Scientists have found a strong two-way link between severe premenstrual disorders and a range of psychiatric conditions, including depression, anxiety, ADHD and bipolar disorder, in one of the largest studies of its kind.
Researchers analysing health records from more than 3.6 million women in Sweden found that those diagnosed with conditions such as severe PMS or premenstrual dysphoric disorder (PMDD) were around twice as likely to later develop a psychiatric disorder.
At the same time, women with existing mental health conditions were also significantly more likely to go on to develop a premenstrual disorder, suggesting a bidirectional relationship between the two.
The findings, published in the journal JAMA Network Open, followed women for an average of more than eight years using national health registers.
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 recognised 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 experts believe many cases remain undiagnosed.
The study found that of more than 100,000 women diagnosed with premenstrual disorders, nearly half had already been diagnosed with a psychiatric condition before their PMD diagnosis, compared with just under 30 per cent of women without PMD.
In recent years, celebrities including former Coronation Street actress Helen Flanagan have spoken of their serious struggles with 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
Overall, women with premenstrual disorders had more than double the risk of developing a psychiatric condition during follow-up.
The strongest links were seen with depression and anxiety. However, researchers also found elevated risks 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, the study found no clear association with schizophrenia in either direction.
Researchers also carried out sibling comparisons to account for shared genetics and upbringing. While the associations were slightly weaker, they remained significant, suggesting the link cannot be fully explained by family or environmental factors.
The authors say 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 stress the study is observational and does not prove causation — only a strong association between the conditions.
Experts say the results highlight the need for greater awareness among clinicians and better integration of menstrual cycle patterns into mental health assessments.
