Treatments

PME Treatments

For many women, the days leading up to their periods aren’t just about bloating or cramps. They also come with emotional instability, mood swings, and a resurgence of psychiatric symptoms.

Today, we'll be exploring the possible treatments for conditions impacted by Premenstrual Exacerbation (PME), which worsens existing mental health conditions in the luteal (premenstrual) phase of your cycle.

Mental Health Disorder	Treatment
Major Depressive Disorder (MDD)	Antidepressant dose adjustment (e.g., increasing sertraline premenstrually) may help, but evidence is still emerging1. Hormonal treatments, like oral contraceptives or gonadotropin-releasing hormone (GnRH) agonists (responsible for releasing the luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which support estrogen and progesterone production), show mixed results2.
Bipolar Disorder	GABA-A receptor modulators (like lamotrigine) combined with hormonal contraceptives may help stabilize mood3. Selective Serotonin Reuptake Inhibitors (SSRIs), which increase serotonin levels in the brain, aren't generally recommended for PME in bipolar cases.
Anxiety Disorder	Rumination-focused cognitive behavioral therapy (CBT) may benefit those with generalized anxiety disorder (GAD), particularly during the luteal phase, when repetitive negative thinking tends to spike.
Trauma/Stress-Related Disorder	Cognitive behavioral therapy (CBT) may benefit those with post-traumatic stress disorder. Hormone stabilization may support mood regulation. However, research is required in this space.
Personality Disorder	SSRIs (during the luteal phase) may help with high-arousal symptoms, like anger4 5. Hormone stabilization may support mood regulation and shows promise for low-arousal symptoms4 5. Non-pharmacological approaches are also effective. These include cycle-tracking and Dialectical Behavior Therapy (DBT)6. Oral contraceptives may worsen symptoms in borderline personality disorder.
Obsessive-Compulsive Disorder (OCD)	SSRIs and mood stabilizers are commonly prescribed. However, there’s still a big research gap when it comes to adequately managing OCD symptoms specifically in relation to the menstrual cycle.
Psychotic Disorder (eg., Schizophrenia)	Adjunctive estrogen therapies (like estradiol or ethinyl estradiol) may help, as estrogen appears to play a protective role in schizophrenia. However, results are inconsistent7. Newer treatments, like selective estrogen receptor modulators, may be worth exploring. Antipsychotic medication adjustment around hormonal changes is a possibility, but results remain complex.

References

1. Miller MN., Newell CL., Miller BE., Frizzell PG., Kayser RA., Ferslew KE. Variable dosing of sertraline for premenstrual exacerbation of depression: a pilot study. J Womens Health (Larchmt). 2008 Jul-Aug;17(6):993-7. doi: 10.1089/jwh.2007.0491.

2. Freeman EW., Sondheimer SJ., Rickels K. Gonadotropin-releasing hormone agonist in the treatment of premenstrual symptoms with and without ongoing dysphoria: a controlled study. Psychopharmacol Bull. (1997) 33:303–9.

3. Robakis TK., Holtzman J., Stemmle PG., Reynolds-May MF., Kenna HA., Rasgon NL. Lamotrigine and GABAA receptor modulators interact with menstrual cycle phase and oral contraceptives to regulate mood in women with bipolar disorder. J Affect Disord. (2015) 175:108–15. doi: 10.1016/j.jad.2014.12.040.

4. 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.

5. Peters JR., Owens SA., Schmalenberger KM., Eisenlohr-Moul TA. Differential effects of the menstrual cycle on reactive and proactive aggression in borderline personality disorder. Aggress Behav. (2020) 46:151–61. doi: 10.1002/ab.21877.

6. 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.

7. Kulkarni J., de Castella A., Fitzgerald PB., Gurvich CT., Bailey M., Bartholomeusz C., et al. Estrogen in severe mental illness: a potential new treatment approach. Arch Gen Psychiatry. (2008) 65:955–60. doi: 10.1001/archpsyc.65.8.955.

Struggling with PME each month? You’re not alone! Reach out to your nearest healthcare professional or gynaecologist for clarity and support.