PMDD and PME - What's the difference?

Premenstrual Exacerbation (PME) refers to the premenstrual exacerbation or worsening of symptoms from another disorder, such as major depressive disorder or generalized anxiety disorder. Premenstrual Dysphoric Disorder (PMDD), on the other hand, is characterized by severe mood and physical symptoms usually starting around one to two weeks before the start of one’s period every cycle (during the premenstrual, or luteal phase) with symptoms subsiding within a few days of starting one’s period.

You may be thinking, “Well, they kind of sound similar, and maybe could overlap as well, right?” While the exacerbated symptoms manifesting in similar ways is common in both PME and PMDD, that does not mean they are the same. With PMDD, symptoms arise premenstrually, subside within the first few days of one’s period, and are not present the week after one’s period ends. PME symptoms, however, are present throughout the entirety of an individual’s cycle and become especially more severe in the premenstrual phase.

Some conditions that could be exacerbated premenstrually are:

• Major depressive disorder

• Persistent depressive disorder (dysthymia)

• Suicidality

• Schizophrenia

• Anxiety disorders

• Alcoholism

• Eating disorders

PME is an understudied condition, and so are the treatment plans for it. Current treatments for Premenstrual Dysphoric Disorder (PMDD) may not be effective for Premenstrual Exacerbation (PME), as PME symptoms extend beyond the premenstrual phase. For example, PMDD-specific treatments, like drospirenone-containing oral contraceptives or intermittent SSRI dosing, do not work well for PME. Preliminary research, though limited, suggests that increasing SSRI doses premenstrually could help with PME in conditions like major depressive disorder, and stabilizing mood throughout the menstrual cycle may benefit those with bipolar disorder. However, more studies are needed to clarify effective treatments, including whether to adjust medications during the luteal phase and which medications to use, as well as the potential role of psychotherapy for PME.

So, ultimately, what is the need to distinguish PME and PMDD from one another?

Distinguishing between the two is imperative for many reasons. The most apparent one is to avoid misdiagnosis. Often, people who seek treatment for PMS or PMDD actually turn out to be experiencing PME or another psychiatric disorder such as depression, which is not PMDD. Correct diagnosis is necessary so that individuals can receive effective treatments for the symptoms they are experiencing.

Medical professionals understand why people may be upset by the idea of having PME instead of PMDD as they experience feelings of dismissal learning that PME is not yet an official diagnosis; however, it is still worth it to separate the two to create a supportive and inclusive healthcare sphere. Separating PME and PMDD allows for the ability and support for those who have symptoms of PME or symptoms that do not fit the typical definition of PMDD. It also allows for the allocation of resources to develop new treatment plans and advocate for more research on the role of the menstrual cycle in PME and various disorders.

At the end of the day, everyone deserves proper treatment, validation, and support, and making the distinction between PME and PMDD is a way through which we can achieve this!

We hope this article was helpful. Whether you have PMDD or PME, know that you are not alone. You can check out some of our resources for more information on this topic.