What is Premenstrual Exacerbation (PME)?

We use the term "Premenstrual Exacerbation" (PME) to describe when symptoms of another condition get worse right before your period. This could be related to depression, anxiety, or some other health issue. Basically, the symptoms stick around throughout your whole menstrual cycle but kick into high gear during the premenstrual phase.

What's the difference between PMDD and PME?

PMDD and PME are pretty similar, making it tough to tell them apart in real life. Both conditions are tied to the menstrual cycle and come with similar symptoms like feeling depressed, anxious, fatigued, and hopeless, especially right before your period.

But hey, they're not exactly the same! If you're dealing with PME, you'll have symptoms more or less throughout your whole cycle, but they really ramp up during the premenstrual phase. On the flip side, with PMDD, your symptoms totally disappear a few days after your period starts. The image below shows the difference pretty well.

PMDD and PME symptoms follow a similar pattern and share a lot of similarities, which makes telling them apart a challenge. The best way to get a proper diagnosis is by keeping a daily record of your symptoms for 2 - 3 months.

You can also have both PMDD and PME at the same time. One doesn't cancel out the other. In that case, you may experience some symptoms throughout your entire cycle and others only during the second half of it.

What conditions can get worse before your period?

Well, symptoms of the following conditions can worsen during your luteal phase:

• Depression
• Anxiety disorder
• Panic disorder
• ADHD
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Addiction
• Suicidal tendencies
• Schizophrenia
• Psychosis
• Eating disorders
• Personality disorders (e.g., borderline)

How do treatments for PMDD and PME differ?

Antidepressants:

For both PMDD and PME, doctors may prescribe specific antidepressants called SSRIs. If you've got PMDD, taking these meds just during the luteal phase seems to do the trick.

But if you've got PME, it means you're dealing with an underlying condition (as listed above). Your symptoms show up during most of your cycle and get worse before your period. In that case, it might be better to take antidepressants throughout your entire cycle, and your doctor could suggest a higher dose to be taken only during the second half of it.

Other treatment options:

There are other treatments for PMDD, but research suggests they might not be as effective for women with PME. These treatments use hormones, like certain birth control pills and GnRH agonists, but they might not necessarily help with reducing symptoms before your period.

Another way to treat PME is to deal with the underlying condition. If you've got an underlying depression, ADHD, or another medical condition, your doctor might want to address that first, which could also help ease the symptoms during your luteal phase.

The research on both PMDD and PME is limited, and treatment options are still not well explored, so it's not entirely clear how effective they are. Plus, every woman is unique, so what works for someone else may not work for you. If you suspect you've got PMDD or PME, it's best to talk to your primary care physician, gynecologist, or psychiatrist.

Conclusion

In real life, it's pretty tough to tell the difference between PMDD and PME since they're both tied to the menstrual cycle, and their symptoms can be pretty similar. But knowing the difference is crucial because they require different treatments.

If you only experience symptoms right before your period, chances are it's PMDD. But if you've got symptoms throughout most of your cycle, it could be PME with an underlying condition. And remember, you could have both PMDD and PME at the same time.

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Sources:

“MANAGEMENT OF PREMENSTRUAL SYNDROME: GREEN‐TOP GUIDELINE NO. 48.” BJOG: AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, VOL. 124, NO. 3, FEB. 2017, PP. E73–105. DOI.ORG (CROSSREF), HTTPS://DOI.ORG/10.1111/1471-0528.14260.  

HTTPS://FAQ.IAPMD.ORG/EN/ARTICLES/2608686-HOW-DO-WE-KNOW-IF-WE-HAVE-PME-OR-PMDD-HOW-DO-WE-DIFFERENTIATE

HTTPS://IAPMD.ORG/PMDD-V-PME