A Qualitative Study of Reproductive Decision-Making Among People with Lived Experience of Premenstrual Dysphoric Disorder

Objectives: Premenstrual Dysphoric Disorder (PMDD) is a cyclical hormone-related condition, causing significant mood symptoms in the luteal phase of the menstrual cycle. Despite the substantial impact it can have on daily life, little is known about how it shapes reproductive decision-making. This study explored how people with PMDD experience and reflect on reproductive decisions, and the role of healthcare support in this. Design: Semi-structured qualitative interviews, informed by a feminist critical realist approach. Methods: Twenty UK-based adults who had received a diagnosis of, or self-identified as having, PMDD took part. Semi-structured interviews explored experiences of how, if at all, PMDD had impacted thoughts and decisions around pregnancy or parenthood. Data were analysed using reflexive thematic analysis, supported by a lived experience advisory group. Results: Four themes were developed: PMDD as a whole-family experience; intergenerational awareness and responsibility; assessing readiness and capacity for parenthood; and self-advocacy and negotiating an unsupportive system. Participants not only spoke about how PMDD symptoms shaped their decision-making, but also considered relational impact, the potential heritability of PMDD, and the limited healthcare support available. Support from loved ones, familiarity with their own symptom patterns and establishing strategies for managing PMDD were often described as facilitators of decision-making. Across themes, findings were interpreted within a “good mother” ideal, helping to explain why reproductive decisions often carried emotional and moral weight. Conclusions: PMDD can shape reproductive decision-making in complex ways. Findings demonstrate the need for PMDD-specific support that helps people make informed decisions aligned with their circumstances and needs.