Understanding the relationship between premenstrual symptoms and perinatal mood disorders

Women with premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) have a higher risk of perinatal depression. Conversely, women with perinatal depression have a higher risk of developing premenstrual disorders. This is shown in a study from Karolinska Institutet published in the journal PLOS Medicine.

Premenstrual disorders like PMS or PMDD and perinatal depression are similar in the way that symptoms appear in connection with hormonal changes. This fact has given rise to the hypothesis that the disorders share both causes and risk factors. Now a study by researchers at Karolinska Institutet shows a bidirectional association between premenstrual disorders and perinatal depression.

We can show that women with PMS or PMDD have a higher risk of developing perinatal depression and vice versa. The results support the hypothesis that the diseases might have common causes."

Qian Yang, affiliated researcher at the Institute of Environmental Medicine, Karolinska Institutet and one of the main authors of the paper

Between 2001 and 2018, approximately 1,800,000 pregnancies were registered in the Swedish Medical Birth Register. Among these, the researchers were able to identify nearly 85,000 women who suffered from perinatal depression. Additional national registers, such as the patient register and the drug register, were also used to identify women diagnosed with PMS or PMDD. These were then compared to a control group of nearly 850,000 birthing women who did not develop perinatal depression during the same period.

The results showed that women with premenstrual disorders were five times more likely to experience perinatal depression. Conversely, women who experienced perinatal depression were twice as likely to develop premenstrual disorders.

The bidirectional association was noted for both prenatal and postnatal depression, regardless of history of psychiatric disorders.

"It is important that healthcare professionals who meet with women during pregnancy are aware of the link between premenstrual disorders and perinatal depression in order to provide well-informed advice," says Donghao Lu, Associate Professor at the Institute of Environmental Medicine, Karolinska Institutet and last author of the paper.

The authors emphasize that more research is needed to understand the biological link between premenstrual disorders and perinatal depression. In addition, more information is needed to clarify whether the association also applies to women with mild PMS or perinatal depression.

The study was financed by Karolinska Institutet, Forte, the Swedish Research Council and the Icelandic Research Fund, among others.