May 15, 2026, 11:35 am | Read time: 5 minutes
Estimates suggest that 20 to 30 percent of all women suffer from moderate or severe premenstrual symptoms. A large Swedish study shows these are closely linked to mental illnesses. Women diagnosed with PMS are significantly more likely to have depression or ADHD—and vice versa. On average, the risk in both directions is “only” twice as high. For some premenstrual disorders, it is even significantly higher.
PMS and Depression, ADHD–Doubled Risk in Both Directions
For the study, researchers analyzed data from over 3.6 million women across Sweden from 2001 to 2022. Previous studies had already shown an increased risk of depression following premenstrual disorders, and others had found that women with mental illnesses more often reported premenstrual symptoms. Therefore, the authors of the Swedish study, Jing Zhou and Zeinab Muse, wanted to know if they influence each other and what the respective risk is. The result of the study, published in the journal “JAMA Network Open”: Affected women had about twice the risk of the other diagnosis.1
The study is based on clinically diagnosed cases of premenstrual disorders (the umbrella term is PMD). PMD includes both PMS and the more severe and much rarer Premenstrual Dysphoric Disorder (PMDD). The women studied suffer from extreme mood swings, anxiety, and irritability during the luteal phase. They are so severely affected that they can no longer manage their normal daily lives as usual.
Women Compared with Their Sisters
Each of the 104,972 women with premenstrual disorders was compared with ten women who did not have such symptoms. These women were of similar age and from the same region. To determine whether the differences were truly related to the disorder—and not just to family or predisposition—affected women were also compared with their own sisters.
Of 100 Women with PMD, Statistically, 35 Develop ADHD and 27 Develop Depression
The key finding: If someone has PMD, the likelihood of mental health issues is significantly higher–and vice versa. The numbers show this: Of the women with PMD, nearly half (about 48 percent) already had a mental illness. Among women without PMD, it was only about one in three (around 30 percent). Conversely, it was found that of the women with PMD, about one in three (around 37 percent) later developed a mental illness. Without PMD, it was only about one in five (around 21 percent).
Among all the mental illnesses studied, there were “leaders.” The connection between PMD and depression, ADHD, bipolar disorders, and anxiety disorders was particularly strong.
Specifically: Women with a PMD diagnosis had
- a 2.7-fold increased risk of depression. This means: Of 100 women with PMD, statistically 27 develop depression.
- a 3.55-fold increased risk for ADHD—this is statistically 35 to 36 out of 100 affected women
- a 3.3-fold increased risk for bipolar disorders and personality disorders
- a 2.51-fold increased risk for autism
- and a 2.43-fold higher risk for an anxiety disorder.
It’s Not Just the Genes!
Can the connection be explained solely by shared genes or the family environment? No! The results remained significant even when compared with biological sisters, although the risk values were slightly reduced (e.g., the overall risk for a later psychiatric disorder decreased from a 2.23-fold to a 1.82-fold risk).
What the Researchers Also Found
- For women under 35, the likelihood of mental health issues was particularly high if they had PMD. And vice versa.
- The connection was neither due to smoking nor obesity (although both are known risk factors for both conditions)
- Women with PMD were on average slightly better educated, slightly wealthier, and slightly more often single—but the differences are rather small.
- Of the 14 psychiatric disorders studied, the researchers found that only schizophrenia had no connection to PMD.
The study has a small caveat: The researchers could not verify for every woman whether the diagnosis was made according to the strictest standard—keeping a daily diary for two months.
Nevertheless, the study shows a strong connection between severe premenstrual disorders and a wide range of psychiatric disorders. The study does not show that one causes the other. Rather, it seems that both problems often have the same biological root.
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Why Is This So—and Can It Be Prevented?
It is likely a complex interplay of biological, genetic, and environmental factors. An important explanatory approach: Women with PMD exhibit an unusual reaction to normal hormonal fluctuations (estrogen and progesterone) during the menstrual cycle. These hormones influence important neurotransmitter systems such as serotonin, dopamine, and GABA, which are closely linked to the development of mental illnesses.
The study does not provide a simple guide to directly “preventing” this association, but it offers important approaches for dealing with it. Because the results were so clear, the authors’ conclusion is also clear: They call for early, holistic treatment that includes the cycle and is tailored to it.
They call for raising awareness among medical personnel to recognize and treat comorbidities earlier. And they hope that a better understanding of the biological mechanisms (such as the influence of hormones on neurotransmitters like serotonin and dopamine) will lead to new therapeutic targets and refined treatment options in the future.
What Does This Mean for Affected Women?
For women suffering from clinically relevant premenstrual symptoms, these findings primarily mean that vigilance is advisable. Mental health issues can worsen significantly in the phase before the period, often requiring an adjustment in treatment. For those affected, it can be helpful to document symptoms over several cycles and discuss both mental and cycle-dependent symptoms with a doctor.
A genetic predisposition or hormonal sensitivity can hardly prevent the connection. But early, holistic treatment that includes the cycle can significantly mitigate the severe consequences and functional limitations in everyday life.