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No explicit link has firmly been established between PCOS and premenstrual dysmorphic disorder or PMDD,[1] an extreme form of PMS with significant mental and physical impairments in the week leading up to menses, the onset of a period, and then improvement in or absence of symptoms in the intervening weeks.[2]

However, individuals with PCOS have a significantly increased likelihood of having autism and/or attention deficit hyperactivity disorder or ADHD.  While only 3-9% of the population experience PMDD,[3] one study found that 46% of women with ADHD and 92% of those with autism have a diagnosis of PMDD.[4]

In this article we explore the potential link between PCOS and PMDD.

A typical menstrual cycle relies on a complex interplay of chemicals over a cycle of around 28 days and comprised of four key phases:[5]

  • Menses: the uterus sheds its lining if pregnancy hasn’t occurred from day 1 of the cycle for a typical period of 3-7 days;

  • Follicular: overlapping with menses and lasting for 10-14 days, the lining of the uterus is restored and follicles in the ovaries grow to produce (usually) a single mature egg or ovum;

  • Ovulation: at roughly day 14, an eggs is released; and

  • Luteal: from day 15-28 the egg travels to the uterus and, if fertilized by a sperm, implants into the uterine wall.

As the luteal phase comes to a close leading up to menstruation, individuals may experience a range of physical and emotional symptoms associated with both PMS and PCOS:[6]

  • Fatigue, insomnia and frequent napping;

  • Bloating;

  • Cramps;

  • Breaking out or acne;

  • Breast tenderness;

  • Headaches;

  • Mood changes, including irritability, anxiety and/or depression;

  • Difficulty concentrating

  • Changes in appetite, including cravings and/or increased/decreased appetite; and

  • Diminished interest in activities, including sex.

Individuals with PMDD experience an extreme form of PMS with more severe expression of these emotional and physical symptoms.[7]  PMDD can even be associated with suicidal feelings.[8]

There are several similarities through which PCOS and PMDD may share underlying mechanisms or through which PCOS may exacerbate PMS symptoms:

  1. Elevated levels of allopregnanolone (ALLO),[9] a very small molecule or metabolite produced when the body breaks down the progesterone hormone, are associated with both PMDD and PCOS.[10],[11]  This is related to increased sensitivity to ALLO through the Gamma-aminobutyric acid-A (GABAA) receptors,[12],[13] neurotransmitters or signaling molecules that reduce the level of neuronal activity by reducing the transmission of signals between neurons.[14]

  2. Alterations to grey matter volume, either in terms of absolute volume in the case of PCOS[15] or asymmetry between the volume in left and right hemisphere of the brain in the case of PMDD.[16],[17]

  3. Individuals with PCOS may experience a more significant burden of PMS symptoms due to the irregular and unpredictable nature of their cycles.

Other risk factors for PMDD may include:[18] 

  • Family history of PMDD or PMS;

  • Personal or family history of other mental health disorders including depression, post-partum disorder or other mood disorders;

  • Lower level of educational attainment; and

  • Use of tobacco.

Reviewed by Sonia Kalra, CEO of NatureMary, biologist and advocate for women’s health


Welcome to Naturemary, where we're pioneering natural solutions for bodycare & pain relief.  Our founder Sonia's expertise in Biology & Neuroscience, coupled with her personal struggle with PMDD, inspired her to pioneer effective natural solutions.  Harness the power of nature with Bioterpene™ Technology, a cutting-edge innovation in pain relief and body care. Bioterpene™ Technology is designed to provide fast-acting and targeted relief for skin and body.


Want to learn more about menstrual conditions related to PCOS?  Check out the sections on PMS, menstrual cramps and irregular periods.

Complications – Menstrual Health

PCOS and Premenstrual Dysmorphic Disorder (PMDD)

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