Half of our student body menstruates. From cramps to mood swings, vomiting to back pain, insomnia to fatigue, the average five-day period is rarely met with joy – especially when you’ve got to cycle to your seminar or stand up for four hours in a lab.
To understand the general experience of menstruators in Cambridge – and in particular during Easter term – Varsity has conducted a survey in collaboration with the Cambridge University Menstrual Health Society. It has received 109 responses detailing answers to two main questions: are menstruators receiving the support they need to thrive academically, and could menstruation (and its associated diseases) contribute to the gender attainment gap of first-class awards at Cambridge?
58.2% respondents experienced at least one severe (impacting many day-to-day activities, requiring prescription medication) or very severe (“life stops until it goes away”) symptom in typical cycles. 52% of all symptoms occurred during menstruation, however, 39% symptoms were premenstrual, and 9% symptoms around ovulation, with there being some cases of severe or worse symptoms occurring at times other than during menstruation.
The most common symptoms are pain (98%), mood (97%) and fatigue (92%), and the most common severe symptoms are pain (32%), mood (28%), cognitive symptoms, such as brain fog and impaired focus (28%), and fatigue (25%). 60 students reported experiencing at least one of these severe symptoms.
Many respondents found these symptoms debilitating: students described suicidal ideation, fainting and vomiting, becoming bedbound with pain and fatigue, and brain fog rendering working difficult or even impossible. Indeed, a recent HEPI survey of 950 menstruators in higher education found that, on average, 6 weeks of study are lost per three-year degree course due to menstrual cycle symptoms.
“The systemic under-diagnosis of menstrual health conditions limits students’ academic engagement”
Despite this concerning data, only 16, around 10%, reported a diagnosed menstrual health condition, mirroring the findings of the HEPI dataset. Meanwhile, over twice as many students (39) reported an undiagnosed but suspected menstrual health condition, such as endometriosis (46%), PMDD (25%) and PCOS (23%).
Of the students with a suspected condition, only 15% were receiving healthcare to diagnose the condition. 15% were on a waiting list, part of the approximately 600,000 individuals on the NHS gynaecology waiting list as of January 2025. 28% hadn’t yet spoken to a health professional, a common scenario due to menstrual health stigma and societal gaslighting.
Most concerningly, 41% respondents had visited their GP but were offered no further investigations. A study by Endometriosis UK showed an average gap between symptom onset and diagnosis of 8 years for those with the condition, with 70% visiting their GP five times or more in this period, and only 17% receiving referrals to a gynaecologist after their first appointment. These failings allow chronic, debilitating symptoms to go unchecked.
During exam season, only 28% of students reported no change in any symptoms. Students who reported moderate or severe symptoms in normal cycles had a 70% chance of worsening or new symptoms during exam season, while students who only reported mild symptoms in normal cycles had a 50% chance of worsening, or new symptoms.
“Students rely on luck more than support to manage menstrual cycle symptoms during exam season”
Exam stress and menstrual cycle symptoms mutually exacerbate each other. Students who experienced only mild symptoms in typical menstrual cycles reported either manageable (30%) or mostly manageable (70%) levels of pre-exam stress, whereas 25% students who reported severe symptoms in typical cycles experienced unmanageable pre-exam stress levels. When on-demand performance determines success, the anxieties accompanying menstruation are exacerbated.
As one respondent wrote, “it is incredibly stressful knowing you are performing below your normal standard, especially when exams [are] approaching”. This is an additional burden that exclusively affects menstruators, and disproportionately those with more severe symptoms, placing students at an unfair disadvantage where their exam performance is more likely to reflect the whims of menstrual health than their true efforts and abilities.
Unfortunately, across the students reporting severe, performance-disrupting symptoms, only around 50% received any exam arrangements such as rest breaks or extra time. Only 15% of students received an accommodation specifically for menstrual cycle-related symptoms. 56% said they were not aware requesting accommodations was an option for menstrual cycle-associated symptoms, 23% felt uncomfortable requesting accommodations, 20% said they believed they wouldn’t be permitted in their case, and 13% felt they lacked the right evidence, although no one was rejected after applying for accommodations.
University guidance states that arrangements are considered on a case-by-case basis, and evidence must “attest to your disability and include a diagnosis with specific recommendations”, but whether a disease-specific diagnosis is needed, as opposed to evidence disabling pain and fatigue, is not specified. This creates wide variation in approaches between colleges and tutors, as well as leaving students unsure about the arrangements they are entitled to.
The HEPI report advises that university support systems should “take into account students who suffer from severe symptoms during their menstrual cycle but who do not have a medical diagnosis,”to promote fairness in the face of systemic underdiagnosis, and to recognise the non-pathological, yet significant, influence of most menstrual cycles.
“the gap begins to open in Michaelmas term”
Instead of using adjustments to prevent menstrual cycle-related exam disruptions, students relied on luck, particularly for exam scheduling relative to menstrual cycle phases. One student said, “I got lucky - but I was worried if [my period] did coincide, it would have disturbed my exams.” Another wrote, “unfortunately, I had a heavy period falling on all my in-person examinations. I definitely performed worse because of that.”
50% of students who reported symptoms said they were worse during term-time than in the holidays. The most likely to get worse were mood (33% students reported), cognitive symptoms (28%) and fatigue (28%). The stress of the high Cambridge workload disproportionately affects some menstruators through the exacerbation of cycle-associated symptoms. Indeed, a recent HEPI report concluded that, on average, menstruators miss 10 days of study per academic year, which rises to 19 days for students with diagnosed menstrual health conditions. 75% of students miss at least one study day per year due to menstruation.
The university must recognise that even mild and moderate symptoms may contribute to inequalities when support is inadequate. Furthermore, with menstrual cycles increasingly regarded as the “5th vital sign”, alongside traditional metrics like blood pressure and respiration rate, significant changes are a red flag for student wellbeing.
If, as our evidence suggests, a subset of Cambridge menstruators are not currently receiving adequate support to thrive academically, it is worth considering the contribution of menstrual cycle-associated difficulties to the gender-gap of first-class degrees.
Although women are, on average, marginally more likely to achieve a 2:1 or higher degree (+0.9% in academic year 2023-4), men are more likely (+9.2% in the same year) to obtain a first-class degree, contrary to national trends. A 2024 HEPI report on the topic concluded: “Institutions should not see [gender awarding gap-related recommendations] as an encouragement to ‘dumb down’ their assessments, [or an attempt to] tailor the examination system so as to yield equal results to women as to men […] but to reconsider what skills they are assessing.” It must be recognised that managing pain, menstrual bleeding, pathological brain fog and fatigue are not reasonable examinable skills, whatever the tripos.
The writer would like to thank Souradip Mookerjee for the data analysis.
