Premenstrual Disorders, PMDD and PME: What can they look like?

PMDD was long grouped with PMS or as a severe form of PMS. But, these are not the same.

April is premenstrual disorder awareness month. The two types of premenstrual disorders are:

  • PMDD: premenstrual dysphoric disorder
  • PME: premenstrual exacerbation

Both of these conditions are severe and cause major disruption in life.

What is PMDD?

For a PMDD diagnosis, five of the following eleven symptoms must be present, with at least one of the first four symptoms:

  1. Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
  2. Marked anxiety, tension, feelings of being “keyed up” or “on edge”
  3. Marked affective lability
  4. Persistent and marked anger or irritability or increased interpersonal conflicts
  5. Decreased interest in usual activities (e.g., work, school, friends, and hobbies)
  6. Subjective sense of difficulty in concentrating
  7. Lethargy, easy fatigability, or marked lack of energy
  8. Marked change in appetite, overeating, or specific food cravings
  9. Hypersomnia or insomnia
  10. A subjective sense of being overwhelmed or out of control
  11. Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain

These symptoms are severe. They interfere majorly with functioning in day to day life: socially, interpersonally, at work, at school, etc.

These symptoms are present in the second half of the menstrual cycle, i.e., in the luteal phase. And, they get better as a period is getting started. They also need to be present for at least two consecutive menstrual cycles, and not be a premenstrual exacerbation (PME) of an underlying medical condition or mental health disorder.

This makes things really difficult diagnosis-wise!

This is all the more difficult because PMDD is associated with other mental health disorders such as bipolar disorder. Moreover, it is often misdiagnosed as another mental health disorder; once another diagnosis is in the mix, the likelihood of a PMDD diagnosis on top of that or in lieu of that is difficult.  

Oftentimes, those with PMDD have a marked decrease in emotional regulation, cognitive function, and executive functioning in the luteal phase. This may manifest as extreme irritability, pervasive thoughts, extreme mood swings, lack of concentration, poor working memory, impulsive behaviours, and even self-harm and suicidal ideation. Patients often share that they feel like they have no control over their emotions and thoughts.

What is PME?

Premenstrual exacerbation is diagnosed when you have an existing mental health (or adjacent) disorder that gets worse in the luteal phase. This might even look like your usual management strategy for your anxiety or depressive or eating disorder not being effective (enough) in the second half of the menstrual cycle.

This can be really difficult to diagnose. It can be confused with a lot of other things.

Some considerations

Premenstrual disorders can lead to huge disruptions in life, even suicidal ideation. Patients tell me that they feel like they’re out of control, they feel super hopeless, they will do anything to not feel the way they’re feeling.

Hormone change at ovulation time is the culprit behind these distressing symptoms. How hormones interact with your brain chemistry, brain signalling, calcium homeostasis, immune and serotonin dysfunction are all contributing elements. We don’t exactly know why this happens, but premenstrual disorders are associated with PTSD, past trauma, high stress at times of significant hormone change (think puberty, pregnancy), abuse, and neglect.

You might need a few different strategies, you likely need to have some conversations with the people in your life, you probably want to work on vitamin D and other foundational supports like iron, B12, nutrition, sleep, and exercise. You may need (cyclic) medication. Actually cyclic medications like Zoloft can be of great utility here. Cyclic use helps decrease adverse effects.

Whatever management strategy works for you is the management strategy to use!

Here’s a post with natural support options for premenstrual disorders. Please use a strategy that helps YOU.