Suicide risk increased by premenstrual disorders

Suicide risk increased by premenstrual disorders | Image Credit: © Kittiphan - © Kittiphan - stock.adobe.com.

The risk of overall early death is not increased among women with premenstrual disorders (PMDs), but these women face increased risks of death by suicide and death at a young age, according to a study in JAMA Network Open.¹

PMDs are adverse physical and mental events occurring during the week before menstruation. These include premenstrual syndrome, present in 20% to 30% of reproductive aged women, and premenstrual dysphoric disorders, present in 2% to 6%.

PMDs have been associated with vasomotor symptoms, with an odds ratio of 1.43.² Women with PMDs have also presented with an increased risk of early menopause and are aged a mean 51.4 years at menopause onset.

Patients’ activities, relationships, and professional performance are often impacted by PMDs.¹ Additionally, data has indicated a potential link between PMDs and mortality, such as a 40% increased risk of hypertension among women with PMDs.

Investigators conducted a cohort study to evaluate the association between PMDs and risk of death. Data was obtained from Swedish national health registers, including all hospital discharge diagnoses, drug prescriptions from all pharmacies, death certificates, sociodemographic information, country of birth and migrations, and parental data.

Reproductive aged women diagnosed with a PMD for the first time between January 1, 2001, and December 31, 2018, were eligible for the analysis. These cases were randomly matched to 5 women without PMD based on year of birth. Exclusion criteria included hysterectomy or bilateral oophorectomy before matching.

Follow-up occurred until death, emigration, or December 31, 2018. Investigators also conducted a sibling analysis to address unmeasured cofounding.

PMDs were determined based on inpatient and outpatient diagnoses using International Classification of Diseases, Ninth Revision (ICD-9) or ICD-10 codes. The National Cause of Death Register was assessed for date and cause of death data.

Deaths because of cardiovascular diseases, neoplasms, and nervous system diseases were also categorized as natural causes, while deaths because of suicide and accidents were nonnatural causes. Covariates included age at diagnosis, country of birth, region of residence, education level, and income at matching.

There were 67,748 women diagnosed with PMDs between 2001 and 2018 included in the analysis, each matched with 5 controls. Over 1 in 3 women with PMD had at least 1 sister, leading to a sibling-matched cohort of 55,801 individuals. Women with PMDs were aged a mean 35.8 years at diagnosis, and 65.4% resided in the middle of the country.

Somatic comorbidities were reported in 9.9% of women with PMDs and 9.1% without PMDs. Psychiatric disorders were reported in 23.8% and 14.1%, respectively, with similar patterns found in the sibling cohort.

Neoplasms were the most common cause of death in 40.9% of women, followed by suicide in 27.2%, cardiovascular diseases in 7.9%, accident in 7.9%, and nervous system disease in 4.9%. Among women with PMD, a lower risk of overall mortality but increased risk of mortality when diagnosed before the age of 25 years was reported, with hazard ratios (HRs) of 0.73 and 2.59, respectively.

Cardio-specific mortality had a reduced risk, with an HR of 0.53. Of cardiovascular disease mortalities, 51.8% were in women aged 45 years or older. Women with PMDs had an HR of 1.59 for deaths from nonnatural causes, indicating increased risk.

Suicide had the highest risk with an HR of 1.92. Additionally, the increased risk was observed among PMD patients regardless of age at diagnosis.

These results indicated an increased risk of mortality among women diagnosed with a PMD at an early age, as well as increased suicide risk regardless of age. Investigators recommended careful follow-up among young women with PMDs and suicide prevention strategies for all women with PMDs.

References

1. Opatowski M, Valdimarsdóttir UA, Oberg AS, Bertone-Johnson ER, Lu D. Mortality risk among women with premenstrual disorders in Sweden. JAMA Netw Open. 2024;7(5):e2413394. doi:10.1001/jamanetworkopen.2024.13394
2. Krewson C. Premenstrual disorders increase early menopause and vasomotor symptom risks. Contemporary OB/GYN. September 21, 2023. June 4, 2024. https://www.contemporaryobgyn.net/view/premenstrual-disorders-increase-early-menopause-and-vasomotor-symptom-risks