The Science

PME Explained: How and Why it Happens

Premenstrual Exacerbation (PME) is when a health condition you already live with, like acne or IBS, flares up in the days leading up to your period. Although research is still emerging on PME, studies have shown us that several pre-existing disorders (psychiatric and non-psychiatric) can be premenstrually exacerbated.¹

The key thing to note? PME symptoms don’t just appear before your period. They’re present all month long!

PME symptoms exist throughout your menstrual cycle, getting more intense in that 1–2 week window before menstruation.⁴ Although your profile of symptoms may be similar throughout your menstrual cycle, the intensity of symptoms becomes greater during the premenstrual phase⁵.

But first, let’s understand why this happens to your body during your menstrual cycle.

What's the science behind PME?

While hormonal shifts are clearly involved, individual sensitivity, genetic predispositions, neurological factors, and lifestyle concerns may all play a role in triggering PME.

Fluctuations in estrogen and progesterone, the two primary female sex hormones that regulate your menstrual cycle, can increase your body's vulnerability to all kinds of mental and physical health symptoms. Studies have shown the correlation between your menstrual cycle, an imbalance of these hormones, and symptoms like mood swings, bloating, and fatigue².

But more specifically, during your cycle's luteal phase (aka the week or two before your period), your hormonal shifts can amplify certain disorders.

PME appears to be due to a sensitivity to the same hormonal fluctuations that women usually experience. Even though the underlying biological mechanisms are still being studied, research shows that a heightened sensitivity to fluctuations of sex hormone levels appears to contribute to PME³. More research is needed to fully understand these connections.

Are mental health conditions premenstrually exacerbated?

When it comes to mental health disorders, PME symptoms depend entirely on your underlying and pre-existing diagnosis. For example, if you usually experience anxiety, you may experience a significantly enhanced version of anxiety, such as in the form of panic attacks, during your premenstrual phase.

The premenstrual 'magnifying glass' effect (aka the magnification of your health conditions before your period) can impact a variety of conditions. These include:

1. Depression

2. Anxiety

3. Attention deficit hyperactivity disorder (ADHD)

4. Psychotic disorders

5. Trauma or stress-related issues

6. Obsessive-compulsive disorder

7. Bipolar disorder

8. Personality disorders

Other health conditions impacted by PME

PME doesn’t just impact mental health – it can also flare up physical, neurological, and inflammatory conditions you may already be managing. Some of these conditions include:

1. Migraines

2. Diabetes

3. Epilepsy

4. Thyroid disorders

5. Multiple sclerosis (MS)

6. Acne

7. Asthma

8. Rheumatoid arthritis

9. Atopic dermatitis (eczema)

10. Gastrointestinal disorders (IBS, bloating, etc.)

If you or someone that you love is dealing with PME, you're not alone! Reach out to your nearest healthcare professional or gynaecologist for support and clarity.

References

1. Lin, J., Susser, LC. Understanding Premenstrual Exacerbations of Psychiatric Illnesses. Anxiety and Depression Association of America. June 15, 2023.

2. Gudipally PR, Sharma GK (2023). Premenstrual Syndrome. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

3. Kuehner C, Nayman S. Premenstrual Exacerbations of Mood Disorders: Findings and Knowledge Gaps. Curr Psychiatry Rep. 2021 Oct 9;23(11):78. doi: 10.1007/s11920-021-01286-0. PMID: 34626258; PMCID: PMC8502143.

4. O'Brien PM, Bäckström T, Brown C, Dennerstein L, Endicott J, Epperson CN, et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health. (2011) 14:13–21. doi: 10.1007/s00737-010-0201-3.

5. O'Brien PM, Bäckström T, Brown C, Dennerstein L, Endicott J, Epperson CN, Eriksson E, Freeman E, Halbreich U, Ismail KM, Panay N, Pearlstein T, Rapkin A, Reid R, Schmidt P, Steiner M, Studd J, Yonkers K. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health. 2011 Feb;14(1):13-21. doi: 10.1007/s00737-010-0201-3.