Menstrual changes v PMS symptoms…

Menstrual Matters
Aug 31, 2018 · 6 min read

Differentiating ‘normal menstrual changes’ [1] from PMS (Premenstrual Syndrome) ‘symptoms’ is a big problem for patients, clinicians, and researchers [2]. There is no biological test that can be used to diagnose PMS and most symptoms rely on patient description e.g. pain, metabolic, or mood-related changes [3].

In fact, the latest clinical guidelines on PMS focus on the timing and severity of (apparently) ‘any’ symptoms:

It is the timing, rather than the types of symptoms, and the degree of impact on daily activity that supports a diagnosis of PMS. The character of symptoms in an individual patient does not influence the diagnosis… There is no limit on the type or number of symptoms experienced” [4].

However, without a list of the most common cyclical symptoms, or knowing how to differentiate between symptoms and ‘normal changes’, it’s possible for patients and clinicians to overlook the role that the menstrual cycle may play in their health…

So, here are some useful lists to help you and your doctor decide what’s going on [5]!

The most common PMS ‘symptoms’

(Cyclical changes that are so severe that they disrupt daily life and/ or require medical support- affecting approx. 3–8% of the menstruating population only [4])

  1. Period pain
  2. Breast pain
  3. Muscle pain (lower back and thighs, in particular)
  4. Fatigue
  5. Diarrhoea
  6. Constipation
  7. Irritability
  8. Anxiety
  9. Low mood/ low self-esteem
  10. Bloating/ trapped gas
  11. Sleep disruption
  12. Headache
  13. Nausea/ vomiting

Normal ‘menstrual changes’

(Cyclical changes that do not disrupt daily life or typically require medical support)

  1. Mild forms of any of the ‘PMS symptoms’ listed above
  2. Restlessness/ pins and needles (Note- this can also be a sign of anaemia)
  3. Mild acne
  4. Water retention
  5. Tearfulness — happy and sad
  6. Dizziness
  7. Libido changes — high and low
  8. Concentration level changes
  9. Mood changes — happy and sad
  10. Energy level changes — high and low
  11. Clumsiness — usually after poor sleep
  12. Body temperature changes

The most common menstrual cycle triggered/ worsened conditions

(Note: These are nearly all female-prevalent conditions)

Originally published on

References and notes:

[1] ‘Menstrual Changes’ were first described by the late, great Mary Brown Parlee (1943–2018) in 1973, as a means to differentiate the positive and non-medical changes associated with the menstrual cycle, in an effort to counter the prevailing (incorrect) assumption that the cycle was a form of illness in itself… Which can still happen all too easily, these days! Parlee, M. B. (1973) ‘The Premenstrual Syndrome’ Psychology Bulletin 80(6) pp 454–465

[2] O’Brien, PMS. (2007) “Preface.” In The Premenstrual Syndromes: PMS and PMDD., edited by Patrick Michael Shaughan O’Brien, Andrea J Rapkin, and Peter J Schmidt, xi–xii. Boca Raton, FL, USA: CRC Press. See page xi.

[3] Halbreich, Uriel. (2007) “The Diagnosis of PMS/PMDD- the Current Debate.” In The Premenstrual Syndromes: PMS and PMDD., edited by Patrick Michael Shaughan O’Brien, Andrea J Rapkin, and Peter J Schmidt, 9–19. Boca Raton, FL, USA: CRC Press. See page 17.

[4] RCOG. (2016) “Management of Premenstrual Syndrome: Green-Top Guideline №48.” BJOG: An International Journal of Obstetrics and Gynaecology 124 (3):73–105. See page 80.

[5] These lists are all informed by data collected through the Menstrual Matters ‘Symptom checker’ application, together with previous research findings, and population studies (see below).

[6] IBS affects approx. 22.7% of UK females- Kennedy TM, Jones RH. Epidemiology of cholecystectomy and irritable bowel syndrome in a UK population Br J Surg. 2000 Dec;87(12):1658–63. Erratum in Br J Surg. 2001 Jul;88(7):1021.

[7] Migraine affects approx. 14.7% of UK adults- Stovner Lj, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, Steiner T, Zwart JA. (2007) The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007 Mar;27(3):193–210.

[8] Insomnia affects approx. 10–30% of US adults- Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002 Apr;6(2):97–111.

[9] Hypersomnia affects approx. 5% of UK adults- Geddes, J., Gelder, M., Price, J., Mayou, R., McKnight, R. (2012) Psychiatry. 4th ed. Oxford University Press p365

[10] Endometriosis affects approx. 7–10% of UK females- Sangi-Haghpeykar H, Poindexter AN. (1995) Epidemiology of endometriosis among parous women. Obstet Gynecol. Jun;85(6):983–92.

[11] Asthma affects approx. 9–11% of UK adults- Simpson, C. R., & Sheikh, A. (2010). Trends in the epidemiology of asthma in England: a national study of 333,294 patients. Journal of the Royal Society of Medicine, 103(3), 98–106.

[12] Iron deficiency anaemia affects approx. 8% of UK females- Ruston D, Hoare J, Henderson L, et al. (2004) The National Diet and Nutrition Survey: adults aged 19–64 years. Volume 4: Nutritional status (anthropometry and blood analytes), blood pressure and physical activity. The Stationery Office. London

[13] Acne affects approx. 85% of US 12–24 year olds and 8% of US adults aged 25 to 34 years- Yentzer BA, Hick J, Reese EL, et al. Acne vulgaris in the United States: a descriptive epidemiology. Cutis. 2010 Aug;86(2):94–9.

[14] Eczema affects approx. 1–3% of US adults- Leung D, Boguniewicz M, Howell MD, et al. New insights into atopic dermatitis. The J Clin Invest. 2004 Mar;113(5):651–7.

[15] PMDD affects approx. 1–8% of UK females — population research is currently inadequate to be any more specific for PMDD- Dennerstein L, Lehert P, Heinemann K. Epidemiology of premenstrual symptoms and disorders. Menopause Int. 2012 Jun;18(2):48–51.

[16 & 17] Anxiety affects approx. 7% and depression affects approx. 4% of UK females- Stansfeld, S., Clark, C., Bebbington, P., King, M., Jenkins, R., & Hinchliffe, S. (2016). ‘Chapter 2: Common mental disorders’. In S. McManus, P. Bebbington, R. Jenkins, & T. Brugha (Eds.), Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey

[18] Diabetes Mellitis (type II) affects approx. 2–4% of UK adults- Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004 May;27(5):1047–53.

[19] ME/ CFS affects approx. 2–3% of English adults — Nacul LC, Lacerda EM, Pheby D, et al. Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in three regions of England: a repeated cross-sectional study in primary care. BMC Med. 2011;9:91

[20] Epilepsy affects approx. 1% of UK adults- ONS (2002) Epilepsy Prescribing Patterns in England and Wales as cited here-

[21] MS affects approx. 0.125% of UK adults- Ford HL, Gerry E, Johnson M, et al. A prospective study of the incidence, prevalence and mortality of multiple sclerosis in Leeds. J Neurol. 2002 Mar;249(3):260–5

[22] Lupus affects approx. 0.028% of English adults- Johnson AE, Gordon C, Palmer RG, et al. The prevalence and incidence of systemic lupus erythematosus in Birmingham, England. Relationship to ethnicity and country of birth. Arthritis Rheum. 1995 Apr;38(4):551–8.

[23] Rheumatoid arthritis affects approx. 1–2% of US adults- Alamanos Y, Voulgari PV, Drosos AA. (2006) Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review. Semin Arthritis Rheum. 2006;36:182–188

[24] Fibromyalgia affects approx. 0.5–5% of US adults- White KP, Harth M. (2001) Classification, epidemiology, and natural history of fibromyalgia. Curr Pain Headache Rep. 2001 Aug;5(4):320–9.

Menstrual Matters

Written by

Check. Track. Manage. Take control of your health by understanding how it relates to your menstrual cycle.

Welcome to a place where words matter. On Medium, smart voices and original ideas take center stage - with no ads in sight. Watch
Follow all the topics you care about, and we’ll deliver the best stories for you to your homepage and inbox. Explore
Get unlimited access to the best stories on Medium — and support writers while you’re at it. Just $5/month. Upgrade