If you've ever felt like your mental health symptoms get worse around your period but no one in your care team has asked about it, you're not alone. A group of psychiatrists and a person with lived experience of psychosis wrote this paper to argue that the menstrual cycle is being overlooked in mental health care — and that it shouldn't be.
The authors highlight that PMDD is now officially recognized in the international diagnostic system (ICD-11), and that many other mental health conditions — including depression, bipolar disorder, psychosis, eating disorders, and anxiety — can also flare up in the days before and during a period. Research has even found that psychiatric hospital admissions and suicide attempts are more common during this phase of the cycle. One co-author shares her own experience of not realizing that her psychotic symptoms were connected to her cycle until a nurse pointed it out.
What's encouraging is that treatments already exist. For PMDD specifically, SSRIs (a type of antidepressant) can work within 48 hours and can even be taken only during the premenstrual phase. Hormonal options like combined oral contraceptives are also recommended as a first-line treatment. For people with conditions like schizophrenia, research suggests that adding hormonal therapy may help reduce symptoms and hospitalizations.
The authors call on mental health professionals to simply start asking patients about their cycles — how symptoms relate to their period, what happens around menstruation in hospital settings, and what might be coming at other hormonal transitions like pregnancy or menopause. They also point out that many patients welcome these conversations and are already noticing patterns on their own. The paper is a call to action for better training, more research, and routine attention to something that affects so many people's mental health every month.
Key findings
- PMDD has a point prevalence of 1.6% when strictly adhering to diagnostic criteria, based on large epidemiological studies
- Meta-analyses show the perimenstrual phase carries increased risk of psychiatric admission across all diagnoses, with particularly elevated risk for psychosis
- Menstruation is associated with increased rates of suicide attempts and completed suicide per meta-analysis
- SSRIs have a much faster onset of action in PMDD (within 48 hours) compared with typical depression, and are equally effective when given only during the premenstrual phase versus continuously
- A meta-analysis of six RCTs found adjunctive oestradiol in women with schizophrenia improved both positive and negative symptom scales versus placebo
- Premenstrual syndrome was identified as the strongest risk factor for postpartum depression in a meta-analysis
Methods, briefly
Perspective/opinion piece synthesizing existing evidence from published meta-analyses, systematic reviews, and clinical guidelines, supplemented with lived experience input from one co-author with schizophrenia. No original data collection.
Limitations to keep in mind
- Not a systematic review; selective presentation of supporting evidence
- Lived experience input from a single individual, not generalizable
- Does not present original data or new analyses
- Focused primarily on UK clinical context and guidelines
The latest PMDD research, in your pocket
The app’s research feed is updated daily with newly published, peer-reviewed PMDD work - summarized in plain language.