What are the risk factors for premenstrual dysphoric disorder?

It should be noted that it doesn’t have one clear cause, but several risk factors increase a woman’s likelihood of developing it.

These are a mix of biological, psychological, and lifestyle-related influences.

1. Genetic vulnerability

• • Family history of PMDD, PMS, or mood disorders heightens risk.

• • A genetic sensitivity to hormonal fluctuations involving estrogen and progesterone may affect how the brain processes mood.

• • Twin studies suggest a heritable component to severe premenstrual symptoms.

2. History of mood disorders

• • Women with major depressive disorder, bipolar disorder, or anxiety disorders are more likely to develop PMDD.

• • PMDD is not just a mood disorder itself, but it shares neurobiological pathways with depression, such as serotonin dysregulation.

• • PMDD symptoms often worsen co-existing psychiatric conditions.

3. Trauma and stress
   
   

• • Childhood abuse, neglect, or other early trauma (physical, sexual, or emotional) is linked to higher PMDD risk.

• • High levels of chronic stress or poor coping mechanisms can aggravate premenstrual symptoms.

• • Tension may increase the brain’s sensitivity to hormone changes during the menstrual cycle.

4. Hormonal sensitivity (not imbalance)

• • Interestingly, women with PMDD have normal hormone levels, but their brains respond abnormally to natural hormonal changes during the cycle, particularly during the luteal phase.

• • This abnormal response affects GABA and serotonin neurotransmission, which are closely tied to mood regulation.

5. Lifestyle factors

While these don’t cause PMDD, they can increase vulnerability or worsen symptoms:

• • Smoking is linked to deteriorating premenstrual symptoms.

• • Poor diet by consuming high sugar, low micronutrient intake (e.g., B6, calcium, magnesium).

• • Low physical activity.

• • Alcohol or substance use.
    

• • Poor sleep habits.

6. Age and menstrual history

• • PMDD typically begins in the late teens to early 30s.

• • Women with shorter or irregular cycles may have more intense luteal-phase shifts.

• • Symptoms often worsen as women approach perimenopause due to more erratic hormone fluctuations.

–> My comprehensive premenstrual dysphoric disorder guide can be found here.

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