Premenstrual exacerbation (PME) is when the symptoms of a preexisting chronic illness get worse before a period. For example, a person with asthma may notice that their symptoms often worsen before periods. This could be due to PME.

PME is not a condition in its own right but a phenomenon that can affect people with many different types of chronic illnesses. This includes physical and mental health conditions, such as depression, bipolar disorder, and obsessive-compulsive disorder (OCD).

PME differs from premenstrual syndrome (PMS) because PMS causes symptoms that stem directly from the menstrual cycle and not another illness.

Read on to learn more about PME, including its symptoms and treatment, and how it compares with other menstrual disorders.

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PME occurs when a person’s menstrual cycle makes the symptoms of an underlying health condition worse. Specifically, the symptoms get worse in the luteal phase, which is the second half of a person’s cycle.

The menstrual cycle typically lasts around 28 days. It begins with the first day of a period. Around halfway through the cycle, ovulation occurs, causing hormones such as progesterone and estrogen to drop.

The luteal phase ends when menstruation begins. Often, PME is at its worst in the days just before a period.

It is unclear how common PME is overall, as there is a lack of research into its prevalence. But in those with depression, it appears to be common.

PME can affect many conditions. This is because hormones are chemical messengers, telling cells and organs how to function. Changes in hormone levels can change how the body functions in many different ways.

Some examples of conditions PME may affect include:

For some of these conditions, there are specific terms for when the symptoms worsen due to the menstrual cycle. For example, PME of epilepsy is known as catamenial epilepsy, and some people refer to PME of asthma as perimenstrual asthma.

The symptoms of PME will vary based on the underlying condition, or conditions, a person has. A person may be experiencing PME if the symptoms of a preexisting illness:

  • reliably get worse after ovulation
  • become harder to manage, or less responsive to medication, in the days leading up to a period
  • get better when menstruation begins or a few days after

PME does not cause brand-new symptoms to appear. Instead, it worsens the symptoms a person already experiences.

Researchers do not fully understand what causes PME. However, they do know that changes in hormone levels in the second half of the menstrual cycle can affect the body in many ways.

For example, a derivative of progesterone plays a role in modulating brain chemicals that affect mood. This may explain why mood disorders can get worse during the luteal phase. Researchers have also found that both rises and declines in estrogen may trigger migraine.

Another theory is that hormonal fluctuations may affect the immune system or trigger inflammation. This could be why the symptoms of asthma tend to shift with hormonal states.

More research is necessary to better understand the impact of the menstrual cycle on different health conditions.

Premenstrual dysphoric disorder (PMDD) is a type of extreme PMS that causes behavioral, mood, and sometimes physical changes that predictably occur before a person’s period. As with PME, the symptoms of PMDD appear during the luteal phase and then resolve around the time a person gets their period.

However, these conditions are different. With PMDD, the symptoms only appear during the second half of the menstrual cycle. They occur on a regular schedule and will resolve completely when a person’s period begins.

PMDD may cause new symptoms that a person does not experience during the rest of their cycle, such as:

  • depression or hopelessness
  • anxiety, tension, or feeling “on edge”
  • feeling overwhelmed or out of control
  • persistent or severe irritability or anger
  • mood swings
  • loss of interest in activities or hobbies
  • difficulty concentrating
  • fatigue
  • significant changes in appetite
  • food cravings
  • sleeping a lot more or less than usual
  • physical symptoms, such as headaches, breast swelling, bloating, or weight gain

In some cases, it may be difficult to distinguish between PMS, PMDD, and PME. For example, if a person has a chronic illness with similar symptoms to PMS or PMDD, it may be hard to tell if their condition is worsening before a period or if they are experiencing two problems at once.

It is important for a doctor to make this distinction, as the treatments for PMDD and PME are very different.

There is not a lot of research into PME treatment, but what does exist suggests that taking hormones to help prevent their sudden drop after ovulation may help some people.

For example, estrogen withdrawal migraine may respond well to estrogen therapy or hormonal contraceptives. Preventing hormonal fluctuations may also help with depression or mood disorders.

It is unclear whether these options would help everyone with PME, though. Depending on the circumstances, a doctor may suggest managing or treating the underlying condition instead, or adding other treatments as a person’s period approaches, to manage the effects.

Research suggests that treatments to suppress hormone production, such as the ones doctors prescribe for PMDD, do not help with PME.

How a person takes care of themselves during PME will depend on the unique way it affects them. However, there are some things people may be able to do to prepare for it, such as:

  • tracking periods so that a person knows when to expect PME
  • letting others in the household know about PME
  • doing tasks, such as freezing healthy meals or refilling prescriptions, in advance of the premenstrual phase
  • asking friends or family for extra help, such as with household chores
  • making time for rest or relaxation, if possible

A person may find that keeping a symptom diary helps them identify strategies that can ease symptoms.

There is currently no research on whether any diets or supplements help with PME.

A person should contact a doctor if they are experiencing any unexplained symptoms before their period, particularly if the symptoms:

  • make it difficult to work, maintain relationships, or carry out daily tasks
  • worsen a condition that requires careful management, such as asthma
  • cause feelings of self-loathing or suicidal thoughts

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

Was this helpful?

PME is when the menstrual cycle makes a preexisting chronic condition worse before a period. PME can affect many conditions, including depression, anxiety, IBS, migraine, and asthma.

There is no specific treatment for PME, but some people may benefit from hormonal treatments that prevent a decline in hormone levels after ovulation. Additional help with managing the underlying condition during the luteal phase may also be beneficial.

People who suspect they may experience PME may find it helpful to record their symptoms for several menstrual cycles to see whether the symptoms tend to worsen before periods. If symptoms are severe, though, always speak with a doctor.