Gender differences have been recognized in asthma. Specifically in women, an exacerbation in symptoms occurring a few days prior to the onset of menstruation constitutes a phenotype that is not yet fully understood. This phenomenon, called "premenstrual asthma," has been reported to affect upto 40% women with asthma. This article reviews the literature on prevalence, effect of menstrual cycle on symptoms and lung function and discusses the proposed mechanisms of pathogenesis including the effects of female sex hormones on symptoms and beta2 adrenergic receptor function, and the role of airway inflammation. Finally, the various treatment options are presented.