If you have PMDD, this study has an important message for you: your history of premenstrual mood symptoms may matter during pregnancy and after childbirth too. Researchers followed over 9,000 women in Sweden from early pregnancy through six months after delivery to understand how having PMS or PMDD before pregnancy relates to depression during the perinatal period.
The results were clear and consistent across two separate groups of women. Those with a history of PMDD had roughly two to three times higher odds of experiencing perinatal depression compared to women without premenstrual symptoms — even after accounting for other risk factors like past depression and antidepressant use. Women with PMS also had elevated risk, though to a lesser degree. The risk was present throughout pregnancy and postpartum, not just after delivery as previously thought.
Interestingly, the study found that women with PMDD were more likely to experience certain patterns of depression during this time, including depression that started during pregnancy, started after birth, or persisted throughout both periods. Their depression symptoms also tended to include more severe combinations of low mood, anxiety, and loss of interest in activities (called anhedonia). This supports the idea that hormonal sensitivity — the same sensitivity behind PMDD — may drive mood difficulties across different reproductive transitions in life.
The researchers emphasize that women with PMS or PMDD deserve coordinated care from mental health professionals, midwives, and gynecologists during pregnancy and postpartum. If you have PMDD and are planning or experiencing a pregnancy, sharing your premenstrual history with your care team could help them screen for and address perinatal mood changes early.
Key findings
- Both PMS and PMDD were associated with higher EPDS scores across pregnancy and postpartum in two independent cohorts (BASIC N=4569, Mom2B N=4591), with those reporting PMS and PMDD having approximately 1.2 and 1.7 times higher EPDS scores respectively compared to those with no premenstrual symptoms in the BASIC cohort.
- Odds of developing perinatal depression were significantly elevated for those with PMS (OR 1.34–1.68) and PMDD (OR 2.31–3.05) across the perinatal period after adjustment for confounders including depression history, antidepressant use, and partner support.
- In the BASIC cohort, using multivariable GEE models across the whole perinatal period, the odds ratios were 1.63 (95% CI 1.47–1.82) for PMS and 2.85 (95% CI 2.45–3.38) for PMDD.
- PMDD was associated with all three PND trajectories (gestational, postpartum, and persistent) compared to controls, with the gestational trajectory showing the largest effect size in the BASIC cohort.
- PND symptom severity did not differ within each trajectory depending on premenstrual symptomatology, but prior PMS/PMDD was associated with dimensional phenotypes including severe and moderate symptoms of depressed mood, anxiety, and anhedonia.
- In the BASIC cohort, 30% reported PMS and 6% PMDD; in the Mom2B cohort, 55% reported PMS and 9% severe PMS.
Methods, briefly
Observational prospective cohort study using two large population-based Swedish cohorts: BASIC (N=4569) and Mom2B (N=4591). Participants were followed from early pregnancy through 6 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS) at multiple time points (4 in BASIC, 6 in Mom2B). Premenstrual symptoms were self-reported retrospectively (DSM-5/ICD-10 criteria in BASIC; yes/no questions in Mom2B). Analyses included repeated measures ANOVA, multivariate logistic regression, generalized estimating equations (GEE), multinomial logistic regression for trajectories, factor analysis, and k-means clustering for dimensional phenotypes. Models were adjusted for age, parity, depression history, antidepressant use, pregnancy complications, and partner support.
Limitations to keep in mind
- Premenstrual symptoms were assessed retrospectively via self-report, not prospectively confirmed across menstrual cycles as recommended for PMDD diagnosis.
- The Mom2B cohort used only two yes/no questions to assess PMS/severe PMS, which is less rigorous than the DSM-5/ICD-10-based assessment used in the BASIC cohort.
- The persistent PND trajectory had a small sample size owing to missing data, limiting the power of analyses for this group.
- Data from the Mom2B cohort were collected during and after the COVID-19 pandemic, which may have influenced anxiety symptoms and overall mental health reporting.
- Both cohorts were Swedish, potentially limiting generalizability to other populations.
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