Study Finds Bidirectional Link Between Premenstrual and Psychiatric Disorders
Sweden: Researchers in a nationwide cohort study from Sweden identified a bidirectional relationship between premenstrual disorders and psychiatric disorders, indicating that each condition may increase the risk of the other. The findings emphasize the importance of sex- and menstrual cycle–informed psychiatric care. Further research is needed to clarify the shared biological and psychological mechanisms underlying these conditions.
The study was published in JAMA Network Open by Jing Zhou, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, and colleagues.
Premenstrual disorders (PMD), including severe mood and physical symptoms linked to the menstrual cycle, frequently overlap with psychiatric illnesses. However, the extent and direction of this relationship across a broad range of psychiatric conditions have remained unclear. To address this gap, researchers conducted a large nationwide cohort study using Swedish national and regional health registers.
The investigators analyzed data from more than 3.6 million eligible women between 2001 and 2022. Among them, 104,972 women were diagnosed with PMD at a mean age of 35.4 years. Each participant with PMD was compared with unaffected women, including unaffected full sisters and matched population controls. Researchers used both case-control and cohort study designs to evaluate whether psychiatric disorders increased the risk of future PMD and whether PMD increased the likelihood of subsequent psychiatric illness.
The study led to the following findings:
- The study identified a strong bidirectional association between PMD and psychiatric disorders.
- Nearly 48% of women with PMD had a previous psychiatric disorder diagnosis compared with about 30% of unaffected controls.
- Women with PMD had more than double the risk of psychiatric disorders compared with unaffected women.
- Women with psychiatric disorders were about twice as likely to later develop PMD compared with women without psychiatric illness.
- The associations remained significant even after sibling analyses accounting for shared familial factors, although the strength of association was slightly reduced.
- The strongest bidirectional associations were observed for depression and anxiety disorders.
- Women with PMD had a significantly higher likelihood of depression and anxiety disorders.
- Women with depression or anxiety disorders also had a higher risk of subsequently developing PMD.
- Significant bidirectional associations were also found for attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, and personality disorders.
- No significant bidirectional association was observed between PMD and schizophrenia.
The authors suggested that shared hormonal, neurobiological, genetic, and psychological factors may underlie the association between PMD and psychiatric disorders. Because PMD symptoms can overlap with psychiatric symptoms, they stressed the importance of considering menstrual cycle patterns during psychiatric assessment and treatment planning.
The researchers noted that women with PMD may benefit from closer psychiatric monitoring, while patients with psychiatric disorders may require screening for menstrual-related symptoms. They added that sex-specific and menstrual cycle–informed approaches could improve diagnosis, treatment, and long-term care.
The authors concluded that the findings strengthen evidence of a close link between PMD and psychiatric disorders and highlighted the need for further research to better understand shared mechanisms and develop targeted therapies.
Reference:
Zhou J, Muse Z, Bränn E, et al. Bidirectional Association Between Premenstrual Disorders and Psychiatric Disorders. JAMA Netw Open. 2026;9(5):e2611765. doi:10.1001/jamanetworkopen.2026.11765
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