Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME) both have a link with the menstrual cycle, as the word ‘premenstrual’ already implies. These two conditions are difficult to distinguish from each other. Since it’s important to make the correct diagnosis, we zoom in on the question: what are the similarities and differences?
You could describe PMDD as an extreme form of PMS. Just like with PMS, the symptoms start one to two weeks before menstruation (i.e. in the luteal or premenstrual phase) and disappear within a few days after the start of menstruation. Unlike PMS, PMDD mainly involves severe psychological complaints. For example: irritability, fears, mood swings, rages, melancholy, depressed moods, and sometimes even suicidal tendencies.
PME stands for premenstrual exacerbation. Exacerbation is a general medical term for chronic conditions that show varying degrees of activity. Therefore PME is an exacerbation of symptoms of another condition in the premenstrual phase. That other condition could be, for example, a depressive disorder or an anxiety disorder. Schizophrenia, PTSD, alcoholism, eating disorders and other addictions, psychoses and personality disorders (borderline) can also worsen in the premenstrual phase.
Super difficult: making the correct diagnosis
It should be no surprise that it’s difficult to correctly diagnose these conditions. To begin with, the diagnosis of PMDD is often missed because the complaints are attributed to a depressive disorder or personality disorder. A bit strange, because mapping the cycle for a few months is enough to show that there is a link. But even if that link has been made, you aren’t there yet. According to the PMDD Netherlands Foundation, about half of women seeking treatment for PMS or PMDD actually have PME from another psychiatric condition, such as depression.
This makes the circle complete again. Legitimate question: why is it important to distinguish PMDD/PMS and PME? The answer is obvious: the correct diagnosis is necessary for an effective treatment. Some treatment options for PMDD (think: chemical or surgical menopause) aren’t effective for PME because they don’t effectively treat the underlying condition. Another example: with PMDD it’s often sufficient to take antidepressants only in the PMS phase, whereas with PME this is probably necessary throughout the entire cycle.
PME, PMDD or PMDD and PME?
On the website of the PMDD Netherlands Foundation we’ve found a clear spot-the-differences list:
- PMDD – if symptoms occur premenstrually. They disappear within a few days of the onset of menstruation and aren’t present in the week following menstruation.
- PME – if symptoms are present throughout the cycle, but become more severe in the luteal/premenstrual phase.
- PMDD AND PME – some symptoms are present throughout the cycle and worsen in the luteal/premenstrual phase. Some additional symptoms occur only in the luteal/premenstrual phase and disappear around the time of menstruation.
Long story short: if you only experience symptoms in the premenstrual phase, it’s most likely PMDD. If you experience symptoms throughout the cycle, but they are more severe in the premenstrual phase, it is most likely PME due to another condition. Nice and complicated: PMDD and PME can also co-exist.
What can you do if you suspect you have PMDD/PMS/PME?
1. Monitor your cycle. For example by using a menstrual diary or a special app.
2. Map your symptoms, and do this for each symptom separately. So don’t say: ‘mental problems-yes’, but specify those psychological problems. Is it fear? Insomnia? gloom? Irritability?
3. Make a doctor’s appointment and bring a list of all your symptoms and how and when they appear throughout your menstrual cycle.
Sources: levenmetpmdd.be, pmddnederland.nl, https://iapmd.org.
More about PMDD
Donna and Ally: on the run with PMDD
Why did I ever think this was normal?, by Clare Knox
PMDD and me, by Cindy Lopez Smith
Me v PMDD: tracking saved my life, by Brett Buchert
PMS’ extreme sister
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