Is Suicidality Be Included in PMDD Diagnosis?

Suicidality in PMDD deserves urgent clinical attention. A 2024 Lancet Psychiatry commentary by Gordon and colleagues argues that suicidal thoughts and behaviours should be investigated for possible inclusion in the diagnostic criteria for premenstrual dysphoric disorder (PMDD), because evidence suggests suicide risk can be high for some people living with this cyclical condition.

Important: If you are thinking about harming yourself, feel unable to stay safe, or have made a plan, seek emergency help now. In India, call 112 for emergency services or contact a local crisis service, trusted person, or nearest emergency department. Do not wait for a symptom tracker or a future appointment.

What Is PMDD and Why Does Suicide Risk Matter?

PMDD is a hormone-sensitive mood disorder in which emotional and physical symptoms emerge in the luteal phase—the time after ovulation and before a period—and improve shortly after menstruation begins. It affects an estimated 1–3% of people assigned female at birth.

PMDD is not the same as typical premenstrual symptoms. It can involve intense depression, irritability, anxiety, mood swings, hopelessness, feeling overwhelmed, and major disruption to relationships, work, education, or everyday life.

For some people, the hardest days may also include:

• Passive thoughts such as “I do not want to wake up” or “I wish I could disappear”

• Thoughts of self-harm or suicide

• Suicidal planning or urges

• A feeling of suddenly becoming unsafe in the days before a period

These experiences are never a personal failure or “just hormones.” They are warning signs that deserve immediate compassion, assessment, and support.

What Did Gordon et al. (2024) Actually Argue?

Gordon, Chenji, Di Florio, Hantsoo, MacDonald, Peters, Ross, Schmalenberger, and Eisenlohr-Moul wrote on behalf of the International Association for Premenstrual Disorders (IAPMD). Their central argument was not that suicidality should be instantly added to PMDD criteria, but that it should be systematically researched for potential inclusion in future diagnostic systems such as the DSM and ICD.

The authors point out that suicidality is already listed among diagnostic symptoms for other mood disorders, including major depressive disorder and bipolar II disorder. They argue that if suicidal thoughts are a frequent PMDD-related experience for a meaningful group of people, diagnostic criteria should reflect that risk rather than leaving it overlooked.

Their professional view is clear: clinicians should routinely ask about suicidal thoughts when PMDD is suspected or diagnosed, and should assess whether those thoughts change predictably across the menstrual cycle.

What Does Research Say About Suicidality in PMDD?

The commentary brings together several important findings. While not every person with PMDD experiences suicidality, the available evidence shows a concerning association that healthcare professionals should not dismiss.

These findings do not mean that everyone with PMDD is suicidal or that PMDD alone explains every suicidal thought. They do show why asking directly, listening without judgment, and planning for high-risk cycle days can be lifesaving.

Why Is Daily PMDD Symptom Tracking So Important?

PMDD diagnosis depends on a repeated cyclical pattern, not a single difficult premenstrual week. Symptoms should be recorded daily across at least two menstrual cycles so a clinician can see whether they rise in the luteal phase and ease after the period starts.

Tracking can help you notice whether suicidal thoughts, self-harm urges, hopelessness, agitation, insomnia, or intense rejection sensitivity appear at a particular point in your cycle. This information can support a more accurate PMDD assessment and a more personalised safety plan.

A simple cycle pattern may look like this:

Ovulation → luteal-phase mood symptoms increase → suicidal thoughts or urges may intensify for some people → period begins → symptoms reduce or shift

This pattern is not universal, and symptoms that continue throughout the month still need full mental-health assessment. PMDD can also exist alongside depression, anxiety, trauma-related conditions, ADHD, bipolar disorder, or other health concerns.

Why Do the Authors Say More Research Is Needed?

The authors are careful not to overstate the evidence. They say there is a high standard of proof before changing formal diagnostic criteria, and several key questions still need answers.

Researchers need to investigate:

• Whether suicidal thoughts in PMDD consistently follow the same “on-off” cycle pattern as other PMDD symptoms

• Whether risk rises specifically in the late luteal phase and reduces after menstruation begins

• How adding suicidality to PMDD criteria could change the estimated prevalence of PMDD

• Whether it would help clinicians distinguish PMDD from bipolar disorder, borderline personality disorder, major depression, or other conditions

• Whether recognising suicidality as a PMDD symptom leads to earlier intervention and better outcomes

• Which treatments most effectively reduce suicide risk in people with PMDD

This is an important distinction: the paper is a call for better research and safer clinical practice, not a claim that the diagnostic criteria have already changed.

Could Including Suicidality Improve PMDD Diagnosis?

Potentially, yes. Gordon and colleagues outline several ways it could improve care if future research supports inclusion.

1. It Could Encourage Routine Suicide Screening

A clinician may ask about low mood but not always ask directly about self-harm or suicide. Making suicide-risk screening a clear part of PMDD assessment could help identify people who need urgent support.

The American College of Obstetricians and Gynecologists states that when someone answers yes to a self-harm or suicide question, clinicians should immediately assess the likelihood, acuity, and severity of suicide risk and arrange risk-tailored management.

2. It Could Reduce Misdiagnosis

Suicidal thoughts may lead clinicians to assume a person must have another psychiatric condition. However, PMDD can be present alongside—or sometimes be mistaken for—other mood-related diagnoses.

Recognising that suicidality may be cyclical for some people with PMDD could encourage clinicians to ask: “Does this worsen at a particular phase of your cycle?” That question does not replace a full psychiatric evaluation, but it can make the assessment more accurate.

3. It Could Change Treatment Planning

When suicidal thoughts are present, PMDD care should not focus only on reducing bloating, irritability, or cramps. The treatment plan should also include suicide-risk assessment, crisis contacts, a safety plan, mental-health support, and follow-up during higher-risk days.

4. What Should You Track If PMDD Symptoms Feel Unsafe?

Use a daily record rather than relying on memory at the end of the month. It can make it easier to explain your experience to a gynaecologist, psychiatrist, therapist, or primary-care clinician.

Track these symptoms daily

• Mood: sadness, hopelessness, anger, anxiety, irritability, overwhelm

• Thoughts: passive death wishes, self-harm thoughts, suicidal thoughts, planning, or feeling unsafe

• Functioning: missed work, conflict, inability to complete routine tasks, social withdrawal

• Body symptoms: sleep changes, appetite changes, pain, fatigue, breast tenderness, bloating

• Cycle details: period start date, cycle day, spotting, ovulation signs if known

• Context: alcohol or substance use, medication changes, major stress, relationship conflict, illness, or poor sleep

Use a safety-focused note

If suicidal thoughts appear, record the intensity and whether you had intent, a plan, access to means, or felt able to keep yourself safe. This is not about monitoring yourself alone—it is information to share with a qualified professional.

HealCycle can help you track daily PMDD symptoms, mood shifts, and cycle timing in one place. Use the patterns you notice to start a more specific conversation with your clinician—but seek immediate emergency support rather than waiting to log symptoms if you may act on suicidal thoughts.

What Can You Do During High-Risk PMDD Days?

A cycle-aware safety plan can be especially useful when you already know certain days are harder. Create it with a mental-health professional wherever possible.

Consider adding these steps to your plan

• Tell one trusted person which cycle days tend to feel most unsafe

• Save emergency contacts and crisis resources where you can access them quickly

• Arrange extra check-ins during your late luteal phase

• Avoid being alone if you feel at immediate risk

• Reduce access to anything you could use to harm yourself, with help from someone you trust

• Keep appointments with your therapist, psychiatrist, gynaecologist, or doctor, especially before expected high-symptom days

• Seek urgent help if your thoughts become more frequent, specific, or difficult to resist

You deserve support even if the thoughts go away once your period starts. A symptom being cyclical does not make it less serious.

Why Does This PMDD Research Matter?

The strongest message from Gordon et al. is that PMDD care must take suicidal risk seriously. The authors call for future PMDD research to track suicidality across the menstrual cycle, test whether it improves diagnosis and treatment, and determine whether future DSM and ICD criteria should include it.

For now, the practical takeaway is straightforward: if suicidal thoughts appear before your period, tell a healthcare professional exactly what is happening and when. Track the pattern with HealCycle, but pair that insight with real-world clinical and crisis support.

References

1. Gordon, J. L., Chenji, S., Di Florio, A., Hantsoo, L., MacDonald, S., Peters, J. R., Ross, J. M., Schmalenberger, K., & Eisenlohr-Moul, T. A. (2025). Suicidality should be considered for inclusion in the diagnostic criteria for PMDD. The Lancet Psychiatry, 12(2), 90–92. https://doi.org/10.1016/S2215-0366(24)00288-8

2. Prasad, D., Wollenhaupt-Aguiar, B., Kidd, K. N., de Azevedo Cardoso, T., & Frey, B. N. (2021). Suicidal risk in women with premenstrual syndrome and premenstrual dysphoric disorder: A systematic review and meta-analysis. Journal of Women’s Health, 30(12), 1693–1707.[pmc.ncbi.nlm.nih]

3. Eisenlohr-Moul, T., Divine, M., Schmalenberger, K., et al. (2022). Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of patients reporting prospectively confirmed PMDD. BMC Psychiatry, 22, 199.

4. Wikman, A., Sacher, J., Bixo, M., et al. (2022). Prevalence and correlates of current suicidal ideation in women with premenstrual dysphoric disorder. BMC Women’s Health, 22, 35.

5. American College of Obstetricians and Gynecologists. (n.d.). Patient screening: Perinatal mental health.[acog]