Common Symptoms

The Many Faces of PME

When it comes to Premenstrual Exacerbation, symptoms of an existing mental health condition, like anxiety, depression, or bipolar disorder, get significantly worse in the week or two before your periods, during the luteal phase.

What makes PME different to other menstrual disorders is that these symptoms don’t just appear in the days leading up to your period. They’re present all month long – and simply amplified during your cycle's luteal phase.

Remember: unlike PMS or PMDD, where symptoms disappear a few days after your period starts, PME symptoms never fully go away. Instead, they surge in intensity premenstrually.

PME symptoms 101

The kind of symptoms you experience with PME almost always depend on your underlying, pre-existing health condition. For example, if you live with depression, your typical low mood may escalate into full-blown feelings of hopelessness, sadness, or thoughts of self-harm during your premenstrual window.

However, to make things easier to understand, we've listed common mental health conditions that get exacerbated by PME.

Mental Health Disorder	Symptoms
Major Depressive Disorder (MDD)	64% of women with MDD report premenstrual worsening of symptoms1. Symptoms include: Longer depressive episodes Greater anxiety Faster relapse More physical complaints Medical comorbidities Reduced physical health
Bipolar Disorder	Studies show that 44–68% of women with bipolar disorder experience menstrual cycle-related mood changes2 3, which: Usually occur premenstrually, during ovulation and menstruation. May worsen disease trajectory with more rapid cycling and functional impairment.
Anxiety Disorder	Research suggests that hormonal fluctuations premenstrually may worsen symptoms of anxiety disorders, such as panic disorders (PD), generalized anxiety disorders (GAD), and social anxiety disorders (SAD).
Trauma/Stress-Related Disorder	Although there is limited research, studies report that women with PTSD experience the following symptoms during premenstrual and menstrual phases4 5 6 : Increased PTSD symptoms. Intensified fear. Avoidance behaviors. Intrusive flashbacks. Phase-specific symptom exacerbations.
Personality Disorder	73% of unmedicated women with borderline personality disorder experience clinically-significant PME of emotional symptoms7 8, including: High-arousal symptoms (e.g., irritability, anger), which peak in the luteal phase. Low-arousal symptoms (e.g., depression), which worsen during menstruation and persist into the follicular phase. Increased risk of suicide attempts in the early follicular phase when estrogen is lowest.
Obsessive-Compulsive Disorder (OCD)	PME is reported in 20–42% of women with OCD8 9, with symptoms intensifying before periods. These include: An increase in symptoms during the premenstrual rather than mid-cycle phase. Serotonergic dysregulation in perinatal women, exacerbated by hormonal shifts during the cycle10. Statistically higher frequency of suicidal ideation and suicide attempts11. Higher scores on the Beck Depression Inventory (a multi-choice, self-reporting inventory to measure depression severity)11.
Psychotic Disorder (eg., Schizophrenia)	Up to 32% of women with schizophrenia experience menstrual-related symptom shifts, while 20% may have PME. Hospital admissions for schizophrenia are 1.48× higher during the perimenstrual window. Moreover, low estrogen is linked to a worsening of psychotic symptoms.

If you’re experiencing PME each month, remember that you’re not alone! There are many ways to help ease the journey, which you can read on our blog. You can also reach out to your nearest healthcare professional or gynaecologist for clarity, advice, and support.

References

1. Kornstein SG., Harvey AT., Rush AJ., Wisniewski SR., Trivedi MH., Svikis DS., et al. Self-reported premenstrual exacerbation of depressive symptoms in patients seeking treatment for major depression. Psychol Med. (2005) 35:683–92. doi: 10.1017/S0033291704004106.

2. Rasgon N., Bauer M., Grof P., Gyulai L., Elman S., Glenn T., et al. Sex-specific self-reported mood changes by patients with bipolar disorder. J Psychiatr Res. (2005) 39:77–83. doi: 10.1016/j.jpsychires.2004.05.006.

3. Teatero ML., Mazmanian D., Sharma V. Effects of the menstrual cycle on bipolar disorder. Bipolar Disord. (2014) 16:22–36. doi: 10.1111/bdi.12138.

4. Nillni YI., Pineles SL., Patton SC., Rouse MH., Sawyer AT., Rasmusson AM. Menstrual cycle effects on psychological symptoms in women with PTSD. J Trauma Stress. (2015) 28:1–7. doi: 10.1002/jts.21984.

5. Bryant RA., Felmingham KL., Silove D., Creamer M., O'Donnell M., McFarlane AC. The association between menstrual cycle and traumatic memories. J Affect Disord. (2011) 131:398–401. doi: 10.1016/j.jad.2010.10.049.

6. Ferree NK., Kamat R., Cahill L. Influences of menstrual cycle position and sex hormone levels on spontaneous intrusive recollections following emotional stimuli. Conscious Cognit. (2011) 20:1154–62. doi: 10.1016/j.concog.2011.02.003.

7. Eisenlohr-Moul TA., Schmalenberger KM., Owens SA., Peters JR., Dawson DN., Girdler SS. Perimenstrual exacerbation of symptoms in borderline personality disorder: evidence from multilevel models and the Carolina Premenstrual Assessment Scoring System. Psychol Med. (2018) 48:2085–95. doi: 10.1017/S0033291718001253.

8. Peters JR., Eisenlohr-Moul TA. Ovarian hormones as a source of fluctuating biological vulnerability in borderline personality disorder. Curr Psychiatry Rep. (2019) 21:109. doi: 10.1007/s11920-019-1096-y.

9. Labad J., Menchón JM., Alonso P., Segalàs C., Jiménez S., Vallejo J. Female reproductive cycle and obsessive-compulsive disorder. J Clin Psychiatry. (2005) 66:428–35. doi: 10.4088/JCP.v66n0404.

10. Jenike MA., Rauch SL., Cummings JL., Savage CR., Goodman WK. Recent developments in neurobiology of obsessive-compulsive disorder. J Clin Psychiatry. (1996) 57:492–503. doi: 10.4088/JCP.v57n1009.

11. Moreira L., Bins H., Toressan R., Ferro C., Harttmann T., Petribú K., et al. An exploratory dimensional approach to premenstrual manifestation of obsessive-compulsive disorder symptoms: a multicentre study. J Psychosom Res. (2013) 74:313–9. doi: 10.1016/j.jpsychores.2012.12.004.