Women with premenstrual symptoms (PMS) and premenstrual dysphoric disorder experience symptoms during the premenstrual phase of their cycles.   Because levels of estrogen and progesterone do not differ significantly between women with PMS and those without, it has long been hypothesized that PMS/PMDD represents an abnormal response to normal hormonal fluctuations (Schmidt et al, 1998).

Given that postpartum depression (PPD) may be triggered by the hormonal shifts that take place after delivery, it has been speculated that women with premenstrual symptoms PMS or PMDD may be more vulnerable to PPD. Somewhat surprisingly, few studies have included PMS and PMDD as potential risk factors for PPD.

A recent study conducted at the University of Iowa examined the role of PMS/PMDD as a risk factor for PPD.  478 women who had given birth within the past 12 months were assessed. Premenstrual symptoms were assessed retrospectively using the Premenstrual Symptoms Screening Tool (PSST) and depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.

The authors found that having a history of moderate to severe PMS/PMDD increased the likelihood of PPD by about twofold.  Thus, in screening women for risk factors for PPD, we should be asking not only about a history of depression but also specifically about symptoms that arise premenstrually.

Ruta Nonacs, MD PhD

Buttner MM, Mott SL, Pearlstein T, et al. Examination of premenstrual symptoms as a risk factor for depression in postpartum women. Arch Womens Ment Health (2013) 16:219–225.