WHAT IS

PME?

🌀 PME (Premenstrual Exacerbation) refers to the premenstrual exacerbation/intensification/worsening of the preexisting symptoms of another disorder, such as major depressive disorder or generalized anxiety disorder, in the luteal phase, or the premenstrual phase of the menstrual cycle.

🔴 🌀 PMDD (Premenstrual Dysphoric Disorder) and PME (Premenstrual Exacerbation) are difficult to distinguish from each other.

🔴 PMDD (Premenstrual Dysphoric Disorder) has symptoms arising during the luteal, or premenstrual phase of the menstrual cycle and subsiding within a few days of menstruation due to the brain's sensitivity to the natural rise and fall of progesterone and estrogen.

🟡 ➡️🩸 Luteal Phase (Premenstrual Phase of the Menstrual Cycle)

→ What it is: The phase that follows ovulation.

→ When it happens: From ovulation and ends when menstruation starts (typically lasting 12 to 14 days on days 15–28 of your 28-day cycle).

→ What happens: The body produces progesterone to support a possible pregnancy. If there's no pregnancy, hormone levels drop, triggering the menstrual period.

📌 Think of 🟡 ovulation as the event, and the luteal phase as the aftermath that prepares your body for either pregnancy or menstruation.

🔴 PMDD is characterized by experiencing severe mood and physical symptoms that present exclusively during the luteal phase, or the premenstrual phase of the menstrual cycle, and subsiding within a few days of menstruation. It can resemble a severe mood disorder. However, the key distinction is that the symptoms consistently resolve shortly after the period begins, indicating a cyclical hormonal pattern rather than a persistent mental health condition.

🌀 Whereas, again, PME refers to the premenstrual exacerbation/intensification/worsening of the preexisting symptoms of another disorder, such as major depressive disorder or generalized anxiety disorder, in the luteal phase, or the premenstrual phase of the menstrual cycle.

🔴🌀 Both PMDD and PME are considered “core premenstrual disorders” by an international group of experts. However, because PMDD has been more extensively researched, it was officially recognized as a diagnosis in the DSM-5 in 2013. In contrast, PME is still primarily explored in research settings and has not yet been formally recognized or widely treated in clinical practice, much like PMDD before its inclusion in the DSM.

🌀 Key Features of PME (Generalized Across Conditions)

→ Symptoms worsen predictably in the luteal phase (7–14 days before menstruation)

→ Symptoms return to baseline or improve shortly after menstruation starts

→ PME does not introduce new symptoms—it amplifies existing ones

→ The pattern can be subtle or dramatic, and can be missed without careful tracking

→ PME is underrecognized in clinical care, but increasingly acknowledged in research. Along with peer-reviewed studies, we emphasize the importance of symptom tracking over at least two cycles to identify PME patterns

💭 I think I have PME.

PME (Premenstrual Exacerbation) refers to the premenstrual exacerbation/intensification/worsening of the preexisting symptoms of another disorder, such as major depressive disorder or generalized anxiety disorder, in the luteal phase or the premenstrual phase of the menstrual cycle. Recognizing this pattern can bring clarity and relief, but also requires adjustment. You're not alone, and support is available.

PME Manifestations of ADHD (Attention-Deficit/Hyperactivity Disorder)

→ Decreased focus and attention

→ Stronger emotional dysregulation

→ Increased impulsivity or hyperactivity

→ Lower frustration tolerance

PME Manifestations of AN (Anorexia Nervosa)

→ Intensified body image disturbances

→ Increased restrictive eating behaviors

→ Heightened anxiety around food and weight

PME Manifestations of AUD (Alcohol Use Disorder/Alcoholism)

→ Elevated cravings or urges to consume alcohol

→ Increased likelihood of heavy drinking during the perimenstrual phase

→ Potential use of alcohol as a coping mechanism for intensified premenstrual symptoms

PME Manifestations of BED (Binge Eating Disorder)

→ Elevated episodes of binge eating

→ Increased emotional eating

→ Greater feelings of distress post-binge

PME Manifestations of BD (Bipolar Disorder)

→ Intensified depressive episodes, especially in Bipolar II Disorder

→ Disruption in mood stability, particularly dysphoric moods

→ Potential for rapid cycling or mixed mood symptoms

PME Manifestations of BN (Bulimia Nervosa)

→ Increased frequency of binge-purge cycles

→ Heightened feelings of loss of control

→ Amplified guilt and shame post-purging

PME Manifestations of CP (Chronic Pain)

→ Intensified pain perception

→ Increased frequency of pain episodes

→ Reduced pain tolerance

PME Manifestations of GAD (Generalized Anxiety Disorder)

→ Heightened worry or panic

→ Increased restlessness or tension

→ Amplified irritability or emotional overwhelm

PME Manifestations of MDD (Major Depressive Disorder)

→ More intense sadness, hopelessness, or worthlessness

→ Increased fatigue

→ Stronger suicidal ideation

→ Greater withdrawal from social or daily life and activities

PME Manifestations of OCD (Obsessive Compulsive Disorder)

→ Increased compulsions or intrusive thoughts

→ Higher distress related to obsessions

→ Fluctuations in disgust sensitivity, particularly in contamination-related OCD

PME Manifestations of PDD (Persistent Depressive Disorder = Dysthymia)

→ Intensified chronic low mood

→ Increased fatigue

→ Greater feelings of hopelessness

→ Enhanced social withdrawal

PME Manifestations of PTSD (Post-Traumatic Stress Disorder)

→ More frequent flashbacks or intrusive thoughts

→ Heightened emotional reactivity

→ Sleep disturbances

→ Increased feelings of fear or hypervigilance

PME Manifestations of Schizophrenia


→ More frequent or intense psychotic episodes (e.g., auditory hallucinations, paranoia)

→ Difficulty forming coherent thoughts or speech may become more severe premenstrually

→ A sharper decline in motivation, emotional expression, or social engagement before menstruation

→ Increased anxiety, agitation, or mood instability near menstruation

→ More noticeable impairments in memory or focus in the premenstrual window

PME Manifestations of Suicidality

→ Suicidal thoughts or hopelessness become more frequent or intense in the 1–2 weeks before menstruation.

→ Heightened feelings of worthlessness, emotional overwhelm, or inner turmoil during the luteal phase.

→ Decreased ability to manage distress using usual tools or support systems.

→ For individuals with underlying impulsivity (e.g., ADHD, BPD), PME may increase the likelihood of acting on suicidal thoughts.

→ Hormonal sensitivity may temporarily distort thinking, increasing the belief that things will never improve.

✅ PME Self-Assessment Tool & Symptom Tracker

Self-Assessment Tool

Use IAPMD’s PME Self-Assessment Tool to help determine if you may have PMDD or PME. It's also possible to have both conditions, and if you're unsure, we recommend consulting an experienced provider for a proper diagnosis.

The PME Self-Assessment Tool is the first globally accessible tool. It was developed with a strong commitment to privacy and data protection, including HIPAA (US) and GDPR (EU) compliance.

Symptom Tracker

If you suspect you may have PME, you can also use our printable tracker for your symptoms.

📌 Disclaimer: This Self-Assessment Tool is not a diagnostic instrument for PMDD or PME and should not replace professional medical care. It is intended solely as a preliminary assessment to help identify potential concerns for further evaluation by a healthcare provider.

Differentiation Through Symptom Tracking

🔴 🌀 Researchers and clinicians recommend daily symptom tracking over at least two menstrual cycles to distinguish between PMDD and PME.

This involves:

→ Recording the severity and presence of symptoms daily.

→ Identifying patterns that correlate with menstrual phases.

→Assessing whether symptoms are exclusive to the luteal phase (suggesting 🔴 PMDD) or are present throughout the cycle with premenstrual intensification (suggesting 🌀 PME).

For example, if an individual with major depressive disorder experiences a noticeable increase in depressive symptoms during the luteal phase, but these symptoms do not remit entirely post-menstruation, it may indicate PME rather than PMDD.

Why Do We Need to Distinguish Between PME and PMDD?

Distinguishing PME from PMDD is crucial for both research and treatment. While the symptoms can look similar, their causes—and the most effective treatments—may differ.

Accurate diagnosis is essential because nearly half of those seeking care for PMS or PMDD symptoms have PME or another underlying psychiatric condition, such as major depression. Many may not receive the most appropriate care for their experiences without identification.

We also understand why some patients may feel frustrated or dismissed when labeled with PME instead of PMDD. Since PME is not yet a formally recognized diagnosis, it can feel less valid or less biological, especially in a healthcare system that still stigmatizes mental health. But it’s important to remember: PMDD itself was only officially recognized in 2013, and it took years of advocacy to get there. The same can be true for PME if we continue to raise awareness.

Of course, adding a new category introduces complexity for patients and providers alike. Some may feel they need a PMDD label to be taken seriously or to access treatment. Still, here’s why drawing the distinction matters:

→ Better Support & Advocacy
PME doesn’t follow the classic PMDD pattern. By recognizing PME, we can better support people who otherwise fall through the cracks, without diluting our understanding of PMDD as a hormone-triggered, luteal-phase-specific disorder.

→ Tailored Treatment
Understanding whether symptoms are rooted in PMDD or PME leads to more effective, individualized treatment options.

→ Advancing Research
Highlighting PME helps highlight how the menstrual cycle affects various chronic conditions, encouraging more inclusive, cycle-aware studies in psychology, psychiatry, and medicine.

How are Treatments for PME and PMDD Different?

Treatment approaches for PME and PMDD differ significantly due to the distinct nature of each condition.

🔴 For PMDD, selective serotonin reuptake inhibitors (SSRIs) are considered a first-line treatment and are often highly effective when taken only during the luteal (premenstrual) phase. Some individuals also respond well to hormonal treatments such as drospirenone-containing birth control pills, GnRH agonists, or Sepranolone.

🌀 In contrast, PME involves the worsening of an existing mental health condition (like depression or anxiety) during the premenstrual phase. Therefore, SSRIs should typically be prescribed throughout the cycle to manage the underlying condition. If symptoms worsen premenstrually, doctors may adjust the dose or timing during that phase.

Notably, several randomized controlled trials (RCTs) suggest that treatments effective for PMDD, such as hormonal contraceptives and Sepranolone, do not work well for PME of depression. No evidence-based treatments have yet been shown to effectively target PME specifically. That said, treating the underlying disorder itself may still help reduce premenstrual symptom severity.

Importantly, more extreme treatments like chemical or surgical menopause, which may benefit those with severe PMDD, do not treat PME, since PME is not caused by hormone sensitivity alone but by how hormones interact with an existing condition.

That’s why an accurate diagnosis, based on detailed symptom tracking, is critical before choosing a treatment path. Distinguishing between PMDD and PME ensures individuals receive the proper support without unnecessary or ineffective interventions.

Acknowledging the Full Spectrum

In the end, everyone deserves validation, support, and access to compassionate, knowledgeable providers who can guide them toward the proper treatment. We recognize both PMDD and PME as core premenstrual disorders because we believe that acknowledging the full range of symptom patterns will lead to better outcomes for everyone living with PMDs.

If we want to understand who responds to which treatment or develop new, effective options for PME, we must have a name and a place for it in research and care. Right now, there is no evidence-based treatment specifically for PME. That has to change.

📌 Sources: Diagnostic and Statistical Manual of Mental Disorders (5th ed.), (2013), American Psychiatric Association. Washington, DC.

Hartlage, S. A. & Gehlert, S. (2001). Differentiating premenstrual dysphoric disorder from premenstrual exacerbations of other disorders: A methods dilemma. Clinical Psychology: Science and Practice, 8(2), 242-253.

Kim, D. R. & Freeman, E. W. (2010). Premenstrual dysphoric disorder and psychiatric comorbidity. Psychiatric Times.

Freeman, E. W., Sondheimer, S. J., & Rickels, K. (1997). Gonadotropin-releasing hormone agonist in the treatment of premenstrual symptoms without ongoing dysphoria: A controlled study. Psychopharmocology Bulletin, 33(2), 303-309.