Prevalence of premenstrual syndrome and premenstrual dysphoric disorder among highly trained and elite female athletes: A systematic review and meta-analysis

Abstract

Premenstrual syndrome (PMS) involves psychological and physical symptoms affecting around 30% of reproductive-age women, while premenstrual dysphoric disorder (PMDD) is a more severe, less common form. The aim of the review was to determine whether PMS and PMDD are more common among highly trained female athletes compared to non-training women.The study protocol was registered with PROSPERO (CRD42022323111). A search of PubMed, Scopus and Web of Science (up to August 2024) identified 12 eligible studies, with 7 included in the meta-analysis. Data from 1570 female athletes and 1165 non-athletes were analysed. A total of 755 cases of PMS and 54 cases of PMDD were found in all included studies. The prevalence of PMS among athletes ranged from 8.6 to 65.8%, while the impact of symptoms on athletic performance was reported by 41.1 to 44.3% of respondents. The meta-analysis on PMS prevalence (n = 2005 women) indicated 16% lower odds for athletes compared to non-athletes, however, the result was not statistically significant (p = 0.409). The prevalence of PMDD among athletes ranged from 1.3 to 13.1%. Meta-analysis results (n = 1314 women) showed 16% higher odds ratio of PMDD prevalence among athletes compared to non-athletes, but the association was also not significant (p = 0.660). This is the first systematic review and meta-analysis on the susceptibility of women to PMS and PMDD symptoms in relation to physical activity at a professional level. The prevalence of PMS among athletes could be highly variable, while PMDD appears to be a relatively minor issue. Further research regarding PMS and PMDD in female athletes is warranted.

Keywords: Athletes; Menstrual cycle; Meta-analysis; Premenstrual dysphoric disorder; Premenstrual syndrome; Sport; Systematic review.

FIG. 1

The potential impact of premenstrual symptoms on a career of individual and team sport athlete. *assuming that the median menarche age is 11.9 years old, and the age of sport retirement for individual athlete is 28 years old, and for team sport athlete 32.

FIG. 2

Literature review and meta-analysis flow diagram of the selection process according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement.

FIG. 3

Forest plot of odds ratios (ORs) and 95% confidence intervals (CIs) for premenstrual syndrome (PMS) among female athletes and non-athletes. The black squares represent the ORs for each study, with their sizes reflecting the weight of the respective studies in the meta-analysis. The horizontal lines indicate the corresponding 95% CIs. The diamond at the bottom center represents the overall summary estimate of the OR, with its width denoting the 95% CI.

FIG. 4

Forest plot of odds ratios (ORs) and 95% confidence intervals (CIs) for premenstrual dysphoric disorder (PMDD) among female athletes and non-athletes. The black squares represent the ORs for each study, with their sizes reflecting the weight of the respective studies in the meta-analysis. The horizontal lines indicate the corresponding 95% CIs. The diamond at the bottom center represents the overall summary estimate of the OR, with its width denoting the 95% CI.

FIG. 5

Factors with potential protective and aggravating effects on the occurrence of premenstrual symptoms in elite female athletes, as well as key considerations for designing and analysing studies on premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) in this population.