When your period can be life-threatening
February 24, 2023 – Most women are aware of the emotional ups and downs that can occur before their monthly period. PMS or premenstrual syndrome. Some women’s PMS symptoms are so severe that they may receive a diagnosis PMDD or premenstrual dysphoric disorder, which is often accompanied by severe mood swings. But a lesser-known condition may be the worst: premenstrual exacerbation or PME.
PME occurs when hormonal changes occur during the luteal phase of the cycle, between ovulation and menstruation. A week or two before a woman’s period, PME can cause a flare-up of symptoms of a preexisting disorder, such as major depression, generalized anxiety disorder, schizophrenia, bipolar disorder, or other mood disorders. One study found that 58% of women with major depressive disorder also have PME, which increases the risk of suicide during this premenstrual period.
“PME, PMS, and PMDD are all associated with premenstrual mood problems,” she says Lauren M. Osborne, MD, vice president for clinical research in the Department of Obstetrics and Gynecology at Weill Cornell Medicine and New York-Presbyterian Hospital in New York. “The difference is that women with PMS and PMDD do not have mood disorders. PME does cause significant mood symptoms 2 weeks before menstruation in a woman if she has a mental health condition.”
Women with PME have an abnormally increased sensitivity to fluctuations in sex hormones during their menstrual cycle, which appears to be the underlying cause. according to German researchers.
What are the symptoms of PME?
PME can manifest itself through the ‘premenstrual breakthrough’. This means that symptoms of a mental health condition that can be controlled if a woman is not premenstruating become more apparent when she is. For example, if a woman is taking medication for bipolar disorder, the dose that usually works well may suddenly not stop her mood swings.
“The difference between PMS, PMDD, and PME is often different symptom quality,” she says Monica Rosen, MD OB/GYN at University of Michigan Health Von Voigtlander Women’s Hospital, Ann Arbor, MI. “With PMS or PMDD, you may feel anxious before your period, but with PME, you’ll have a full-on panic attack.”
According to the International Association of Premenstrual Disorders (IAPMD)The symptoms of the following conditions may also be worsened by PME:
- Alcoholism
- Attention Deficit Hyperactivity Disorder
- Borderline personality disorder
- Schizophrenia
- Eating disorders
- Post-traumatic stress disorder
- Persistent depressive disorder
- Psychosis
- Substance use disorders
How is PME diagnosed?
PME in itself is not yet a recognized diagnosis. Rather, it is related to a diagnosis of an underlying mental health condition.
“It’s a lot harder to deal with a depressive episode or an anxiety attack when it comes seemingly out of nowhere,” says Sabrina Romanoff, PsyD, a clinical psychologist in New York. “PME has the advantage of time, which allows you to know the harder days.”
But “many women with PME don’t recognize that they have a mood disorder,” says Osborne. “They may have undiagnosed depression and often seek help for PME symptoms.”
According to the IAPMDabout half of women who believe they seek medical help for PMS or PMDD find out they actually have PME or a psychiatric illness they didn’t know they had.
To confirm PME, the doctor will likely ask the patient to record how she feels right before her period.
“It’s important to be aware of what specific symptoms are triggering you,” says Rosen. “Many of my patients use a tracking app, which is very helpful in determining how they’re feeling on a given day.”
How is PME treated?
PME is primarily used to treat a mental health condition that causes symptoms to worsen.
“For women who have been diagnosed and are taking antidepressants, increasing the dose during the premenstrual period can stop symptoms,” says Osborne. “Sometimes, if the depression is treated properly, PME goes away.”
If not, stepping up other forms of treatment may make a difference.
“Talk therapy is always helpful,” says Rosen. “Many women may benefit from hormonal cycle medications, such as birth control pills or rings.” As a last resort, some women may choose to do so surgical menopause to stop extreme PME symptoms.
It is important to know that self-help can also greatly contribute to the relief of PME.
For example, it may be helpful for women with PME to rearrange their schedule in the days before menstruation to lighten the workload and avoid excessive stress as much as possible.
People with PME should also avoid isolating themselves from others.
“Schedule time with friends ahead of time,” suggests Romanoff, as this sense of connection can help reduce symptoms. Patients can also find it PME support groups onlinetalk to other patients who can give great advice.
The bottom line: “PME is controllable,” says Romanoff.
Take PME seriously, but don’t focus on the fear. Instead, get the help you need and wait until you feel better.
Source: https://www.webmd.com/women/pms/news/20230224/premenstrual-exacerbation-what-to-know?src=RSS_PUBLIC
