People with premenstrual dysphoric disorder – a more serious form of premenstrual syndrome, commonly known as PMS – are more likely to experience suicidal thoughts and behaviors than people without it.

That is a key finding of our recent systematic review, published in the journal Administration and Policy in Mental Health and Mental Health Services Research.

We searched for information on suicidality – meaning the risk of suicide and encompassing a spectrum of thoughts, plans and behaviors intended to end one’s life – in people with this disorder. We found 18 studies, which spanned more than 2 million people who menstruate.

The likelihood of experiencing suicidal thoughts and behaviors in people with the disorder varied depending on the study and the way the participants were identified, but in general these thoughts and behaviors were relatively common.

In a study in adolescents with premenstrual dysphoric disorder, or PMDD, almost one-third of participants reported suicidal thoughts or behaviors. Similarly, in a study in adult women with the condition, a quarter of respondents reported thinking about, considering or planning suicide. Rates were high in women who lived with PMDD alongside other mood disorders, such as depression.

Why it matters

PMDD is a long-term condition, officially recognized in 2013, that may affect up to 6% of people who have periods. It has long been considered a severe form of PMS but differs because it causes serious mood and emotional problems and is a chronic, lifelong condition.

To be diagnosed, a person must meet strict criteria, which can make it harder for some people to get the right diagnosis. A formal diagnosis requires that people track their symptoms and rate them against specific criteria over at least two menstrual cycles. Our new finding – that people with the disorder may have a higher risk of suicidal thoughts and behaviors compared with those without it – shows how important it is to identify and treat this condition without delay.

In the studies we reviewed, we found that reported rates of suicidal thoughts and behaviors varied a lot – from as low as 0.011% in a large group of people with premenstrual disorders to as high as 86% in a worldwide group of patients with confirmed PMDD.

This wide range suggests that the results depend heavily on how the studies were done, who was included and how the disorder was defined and measured. When in the menstrual cycle people were evaluated might also affect this, as research shows that suicidal thoughts and behaviors are strongly linked to hormonal changes during the menstrual cycle.

What still isn’t known

A great deal more research is needed to understand how suicide risk can change during the menstrual cycle.

Though we didn’t find any studies that tested treatments to address suicidal thoughts and behaviors in people with PMDD, there are evidence-based treatments for PMDD that can improve well-being, including antidepressants, hormonal contraceptives, hormone-blocking agents, cognitive behavioral therapy and lifestyle changes, such as dietary changes and exercise.

For people living with PMDD and their caregivers, seeking support is essential. For clinicians, learning to recognize and treat PMDD is a priority.

If you or someone you know is in crisis and are based in the U.S., call the 988 Suicide & Crisis Lifeline to speak with a trained listener, or text HELLO to 741741. Both services are free, available 24/7 and confidential. If you are a reader from outside the U.S., please use a helpline like the one above (for a list of resources in other countries, see here) or speak to a healthcare professional.

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The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.