Women with premenstrual dysphoric disorder (PMDD) are at an almost seven times higher risk of a suicide attempt according to a meta-analysis published in the Journal of Women’s Health.

They also four times more likely to exhibit suicidal ideation, while women suffering from premenstural syndrome (PMS) also show higher levels of ideation, but no higher risk of suicide attempts, the authors found after reviewing 13 studies, seven of which investigated the relationship between PMDD and suicidality.

The authors said their findings impact how clinicians treat their patients with PMDD and PMS 

“These findings support routine suicidal risk assessments for women who suffer from moderate-to-severe premenstrual disturbance,” they note. “Furthermore, psychosocial treatments for women diagnosed with PMS/PMDD should consider and target suicidality to minimize risk and improve well-being.”

The authors note that pharmacotherapy is a first-line intervention and while cognitive behavioral therapy (CBT) has been explored, it has been found to be less effective.

“While psychotherapy may be useful as adjunctive to pharmacotherapy, the importance of medical treatments for PMDD cannot be understated,” they wrote. “Future research should explore multidimensional treatment approaches for individuals with severe premenstrual disturbances, whereby pharmacotherapy and psychotherapy can complement one another to potentially reduce suicidal risk.”