Mental Health and Quality of Life in Patients with Premenstrual Exacerbation: A Cross- Sectional Study in Japan

Abstract Background: Premenstrual symptoms in women affect their social life and require treatment based on an appropriate diagnosis. In the classification of premenstrual disorders (PMDs), premenstrual exacerbations of the underlying medical conditions are listed as premenstrual exacerbation (PME) as one of the variants of PMDs along with core premenstrual disorder (PMD). However, the incidence of PME and its impact on mental health and quality of life have not been studied. Therefore, we examined the prevalence of PME among women seeking treatment for premenstrual symptoms in Japan and compared the degree of anxiety, depression, and quality of life between women with PME and premenstrual syndrome (PMS). Methods: Women who presented to the obstetrics and gynecology department of our hospital for the treatment of premenstrual symptoms and were diagnosed with PMDs using forward-pointing records were included in the study. Based on the diagnosis, patients were divided into three groups (PMS, PMDD, and PME), and their responses to a mental health and quality of life questionnaire during the initial visit were analyzed. Results: Overall, 32 women were diagnosed with PMDs (53.1% with PMS, 15.6% with PMDD, and 31.3% with PME). All underlying medical conditions in women with PME were psychiatric disorders. Except for parity, there were no significant differences in various factors among the PMS, PMDD, and PME groups. Regarding mental health, the PME group had higher anxiety and depression scores than the PMS group. In terms of quality of life, the PME group had lower scores in all domains, except physical functioning, compared to the PMS group, while the PMDD group had lower scores in social functioning. Conclusions: Approximately 30% of women with PMD had PME. Women with PME were more anxious and depressed than those with PMS, and their quality of life was extremely low in both physical and psychological domains. Patients with premenstrual symptoms should be managed with the consideration of the possibility of PME.