As a lot of people who menstruate will be all too aware, navigating the week before your period can be a real rollercoaster. One moment you might find yourself crying over nothing, and the next you’re dealing with a combination of headaches, bloating and a seemingly endless supply of breakouts. Ah, PMS.

But for many women, this part of the menstrual cycle can bring additional challenges. For up to 8% of us, that comes in the form of pre-menstrual dysphoric disorder, or PMDD – a mood disorder that can trigger severe emotional symptoms including depression, anxiety and even suicidal thoughts. But for others, pre-menstrual exacerbation or PME is to blame.

If you’ve ever found pre-existing symptoms get worse around your period, then PME might be the cause. But what is PME? How does it work? And what’s the best way to deal with it? We asked Dr Safia Debar, GP at Mayo Clinic Healthcare in London, to talk us through it all. 

Pre-menstrual exacerbation is not a condition or syndrome in itself – rather, it’s a phenomenon that affects other pre-existing conditions.

“Pre-menstrual exacerbation refers to the cyclical exacerbation or worsening of physical or mental symptoms during the luteal phase of the menstrual cycle between ovulation and the onset of menstruation,” Dr Debar explains. “Symptoms of underlying medical or mental health conditions can be more intense and noticeable during this time.”

A range of conditions can be affected by pre-menstrual exacerbation, such as:

• Depression
• Anxiety
• Bipolar disorder
• Obsessive compulsive disorder (OCD)
• Asthma
• Migraines
• Eczema
• Epilepsy
• Irritable bowel syndrome (IBS)
• Myalgic encephalitis/chronic fatigue syndrome (ME/CFS)
• Fibromyalgia
• Bladder pain syndrome (interstitial cystitis) 

Because pre-menstrual exacerbation is a term used to describe the worsening of other illnesses, there are no set ‘symptoms’ that can be used to diagnose PME.

Instead, pre-menstrual exacerbation is typically diagnosed when symptoms of a pre-existing illness get worse after ovulation and ease off once your period starts. Symptoms may also be less responsive to medication in the days leading up to the period.  

Much like PMS, experts aren’t exactly sure what causes pre-menstrual exacerbation. However, it’s suspected that the hormonal changes that occur post-ovulation could have a knock-on effect on other areas of the body, leading to exacerbated symptoms.

“In the luteal phase of the menstrual cycle, both oestrogen and progesterone levels rise in response to ovulation,” Dr Debar says. “These hormones, particularly progesterone, affect both neurotransmitters and other hormones, such as serotonin and GABA. These fluctuations and changes can then cause symptoms in some women.” 

If you’re experiencing pre-menstrual exacerbation, you don’t need to suffer alone. There are things which can be done to help manage your symptoms and minimise PME’s impact on your day-to-day life. The first step, says Dr Debar, should be talking to a professional.

“You should absolutely see a doctor about pre-menstrual exacerbation – do not suffer alone,” she says. “By understanding the different stages of the menstrual cycle as well as the other hormone pathways that it can impact, you can work to optimise and support each area to improve symptoms. It starts with awareness and then systematically addressing each pathway within the context of the patient in a holistic manner.”

Some things that can be done to minimise the impact of PME include:

• Tracking symptoms and ovulation (so you know when to expect changes)
• Optimising your metabolism and supporting each phase of the menstrual cycle through nutrition, exercise, sleep and stress management
• Looking after your gut health to ensure it’s able to get rid of excess hormones
• Being aware of other hormone pathways that can affect the menstrual cycle and reproductive hormones, such as thyroid function, cortisol and the stress cycle/response 

“We need to look at the whole picture and know the function of each hormone as well as the impact of other hormone pathways,” Dr Debar adds.

To understand this, Dr Debar recommends asking for an in-depth hormone panel, including “thyroid, vitamin D and in-depth assessment of sex hormones and their metabolites”. This will allow your doctor to see how your body is handling and processing your hormones and suggest possible changes that might ease your specific symptoms. 

Images: Getty