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Endometriosis: what the research says

64 studies on endometriosis in PMS and PMDD, each explained in plain English. 6 of them use the strongest designs: randomised trials and systematic reviews.

Review 19Survey study 15Cohort study 9Study 6Randomised trial 4Case report 4
Cohort study, 2026

Do sleep, exercise, and diet quality affect period pain, heavy bleeding, and PMS in midlife?

Women with poor sleep regularity and low moderate-to-vigorous activity had more painful and heavy periods and more PMS. Diet quality showed only a small effect. These are associations, not proof of cause and effect.

Survey study, 2025

Is premenstrual syndrome inherited from your family?

A study found that genes play a small role in who gets PMS symptoms. One genetic change was linked to PMS, and this same genetic pattern is also linked to depression.

Systematic review, 2025

Do progestins reduce pain from endometriosis, fibroids, and PMS?

Progestins significantly reduced pain in 18 of 19 endometriosis studies and in both fibroid studies. However, no studies examined PMS pain, so there is no evidence for PMS.

Review, 2015

Do hormonal contraceptives have benefits beyond preventing pregnancy?

Yes. Combined oral contraceptives can reduce heavy periods, anemia, and PMDD symptoms. Several other contraceptive methods also offer additional health benefits.

Randomised trial, 2003

What complementary and alternative medicines help with women's reproductive health issues?

Acupressure helps with pregnancy nausea and calcium helps with PMS. Vitamin B6, ginger, magnesium, chaste-tree berry, low-fat diet, exercise, and fish oil show promise but need more research.

Systematic review, 1998

Do stomach and intestinal symptoms change during the menstrual cycle?

Yes. About one-third of women without usual gut problems get gut symptoms around their period. Almost half of women with irritable bowel syndrome report their symptoms get worse perimenstrually.

Cohort study, 2026

Do early-life exposures like antibiotics or breastfeeding affect PMS risk?

Yes. Long-term antibiotic use, earlier puberty, maternal smoking, and not being breastfed were linked to higher PMS odds. But only 0.07% of the study had PMS, so findings need careful interpretation.

Randomised trial, 2026

Does vitamin D help with PMS symptoms?

This review found that low vitamin D is linked to more severe PMS symptoms, and supplementation significantly reduces PMS scores, especially for mood-related symptoms. However, the studies used different doses and measuring methods, so more rigorous research with standardized dosing is needed.

Cohort study, 2026

Which established risk factors genetically cause premenstrual disorder?

Genetic analysis suggests three factors cause premenstrual disorder: earlier age at first period, higher BMI, and smoking. However, when tested in a smaller group, results were not consistent, so more research is needed to be sure.

Survey study, 2026

What menstrual cycle symptoms do people experience and how much do they interfere with daily life?

Most symptoms cause modest interference with daily life, but distress is highest during menstruation. Pain and discomfort are the strongest predictors of difficulty with daily activities.

Survey study, 2022

What are the biggest research gaps in women's health, especially for menstrual conditions?

Research is lacking in many important areas, especially communication between women and doctors about health, and support for menstrual conditions like PMDD and heavy periods. There is more research on menopause but not on how to help women manage other conditions.

Case-control study, 2021

Can TSH level and premenstrual spotting help diagnose endometriosis without surgery?

High TSH levels and premenstrual spotting might help identify endometriosis, though neither marker alone is definitive. A diagnosis still typically requires surgery to confirm.

Cohort study, 2018

Do women with PMS or period pain use more complementary therapies like vitamins or yoga over time?

Yes. Over 7 years, Australian women's use of vitamins, yoga, massage and similar therapies linked to PMS and period problems went up, but this study can't say whether those therapies actually worked.

Cohort study, 2016

How many Australian women have PMS and do they use complementary medicine?

41.2% of women aged 34-39 reported PMS. Women with PMS used complementary medicine practitioners and therapies significantly more often than those without.

Cohort study, 2014

Is spotting before the period a sign of endometriosis?

Yes. Women with premenstrual spotting lasting 2 or more days were much more likely to have endometriosis, making this symptom a strong predictor of the condition.

Review, 2013

How do immune cells change during menstruation and what role do they play in heavy bleeding and endometriosis?

A review found that menstruation is an inflammatory process where immune cells change significantly, especially before and during the period. These changes may explain symptoms in women with heavy bleeding or endometriosis, but more research is needed.

Review, 2005

Do birth control pills help with menstrual problems?

Yes. Birth control pills reduce heavy periods, painful periods, and irregular bleeding. Many women also see improvement in acne and excess hair growth.

Review, 2001

What health benefits does the oral contraceptive pill provide?

The oral contraceptive pill has proven benefits including protection against ovarian and endometrial cancers, preventing serious infections and pregnancy complications, and preventing anemia. It can also treat painful periods, heavy bleeding, acne, and endometriosis pain.

Review, 2001

What medical problems can the levonorgestrel intrauterine device treat?

The levonorgestrel IUD can treat heavy periods, period pain, and prevent anemia. It may also help endometriosis pain, though this is based on a review article rather than new clinical research.

Review, 1981

What causes period pain and how is it treated?

Period pain is caused by increased muscle activity in the uterus and is effectively treated with birth control pills or medications called prostaglandin inhibitors.

Survey study, 2026

Could hormonal changes and immune problems explain menstrual issues in autistic women?

This paper proposes that autistic women may experience severe menstrual and reproductive health problems because their immune cells react strongly to hormonal changes during menstruation and pregnancy. This proposed connection has not yet been tested.

Interview study, 2026

How does PMDD change how women feel about themselves in their relationships?

This study interviewed 20 women with PMDD to understand how the condition affects their sense of self as partners, mothers, and friends. The abstract does not include what the researchers actually found.

Survey study, 2025

How do menstrual health and mental health affect each other?

Menstrual problems like PMS, painful periods, and endometriosis affect mood, stress, and thinking. Poor mental health can make menstrual symptoms worse. Connections involve hormones, emotions like stigma and body image, and social factors like education and hygiene access.

Non-randomised trial, 2023

Does aerobic exercise work better than vestibular stimulation for PMS?

Aerobic exercise reduced PMS symptoms and cholesterol levels more than vestibular stimulation, but the study lacked a true control group so we cannot be certain exercise itself caused the improvement.

Study, 2023

How does menstruation affect different areas of women's lives?

Menstruation affects mental health, education, money, and culture, and the challenges are worse for some women depending on race and economic status.

Survey study, 2022

What factors make PMS mood swings worse?

Stress, gynecological conditions like endometriosis and PCOS, and family history of bipolar disorder can worsen PMS. About two-thirds of women (67.4%) reported PMS and a quarter (25.6%) had PMDD.

Case report, 2022

Can endometriosis grow inside the nose and cause nosebleeds during the menstrual cycle?

Yes. One 37-year-old woman had endometriosis inside her nose that caused periodic nosebleeds, nasal pain, and a feeling of fullness. After treatment, she had significant relief of these symptoms over one year.

Review, 2021

Can diet help with PMS and other menstrual disorders?

Diet may help. Eating fresh whole foods while avoiding refined carbohydrates, salt, and alcohol is recommended. Evening primrose oil appears to have positive effects on PMS.

Randomised trial, 2020

How should premenstrual syndrome be diagnosed and treated?

PMS is diagnosed by tracking cyclical symptoms that appear 2-14 days before menstruation and disappear when menstruation starts. Both hormonal treatments like birth control pills and non-hormonal treatments like Vitex extract have been shown in research to be effective.

Survey study, 2019

How common are menstrual symptoms and how much do they affect women's daily lives?

Menstrual symptoms are very common. 85% have period pain, 77% have mood symptoms, and 71% have tiredness. About 1 in 3 women cannot do their usual activities during their period.

Case report, 2018

Does dienogest help premenstrual mood changes in someone with schizophrenia?

One woman with schizophrenia improved in her premenstrual mood symptoms and returned to work. This is one person's experience, so we can't be sure others would benefit.

Survey study, 2017

Does fear of period pain affect mood and thinking during the menstrual cycle?

Yes. Women expecting severe period pain showed increased anxiety and depression and slower thinking response during the premenstrual phase, suggesting that fear of pain affects emotions and cognition.

Non-randomised trial, 2016

Does a low-dose birth control pill help with menstrual pain in women with endometriosis?

Yes. A birth control pill containing drospirenone and ethinylestradiol significantly reduced menstrual pain, pelvic pain, pain with sex, and premenstrual bloating and mood symptoms. The study had no control group, so we cannot be completely certain the improvement was from the pill.

Case report, 2015

Can endometriosis develop in the Bartholin gland?

Yes, endometriosis can develop in the Bartholin gland. It may be mistaken for a cyst but can be correctly diagnosed using ultrasound imaging.

Review, 2014

Do birth control pills help PMS?

Yes. Birth control pills can treat and prevent premenstrual syndrome according to this review, though the abstract does not provide specific details about the strength of benefit.

Study, 2014

Does Magnicum help premenstrual syndrome in women with endometriosis?

Magnicum tablets worked as well as a standard PMS medication in women with endometriosis, especially for swelling and mood and headache symptoms.

Study, 2013

What health problems can birth control pills help with besides preventing pregnancy?

Many. Birth control pills can treat or prevent PMS, PMDD, painful periods, irregular bleeding, acne, cysts, endometriosis pain, fibroids, and reduce risk of some cancers.

Review, 2012

Do GnRH agonist drugs treat PMS?

Yes, GnRH agonist drugs can completely abolish PMS symptoms. However, they cause significant side effects from lowered estrogen that can be managed with add-back therapy.

Review, 2012

How can doctors manage premenstrual-like symptoms caused by hormonal treatments containing progestogen?

No clear evidence exists, but doctors should recognize that hormonal treatments like contraception can cause PMS-like symptoms cycling with medication use, termed progestogen-induced premenstrual disorder, and manage based on clinical experience.

Case report, 2012

Can endometriosis grow around the sacral nerves and cause leg pain and bladder problems?

Yes. Endometriosis can grow around the sacral nerves, causing leg pain around menstruation and bladder problems that surgery can fix.

Survey study, 2009

Can long-cycle birth control pills reduce PMS and menstrual symptoms?

Long-cycle birth control pills may reduce PMS and related symptoms by lowering hormonal fluctuations. This is based on clinical opinion rather than a controlled trial.

Cohort study, 2009

How common is PMDD among preschool teachers in one city?

About 27.3 percent of teachers in this study had PMDD, which is higher than the 3 to 8 percent reported in general. Physical symptoms were the most bothersome.

Cohort study, 2008

What makes the lining of the womb break down at the start of a period?

This lab study suggests a protein called CYR61 rises just before and during a period, pushed up by low oxygen and certain inflammation chemicals, which may help trigger the womb lining to shed. It is basic lab biology, not a test in women with symptoms, so it cannot say this is the full cause.

Cohort study, 2006

How should severe period pain in teenagers be treated?

Regular pain relief medication (NSAIDs) started before periods begin may help. In one teenager, severe pain improved from 8 out of 10 to 5 out of 10.

Review, 2005

Can a levonorgestrel IUD help with gynecological problems?

A levonorgestrel IUD is used for various gynecological conditions. Some women stop using it due to breakthrough bleeding, but counseling can help them continue.

Survey study, 2002

What causes period pain, endometriosis, and PMS in teenage girls, and what treatments work?

Period pain affects 80-90% of adolescent girls and is caused by chemicals in the uterus and abnormal muscle contractions. Treatment starts with relaxation and pain relief drugs, or hormonal medications if needed.

Study, 2002

What chemical changes in menstrual blood might cause endometriosis?

The study suggests that menstrual tissue contains high levels of proteins and chemicals that could help menstrual fragments stick to other body areas if they escape. These chemicals are activated when progesterone drops before menstruation.

Non-randomised trial, 2002

Is it safe to use hormone therapy alongside GnRH-agonist treatment for severe PMS?

In this small study, yes. Hormone therapy appeared safe and effective, protecting bone health and controlling PMS symptoms.

Review, 2000

What is GnRH and what is it used for in women?

GnRH is a hormone medication that stops the release of other hormones involved in ovulation. It is used to treat PMS, endometriosis, fibroids, and other conditions.

Study, 2000

What causes PMDD and how should it be treated?

PMDD is an intense version of the normal mood and physical changes that happen before menstruation, involving genetics, brain chemistry and hormones. SSRI medications are now used as a treatment.

Review, 1999

Can different progestin hormones help treat various women's health problems before menopause?

This is a general overview article, not a new study. It explains that different progestins may suit different conditions, but it gives no trial results to prove any specific benefit.

Survey study, 1999

Do bowel symptoms vary with the menstrual cycle in women with IBS and inflammatory bowel disease?

Yes. About two-thirds of women with Crohn's disease and ulcerative colitis reported that their symptoms got worse with their cycle. Women with IBS and inflammatory bowel disease reported more cyclical changes in bowel habits than women with normal bowel function.

Survey study, 1997

How common are premenstrual symptoms, what treatments do women use, and do they work?

Between 11-32% reported severe or extreme symptoms, and 85% had tried treatments. Women reported that dietary changes, evening primrose oil, vitamins, and exercise worked best.

Randomised trial, 1996

Does hormone replacement therapy prevent low-estrogen side effects of GnRH agonist treatment for severe PMS?

Gonadotropin-releasing hormone agonists help mood symptoms in severe PMS but cause low-estrogen side effects. Adding hormone replacement therapy prevents some side effects (bone loss and hot flashes) but not all progestin side effects.

Review, 1995

What causes pelvic congestion in PMS and how should it be treated?

PMS involves pelvic congestion caused by hormonal and circulatory factors, typically treated with a combination of hormone medications (progestogens) and venotonics (medications that help veins).

Review, 1995

Can GnRHa hormone therapy treat premenstrual syndrome?

GnRHa is used to treat PMS, but a 6-month course causes about 8.2% bone loss that may not fully recover, which is a concern for long-term use.

Review, 1994

Can GnRHa hormone therapy treat premenstrual syndrome long-term?

GnRHa treats PMS but causes about 8.2% bone loss in 6 months that may not fully reverse, creating a challenge for longer-term use.

Survey study, 1991

How common are menstrual symptoms in working women?

The most common symptoms were weight gain and swelling (over 60% of women), followed by anxiety, tension, irritability, fatigue, cramps, breast pain, mood swings, and food cravings. Symptoms were more common in younger women.

Review, 1991

What are progestogens used for, and what side effects do they have?

Progestogens are medications used to regulate menstrual bleeding, protect the uterine lining, provide contraception, and treat cancer. They can cause physical, psychological, and metabolic side effects including changes in blood fats that need to be considered.

Review, 1987

How well do hormone-suppressing drugs work for treating gynaecological conditions?

This review suggests that hormone-suppressing drugs called LHRH agonists work well for several gynaecological conditions and have few serious side effects, though larger studies are needed to compare which drugs and doses work best.