Associations between Premenstrual Symptoms and (Traumatic) Stress: A Systematic Review and Three Multilevel Meta-Analyses

BackgroundCore Premenstrual Disorders (PMDs), including Premenstrual Syndrome and Premenstrual Dysphoric Disorder, can cause significant impairment. Despite evidence of associations between stress and premenstrual symptoms, a systematic synthesis is lacking.AimsTo systematically review the literature and meta-analyse evidence on the relationship between premenstrual symptoms and stress. MethodFour databases were searched for studies indexed before 27.8.2024 (no language or year restrictions) to identify studies assessing the relationship between stress and premenstrual symptoms in regularly menstruating individuals (PROSPERO: CRD42021244503). Three multilevel meta-analyses were performed to estimate (1) the correlation between stress and premenstrual symptom severity, (2) stress differences between individuals with and without core PMD across the menstrual cycle, (3) the impact of traumatic experiences on developing premenstrual symptoms. Study quality and publication bias were assessed.Results188 effect sizes from 67 studies (N = 38,494) were synthesised. Results showed (1) a positive correlation between symptom severity and stress (r = .29, 95% CI .23–.36), (2) higher stress levels in subjects with core PMD (d = 0.79, 95% CI 0.35–1.22), particularly during the luteal phase (d = 1.07, 95% CI 0.54–1.60), (3) more than twofold higher odds (OR = 2.45, 95% CI 1.89–3.18) of PMS in individuals with a history of trauma. Heterogeneity was high (I2 84.64–91.38%); two analyses showed evidence of publication bias.ConclusionsThe results indicate an association between stress and premenstrual symptoms, an effect of cycle phase, and trauma as a risk factor for premenstrual symptoms. Future research should investigate the biopsychological dynamics across the menstrual cycle.