Study: The costs of PMDD and the failure of the system

Premenstrual Dysphoric Disorder (PMDD) remains one of the most misunderstood—and underestimated—conditions in women’s mental health. A recent study in Frontiers in Psychiatry makes one thing clear: the burden of PMDD is far greater than most people, including many clinicians, recognize.

What emerges is not just a story about a disorder—but about a healthcare system that consistently fails to see it.

A Common Condition Hiding in Plain Sight

PMDD affects a significant portion of women during their reproductive years—but exactly how many depends on how carefully you look.

• Studies using strict diagnostic criteria estimate prevalence at 1.6%–3.2%

• Broader estimates suggest rates as high as 7.7%

In some regions, the numbers are even higher:

• 13.1% in Brazil

• Up to 27.8% in African (though likely inflated due to diagnostic differences)

Even at the lowest estimate, millions of women are affected. Yet PMDD remains underdiagnosed and often dismissed.

The delay is staggering: symptoms typically begin around age 15, but diagnosis doesn’t occur until age 35 on average. That’s a 20-year gap spent cycling through severe psychological and physical symptoms without answers.

A Serious Mental Health Risk—Not “Just PMS”

PMDD is not a mild inconvenience. It is a condition with profound consequences.

Research shows:

• PMDD doubles the risk of suicidal thoughts and behaviors

• Women with PMDD have 7 times higher risk of suicide attempts

• And nearly 4 times higher risk of suicidal ideation

In some studies:

• 72% of women with PMDD report suicidal thoughts

• 49% report planning

• 34% report attempts

These are not marginal numbers. They place PMDD among the most serious mood disorders in terms of risk.

The Hidden Economic Cost

The burden of PMDD is not just personal—it’s economic.

Women with PMDD:

• Miss more than 8 hours of work per menstrual cycle

• Generate over $4,000 per year in indirect costs from absenteeism and reduced productivity (I personally think that’s low and dependent on salary)

They are also:

• Three times more likely to visit specialist physicians

Over a lifetime—roughly 480 menstrual cycles—the cumulative impact becomes enormous, both for individuals and for the healthcare system.

Why PMDD Remains Invisible: Stigma and Structural Bias

If PMDD is this common and this severe, why is it still overlooked? The answer lies in a combination of stigma and structural bias.

Menstruation itself remains taboo in many cultures, discouraging open discussion and care-seeking. Layer on top of that the stigma of mental illness, and PMDD becomes a “double stigma” condition—easy to minimize, easy to ignore.

Even within medicine, bias persists:

• Women’s symptoms are often dismissed or minimized (“medical gaslighting”)

• Only 19% of psychiatric studies adequately account for sex differences

• Just ~5% of studies focus exclusively on women

The result is predictable: a condition that is poorly understood, inconsistently diagnosed, and inadequately treated.

Who Gets Left Out Entirely

The gaps in research don’t affect everyone equally. Women from marginalized groups—whether defined by race, income, or geography—face even greater barriers:

• Less access to care

• Higher exposure to stressors that worsen symptoms

• Greater likelihood of misdiagnosis

In Latin America, for example, there are virtually no recent data on PMDD prevalence. Transgender individuals are almost entirely absent from the research.

Without an “intersectional” lens—one that considers how overlapping identities shape health—entire populations remain invisible.

A Vicious Cycle of Neglect

The study describes a self-perpetuating cycle:

PMDD is under-researched → so it appears less prevalent → so it receives less funding and attention → which leads to continued underdiagnosis

This cycle has persisted for decades, leaving patients to navigate years—often decades—without recognition or support.

What Needs to Change

According to the authors, breaking the cycle requires structural change:

• Earlier and more accurate diagnosis

• Greater investment in research—especially focused on women

• Integration of gender and intersectional perspectives in healthcare

• Public conversations that normalize, rather than stigmatize, menstrual health

READ THE STUDY: Islas-Preciado D, Ramos-Lira L and Estrada-Camarena E (2025) Unveiling the burden of premenstrual dysphoric disorder: a narrative review to call for gender perspective and intersectional approaches. Frontiers in Psychiatry 15:1458114. doi: 10.3389/fpsyt.2024.1458114