Unusual symptoms/ underlying conditions- PME

What are unusual symptoms?

What are unusual symptoms?

What's (pre)menstrual exacerbation -PME?

What's (pre)menstrual exacerbation -PME?

PME versus PMI

PME versus PMI

Tips and tricks

Tips and tricks

Unusual changes

Unusual symptoms/ underlying conditions...

Particular symptoms that indicate an underlying health issue or regularly severe cyclical symptoms that do not significantly improve with anti-inflammatory approaches.

In a nutshell, if your symptoms are regularly severe, they are unlikely to be due to normal premenstrual change, or Premenstrual Inflammation- PMI (formerly known as PMS). You are much more likely to have an underlying condition.

Many conditions are triggered or worsened at certain times in the menstrual cycle due to associated systemic inflammation and other healthy physiological changes [1].

What are unusual symptoms?

These are all indicative of an underlying health condition.

Please seek medical advice.

[Click on individual symptoms to find more specific tips and tricks]
  1. Suicidal ideation/ intent to self-harm (acute depression/ anxiety/ PMDD)
  2. Severe negative mood change (depression/ anxiety/PMDD)
  3. Prolonged or mid-cycle bleeding (fibroids, contraceptive medication side-effects, polyps, gynaecological cancers)
  4. Irregular (after age 20yrs) or lack of bleeding (PCOS- Polycystic Ovary Syndrome, anorexia, amenorrhea, menopause, contraceptive medication side-effects) 
  5. Heavy bleeding- over 80ml  blood/160ml fluid per period (polyps, adenomyosis, fibroids, womb cancer, blood clotting disorders, ovulatory disorders, medication side-effects)
  6. Regularly very painful periods (fibroids, endometriosis, adenomyosis, Pelvic Inflammatory Disease)
  7. Itchy/ painful vulva/ vagina (usually thrush, sometimes vulvodynia, only very rarely cancer of the vulva)
  8. Itchy vulva with yellow creamy discharge or 'fishy' smelling discharge (Thrush or Bacterial Vaginosis-BV)
  9. Sudden sharp abdominal pain- not period pain (Ovarian cysts, endometriosis, Pelvic Inflammatory Disease)
  10. Extreme sensitivity to light, sound, odour (Menstrual migraine, with or without headache)
  11. Weak bladder/ incontinence (Pelvic floor weakness, womb or bladder prolapse)
  12. Pain during sex/ tampon insertion (Vaginismus, fibroids, or very rarely gynaecological cancers)


Severe period pain is not 'normal'
Severe period pain is not 'normal'
Inflaming the issue... PME.
Inflaming the issue... PME.

What's Premenstrual Exacerbation- PME?

A fancy way of describing underlying conditions that are triggered or worsened by the inflammatory effect of the healthy menstrual cycle.

Symptoms may improve with anti-inflammatory approaches but unlikely to fully resolve without additional intervention - please seek medical advice.

  1. Iron deficiency/ anaemia [specific tips coming soon- NHS info here]
  2. Irritable Bowel Syndrome (IBS)
  3. Menstrual Migraine
  4. Fibroids
  5. Endometriosis/ Adenomyosis
  6. Ovarian cysts
  7. Anxiety/ Depression
  8. PMDD (Premenstrual Dysphoric Disorder)
  9. Polycystic Ovarian Syndrome (PCOS)
  10. Asthma
  11. Heavy Menstrual Bleeding (HMB)
  12. Epilepsy [specific tips coming soon- NHS info here]
  13. Myalgic Encephalitis/ Chronic Fatigue Syndrome
  14. Diabetes [specific tips coming soon- NHS info here]
  15. Skin disorders; acne, eczema, psoriasis [NHS info provided]
  16. Sleep disorders; insomnia, hypersomnia
  17. Auto-immune disorders; Multiple Sclerosis (MS), Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis, or Fibromyalgia [NHS info provided]

PME versus PMI...

You may not have heard of either of these terms before...?

PME- stands for Premenstrual Exacerbation- and typically refers to underlying conditions such as migraine, epilepsy, IBS, or asthma that can be triggered by the inflammatory and other changes involved in the healthy menstrual cycle, as well as 'any' chronic condition that gets worse at certain points of the cycle- usually during the luteal phase, and/ or around menstruation [1].

PMI- stands for (Pre)menstrual Inflammation and is a term coined by Menstrual Matters founder, Sally King. Based on the available evidence, describing cyclical changes in relation to inflammatory processes, is not only more accurate [2], but also less stigmatising than previous definitions of these experiences e.g. 'Premenstrual Tension- PMT' or 'Premenstrual Syndrome- PMS' [3]. Please see here for more details.

The main difference is that PMI symptoms are solely caused by the menstrual cycle and respond well to anti-inflammatory interventions, whereas PME involves an underlying condition that may be slightly alleviated by anti-inflammatory interventions, but is unlikely to resolve completely without additional medical advice or treatment.

Tips and tricks...

Ooh! What a useful tracker chart!
Ooh! What a useful tracker chart!

1. If you have any of the regularly severe or unusual symptoms listed above, especially if they do not respond significantly to anti-inflammatory interventions, please seek medical advice.

2. The tips and tricks listed under each symptom type and the steps to reduce PMI may improve your symptoms a little, but they are unlikely to fully resolve without further treatment, so again, please seek medical advice.

3. If your symptoms may be caused or worsened by a contraceptive or other type of medication, we also suggest that you please seek medical advice.

4. We highly recommend that you track your symptoms over at least a couple of cycles on an app, or using our tracker chart, so you can show the pattern to your doctor.

5. If you feel like your doctor is not taking you seriously or is minimising your experiences without examining you or running any tests, please seek a second opinion. Sadly, this is quite a common experience for female patients, and especially so for those from Black or other racialised or oppressed ethnic groups [4]. Regularly severe symptoms, or the above 'unusual' ones, are not normal (pre)menstrual experiences, you deserve to be treated with appropriate respect and attention.


Page last reviewed: Dec 2020


[1] A range of female prevalent conditions are known to be triggered by the healthy physiological changes involved in the menstrual cycle. For example;

Allais G, Castagnoli Gabellari I, Burzio C, Rolando S, De Lorenzo C, Mana O, Benedetto C. Premenstrual syndrome and migraine. Neurol Sci. 2012 May;33 Suppl 1:S111-5. doi: 10.1007/s10072-012-1054-5. PMID: 22644184.

Eisenlohr-Moul TA, Schmalenberger KM, Owens SA, Peters JR, Dawson DN, Girdler SS. Perimenstrual exacerbation of symptoms in borderline personality disorder: evidence from multilevel models and the Carolina Premenstrual Assessment Scoring System. Psychol Med. 2018 Sep;48(12):2085-2095. doi: 10.1017/S0033291718001253. Epub 2018 May 28. Erratum in: Psychol Med. 2018 Sep;48(12):2100. PMID: 29804553; PMCID: PMC6436806.

Baldaçara RP, Silva I. Association between asthma and female sex hormones. Sao Paulo Med J. 2017 Jan-Feb;135(1):4-14. doi: 10.1590/1516-3180.2016.011827016. Epub 2017 Jan 5. PMID: 28076614.

Herzog AG. Catamenial epilepsy: Update on prevalence, pathophysiology and treatment from the findings of the NIH Progesterone Treatment Trial. Seizure. 2015 May;28:18-25. doi: 10.1016/j.seizure.2015.02.024. Epub 2015 Feb 23. PMID: 25770028.

Jane ZY, Chang CC, Lin HK, Liu YC, Chen WL. The association between the exacerbation of irritable bowel syndrome and menstrual symptoms in young Taiwanese women. Gastroenterol Nurs. 2011 Jul-Aug;34(4):277-86. doi: 10.1097/SGA.0b013e3182248708. PMID: 21814061.

[2] Bertone-Johnson, E (2016) "Chronic Inflammation and Premenstrual Syndrome: A Missing Link Found?." Journal of Women's Health, 25(9), pp. 857–858 https://doi.org/10.1089/jwh.2016.5937

[3] Chapter 4- 'The menstrual cycle; attitudes and behavioural concomitants' by Chrisler, J & Gorman, JA. in Ussher, J.M., Chrisler, J.C., & Perz, J. (Eds.). (2019). Routledge International Handbook of Women’s Sexual and Reproductive Health (1st ed.). Routledge. https://doi.org/10.4324/9781351035620

[4] Sadly, sex and racial discrimination within the clinical context is prevalent within the UK and US. For example;

Samulowitz A, Gremyr I, Eriksson E, Hensing G. "Brave Men" and "Emotional Women": A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Res Manag. 2018 Feb 25;2018:6358624. doi: 10.1155/2018/6358624. PMID: 29682130; PMCID: PMC5845507.

MBRRACE (2019) Saving Lives, Improving Mothers’ Care; Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal
Deaths and Morbidity 2015-17 https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202019%20-%20WEB%20VERSION.pdf

Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017 Apr 8;389(10077):1453-1463. doi: 10.1016/S0140-6736(17)30569-X. PMID: 28402827.