Cohort study, 2025

Does having PCOS raise the risk of premenstrual disorders like PMS or PMDD?

Yes. Women with PCOS had a higher risk of being diagnosed with a premenstrual disorder than women without PCOS, and this held up even when comparing sisters to each other.

Strong study design Nearly 3 million women in Sweden, including 41,515 with PCOS; sibling comparison used 160,566 people.

What they did

A nationwide Swedish register study followed almost 3 million women from 2001 to 2018. It compared 41,515 women with a PCOS diagnosis to women without PCOS, and also compared sisters (160,566 people) to control for shared family and genetic factors. They tracked who later got a premenstrual disorder diagnosis or related prescription over an average of 15.3 years.

What they found

1.9% of women with PCOS (1,308 people) developed a premenstrual disorder during follow-up. Women with PCOS had more than double the risk compared to women without it (HR 2.26). After adjusting for other factors like socioeconomic status, other mental health conditions and obesity, the risk was still higher (HR 1.54). The sister comparison found a similar result (HR 1.61). The link remained whether or not women had other psychiatric conditions.

What it means for you

PCOS appears to be a real risk factor for premenstrual disorders, not just something explained by family background or other illnesses. This is register data from one country, so it relies on diagnosis and prescription records rather than detailed symptom tracking, and it cannot prove PCOS directly causes PMDs.

HR 2.26

risk of PMD with PCOS, age-adjusted

HR 1.54

risk after full adjustment

1.9%

of PCOS women diagnosed with a PMD

About the study

Original title: Polycystic Ovary Syndrome and the Risk of Premenstrual Disorders: A Nationwide Register-Based Study in Sweden
Authors: Opatowski M, Deng J, Yang Q et al.
Journal: Depression and anxiety
Year: 2025
Study design: Cohort study
Participants: 160,566
What was tested: None (observational study, no treatment tested).
Open access: Yes
Read the paper: doi.org/10.1155/da/8226088

Original abstract

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age. It has been linked to a range of psychiatric disorders. Although premenstrual disorders (PMDs) are characterized by psychiatric symptoms in tandem with hormone changes controlled by the endocrine system, the association between PCOS and PMDs remains unknown. Methods: We conducted a nationwide register-based cohort study including 2,965,178 females during 2001-2018 in Sweden. Individuals with PCOS were identified from clinical diagnoses recorded in the Swedish national registers ( n = 41,515) and PMDs were identified based on clinical diagnoses and prescriptions with a clear indication of PMDs during follow-up. Using multivariable Cox regression, hazard ratio (HRs) of PMDs were estimated by comparing individuals with PCOS to those without. To account for confounders such as genetics or family environment, we conducted sibling comparison ( N = 160,566). Results: During a median follow-up of 15.3 years, 1308 (1.9%) individuals with PCOS had a premenstrual disorder (PMD) (4.67/1000 person-years). Compared to individuals without PCOS they had more than doubled risk of PMDs (age-adjusted HR: 2.26, 95% CI 2.14- 2.39). The association was attenuated after adjustment for demographic and socioeconomic factors as well as for comorbid psychiatric disorders and obesity yet remained significant (HR: 1.54, 95% CI 1.46-1.63). The sibling comparison showed similar findings (full-adjusted HR: 1.61, 95% CI 1.36-1.92). The association between PCOS and PMDs remained statistically significant regardless of the presence of psychiatric comorbidities, with HR of 1.33 (95% CI 1.20-1.47) for individuals with psychiatric comorbidities and 1.55 (95% CI 1.45-1.65) for those without. Conclusions: Our findings suggest that individuals diagnosed with PCOS were at increased risk for PMDs. This association could not be entirely explained by shared risk factors, including such that sisters share.

Reproduced under CC-BY.

Topics

Premenstrual syndrome (PMS)Premenstrual dysphoric disorder (PMDD)Polycystic ovary syndrome (PCOS)

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