February 24, 2023 – Most women are aware of the emotional ups and downs that may occur before their monthly period, referred to as PMS or premenstrual syndrome. For some women, PMS symptoms are severe enough to warrant a diagnosis: PMDD or premenstrual dysphoric disorder, which is usually accompanied by severe mood swings. But a lesser-known condition may very well be the worst of all: premenstrual exacerbation or PME.
PME occurs when hormonal changes occur within the luteal phase of your cycle, between ovulation and menstruation. One or two weeks before a girl's period, PME may cause symptoms of a pre-existing disorder reminiscent of major depression, generalized anxiety disorder, schizophrenia, bipolar disorder, or other mood disorders to flare up. A study found that 58% of girls with depressive disorders also suffer from PME, which increases their risk of suicide during this premenstrual phase.
“PME, PMS and PMDD are all related to mood problems before your period,” says Lauren M. Osborne, MDvice chair for clinical research within the department of obstetrics and gynecology at Weill Cornell Medicine and New York-Presbyterian Hospital in New York City. “The difference is that women with PMS and PMDD do not have a mood disorder. PME really causes significant mood symptoms 2 weeks before a woman's period if she has an underlying mental illness.”
Women with PME show an unusually increased sensitivity to fluctuating sex hormones during their menstrual cycle, which appears to be the trigger. according to German researchers.
What are the symptoms of PME?
PME can present itself as a “premenstrual breakthrough,” which suggests that symptoms of a mental illness which are manageable in a girl and not using a premenstrual period change into more pronounced when she does have a premenstrual period. For example, if a girl is taking medication for bipolar disorder, she may find that the dose that normally works well suddenly not prevents her mood swings.
“The difference between PMS, PMDD and PME is often a different symptom quality,” says Monica Rosen, MD, an obstetrician-gynecologist on the University of Michigan Health Von Voigtlander Women's Hospital in Ann Arbor, Michigan. “With PMS or PMDD, you may feel anxiety before your period, but with PME, you get a full-blown panic attack.”
According to the International Association for Premenstrual Disorders (IAPMD)The symptoms of the next conditions can also worsen because of PME:
- alcoholism
- Attention deficit/hyperactivity disorder
- Borderline personality disorder
- schizophrenia
- Eating disorders
- Posttraumatic stress disorder
- Persistent depressive disorder
- psychosis
- Substance use disorders
How is PME diagnosed?
PME isn’t yet a recognized diagnosis in its own right. Rather, it’s linked to the diagnosis of an underlying mental illness.
“It's much harder to cope with a depressive episode or anxiety attack when they seem to come out of nowhere,” says Sabrina Romanoff, PsyD, a clinical psychologist in New York City. “With PME, you have the benefit of time, which gives you knowledge of the days that might be more difficult.”
But “many women with PME don't realize they have a mood disorder,” says Osborne. “They may have undiagnosed depression, and the diagnosis is often not made until they seek help for their PME symptoms.”
According to the IAPMDAbout half of girls who seek medical help for suspected PMS or PMDD symptoms discover that they really have PME or a psychiatric disorder they were unaware of.
To confirm PME, a physician will probably ask the patient to report how she feels immediately before her period.
“It's important to be aware of what specific symptoms you're experiencing,” says Rosen. “Many of my patients use a tracking app that's very helpful in figuring out how you're feeling on a given day.”
How is PME treated?
PME is primarily treated by treating the mental illness that’s causing your symptoms to worsen.
“For women who are diagnosed and taking antidepressants, increasing the dose during the premenstrual period can relieve their symptoms,” says Osborne. “Sometimes PME goes away when we treat depression properly.”
If not, intensifying other types of treatment may make a difference.
“Talk therapy is always helpful,” says Rosen. “Medications to support the hormonal cycle, such as birth control pills or birth control rings, can also help many women.” As a final resort, some women go for surgical menopause to stop extreme PME symptoms.
It is vital to know that self-help can even make a giant difference in relieving PME.
For example, women with PME may find it helpful to rearrange their schedule in the times before their period to scale back workload and avoid excessive stress as much as possible.
People affected by PME also needs to avoid isolating themselves from others.
“Plan time with your friends in advance,” Romanoff suggests, as this sense of connection will help ease symptoms. Patients can also find PME self-help groups onlineto refer to other patients who can provide good advice.
The bottom line is: “PME is controllable,” says Romanoff.
Take PME seriously, but don't give attention to your fear. Instead, get the allow you to need and sit up for feeling higher soon.