Premenstrual intensification: Signs and remedies
Premenstrual Exacerbation (PME) is a phenomenon where the symptoms of a preexisting chronic illness worsen before a period. While PME does not cause brand-new symptoms to appear, it can aggravate the symptoms a person already experiences. However, it's unclear whether these options would help everyone with PME.
PME typically worsens in the luteal phase, which is the second half of a person's menstrual cycle. This phase is characterised by a drop in progesterone and estrogen levels. Common chronic illnesses and mental health conditions that can be potentially affected by PME include mood disorders, thyroid dysfunction, and trauma-related conditions.
Mood disorders such as major depressive disorder (MDD) and bipolar disorder may worsen during the premenstrual phase, sometimes mimicking or overlapping with Premenstrual Dysphoric Disorder (PMDD). Thyroid dysfunction, especially hypothyroidism, can exacerbate PMDD symptoms like fatigue, depression, irritability, and anxiety. Posttraumatic stress disorder (PTSD) and a history of trauma or abuse have been independently associated with heightened PMDD symptoms.
PMDD is a type of extreme PMS that causes behavioral, mood, and sometimes physical changes before a person's period, but it occurs only during the luteal phase and resolves around the time a person gets their period. Unlike PME, the symptoms of PMDD occur on a regular schedule and will resolve completely when a person's period begins.
Examples of new symptoms caused by PMDD include depression or hopelessness, anxiety, feeling overwhelmed or out of control, persistent or severe irritability or anger, mood swings, loss of interest in activities or hobbies, difficulty concentrating, fatigue, significant changes in appetite, food cravings, sleeping a lot more or less than usual, physical symptoms such as headaches, breast swelling, bloating, or weight gain.
For some conditions, there are specific terms for when the symptoms worsen due to the menstrual cycle, such as catamenial epilepsy and perimenstrual asthma.
Research suggests that treatments to suppress hormone production, such as the ones doctors prescribe for PMDD, do not help with PME. There is not a lot of research into PME treatment, but taking hormones to help prevent their sudden drop after ovulation may help some people.
If symptoms are severe, always speak with a doctor. People who suspect they may experience PME may find it helpful to record their symptoms for several menstrual cycles to see whether the symptoms tend to worsen before periods. Depending on the circumstances, a doctor may suggest managing or treating the underlying condition instead, or adding other treatments as a person's period approaches, to manage the effects.
[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. [2] Harlow, D. L., & Johnson, S. L. (2014). Thyroid and menstrual disorders. In M. A. Fauci, K. L. Braunwald, D. S. Kasper, et al. (Eds.), Harrison's principles of internal medicine (19th ed., pp. 1053-1061). New York, NY: McGraw-Hill Education. [3] Rubinow, D. R., & Schmidt, P. J. (2006). Premenstrual dysphoric disorder. In J. D. Sadock, B. J. Sadock, P. A. Ruiz (Eds.), Kaplan and Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry (9th ed., pp. 1351-1352). Philadelphia, PA: Lippincott Williams & Wilkins. [4] Yonkers, K. A., & Schmidt, P. J. (2011). Premenstrual dysphoric disorder. In D. H. Kupfer, D. J. Levinson, S. M. Wasserman (Eds.), American Psychiatric Publishing textbook of mood disorders (2nd ed., pp. 569-572). Washington, DC: American Psychiatric Publishing. [5] Wittchen, H. U., & Cloninger, C. R. (1998). The descriptive epidemiology of premenstrual dysphoric disorder. In D. H. Kupfer, D. J. Levinson, S. M. Wasserman (Eds.), Premenstrual dysphoric disorder: a comprehensive textbook (pp. 11-21). Washington, DC: American Psychiatric Publishing.
- Women with pre-existing chronic health conditions, such as mood disorders, thyroid dysfunction, or trauma-related conditions, may experience worsened symptoms during the menstrual cycle due to a phenomenon known as Premenstrual Exacerbation (PME).
- Mental health conditions, like major depressive disorder (MDD) and bipolar disorder, can potentially be affected by PME, mimicking or overlapping with Premenstrual Dysphoric Disorder (PMDD).
- Health-and-wellness therapies and treatments, such as those prescribed for PMDD to suppress hormone production, may not help with PME.
- In the absence of extensive research on PME treatment, managing or treating the underlying condition and considering additional therapies as a person's period approaches may help in managing the symptoms of PME.
