Premenstrual Exacerbation: Everything You Need To Know About It.

premenstrual exacerbation

Premenstrual exacerbation or PME is a condition when the symptom of pre-existing chronic illness gets worse over time. Those of us who experience premenstrual syndrome will know the ups and downs that come with it. However, there are other conditions that can cause many severe complications.   

It is also possible to confuse premenstrual exacerbation with another severe complication, such as PMDD or premenstrual dysphoric disorder. The two differ in the severity. When the PMS symptoms over-qualifies as a PMS symptom, you can receive a diagnosis of PMDD.   

There are two schools of thought on PMDD and PME. One classifies them as a complication of PMS, and the other as a separate condition that has characteristics similar to PMS.   

This article will elaborate on the difference between the two, the causes and treatment, and more! Read on to know more.   

Diagnostic Issues

Diagnostic Issues

Premenstrual exacerbation is known to cause a lot of complications, including those that are not directly related to menstruation. The menstrual cycle is known to cause different symptoms in an individual. As you know, some may experience severe cramps. Some may get irregular periods. As long as they are tolerable and you can perform activities of your daily life while on your period, there is no reason to be scared.   

The menstrual cycle is a period during which the body undergoes several changes in preparation for pregnancy. This is when different hormones play a part in the release of the egg that can receive the DNA from a viable sperm.   

In addition, the menstrual cycle isn’t the same for everyone. Thus, there is a chance that one individual will experience three days, and the other will experience a 5-day, 6-day period. There isn’t a set number of days that someone experiences.   

A menstrual cycle lasts for 21 to 35 days (about one month, four and a half days) and can last for 2 to 7 days. The first few years of menstruation can have long cycles for the person. However, you can shift to shorter cycles that are more regular.   

There are mainly four phases of the menstrual cycle:   

  • Menstrual phase  
  • Follicular phase  
  • Ovulatory phase  
  • Luteal phase   

The menstrual cycle that continues “normally” for individuals can experience changes that may be due to the underlying conditions. When these changes occur throughout the month, these are the symptoms of premenstrual exacerbation (PME).   

Alternatively, when these symptoms of change are present during the luteal phase, they represent PMDD or premenstrual dysphoric disorder.   

The differentiation between the two conditions can be confusing as both are related to the premenstrual period. However, when you are careful of the symptoms you experience, you can see which condition you’re experiencing.   

PMDD usually appears near the luteal phase, from when ovulation begins to the menstrual phase. This is when you will see many changes in your overall health. For instance, if an individual has anxiety, the symptoms can get worse around the luteal phase.   

In contrast, when you have PME, you would experience worsening anxiety symptoms throughout the month. Several risk factors can come into play for a person with PME or PMDD. These are:   

  • Family history of the condition  
  • Stress   
  • Age   
  • Personal history of anxiety or mood disorder  

There may also be medical illnesses such as fibromyalgia, irritable bowel syndrome, or chronic fatigue syndrome. Psychiatric illnesses such as anxiety disorders or depression can worsen during the premenstrual period, which is akin to PMDD symptoms.   

PME of Mood Disorders

PME of Mood Disorders

As per systematic research and randomized controlled trials, the PMEs of mood disorders can manifest (show up) in a person as a worsening of bipolar disorder or ongoing depressive disorder.   

A premenstrual breakthrough for PMEs of mood disorder is described as an onset of symptoms of the underlying condition. These may be diabetes, anxiety, or other mood disorder types. As per a study, these underlying conditions respond well to the rest of the cycle.   

The clinical studies based on community concluded that at least 60% of the women reported PME. They also exhibit the presence of mood disorders. Moreover, some women with bipolar disorder were shown to display exacerbations of symptoms around ovulation. Additionally, there are also severe illnesses that can increase the burden.   

Premenstrual breakthrough is a specific variant of PME. Implying that the symptoms of mental health conditions can be brought under control. This crucial point of control comes before the individual is premenstrual. PME occurs during the hormonal changes during the luteal phase, between ovulation and menstruation.   

Nearly 58% of the women with depressive disorders were also found to have PME, which increases the risk of suicide during the premenstrual phase of the cycle. In addition, all the mood issues before the period relate to PME, PMDD, and PMS.   

The fluctuation of hormones can cause a lot of sensitivity in individuals with PME. This is because the hormones during the menstrual cycle are triggered. The difference between the two can be understood through the affective symptoms.   

Such as:  

  • Irritability   
  • Anger   
  • Depression   
  • Feelings of hopelessness  
  • Increase in interpersonal conflicts   
  • Tension  
  • Feelings of being on edge   

Additional psychological symptoms may also manifest in the form of irritability, mood swings, and other physical symptoms. There is also a difference in symptoms depending on the comorbidities.   

If by now you are wondering what percentage of women experience premenstrual mood exacerbation? Here’s what the existing data suggests:   

The data also shows that 40% of women who did not have depression but were on antidepressants showed signs of PME. Moreover, in patients with major depression, the prevalence rate of regular premenstrual or menstrual mood changes was found to be nearly 68.5%, which is twice as high as those without the diagnosis.   

Moreover, the symptoms of PME coexist with symptoms of perimenopause or postpartum in women with MDD.   

All these data suggest that there exists a worsening effect of hormones on menstruating individuals. They can experience depressive worsening irrespective of the phase of the menstrual cycle they are in.   

Let us now look at the different treatment options that allow managing PME.   

How To Deal With Premenstrual Exacerbation

How To Deal With Premenstrual Exacerbation

If you are wondering how to treat premenstrual exacerbation, this section will be helpful!   

This condition’s treatment is based on the existing conditions for which the patient has been diagnosed. Apart from that, the doctor may also conduct a diagnosis to know more about your overall condition. This will help them determine if there are comorbidities they need to take care of as well.   

As premenstrual exacerbation is not a proper condition due to the lack of sufficient research, its treatment options are scarce. However, there are ways to manage the symptoms present in an individual with signs of this exacerbation. One obvious way you may already have predicted is by treating the underlying conditions. As PME is primarily the worsening of symptoms other than those related to menstruation, this approach makes sense.   

For instance, in the case of PME of mood disorders, the treatment approach involves taking care of the symptoms of the respective mood disorders. This may be increasing the dose of antidepressants during their premenstrual period.   

How does this help?   

As per research, PME occurs throughout the ‘month,” so it is best to take care of the symptoms right before the premenstrual period begins so that the patient’s quality of life is preserved.   

Potential treatments for PME

Potential treatments for PME

The other potential treatment options that work well for PME are:   

Talk therapy is used to take care of emotional and mental well-being.   

Birth control pills or rings for hormone control during the premenstrual period.   

Surgical menopause in extreme cases of PME symptoms.   

Individuals with PME can rearrange their schedules to avoid excess stress, which can help them take better control of their health.   

Birth control pills and devices such as rings help in hormone cycling and can bring the exacerbation under control. Self-help is another way to find relief from PME.  

The treatment also depends on the identification and management of PME in patients with underlying mood disorders. These can help improve the condition while easing the severity of the symptoms one experiences.   

Research Implications

The research mainly focuses on PMDD as a menstrual health issue. This leads to a significant gap in the data on PME and its impact on the individual. This makes it difficult for people with this condition to handle the symptoms.   

The current research leaves a cavity in treatment, understanding of the condition, and more accurate impact of the exacerbation. Thus, there is a pressing need for further research on epidemiology and the mechanism of exacerbation.   

Clinical and Practical Considerations

The research gap makes diagnosing PME and its proper management even more important. It ensures that the individual presenting with the symptoms can receive a diagnosis at the proper time.   

Moreover, it is also important that proper research data exists to back the treatment options, as it will support the clinical and practical aspects of PME. It has a significant impact on the treatment planning and overall patient care.   


Thus, the concluding remarks for the article would be the intricate detail of premenstrual exacerbation that most blogs miss out on. The time these symptoms appear determines if it’s PME or PMDD.   

Another noteworthy point about PME is the severity of the symptoms that a person with a mental disorder may experience.   

Lastly, it is important that you self-monitor your menstrual cycle to observe if there is a change in your cycle or the symptoms. The research gap that exists for PME requires sufficient attention to be addressed.   

Have any questions for PME? Comment below!   


Birth control pills and devices can affect menstrual phase and reproductive health. Consult your OBG before choosing these options.

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