BOSTON, MA, June 13, 2022 -- A new global study finds an extremely alarming number of people - 34% - with premenstrual dysphoric disorder (PMDD) have attempted suicide to escape the debilitating symptoms. Suicide is the second leading cause of death among Americans ages 10 to 34, with alarming recent increases in suicide rates among those assigned female at birth. The study appears in BMC Psychiatry. 

PMDD is a cyclical, hormone-based disorder that impacts approximately 1 in 20 females of reproductive age - a staggering 60 million worldwide.  A life-threatening condition that causes depression, anxiety, hopelessness, and physical symptoms in the two weeks before menses, PMDD is often underdiagnosed, misdiagnosed, or dismissed entirely by medical professionals.

To better understand PMDD, the International Association for Premenstrual Disorders (IAPMD), Me v PMDD and Vicious Cycle: Making PMDD Visible, undertook the first-of-a-kind  Global Survey of Premenstrual Disorders (2018 GSPD) to examine the scope of the problem of premenstrual disorders and how PMDD impacts the lives of sufferers. The full study included 3,153 people from over 56 countries served online by the IAPMD.  A deeper analysis of 591 patients who reported a prospective clinical diagnosis of PMDD, revealed that 34% have made a suicide attempt during a PMDD episode.

Shockingly, patients also waited an average of 12 years and saw an average of 6.15 providers before receiving an accurate diagnosis of PMDD.

Although previous studies report an association between PMDD and suicidal ideation, this study confirms that women who are neurobiologically sensitive to hormone changes, as in the case with PMDD, may be at increased risk of not only suicidal thoughts but also suicidal behavior. The results further point to a need for increased awareness and training among health care professionals and a need for improved and standardized screening of suicidal ideation in women with PMDD. The findings also suggest a need for considering STBs (suicidal thoughts and behaviors) as a diagnostic criterion for PMDD and for the inclusion of PMDD patients with STBs in pathophysiology and treatment studies. 

“We’ve uncovered an extremely worrying rate of suicide ideation and attempts among those with PMDD, highlighting the need to take this issue seriously and boost funding for research and support,” according to Dr. Tory Eisenlohr-Moul, assistant professor of psychiatry at the University of Illinois Chicago, lead author of the study, and IAPMD Clinical Advisory Board Chair.  “Our findings are consistent with a history of studies finding higher suicide attempt risk around the onset of menses,” added Dr. Eisenlohr-Moul. 

“Our study reveals just how destructive PMDD is,” according to Sandi MacDonald, IAPMD Executive Director.  “This is a galvanizing movement in women’s health. PMDD is a perfect storm where #MeToo and #TimesUp, meet mental health awareness, meets suicide prevention.”

A previous publication, “Patient Experiences of Health Care Providers in Premenstrual Dysphoric Disorder: Examining the Role of Provider Specialty,” based on the same study, revealed a clear knowledge gap across medical specialties and the ability of providers to deliver quality care to those suffering from PMDD. General Practitioners received low ratings on awareness, knowledge, and treatment of PMDD, despite the American Academy of Family Physicians (AAFP) inclusion of knowledge of PMDD as a recommended competency of medical student residents. This is especially worrying for patients who do not have access to multiple providers.

Other findings from the study revealed that out of 1,425 patients with prospectively-confirmed PMDD:

• 16.8% reported having lost a job due to PMDD

• 56.7% reported having lost an intimate partner relationship due to PMDD 

• 98% and 97% feel PMDD puts a significant strain on their intimate partner relationship and family relationships, respectively 

• 42.7% reported problems with parenting due to PMDD, with 10.5% feeling completely unable to parent during PMDD 

While PMDD is directly connected to the menstrual cycle, it is not a hormone imbalance but rather a severe neurobiological reaction to the natural rise and fall of estrogen and progesterone. Symptoms occur the week or two before menstruation and go away a few days after bleeding begins. There is no blood or saliva test to diagnose PMDD, but these tests can rule out other underlying disorders. Diagnosis is done by tracking symptoms for at least two menstrual cycles. Although PMDD has been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) for years, it continues to be disregarded or misunderstood by doctors and the general public.

For comment, contact Sandi MacDonald, IAPMD Co-founder & Executive Director at media@iapmd.org. We have patients, experts, and family members of patients available and eager to contribute their experience and expertise.