A large population-based study involving over 3.6 million women has found a significant bidirectional association between premenstrual disorders (PMDs) and a range of psychiatric conditions, with each appearing to increase the risk of the other. The findings, published in JAMA Network Open, draw on 22 years of data from Sweden’s national health registers.
The study included women aged 16 to 52, of whom approximately 105,000 had received a diagnosis of either premenstrual dysphoric disorder (PMDD) or premenstrual syndrome (PMS). Researchers compared affected women with unaffected women of the same age and region. Also, they conducted within-family analyses using sister pairs to help account for shared genetic and environmental factors.
Women with a prior psychiatric diagnosis were approximately twice as likely to subsequently develop a premenstrual disorder. Conversely, women diagnosed with a PMD faced roughly double the risk of later developing a mental health condition. The bidirectional association was strongest for depression, anxiety, ADHD, bipolar disorder, and personality disorders. No significant association in either direction was found with schizophrenia.
Sister comparisons indicated that shared genetics and family environment contributed to the relationship but did not fully account for it, suggesting that common biological mechanisms are also involved. The authors propose that an atypical sensitivity of the brain to normal fluctuations in oestrogen and progesterone across the menstrual cycle may underlie both PMDs and certain psychiatric conditions, given that these hormones directly influence serotonin, dopamine, and GABA systems implicated in mood regulation.
PMDD affects up to 6% of women and is associated with an elevated risk of suicidal ideation and depression during pregnancy, among other outcomes. The authors call for menstrual cycle-informed approaches to mental health assessment and treatment.
Source: Zhou J et al. Bidirectional Association Between Premenstrual Disorders and Psychiatric Disorders. JAMA Network Open (2026). DOI: 10.1001/jamanetworkopen.2026.11765
