Premenstrual disorders: what it means

"Premenstrual disorders" is the umbrella term for three patterns linked to the hormone shifts before a period: PMS and PMDD, which ease once bleeding starts (ACOG, 2023) [3], and premenstrual exacerbation, where an existing condition worsens before a period without fully easing once it starts.

• Premenstrual syndrome (PMS): physical or emotional symptoms in the one to two weeks before a period, common, and resolving once your period starts.
• Premenstrual dysphoric disorder (PMDD): a DSM-5-TR diagnosis needing at least five symptoms, one of them a mood symptom, confirmed with daily tracking over two cycles.
• Premenstrual exacerbation (PME): an existing condition, like depression or anxiety, that worsens before a period but stays present all month (American Journal of Obstetrics and Gynecology, 2018) [5].

PMDD, and likely PMS, come from a different reaction to normal hormone changes rather than abnormal hormone levels themselves (Schmidt et al., 1998, NEJM; Dubey et al., 2017, Molecular Psychiatry). Whether PME shares that same mechanism is still unclear [1]. For more on what drives that reaction, see what causes PMDD.

Most research on premenstrual disorders focuses on PMDD, but premenstrual exacerbation (PME) is catching up.

Around 60% of women with an existing mood disorder report it worsening before their period, a separate pattern from PMDD itself (Current Psychiatry Reports, 2021) [1].

A 2022 review found clear evidence of premenstrual exacerbation in several conditions (Archives of Women's Mental Health, 2022) [4]:

• Psychotic disorders
• Panic disorder
• Eating disorders
• Depression
• Borderline personality disorder

Evidence was less consistent for anxiety.

The overlap between PME and PMDD's underlying biology still isn't clear. Either way, diagnosis relies on tracking symptoms daily across two cycles, rather than judging from a single week before her period (ISPMD consensus, 2016) [2].

A 2024 thematic synthesis of 17 studies and 479 women in Frontiers in Psychiatry described premenstrual disorders as intense and life changing, with women often left to manage and explain the condition largely on their own [7].

It matters because the three patterns respond differently to the same treatments.

Treatments that work well for PMDD often help less with PME, since the underlying condition needs its own plan, which a doctor may adjust during the luteal phase (Current Psychiatry Reports, 2021) [1].

Getting the label right matters: an SSRI dosed for PMDD is a different plan from adjusting medication for a mood disorder that flares before your period. A doctor decides which pattern fits, based on your symptom diary (Swiss interdisciplinary consensus, 2017) [6].

If you want somewhere to write down what you're feeling, or put words to a hard moment while you wait, Niyora is a PMS and PMDD support app. Its Moon feature lets you write what happened and see it from another angle.

A few related terms come up alongside "premenstrual disorders," and knowing them helps you read the research and talk to a doctor using the same words clinicians use.

• PMDD (premenstrual dysphoric disorder): the clinical diagnosis under this umbrella, with its own tracking criteria. See PMDD explained.
• Luteal phase: the back half of your cycle, when all three patterns show up. See the luteal phase.
• Corpus luteum: the structure that makes progesterone after ovulation. See corpus luteum.
• Allopregnanolone: a hormone byproduct linked to PMDD's mood effects. See allopregnanolone.

If a doctor uses one of these words and it doesn't match what you're feeling, say so and ask what it means for your particular pattern. For the research behind these terms, including the comorbidity between premenstrual disorders and mood disorders, see PMS and PMDD research, summarised.