Abstract

Background: Premenstrual mood symptoms are frequently encountered in gynecological practice. However, severe affective presentations may correspond either to Premenstrual Dysphoric Disorder (PMDD) or to Premenstrual Exacerbation (PME) of an established psychiatric disorder. Failure to distinguish these entities may result in inappropriate hormonal modification or insufficient psychiatric management.
Objective: To review current evidence on epidemiology, pathophysiology, clinical differentiation, and treatment of PMDD and PME, emphasizing practical implications for gynecological and perinatal care. Methods: Narrative review of recent systematic reviews, meta-analyses, and clinical guidelines addressing menstrual cycle-related mood disorders and reproductive psychopharmacology.
Results: PMDD is defined by affective, cognitive, and somatic symptoms confined to the luteal phase, with full remission in the follicular phase. Prospectively confirmed prevalence ranges from 1.6% to 3.2%. PME refers to cyclical worsening of pre-existing psychiatric disorders, including major depressive disorder, bipolar disorder, anxiety disorders, obsessive-compulsive disorder, psychotic disorders, and borderline personality disorder, without complete intermenstrual remission. PMDD involves abnormal central nervous system sensitivity to physiological ovarian steroid fluctuations, particularly progesterone-derived allopregnanolone. PME reflects hormone-triggered amplification of symptoms in biologically vulnerable neural systems. Therapeutic strategies differ substantially: intermittent Selective Serotonin Reuptake Inhibitors (SSRIs) and drospirenone-containing combined oral contraceptives are first-line for PMDD, whereas PME requires optimization of baseline psychiatric treatment, with hormonal strategies considered adjunctive.
Conclusion: Accurate differentiation between PMDD and PME is essential in gynecological and perinatal practice. Incorporating systematic menstrual assessment into routine evaluation improves diagnostic precision, reduces psychiatric morbidity and suicide risk, and supports preventive strategies in reproductive mental health.

Keywords:Premenstrual dysphoric disorder; Premenstrual exacerbation; Menstrual cycle; Reproductive psychiatry; Perinatal mental health; Women’s mental health