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What Is Premenstrual Exacerbation and How Can It Affect Your Mental Health?

Menstrual and mental health are interconnected and can impact one another. Sometimes the effect is so strong that it disrupts your daily life. Hormonal imbalances, menstrual disorders, and other dysfunctional reproductive processes can make you feel overwhelmed, anxious, and even depressed.

It might not seem like a big deal, but the menstrual cycle is powerful and affects many aspects of a woman’s life. While we can’t help but pay attention to the menstrual period of the cycle, we don’t always recognise the many crucial processes that happen during the rest of the cycle. Hormonal fluctuations influence your looks, moods, cravings, and desire. And on top of that, they can significantly influence your mental health.

Menstrual and mental health

Countless factors determine our mental health and well-being. Triggers such as trauma, stress, societal and peer pressure, and poor living conditions sway our physical and psychological state. Less noticeable are the invisible internal chemical and hormonal fluctuations that can significantly impact the way we feel. For example, endorphins—the happiness hormones—make you feel cheerful and excited and can even reduce pain.


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On the other hand, sometimes, hormones do more harm than good. If you have ever experienced premenstrual syndrome (PMS), then you know that hormonal fluctuations can make you moody, irritable, emotional, and in some cases severely depressed, anxious, and even suicidal. In this article, we want to talk about a condition called premenstrual exacerbation (PME) and how it can challenge your daily life.

What is PME?

Premenstrual exacerbation is both an endocrine condition and a mental health condition that usually manifests during the third stage of the menstrual cycle, called the luteal phase. It describes the worsening of pre-existing mental disorders such as depression, anxiety, eating disorders, etc.

The symptoms of PME

Unlike the more typical premenstrual symptoms, PME symptoms are mostly psychological and manifest in worsening mental health.


For instance, if you have a general anxiety disorder a week or two before your period, you might feel more overwhelmed than usual, suffer from intrusive thoughts, and might experience social phobia.

However, it is not uncommon to feel slightly more agitated before your period, so to determine if you have PME, you can also look for other symptoms:

  • severe mood swings
  • depressive periods
  • crying spells
  • emotional eating
  • migraines
  • seizures
  • schizophrenia
  • bipolar disorder

What causes PME?

Studies on premenstrual exacerbation are still in their infancy. A similar condition called Premenstrual Dysphoric Disorder (PMDD) was recognised as an official diagnosis only in 2013. Clearly, more research is needed to understand better what women experience and find better ways to treat them. Most experts now agree that sudden changes in mental health can occur due to hormonal fluctuations.

The luteal stage marks a drop in oestrogen and a rise in progesterone. Some women are more sensitive to these highs and lows, which can then lead to mood shifts. Menstruation-related hormonal fluctuations can result in a lack of serotonin—one of the chemicals responsible for feeling good. Serotonin deficiency can cause a person’s sense of well-being to plummet.


Women with a history of PME in the family are also more likely to experience the condition. Preliminary research also shows a link between deficiencies in calcium and vitamin B6 and thyroid problems.

Women who experience hormonal imbalance, in general, are also more likely to experience PME and other menstrual disorders. Unfortunately, there’s still a lot of stigma surrounding menstrual and mental health. Even those who suffer from these conditions don’t seek help because they assume their uncomfortable premenstrual symptoms are something to suffer through rather than an alarming signal that the body is asking for help. We must be kind to ourselves and educate ourselves. Therefore we must share our experiences and learn to distinguish PME from other menstrual conditions.


PME vs PMS

Premenstrual syndrome (PMS) is probably the best-known menstrual condition. Several days or up to a week before the menstrual period begins, hormonal changes surge and can cause a variety of symptoms. Unfortunately, most of what women experience before menstruation is often downplayed and blamed on PMS, which is not always the case.

PMS comes with physiological and psychological symptoms that can be distressing and uncomfortable but generally aren’t life-altering. Physical symptoms include bloating, tender breasts, cramps, back pain, and tiredness. Psychological symptoms are usually much softer than those associated with PME and include mood swings, irritability, cravings, and difficulty with sleeping. And while women who suffer from PME often experience the physical symptoms of PMS, the condition can be distinguished by severe changes in mood and the feeling that you are losing your mind.

PME vs PMDD

These two conditions are very alike. Just like PME, PMDD also manifests in intensifying mood changes. PMDD is a severe version of PMS that brings on physiological symptoms and much more serious mental well-being changes. A person suffering from PMDD might experience crying spells, depression, suicidal thoughts, emotional eating, substance abuse, fatigue, and an inability to concentrate or perform daily duties at work, at home, for childcare, or in relationships.

One thing that differentiates PMDD from PME is that mental disorders already exist in people with PME but get worse as the menstruation period approaches. With PMDD, a person might feel completely fine during the first half of the cycle and fall apart on the second.

Early statistics show that people with PMDD are more likely to contemplate and commit suicide. Both conditions can affect a person’s ability to function in daily life and are serious mental and endocrine health disorders that must be addressed.

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How to navigate living with PME

Mental health disorders shouldn’t be ignored, even if you think your hormones are to blame. Poor mental health should be taken seriously, regardless of the cause. While no medicine specifically targets PME, you can manage the symptoms with lifestyle changes and some medication.

A balanced diet and supplements

It is important to keep your brain healthy and your hormones balanced. One way to do it is to get enough of the right nutrients, balance your blood sugar, and reduce the cortisol rollercoaster. Blood sugar spikes can cause energy peaks and crashes, which exacerbate mood swings and make you more irritated. You can avoid the rollercoaster by eating regularly and often but in smaller amounts. Meals should contain both carbohydrates and proteins to provide you with energy that converts slowly.

Going a long time without eating can increase cortisol—a stress hormone—so establish a routine where you eat smaller amounts of food 5–6 times a day. Some studies have shown that calcium, B group vitamins, magnesium, and vitamin E may play a role in reducing the symptoms of PMS and PMDD. If your diet lacks these nutrients, discuss the possibility of using supplements with your doctor.

Medicine

If your symptoms get worse, don’t hesitate to contact your family doctor to recommend a psychiatrist. There are many different types of mental health specialists, but only psychiatrists have the medical training to prescribe antidepressants or antianxiety medication. If your mental condition isn’t giving you much trouble in the first half of your cycle, you can start your prescription two weeks before your period.

Hormonal birth control has been known to help some women with the symptoms of PMS as it manages hormone fluctuations throughout the cycle. Make sure to assess all potential benefits and drawbacks of hormonal contraception to choose the type that suits your situation best.

Other lifestyle changes

Some people who suffer from PME or PMDD report having positive changes after incorporating the right physical activity and relaxation techniques into their weekly routine. Adjust your fitness routine to the demands of your cycle for maximum benefit. For instance, in the first week of your cycle, it’s better to take things slow and let your body menstruate. You can go on long walks and do yoga. During the second and the third weeks of your cycle, you can do more challenging exercises such as weightlifting and cardio. The fourth week is the week before your period, so again, allow your body sufficient rest and concentrate on gentle movement such as walking, yoga, and easy aerobic exercises. 

Relaxation techniques can help you manage the stress in your life and reduce anxiety. Meditation is a go-to solution that you can easily do at home. Also, consider getting a massage, an acupuncture treatment, or another relaxing body therapy. It might be worth reducing your workload the week before you start menstruating and rescheduling important and stressful tasks for later.

A healthy menstrual cycle contributes to your well-being. But more often than not, in the stressful modern world, it can be the opposite. PME and other menstrual disorders can be overwhelming, so it is very important to search for ways to help yourself and not accept your suffering as normal. With the right routine, a few lifestyle changes, and perhaps some medication, you can lead a happy and wholesome life.

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https://iapmd.org/pmdd-v-pme
https://www.med.unc.edu/psych/wmd/resources/mood-disorders/menstrually-related/
https://www.healthline.com/health/anxiety-before-period#prevention
https://www.uptodate.com/contents/premenstrual-syndrome-pms-and-premenstrual-dysphoric-disorder-pmdd-beyond-the-basics
https://link.springer.com/article/10.1007/s00737-020-01054-8
https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/diagnosis-treatment/drc-20376787
Anxiety is a normal part of our lives. It comes at moments of stress and when we face something new and unfamiliar. Anxiety can present as anything from mild feelings of unease to severe distress—impaired breathing, increased heart rate, an anxiety attack.
The average menstrual cycle lasts 28 days. Our lives impact our hormones, and therefore our cycles—for example, stress can delay your period. Some variation is to be expected, but bigger fluctuations are reason to investigate.
The average woman spends roughly six years of her life menstruating. Most of us just accept this as part of life, but it would be really nice not to have to worry about it.