase, such as nonsteroidal anti-inflammatory agents, are extremely effective in alleviating dysmenorrhea. There is great disagreement on the nature, timing, pathogenesis, treatment, and even the existence of the disorder. Physical symptoms include bloating, breast swelling and discomfort, pelvic pain, headache, ankle swelling, and bowel changes. Psychological symptoms include irritability, aggressiveness, depression, anxiety, tension, and changes in libido. There is no physical sign or laboratory marker of PMS, but charting of symptoms by the patient for two to three months should reveal the menstrual association and serve as a guide to therapy.