Scientists have uncovered a robust two-way connection between severe premenstrual disorders and a variety of psychiatric conditions, including depression, anxiety, ADHD, and bipolar disorder, in one of the most extensive investigations of its kind.
Study overview
Researchers analyzing health records from over 3.6 million women in Sweden discovered that those diagnosed with conditions such as severe premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) were approximately twice as likely to develop a psychiatric disorder later. Conversely, women with pre-existing mental health conditions were also significantly more prone to subsequently develop a premenstrual disorder, indicating a bidirectional relationship.
The findings, published in JAMA Network Open, tracked women for an average of more than eight years using national health registers.
Understanding PMDD
PMDD is a severe form of premenstrual disorder that can cause extreme mood swings, anxiety, irritability, and even suicidal thoughts in the weeks before a period. Unlike typical PMS, PMDD is recognized as a psychiatric condition and was formally included in the World Health Organisation’s diagnostic system in 2019. It is estimated to affect around one in 20 women in the UK, although many cases remain undiagnosed.
Key findings
The study found that of over 100,000 women diagnosed with premenstrual disorders (PMDs), nearly half had already been diagnosed with a psychiatric condition before their PMD diagnosis, compared with just under 30% of women without PMD. Overall, women with premenstrual disorders had more than double the risk of developing a psychiatric condition during follow-up.
The strongest links were observed with depression and anxiety. However, elevated risks were also found for ADHD, bipolar disorder, and personality disorders. In some analyses, women with PMD were more than three times as likely to later be diagnosed with ADHD or bipolar disorder. Importantly, no clear association was found with schizophrenia in either direction.
Sibling comparisons
Researchers also conducted sibling comparisons to account for shared genetics and upbringing. While the associations were slightly weaker, they remained significant, suggesting that the link cannot be fully explained by family or environmental factors.
Possible explanations
The authors indicate that the findings point to shared biological or genetic mechanisms rather than a simple one-way cause-and-effect relationship. One possible explanation is increased sensitivity to hormonal fluctuations, alongside overlapping brain pathways involving serotonin, dopamine, and stress regulation systems. However, they emphasize that the study is observational and does not prove causation—only a strong association between the conditions.
Clinical implications
Experts say the results highlight the need for greater awareness among clinicians and better integration of menstrual cycle patterns into mental health assessments. Celebrities, including former Coronation Street actress Helen Flanagan, have recently spoken about their serious struggles with PMDD, bringing attention to this debilitating condition.
