What do we know about PMDD in autistic people and those with ADHD?

Premenstrual dysphoric disorder (PMDD) is a severe cyclical mood disorder characterised by affective, cognitive and somatic symptoms that emerge during the luteal phase of the menstrual cycle and remit following menstruation (O'Brien et al., 2011). PMDD is formally recognised within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and differs from premenstrual syndrome (PMS) due to the severity of emotional distress and functional impairment associated with the condition. Symptoms commonly include affective instability, irritability, anxiety and impaired occupational or interpersonal functioning. The literature showed that neurodivergent individuals may also experience heightened sensory distress and worsening executive functioning during the menstrual cycle (Wynchank, 2025). Diagnosis requires prospective symptom confirmation across at least two menstrual cycles using validated instruments such as the Daily Record of Severity of Problems (DRSP) (American Psychiatric Association, 2013). Despite increasing recognition of PMDD within psychiatric and gynaecological research, limited evidence has examined how PMDD presents among neurodivergent populations, particularly autistic individuals and those with attention-deficit/hyperactivity disorder (ADHD). Emerging literature suggests that neurodivergent AFAB adults may experience heightened menstrual-related distress, emotional dysregulation, sensory difficulties and worsening executive-function impairment across the menstrual cycle (Steward et al., 2018). Research involving autistic adults has demonstrated that menstruation may exacerbate sensory overload, emotional exhaustion and difficulties with daily functioning (Young et al., 2018). Proposed mechanisms linking PMDD with neurodivergence include altered serotonergic functioning, heightened sensory processing sensitivity, hormonal reactivity, stress dysregulation and executive dysfunction (Kornstein & Pearlstein, 2021). However, current evidence remains dispersed across psychiatry, neurodevelopmental, reproductive health and women’s health literature. Neurodivergent individuals have historically been underrepresented in reproductive mental health research, contributing to limited understanding of PMDD symptom profiles, treatment response and healthcare needs within these populations (Halladay et al., 2015). Clinical care gaps also appear substantial. Neurodivergent AFAB adults may experience diagnostic overshadowing, where cyclical PMDD symptoms are attributed solely to autism or ADHD rather than recognised as hormone-related distress (Steward et al., 2018). Difficulties accessing gynaecological care, limited clinician awareness of neurodivergent presentations, communication barriers and the absence of neurodiversity-adapted interventions may further contribute to delayed diagnosis and unmet treatment needs. Given the emerging and heterogeneous nature of this evidence base, a scoping review is considered the most appropriate methodology to systematically map existing evidence, identify conceptual trends, summarise proposed mechanisms and care-related findings and highlight gaps requiring future investigation (Arksey & O’Malley, 2005; Peters et al., 2020). The review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews and will be reported according to the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines (Tricco et al., 2018).

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