Monthly, 30-50% of fertile women experience physical and emotional disturbances before and during their period due to their changing hormone level. These disturbances can strongly affect everyday working life and diminish the quality of living. [18]

Premenstrual Syndrome
Premenstrual syndrome (PMS) refers to physical and emotional symptoms that occur 4 to 14 days before a woman's period. [2] The degree, length and form of disorders depend on the individual hormone level but can be grouped as follows: [15]

PMS-A (anxiety): mood swings, anxiety, fury, nervousness, aggression, irritation
PMS-C (craving): food cravings (especially for sweets), excited appetite, fatigue, exhaustion, headache
PMS-D (depression): depressive mood, weepiness, lethargy, sleeping disorder
PMS-H (hyperhydration): wateriness, swelling in the breasts, weight gain
PMS-O (other): refers to others than above mentioned types
PMS-T (total overall symptoms): various symptoms from different groups

According to statistics, around 30-90% of women are affected. [6] [7]

Until today, the causes of PMS are not clear but scientists assume that several factors may be involved. Some women might react to a declining estrogen level during the second half of the menstrual cycle. Next to the decrease of the serotonin level, the amount of prolactin increases. [17] Estrogen and progesterone seem to be a modulating factor for the concentration of serotonin which is responsible for calm, content and inner peace.

Studies conducted by the gynecologist Paul Dimmock of Keele University and North Staffordshire Hospital show that serotonin-specific reuptake inhibitors (SSRIs) distinctively improve the above mentioned symptoms.

Some researchers, like the psychologist Robyn Stein DeLuca, [6] criticize PMS because the symptoms seem to be body perceptions which are not related to the menstrual cycle. [7] Thus, PMS might be a social attempt to explain women who seem to be irrational. [6] [8]

Premenstrual dysphoric disorder
Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS that has greater psychological symptoms. PMDD affects three to eight percent of pre-menopausal women. They feel like a different person in their second half of the menstrual cycle. As Anke Rohde, head of department for Gynecologic Psychosomatics in Bonn puts it: "They say or do things that they know are wrong. In worst cases, they beat their child, scream at their partner or throw around objects." [18] Before PMDD had been included in the guideline for psychic disorders, women were often diagnosed with impulse control disorder.

An important tool in diagnostic method is the observation of correlation between symptoms and cycle over a period of at least two months. Among the symptoms are irritability as well as tension and aggression which appear in several consecutive cycles. [18]

Dysmenorrhea
Dysmenorrhea, also known as dysmenorrhoea, painful periods, or menstrual cramps, is pain (nausea, vomiting, fatigue, mood swings etc.) during menstruation. The contractions of the uterine muscles shed the endometrial tissue through the vagina and are responsible for the pain. Heat, relaxation, soft sport and pain killers can provide a remedy. [1] In severe cases, hormone preparations will mitigate the menstruation [2] [11]. Sometimes certain antidepressants, which regulate the serotonin level, seem to have a soothing effect. [12]

Endometriosis
Endometriosis is a well-researched disease in which tissue that normally grows inside the uterus grows outside it and is estimated to occur in roughly 10–15% of women in the course of their lives. Its exact cause is not entirely clear. Most often the ovaries, fallopian tubes, pelvis, intestines and ureter are affected by the metastasis of the endometrial tissue; however, in rare cases it may also occur in other parts of the body, like the lungs. Since those lesions react to sexual hormones, they can cause painful adhesions, cysts, inflammations and scarring. Hormones and/or operations as well as adequate pain medication and complementary medicines might be part of the therapeutic approach. [3]

Toxic Shock Syndrom (TSS)
The Toxic Shock Syndrom (TSS) can be caused by a tampon which has remained in the vagina for too long. The bloody tampon serves as a breeding ground for the bacteria Staphylococcus aureus und Streptococcus pyogenes. They produce a so-called superantigen which can cause a severe immune response or even a sepsis. [4] Symptoms are high fever, nausea and vomiting, diarrhea, dizziness, drop in blood pressure and skin rash. [13] The use of plastic fibers, like rayon, in tampon production is considered as potentially dangerous and should be replaced by cotton. [14] However, TSS only appears very rarely (annually 1:200.000). [5]