Understanding PMDD and PME: When Periods Impact Mental Health
By Stephanie Samar, PsyD
For many people, periods bring uncomfortable but manageable symptoms - bloating, irritability, or fatigue. But for others, the days leading up to a period can trigger dramatic emotional and physical changes that disrupt daily life. These experiences are not simply “bad PMS.” They may be signs of Premenstrual Dysphoric Disorder (PMDD) or Premenstrual Exacerbation (PME).
Raising awareness is key. A Washington Post article recently highlighted how often these conditions are misunderstood or misdiagnosed, leaving people struggling in silence. At Evoke Psychology, we want our community to know what these terms mean, how they show up, and what supports are available.
What Is PMDD?
PMDD is a hormone-sensitive condition that affects about 3–8% of menstruating people. It occurs in the luteal phase, the week or so before a period begins, and typically eases once menstruation starts.
Common symptoms include:
Intense mood swings or irritability - at times including suicidal thoughts or urges
Feelings of sadness, hopelessness, or anxiety
Difficulty concentrating
Sleep changes and fatigue
Physical symptoms such as bloating, cramps, or headaches
PMDD is not simply “moodiness.” The symptoms can feel overwhelming and even lead to thoughts of self-harm. Knowing the signs is an important first step toward getting help.
What Is PME?
PME, or Premenstrual Exacerbation, happens when an existing condition, such as depression, anxiety, bipolar disorder, migraines, or chronic pain, worsens during the premenstrual phase.
Unlike PMDD, symptoms don’t vanish once the period begins. Instead, they return to their usual baseline.
Why Awareness Matters
Both PMDD and PME can deeply affect relationships, school, work, and self-esteem. Unfortunately, many people are told their symptoms are “just PMS” and go untreated. Greater awareness can:
Reduce stigma around menstrual health
Help people recognize patterns in their own experiences
Encourage earlier conversations with providers
Lead to more accurate diagnoses and tailored treatments
What Helps
Treatment is not one-size-fits-all, but some helpful approaches include:
Symptom tracking: Keeping a daily record of mood, energy, sleep, and physical symptoms over two or more cycles can reveal patterns.
Professional support: A therapist or prescriber familiar with PMDD and PME can help differentiate what’s happening and suggest targeted treatment.
Medical options: For PMDD, SSRIs (sometimes only taken during the luteal phase) or specific hormonal interventions may be helpful. For PME, adjusting existing medications during vulnerable times may make a difference.
Lifestyle and coping tools: Exercise, sleep routines, and stress-reduction practices can support stability, while therapy offers strategies to navigate emotional intensity.
If you think you might be experiencing symptoms of PMDD or PME, it is important to speak with someone who is well-informed about these presentations. If you feel your concerns are not being taken seriously consider seeking a second opinion.
Final Thoughts
Living with PMDD or PME can feel isolating, but you are not alone. These conditions are real, and recognition is growing in both the medical and mental health communities. If you or someone you love is struggling with severe premenstrual symptoms, know that support and treatment are available.
