More Than “Just a Bad Period”: Understanding Endometriosis, PMS, PMDD and PMOS
One of the biggest problems in menstrual health is that we have been taught to normalise too much.
We’ve been taught to believe that because something is common, it’s normal and we should accept it.
However, I just don’t think that’s the case when menstrual health leaves many of us with pain, exhaustion, intense mood fluctuations, heavy bleeding, more questions than answers, irregular periods and being dismissed, delayed or told to “just get on with it”.
Introduction
Menstrual health is much more than periods, and nobody should have to suffer without support.
The World Health Organisation has framed menstrual health as a health and human rights issue, with physical, psychological and social dimensions across the life course and we see this in our realities every day.
Menstrual health includes bleeding, pain, symptoms, PMS, PMDD, endometriosis, PCOS, perimenopause, menopause, mental health, energy, sleep, stress, access to support and the ability to participate fully in life, work and community.
That matters because menstrual health conditions do not just affect the body. They affect work, relationships, confidence, mental health, sex, identity, energy, social life and the way people understand themselves.
Research, infrastructure and awareness is lagging behind the reality many of us experience but were never taught to understand.
So this is a starting point for those who want to know more.
This article isn’t here to diagnose you, panic you or turn your body into another project. It’s to give you the language, context and hopefully – a clearer sense of what might be going on.
Because if symptoms are affecting your life, they deserve attention.
Endometriosis
Let’s take a deep breath and start with a big one.
Endometriosis is a significant, life-impacting chronic gynaecological condition where tissue similar to the lining of the womb grows elsewhere in the body. This can cause inflammation, pain, adhesions and, for some people, involvement with other organs.
It is often described as a period condition, but that does not really capture it.
Endometriosis can affect:
pain levels - significantly
energy and fatigue
digestion, bladder and bowel symptoms
pressure around reproductive choices and bodily autonomy
capacity – mentally, emotionally and physically
sex, fertility and relationships
work, identity and mental health
confidence and quality of life
ability to work, travel, exercise and socialise
multiple other organs and systems in your body
It is a whole-body, whole-life condition.
It can show up as painful periods, pelvic pain, pain during or after sex, bowel pain, bladder pain, ovulation pain, fatigue, nausea, bloating, back pain, leg pain and pain that continues outside bleeding. I also want to give a shout out here to Adenomyosis which has similar symptoms, but the cause it the tissue growing within the wall of the uterus, rather than outside of it.
For some people, symptoms are strongly cyclical. For others, they are chronic and present throughout the month.
It affects around 1 in 10 people who menstruate in the UK which is approximately 1.5 million people, and the average time to diagnosis is now 9 years and 4 months. Since 2003, there have reportedly been 35 endometriosis-related research projects compared with 1,758 diabetes projects, despite endometriosis being similarly prevalent.
That is not just a medical delay – it is nearly a decade of people adapting their lives around pain they may not yet have a name for. It’s not surprising it affects mental health, work and trust in your own body.
What can help?
With endometriosis, support usually needs to be layered.
I have an advanced understanding of endometriosis, as I am diagnosed with Stage 4 Infiltrative Endometriosis and have worked with the condition holistically for many years.
Medical support matters, and for some people - surgery, hormonal treatment, pain management or specialist care can be life changing. But many people also need support with fatigue, stress, inflammation, nervous system load, digestion, movement, pacing, boundaries and recovery.
Cycle tracking can be useful because it helps you identify whether symptoms cluster around menstruation, ovulation, luteal phase, stress, sleep disruption, food, movement, travel or overexertion. It can give you better language for appointments and help you notice patterns rather than feeling like everything is random.
Support might include:
tracking pain, energy, digestion, bleeding and flares
noting ovulation pain, bowel/bladder symptoms and fatigue
pacing around vulnerable points in the cycle
reducing high-impact exercise during flares
supporting sleep and recovery
preparing for appointments with symptom evidence
asking for referral to a specialist where appropriate
exploring pelvic health, nutrition, nervous system support or bodywork with qualified practitioners
Remember: Life-disrupting pain is not something you should have to quietly absorb.
Polyendocrine Metabolic Ovarian Syndrome (PMOS)
Formerly - Polycystic Ovary Syndrome (PCOS)
In May 2026, after a global consensus process, PCOS transitioned to PMOS and actually, that’s quite an important development in menstrual healthcare.
For years, PCOS was often misunderstood as being mainly about ovarian cysts. But many people with the condition do not have “cysts” in the way people imagine, and the word itself has contributed to confusion, dismissal and delayed understanding.
PMOS is one of the most common conditions, affecting 10-13% of people who menstruate, and it’s estimated that up to 70% of people with the condition don’t even know they have it.
PMOS is a more accurate name because it reflects what the condition actually involves: hormones, metabolism, ovulation, skin, hair, mood, energy, insulin, weight, inflammation and wider long-term health.
PMOS can affect:
cycle regularity
ovulation
fertility
skin and acne
hair growth or hair thinning
insulin and blood sugar
appetite and cravings
weight and metabolism
inflammation
fatigue and energy
Like endometriosis, it is a whole-body condition.
PMOS is one of the most common hormonal conditions, affecting around 1 in 8 women globally and can be very emotionally charged as a topic. Symptoms like acne, hair growth, weight changes and irregular cycles can affect confidence, body image, relationships, sex, identity and mental health.
But, because previously it has been narrowly framed around fertility and appearance- people may not always get access to the wider metabolic, psychological and whole-body support they need.
What can help?
Support for PMOS often needs to be broader than simply “regulating periods”.
Because PMOS can involve blood sugar, insulin, stress, sleep, inflammation, movement, hormones and mental health, support usually works best when it looks at the whole person.
Cycle tracking can be helpful, but it may look different if your cycle is irregular or absent. Instead of only tracking cycle phases, you might track mood, energy, skin changes, cravings, sleep, stress, appetite, digestion, exercise, medication, supplements and signs of ovulation if relevant.
Support might include:
speaking to a GP or specialist about diagnosis and management
tracking cycles, symptoms and metabolic patterns
supporting blood sugar with regular meals and enough protein/fibre
choosing movement that supports insulin sensitivity without overloading the nervous system
prioritising sleep and recovery
reducing stress where possible
seeking support for acne, hair changes or body image if needed
exploring medication or hormonal options where appropriate
asking for proper investigation if periods are irregular, absent or symptoms are worsening
Remember: PMOS is a hormonal and metabolic condition, and you deserve support that treats it that way.
Post-Menstrual Syndrome (PMS)
PMS refers to physical, emotional and behavioural symptoms that happen in the luteal phase- usually in the days or weeks before a period, and they tend to improve once bleeding starts.
It is very common, but it is also under-recognised with the National Association for Premenstrual Symptoms (NAPS) noting World Health Organisation definitions of PMS captures up to 80% of people who menstruate.
PMS can include:
bloating and breast tenderness
headaches, migraines and fatigue
cravings, irritability and sensory overload
digestive issues and skin changes
cognitive capacity and brain fog
anxiety, low mood, tearfulness
The fact that something happens premenstrually does not make it imaginary. In many cases, the luteal phase reveals what is already under strain. It can show you where you are depleted, overloaded, unsupported, undernourished, under-rested or emotionally stretched.
This is why I often describe luteal as the phase that asks: how are you really?
What can help?
The starting point with PMS is noticing the pattern.
If symptoms happen at the same point each cycle, that is information. You can begin to ask: what is my body asking for before my period, and what happens when I ignore it?
Support might include:
tracking symptoms for 2–3 cycles
supporting blood sugar with regular meals
reducing alcohol and caffeine if they worsen symptoms
prioritising sleep in the luteal phase
lowering unnecessary social or work demands before bleeding
moving gently rather than forcing intensity
planning simpler meals and softer routines
communicating needs before you reach breaking point
Sometimes PMS is manageable with lifestyle adjustments and body literacy, but equally – it can require medical support, especially if symptoms are severe, worsening or affecting daily life.
Remember: Your feelings aren’t irrational, and you’re not to blame.
Pre-Menstrual Dysphoric Disorder (PMDD)
Let’s be really clear – PMDD is not just “bad PMS”.
It is a severe cyclical condition where intense emotional and psychological symptoms occur before a period and significantly impair daily life.
It can cause:
severe depression and anxiety
overwhelm, stress and concentration difficulties
rage, panic and hopelessness
self-harm thoughts and suicidal thoughts.
PMDD is important because it is significant, and like most menstrual health conditions, is widely misunderstood.
People who have PMDD may feel like they become a completely different person in the luteal phase. They may experience a dramatic shift in mood, relationships, self-worth, body image, sensitivity, distress or ability to cope, and then feel relief once bleeding starts.
Personally and professionally, I think that is worth paying attention to.
PMDD affects an estimated 1.2 million people in the UK and has been described as having a functional impact similar to major depression. Of those with PMDD, 72% experience suicidal ideation and more than 50% self-harm.
So, it’s not a personality flaw, people aren’t being “dramatic” and it is not “just hormones”. It’s a condition that causes significant distress to people and deserves proper care.
What can help?
With PMDD, tracking is often essential because it can show whether symptoms are cyclical. That matters for diagnosis, treatment and self-understanding.
Useful things to track include mood, anxiety, rage, hopelessness, intrusive thoughts, sleep, conflict, sensory sensitivity, energy, self-harm thoughts, suicidal thoughts, cycle day and when symptoms lift.
Support may include:
speaking to a GP or healthcare professional
taking symptom tracking evidence to appointments
crisis planning for high-risk days
reducing load before symptoms peak
telling trusted people what happens and what helps
avoiding major decisions during severe symptom windows where possible
exploring treatment options, which may include medication, hormonal options or specialist support
working with a therapist or practitioner who understands cyclical mental health patterns
Remember: If PMDD symptoms include self-harm urges or suicidal thoughts, that needs proper support. Tracking can help you understand the pattern, but you should not be left to manage that alone.
Conclusion
As you can clearly see, these health conditions are not small, niche or insignificant.
Endometriosis, PMOS, PMS and PMDD can affect every part of a person’s life so they deserve proper research, recognition, diagnosis, treatment and care.
More than anything, people deserve to understand what is happening in their own bodies. For too long, too many of us have been taught to minimise pain, explain away symptoms, push through exhaustion, hide distress and accept long waits, vague answers or outright dismissal as normal.
But menstrual health is health – and the symptoms provide information we need to pay attention to.
As somebody who lives with Stage 4 Infiltrative Endometriosis, I know how confusing, frightening and isolating it can feel when your body is doing things you do not understand, and the systems around you are not moving quickly enough to help.
So if any part of this resonated with you, please know this: you are not being dramatic, asking for too much and it’s reasonable to want answers, support and care.
And I stand with you firmly in that mission.
If this resonated with you, and you’d like to explore how working with me can support you, please do get in touch, I’d love to hear from you.
Explore my work:
hello@flowwithpaige.com
