Premenstrual symptom exacerbation- Symptoms-Causes-Treatments-more

What is PMS (Premenstrual symptoms)? 

Before knowing premenstrual exacerbation (PME), you must know premenstrual symptoms (PMS). PMS is observed before one or two weeks of their period as the worsening of PMS leads to PME and PMDD (premenstrual dysphoric disorder). According to NCBI, nearly 95% of women of reproductive age experience premenstrual symptoms. And PMDD is observed in the remaining 5% of women.

These symptoms are seen during the luteal phase of the menstrual cycle and resolve by the end of menstruation.

Most women experience premenstrual symptoms like,

• Mood swings
• Feeling upset, irritable or anxious
• Sleeping disorder
• Bloating
• Pain in the lower abdomen
• Headaches  

According to NCBI’s research article, there are nearly 17 symptoms that deal with physical, behavioural and psychological symptoms. Among them, there are four most common premenstrual symptoms that most women experience.

• Mood swings
• Bloating
• Pain in the lower abdomen
• Anxiety

When acute PMS is observed in women, it is named PMDD. Medical support is needed to treat PMDD. When PMDD is left untreated, it leads to a problem of social withdrawal and detachment from life.  

Difference between PMS and PMDD (premenstrual dysphoric disorder) 

It is very challenging to differentiate PMS, PME and PMDD as they all have the same symptoms, but their intensity differs. But then, various research is being done to know the symptoms of PME and PMDD, to reduce their growing impact on women.

Premenstrual syndrome (PMS)	Premenstrual dysphoric disorder (PMDD)
Suffering from short-term depression	Suffering from uncontrollable depression
Temporary and mild anxiety	Extreme and prolonged anxiety
Feeling detached from daily routine	Terminates caring about the things once they were passionate about
Interim sleep disturbances and mild tiredness	Prolonged sleep disturbances and extreme tired
Fugacious discomfort	Severe discomfort that keeps them away from their daily lives

What is PME (Premenstrual symptom exacerbation)?

Generalized anxiety disorder or major depressive disorder are the symptoms of other disorders that worsen when a person has premenstrual exacerbation (PME). Though PME has symptoms similar to PMDD, the intensity of the symptom is more in PMDD than in PME.

Causes of premenstrual symptom exacerbation 

“Till now, the exact cause for the premenstrual symptom exacerbation is unknown, but it is believed that other factors, including hormonal imbalance, probably contribute,” says NCBI.

Treatment  

Here are certain treatments that were done to cure PME and PMDD.

Selective serotonin reuptake inhibitors (SSRI)

Serotonin is a chemical that transmits a message from the brain’s nerve cells to the body. Serotonin is the chemical responsible for happiness, focus, emotional stability, peace of mind, etc. SSRIs will block serotonin reabsorption (reuptake) in neurons. Due to that, there will be more serotonin available in the body.

SSRI is the antidepressant used to treat depression in PME and PMDD sufferers. It helps to boost the emotions mentioned earlier in your body.

 Apart from SSRIs, doctors recommend a few other antidepressants on the market. SSRI is approved as an antidepressant by the food and drug administration (FDA).

According to the NCBI, antidepressants relieve moderate to severe depression. SSRI is effective for various anxiety disorders. But for a few patients, SSRI usage has caused negative effects. Due to that reason, the FDA advised clinicians to follow up on the patients who consume SSRIs.  

Depressive disorders 

As treatments for depression are lacking, only countable treatments available worldwide are approved.

• Oral contraceptives
• Gonadotropin-releasing hormone (GnRH) agonists
• ALLO inhibition

These are the treatments for PME depression which will suppress ovulation and helps manage the depression.

According to a research article by NCBI, oral contraceptives are beneficial for women suffering from premenstrual exacerbation. But in women with a family history of PME, it may aggravate the symptoms of increased negative thoughts. Apart from them, other women get relief from PME symptoms through oral contraceptives. 

Variable Dosing of Antidepressants  

Research conducted by NCBI states that when women with PME were given sertraline (an antidepressant) of the same dose for 2 months showed no reduction in the symptoms of PME.

Then for another 2 months, those women were given a placebo or sertraline (50% increased dose) for 10 days during their menstrual cycle. This showed a reduction in premenstrual depression in the follicular phase of those women.

GABAA Antagonist Sepranolone (UC1010) 

It is a steroid that acts against the progesterone metabolite allopregnanolone. In women with PMDD, this allopregnanolone increases negative mood. UC1010 treatment reduces the negative mood during the premenstrual phase. This treatment is safe, and it can be compared with other treatments.  

Suppression of Ovulation by GnRH Agonists  

Women with PME depression are not benefited from the GnRH agonists. The GnRH agonists induce reversible menopause, like leuprolide. But this treatment is effective in treating PMDD. Whereas PMS leuprolide improved in women suffering from PMS, reducing the symptoms in their follicular phase.

Augmentation of Antidepressants with combined oral contraceptives, Including Drospirenone  

“Combining the drospirenone (a synthetic progesterone) with the ethinyl estradiol (EE), delivered in a 24/4 (supplies pills with hormones for 24 days and pills without hormones for 4 extra days) dosage regimens, has proved to treat PMDD and PMS,” says an NCBI research paper.

Biological mechanisms underlying premenstrual exacerbations of mood disorders 

The NCBI research paper states that mood disorders are triggered due to fluctuations of progesterone and oestrogen hormones during the menstrual cycle.

According to the NCBI, clinical studies estimate that around 60% of women with mood disorders report premenstrual exacerbation. And women with bipolar disorder also show the exacerbation symptom around ovulation.

The research further says that the reproductive hormones act as neurotransmitter systems, and brain regions are especially involved in the regulation of mood and processing of emotion.

Before one or two weeks of the menstrual cycle, women undergo clinical levels of depression or anxiety. According to the research paper of the UNC school of medicine, premenstrual exacerbation symptoms are common, and the physical, behavioural and psychological symptoms interfere with the normal lifestyle.  

Strategies to cope with PME

• Eating a healthy diet is crucial in coping with premenstrual exacerbation. According to BMC women’s health (an Arabic research article), premenstrual exacerbation is majorly related to women’s food intake. So, following a healthy diet will reduce the PME risk.  

• Regular exercise will help you to overcome various physical and psychological discomforts. Exercising every day will reduce PME symptoms. 

Risk factors 

There are certain risk factors that a woman may suffer from are explained as follows.

Genetics

According to a research study of NCBI on PME, the probandwise concordance for premenstrual syndrome is noticed in identical twins than in non-identical twins. It causes a severe genetic effect on them. This study proves that a familial inheritance causes PME.

Change in lifestyle

The risk factors causing PME are as follows.

• Smoking
• Physical inactivity
• Inadequate sleep
• Consuming added sugar, fat-rich foods and salt.

• A family history of depression, bipolar depression and postpartum depression will increase the PME risk.

Hormonal change

Changes in hormones like progesterone and oestrogen levels will increase the risk of premenstrual exacerbation.

Chemical change

Serotonin and norepinephrine are the hormones that act as chemicals that transmit neural messages to the brain. They are also responsible for regulating behaviour, mood and emotion. 

Conclusion 

Premenstrual exacerbation is common among women, especially in reproductive age. When there is mild to moderate symptom of PME, it can be treated with a change in diet and regular exercise. If the symptoms are intolerable, taking the medical practitioner’s consultation is advised.

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