Editing Menstruation (section)

== Side effects==
===Menstrual health overview===
{{excerpt|Menstrual cycle#Menstrual health|paragraphs=1,2}}

===Moods and premenstrual syndrome (PMS)===
{{main|Menstruation and mental health}}
{{excerpt|Premenstrual syndrome}}

===Cramps===
In most women, various physical changes are brought about by fluctuations in hormone levels during the menstrual cycle. This includes muscle contractions of the uterus (menstrual cramping) that can precede or accompany menstruation. Many women experience painful cramps, also known as [[dysmenorrhea]], during menstruation.<ref name="The prevalence and risk factors of">{{cite journal | vauthors = Ju H, Jones M, Mishra G | title = The prevalence and risk factors of dysmenorrhea | journal = Epidemiologic Reviews | volume = 36 | issue = 1 | pages = 104–113 | date = 1 January 2014 | pmid = 24284871 | doi = 10.1093/epirev/mxt009 | doi-access = free }}</ref> Among adult women, that pain is severe enough to affect daily activity in only 2%–28%.<ref name="The prevalence and risk factors of"/> Severe symptoms that disrupt daily activities and functioning may be diagnosed as [[premenstrual dysphoric disorder]].<ref name="WH2020">{{cite web|date=12 July 2017|title=Premenstrual syndrome (PMS)|url=https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome|access-date=3 January 2020|website=womenshealth.gov|language=en|archive-date=8 December 2016|archive-url=https://web.archive.org/web/20161208172815/https://www.womenshealth.gov/publications/our-publications/fact-sheet/premenstrual-syndrome.html|url-status=live}}</ref> These symptoms can be severe enough to affect a person's performance at work, school, and in everyday activities in a small percentage of women.<ref name="AFP2011" />

When severe pelvic pain and bleeding suddenly occur or worsen during a cycle, this could be due to [[ectopic pregnancy]] and [[miscarriage|spontaneous abortion]]. This is checked by using a pregnancy test, ideally as soon as unusual pain begins, because ectopic pregnancies can be life‑threatening.<ref>{{cite web|title=Ectopic Pregnancy Clinical Presentation: History, Physical Examination|url=http://emedicine.medscape.com/article/2041923-clinical|url-status=live|archive-url=https://web.archive.org/web/20130329020606/http://emedicine.medscape.com/article/2041923-clinical|archive-date=29 March 2013|website=emedicine.medscape.com|df=dmy-all}}</ref>

The most common treatment for [[menstrual cramps]] are [[non-steroidal anti-inflammatory drugs]] (NSAIDs). NSAIDs can be used to reduce moderate to severe pain, and all appear similar.<ref name="Dysmenorrhoea">{{cite journal | vauthors = Latthe PM, Champaneria R | title = Dysmenorrhoea | journal = BMJ Clinical Evidence | volume = 2014 | pages = 390–400 | date = October 2014 | pmid = 25338194 | pmc = 4205951 | doi = 10.1016/j.ajog.2017.08.108 }}</ref> About 1 in 5 women do not respond to NSAIDs and require alternative therapy, such as simple analgesics or heat pads.<ref>{{cite journal | vauthors = Oladosu FA, Tu FF, Hellman KM | title = Nonsteroidal antiinflammatory drug resistance in dysmenorrhea: epidemiology, causes, and treatment | journal = American Journal of Obstetrics and Gynecology | volume = 218 | issue = 4 | pages = 390–400 | date = April 2018 | pmid = 28888592 | pmc = 5839921 | doi = 10.1016/j.ajog.2017.08.108 }}</ref> Other medications for pain management include aspirin or paracetamol and combined oral contraceptives. Although combined oral contraceptives may be used, there is insufficient evidence for the efficacy of intrauterine progestogens.<ref name="Dysmenorrhoea"/>

One review found tentative evidence that acupuncture may be useful, at least in the short term.<ref>{{cite journal | vauthors = Woo HL, Ji HR, Pak YK, Lee H, Heo SJ, Lee JM, Park KS | title = The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis | journal = Medicine | volume = 97 | issue = 23 | pages = e11007 | date = June 2018 | pmid = 29879061 | pmc = 5999465 | doi = 10.1097/MD.0000000000011007 }}</ref> Another review found insufficient evidence to determine an effect.<ref>{{cite journal | vauthors = Smith CA, Armour M, Zhu X, Li X, Lu ZY, Song J | title = Acupuncture for dysmenorrhoea | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 4 | pages = CD007854 | date = April 2016 | pmid = 27087494 | pmc = 8406933 | doi = 10.1002/14651858.CD007854.pub3 }}</ref>

=== Interactions with other conditions ===
Known interactions between the menstrual cycle and certain health conditions include:

* Some women with [[Neurology|neurological conditions]] experience increased activity of their conditions at about the same time during each menstrual cycle. For example, drops in estrogen levels may trigger [[migraines]],{{medical citation needed|date=February 2021}} <ref>{{cite journal | vauthors = Reddy N, Desai MN, Schoenbrunner A, Schneeberger S, Janis JE | title = The complex relationship between estrogen and migraines: a scoping review | journal = Systematic Reviews | volume = 10 | issue = 1 | pages = 72 | date = March 2021 | pmid = 33691790 | pmc = 7948327 | doi = 10.1186/s13643-021-01618-4 | doi-access = free }}</ref> especially when the woman who has migraines is also taking the birth control pill.
* Many women with [[epilepsy]] have more seizures in a pattern linked to the menstrual cycle; this is called "[[catamenial epilepsy]]".<ref name="pmid18164632">{{cite journal | vauthors = Herzog AG | title = Catamenial epilepsy: definition, prevalence pathophysiology and treatment | journal = Seizure | volume = 17 | issue = 2 | pages = 151–159 | date = March 2008 | pmid = 18164632 | doi = 10.1016/j.seizure.2007.11.014 | s2cid = 6903651 | doi-access = free }}</ref> Different patterns seem to exist (such as seizures coinciding with the time of menstruation, or coinciding with the time of ovulation), and the frequency with which they occur has not been firmly established.
* Research indicates that women have a significantly higher likelihood of [[anterior cruciate ligament]] injuries in the pre-ovulatory stage, than post-ovulatory stage.<ref>{{cite journal | vauthors = Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust G, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L | display-authors = 6 | title = Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement | journal = British Journal of Sports Medicine | volume = 42 | issue = 6 | pages = 394–412 | date = June 2008 | pmid = 18539658 | pmc = 3920910 | doi = 10.1136/bjsm.2008.048934 }}</ref>

=== Sexual activity ===
{{Further|Culture and menstruation}}
Sexual feelings and behaviors change during the menstrual cycle. Before and during ovulation, high levels of estrogen and [[androgen]]s result in women having a relatively increased interest in sexual activity, and relatively lower interest directly prior to and during menstruation.<ref>{{cite book| vauthors = Levay S, Baldwin J, Baldwin J |title=Discovering Human Sexuality |publisher=Sinauer Associates, Inc. |year=2015 |isbn=9781605352756 | location = Massachusetts |pages=44 |chapter=Women's Bodies|name-list-style=vanc}}</ref> Unlike other mammals, women may show interest in sexual activity across all days of the menstrual cycle, regardless of fertility.<ref>{{cite book| vauthors = Thornhill R, Gangestad SW |title=The Evolutionary Biology of Human Female Sexuality|publisher=Oxford University Press|year=2008|isbn=9780195340990|location=New York|pages=12|chapter=Background and Overview of the Book|name-list-style=vanc}}</ref>

There is no reliable scientific evidence that would advise against [[sexual intercourse]] during menstruation based on medical grounds.{{medical citation needed|date=February 2021}}

=== Fertility aspects ===
Peak [[fertility]] (the time with the highest likelihood of pregnancy resulting from sexual intercourse) occurs during just a few days of the cycle: usually two days before and two days after the [[ovulation]] date.<ref>{{cite web|title=My Fertile Period | work = DuoFertility | publisher = Cambridge Temperature Concepts Limited |url=http://www.duofertility.com/en/my-body/my-cycle/my-fertile-period.html|url-status=dead|archive-url=https://web.archive.org/web/20081221225600/http://www.duofertility.com/en/my-body/my-cycle/my-fertile-period.html|archive-date=2008-12-21|access-date=2008-09-22}}</ref> This corresponds to the second and the beginning of the third week in a 28-day cycle. This [[fertile window]] varies from woman to woman, just as the ovulation date often varies from cycle to cycle for the same woman.<ref>{{cite journal | vauthors = Creinin MD, Keverline S, Meyn LA | title = How regular is regular? An analysis of menstrual cycle regularity | journal = Contraception | volume = 70 | issue = 4 | pages = 289–292 | date = October 2004 | pmid = 15451332 | doi = 10.1016/j.contraception.2004.04.012 }}</ref> A variety of methods have been developed to help individual women [[Fertility testing|estimate the relatively fertile]] and the relatively infertile days in the cycle; these systems are called [[fertility awareness]].{{medical citation needed|date=February 2021}}