If once a month your brain feels like it’s on fire, you can’t focus to save your life, the sadness feels crushing, and the rage feels inescapable – it may be PMDD or PME.
What are Premenstrual Disorders, PMS, and PME?
Premenstrual Disorders (PMD’s) include Premenstrual Syndrome (PMS), Premenstrual Dysphoric Disorder (PMDD), and Premenstrual Exacerbation (PME). All are neuroendocrine conditions that occur due to an abnormal sensitivity to the hormonal fluctuations of the menstrual cycle each month. The main hormones implicated are Estrogen and Progesterone. So, when these hormones fluctuate in the luteal phase (aka the 1-2 weeks before menses), this is what causes symptoms to occur. The severity of these conditions can range from mild to completely destabilizing. Understandably, accessing PMS, PME, and PMDD treatment can be life-changing.
PMS (Premenstrual Syndrome):
Premenstrual symptoms or ‘PMS’ affects almost 50% of reproductive-aged menstruating people. Additionally, 20% of people reported that their symptoms are severe enough that they can disrupt their daily lives, work, and/or relationships. Generally for the majority, PMS is mild-moderate emotional and physical symptoms that may occur premenstrually. The key is that these symptoms typically do not cause significant impairment in daily life and cease a few days into the menses.
Symptoms of PMS include:
- Changes in appetite and cravings
- Weight gain
- Abdominal pain
- Back pain/low back pain
- Headaches
- Swelling and tenderness of the breasts
- Nausea
- Constipation
- Anxiety
- Irritability and anger
- Fatigue
- Restlessness
- Mood swings and crying
PMDD (Premenstrual Dysphoric Disorder):
PMDD is often referred to as a severe version of PMS but it is actually a distinct, diagnosable psychiatric condition that can be found in the DSM-5. Moreover, it’s been found that PMDD affects ~5-8% of menstruating individuals. Conditions like ADHD, and history of trauma show an increased risk. Symptoms include depression, anxiety, feeling overwhelmed, mood swings, rage, and suicidal ideation that are disabling. These symptoms disrupt work, school, and relationships, which leads to significant distress monthly. This cluster of symptoms arises after ovulation (~day 14 of the cycle) and resolves with menstruation.
PME (Premenstrual Exacerbation):
PME occurs when an existing mental health disorder (such as MDD, GAD, ADHD, or bipolar disorder) worsens premenstrually, without symptom remission between cycles. For the most part, worsening of symptoms is thought to occur due to the neurotransmitter imbalances of these conditions. So, when hormones shift during menses, these imbalances are often exacerbated. Although PME is not a stand-alone diagnosis, it is important to recognize and differentiate it from PMS and PMDD to ensure appropriate support.
Also, it’s important to know it is possible to have both PMDD and PME from another condition.
Living with PMS, PMDD, and PME’s
People experiencing symptoms related to PMS, PMDD, or PME often assume they need hormone testing or balancing. However, hormone levels in these cases are typically normal. In actuality, it’s the brain’s sensitivity to hormonal fluctuations that contributes to symptoms, and this sensitivity can’t be measured through standard tests. While the exact cause of these conditions isn’t fully understood, contributing factors include altered sensitivity to hormones, imbalances in neurotransmitters (serotonin and GABA), as well as stress, and inflammation.
Presently, the diagnosis of PMS, PMDD, or PME is clinical, and the first step in management is careful tracking of cycles and symptoms. For PMS and PMDD, symptoms are usually alleviated with menstruation. Contrarily, in PME, symptoms may lessen but often persist due to the underlying mental health condition. Differentiating between these conditions is key: PMS can often be managed with lifestyle changes, stress reduction, SSRIs, oral contraceptives, or herbs like chastetree (Vitex agnus-castus). Typically, PMDD treatment requires a more targeted approach. Such as certain oral contraceptives or specific SSRI’s, which can be dosed continuously or cyclically. Finally, PME management focuses on addressing the root mental health condition and supporting neurotransmitter balance to minimize hormonal sensitivity. Generally, in all cases, understanding where you are in your cycle can help reduce emotional distress and empower more effective symptom management.
Naturopathic Medicine Can Help
As a naturopathic doctor, my goal is always to support the whole person and not just manage symptoms. If any of this resonates with you, know that you’re not alone, you’re not broken, and there are evidence-based and holistic tools that can help. Premenstrual disorders are real, complex, and valid experiences. With the right support, you can begin to feel more like yourself again.
Healing starts with awareness. And from there, we build a plan that works for you: Book Online
Disclaimer: The information provided in this blog is for educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition, treatment, or are in need of support.
References:
- Gudipally PR, Sharma GK. Premenstrual Syndrome. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560698/
- Tiranini L, Nappi RE. Recent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome. Fac Rev. 2022;11:11. Published 2022 Apr 28. doi:10.12703/r/11-11
- Mishra S, Elliott H, Marwaha R. Premenstrual Dysphoric Disorder. [Updated 2023 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532307/
- International Association for Premenstrual Disorders. (n.d.). Free IAPMD Premenstrual Disorders (PMDs) Treatment Guidelines. IAPMD. https://www.iapmd.org/shop/p/free-iapmd-premenstrual-disorders-pmds-treatment-guidelines
