Unkown multifactorial causes.
Keep a diary, find triggers, high fiber and high carbs, small frequent meals, no caffeine, sugar, chocolate, alcohol, dairy, and red meat, exercise, good lighting, antidepressants, oral contraceptives, homeopathy (yoga, accupuncture, hypnosis). Use Ca+ to decrease bloating, pain, and mood changes. Use Mg+ to decrease H2O retention.
Dx: Test HcG, Hct, TSH, CBC with platelets, prolactin level, u/s, endometrial biopsy, histosalphingogram.
Management: tx cause, hormones, GNRH agonist, surgery (hysterectomy, D&C, oopherectomy)