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Should we differentiate between PMDD and PME? Aren’t they totally different? Why are we lumping them together?
Should we differentiate between PMDD and PME? Aren’t they totally different? Why are we lumping them together?

Keywords: PME. Premenstrual Exacerbation.

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Written by IAPMD
Updated over a week ago

Firstly, some background. In PMDD, symptoms present only in the luteal phase (from ovulation to around the time of menstruation), whereas in PME, symptoms of a psychiatric or physical disorder are present all month long with significant worsening of symptoms during the luteal or menstrual phases.

Both PME and PMDD are described as “Core Premenstrual Disorders” by an International Group of Experts. However, the larger amount of research conducted on PMDD has led to PMDD becoming an official diagnosis in the DSM-5 as of 2013, whereas the research on PME is still lagging behind, and it remains a phenomenon studied in research but not yet diagnosed and treated clinically (similar to PMDD prior to 2013!).

Are they actually different? At the moment, the best answer seems to be “Sometimes.” More precisely, it does seem that PME of depression specifically (as opposed to anxiety or irritability) might have a unique biology that is different from that of PMDD.

Several RCTs (randomized controlled trials) indicate that those with PME of depression don’t seem to respond well to some of our best treatments for PMDD, including drospirenone-containing oral contraceptive pills, GnRH agonists, or Sepranolone. So far, no studies have demonstrated the effectiveness of any treatment for PME of depression, although of course any treatment that improves the underlying depression may be expected to have a positive impact on the person’s overall symptoms.

We must have a label or category for those individuals (who live with PME) if we are going to predict who responds to which treatment, and demand the development of new treatments that are effective for PME (currently there are no evidence-based treatments).

We also want to make it clear that we understand why some people would be resistant or upset by the idea that they have PME rather than PMDD. Many patients report feeling dismissed by the idea of having PME rather than PMDD since this means that their problem is not yet an official diagnosis.

This is understandable, although do remember that PMDD wasn’t an official diagnosis either until 2013, and it is important to fight to make sure that the experiences of real patients are reflected in our diagnostic systems. Due to mental health stigma, some patients feel as though their symptoms must be ‘less biological’ if they are labeled “PME of depression” rather than “PMDD”.

The downside to having this additional category is that it adds increasing possible confusion for patients and providers. Additionally, some patients say that they feel as though they need to have PMDD (rather than PME) to be taken seriously and receive treatment. Nevertheless, here is why we think it’s worth it to separate them:

  1. Ability to support and advocate for those whose symptoms don’t show the prototypical PMDD pattern: Since those with PME do not meet diagnostic criteria for PMDD, we need a new category for them that allows us to provide them with education, support, and advocacy without changing our fundamental understanding of PMDD as a luteal phase disorder.

  2. Development of new treatment options.

  3. Advocating for research on the role of the cycle in PME of various disorders. By highlighting that the symptoms of various chronic disorders show fluctuating severity across the cycle, we can raise awareness of these issues in many different clinical and research areas that would otherwise ignore the impacts of the menstrual cycle.

In the end, everyone deserves validation, support, and a compassionate and knowledgeable group of providers to help them find the right treatment for them. We acknowledge both PMDD and PME as core premenstrual disorders because we believe that this acknowledgment of diverse symptom presentations will improve the lives of those living with PMDs.

If you are unsure if you have PMDD or PME you can try our self-screen here.

- Dec 8th 2020

Dr. Tory Eisenlohr-Moul, IAPMD Clinical Advisory Board Chair

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