Dr Hema Divakar, internationally renowned gynaecologist and obstetrician from Dr Divakar’s Speciality Hospital in Bengaluru, said the study’s finding “doesn’t mean every woman with PMS should panic.”
Published Jul 12, 2025 | 7:00 AM ⚊ Updated Jul 12, 2025 | 7:00 AM
Premenstrual symptoms, experienced by many women in the days leading up to their period, often include mood swings, fatigue, breast tenderness, and bloating.
Synopsis: Women with premenstrual symptoms such as PMS or PMDD face a notably higher risk of developing heart conditions, including arrhythmias and stroke, according to a major Swedish study tracking over 90,000 women for more than two decades. The risk was especially marked in women diagnosed before age 25 or those with postnatal depression, pointing to possible hormonal and inflammatory links.
A large-scale study tracking nearly one lakh women over two decades has found that those with premenstrual symptoms – including Premenstrual Syndrome (PMS) and the more severe Premenstrual Dysphoric Disorder (PMDD) – face a significantly higher risk of developing heart conditions such as arrhythmias and stroke.
Premenstrual symptoms, experienced by many women in the days leading up to their period, often include mood swings, fatigue, breast tenderness, and bloating.
While these symptoms have long been dismissed as “part of being a woman,” new research suggests they may be a red flag for future cardiovascular disease.
Published in Nature Cardiovascular Research, the Swedish study found that women with premenstrual symptoms had a 10 per cent higher risk of heart disease compared to those without.
More alarmingly, their risk of heart rhythm disorders was 31 per cent higher, and the risk of stroke was 27 per cent higher – even after accounting for lifestyle factors such as smoking, BMI, and mental health.
“These findings are very interesting and important,” said Dr MSS Mukharjee, a renowned interventional cardiologist from Hyderabad.
“We often think of premenstrual disorders as purely hormonal or emotional, but this shows there may be deeper physiological impact.”
Premenstrual Syndrome refers to a group of emotional, physical, and behavioural symptoms that occur in the days or weeks before a woman’s period and usually subside once menstruation begins.
Emotional and behavioural symptoms include:
Physical symptoms may involve:
While PMS is more common and milder, PMDD (Premenstrual Dysphoric Disorder) is a more severe form that causes intense emotional and physical symptoms in the days leading up to menstruation.
PMDD symptoms include:
Unlike PMS, PMDD can significantly disrupt daily life, work, and relationships. It affects around 3 to 8 per cent of menstruating women.
If PMS symptoms are mild, lifestyle changes such as regular exercise, adequate sleep, and a balanced diet can help. But if symptoms are severe or affect quality of life, it is advisable to consult a doctor to assess if it could be PMDD.
The researchers aimed to determine whether experiencing PMS is linked to a higher long-term risk of cardiovascular disease (CVD), and to identify which specific heart conditions are involved. Over 90,000 women who reported PMS, along with a comparable group without symptoms, were tracked for up to 22 years.
The study compared symptomatic women to the general population. Led by researchers at the Karolinska Institutet in Sweden, it also accounted for shared family traits by comparing women with their sisters – a method that strengthens the evidence for a biological link.
Outcomes such as incidence of arrhythmias, ischaemic stroke, heart attack, and other heart conditions were measured. The statistical models adjusted for a range of factors, including smoking, BMI, mental health, education, physical activity, and other lifestyle and demographic variables.
The study also explored differences in risk among women diagnosed with PMS before the age of 25 and those with a history of postnatal depression. Biological markers were also taken into account.
Interestingly, the study found that women with PMS had a 10 per cent higher risk of developing CVD. The risk of arrhythmias was higher by 31 per cent, and the risk of ischaemic stroke increased by approximately 27 per cent.
The risk was particularly pronounced among women diagnosed with PMS or PMDD before the age of 25, and among those who had also experienced postnatal depression – both conditions linked to hormonal changes.
Researchers believe several biological mechanisms could explain the connection. One theory is that women with premenstrual symptoms may have a dysregulated renin-angiotensin-aldosterone system (RAAS) – the system that helps regulate blood pressure and fluid balance.
Another possibility is chronic low-grade inflammation, a known risk factor for heart disease. A third hypothesis points to underlying metabolic issues, which are often associated with strokes and heart attacks.
Dr Mukharjee said the increased cardiovascular risk – especially in younger women and those with perinatal depression – is a warning sign.
“It reminds us to take PMS symptoms seriously. It is not just for symptom relief, but also as a possible marker for future heart disease risk,” he said and added that early screening and lifestyle modification in this group may help reduce long-term cardiac events.
However, Dr Hema Divakar, internationally renowned gynaecologist and obstetrician from Dr Divakar’s Speciality Hospital in Bengaluru, said the study’s finding “doesn’t mean every woman with PMS should panic.”
She explained that there is already substantial evidence linking menopause, PCOS, pregnancy-related conditions, and lifestyle factors like obesity and smoking with cardiovascular risks in women. But the link between PMS and heart health isn’t well established.
Dr Hema said that cardiovascular events are typically handled by cardiac specialists, and rarely does anyone ask about PMS.
“This new study brings an interesting observational angle, but it’s too early to treat PMS as an independent risk factor,” she added.
In fact, women without PMS but with other well-known risk factors are at greater risk, she added.
While doctors agree that more research is needed to identify why this link exists and how to prevent it, they say menstrual health and heart health should be looked at together.
They also point out that there is sufficient evidence linking early menopause with increased risk of heart ailments.
“Young girls should not worry excessively about PMS and heart-related risks now. There needs to be more evidence for this,” Dr Hema added.
The next steps, according to the study’s authors, include further research into hormonal treatments, lifestyle interventions, and the potential role of anti-inflammatory therapies for women with severe PMS or PMDD.
(Edited by Dese Gowda)
