This is a tricky task, but it can be done. With PMDD, symptoms are ONLY present between ovulation and menstrual bleeding—they begin to clear up a lot within a few days of the period starting, and should go away completely for a while after your period before the next ovulation. If you’re not sure when you ovulate, you can order urine ovulation tests online that can help you track that. PME symptoms are present all of the time to some extent, but become much worse before or during menses.

Tracking symptoms on a daily basis can help highlight patterns. A skilled Healthcare professional can help make a differential diagnosis. 

Some people have one or the other (only PMDD or only PME)… but often people have both

Anecdotally, I have often observed individuals with PME of depression (chronic depression with worsening before and during menses) who also have PMDD of five other symptoms—usually physical symptoms, mood swings, anger/irritability, and rejection sensitivity symptoms that ONLY ever show up at all between ovulation and menses.

When it comes to treatment, we know that symptoms showing a PME pattern tend not to respond as consistently to PMDD treatments (although of course each person is unique). Some evidence suggests that PME of depression does not improve with medical menopause using GnRH agonists, with drospirenone-containing oral contraceptives, or with in-development GABA-focused treatments like isoallopregnanolone). This suggest that PME, especially of depressive symptoms, may have a different mechanism that requires a different treatment approach. My laboratory has conducted experiments showing that hormone changes do trigger PME of depression, but possibly in a different way than in PMDD. We hope that our work will eventually clarify the unique mechanisms of PME and help to develop more effective, targeted treatments for PME.


Updated 16 November, 2019 by Tory Eisenlohr-Moul, PhD

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