THE PREVALENCE, BURDEN, TREATMENT AND BARRIERS TO ACCESSING TREATMENT FOR PREMENSTRUAL SYNDROME AND PREMENSTRUAL DYSPHORIC DISORDER: A SYSTEMATIC SCOPING REVIEW

THE PREVALENCE, BURDEN, TREATMENT AND BARRIERS TO ACCESSING TREATMENT FOR PREMENSTRUAL SYNDROME AND PREMENSTRUAL DYSPHORIC DISORDER: A SYSTEMATIC SCOPING REVIEW | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 1 August 2025 V1 Latest version Share on THE PREVALENCE, BURDEN, TREATMENT AND BARRIERS TO ACCESSING TREATMENT FOR PREMENSTRUAL SYNDROME AND PREMENSTRUAL DYSPHORIC DISORDER: A SYSTEMATIC SCOPING REVIEW Authors : Meghna Prasannan Ponganam 0009-0000-1043-3633 , Maureen Makama 0000-0002-4164-3702 , Evie Kayes , Tahlia Guneratne , Lily Aboud , Kate Mills 0009-0003-6262-7220 , Anne Ammerdorffer 0000-0002-1059-061X , … Show All … , Lorena Romero , Luis Bahamondes , Jen Sothornwit 0000-0002-5985-7389 , Pisake Lumbiganon , Ahmet Gulmezoglu 0000-0003-4674-0998 , Joshua P Vogel , and Annie McDougall 0000-0003-1182-6679 [email protected] Show Fewer Authors Info & Affiliations https://doi.org/10.22541/au.175403722.22984663/v1 649 views 372 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are menstrual disorders that are often overlooked clinically and academically, despite their significant morbidity. Objective: To summarise the available evidence on prevalence, burden, treatment, and barriers to accessing treatment for PMS and PMDD in low-and middle-income countries (LMICs). Search Strategy: A systematic search of nine databases (Medline, Embase, Emcare, CINAHL, PsycInfo, Global Index Medicus, Web of Science, Global Health and Scopus) was conducted (January 2000-June 2024), along with grey literature searches (May 2023-June 2024). Women’s health organizations (412) were searched for clinical guidelines. Selection Criteria Studies from LMICs addressing prevalence, burden, and treatment barriers were included. Clinical guidelines and treatment studies were eligible irrespective of income level. All primary research studies were included. Data Collection and Analysis This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Two reviewers independently screened titles/abstracts/full texts and performed data extraction. Main Results: Overall, 23,435 records were identified, with 504 included. Prevalence rates ranged from 5.5% to 98.2% for PMS and 0.5% to 65.7% for PMDD. Included studies used twelve different diagnostic tools for PMS. Treatment studies were primarily conducted in high-income countries (HICs) with all three clinical guidelines being from HICs.Conclusion: Despite their prevalence, there is a lack of standardized diagnostic criteria for PMS and guidance on management for both conditions. Further studies are needed to address burden of PMS and PMDD and to identify effective treatment in LMICs. Funding This study did not receive any funding. THE PREVALENCE, BURDEN, TREATMENT AND BARRIERS TO ACCESSING TREATMENT FOR PREMENSTRUAL SYNDROME AND PREMENSTRUAL DYSPHORIC DISORDER: A SYSTEMATIC SCOPING REVIEW Meghna Prasannan Ponganam, 1,2 Maureen Makama, 1,2 Evie Kayes, 1,3 Tahlia Guneratne, 1 Lily Aboud, 1 Kate Mills, 1 Anne Ammerdorffer, 4 Lorena Romero, 5 Luis Bahamondes, 6 Jen Sothornwit, 7 Pisake Lumbiganon, 7 A. Metin Gülmezoglu, 4 Joshua P. Vogel, 1,8 Annie R.A. McDougall 1,8 1. Women’s, Children’s, and Adolescents’ Health Program, Burnet Institute, Melbourne, Australia 2. Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia 3. Health and Community Services, School of Public Health, Deakin University, Melbourne, Australia 4. Concept Foundation, Geneva, Switzerland/ Bangkok, Thailand 5. The Ian Potter Library, Alfred Health, Melbourne, Australia 6. Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences Campinas, SP, Brazil 7. Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 8. Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia Corresponding author: Dr Annie R.A. McDougall Email address: [email protected] Address: 85 Commercial Rd, Melbourne, Victoria, Australia 3004 Disclosure of interests The authors report no conflict of interest. Registration Open Science Framework (OSF) available at https://doi.org/10.18702/OSF.IO/U3JR9. Date Registered: 13/06/2023 Short title: Review of Prevalence, Burden and Treatment for PMS and PMDD Abstract Background : Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are menstrual disorders that are often overlooked clinically and academically, despite their significant morbidity. Objective: To summarize the available evidence on prevalence, burden, treatment, and barriers to accessing treatment for PMS and PMDD in low-and middle-income countries (LMICs). Search Strategy: A systematic search of nine databases (Medline, Embase, Emcare, CINAHL, PsycInfo, Global Index Medicus, Web of Science, Global Health and Scopus) was conducted (January 2000-June 2024), along with grey literature searches (May 2023-June 2024). Women’s health organizations (412) were searched for clinical guidelines. Selection Criteria Studies from LMICs addressing prevalence, burden, and treatment barriers were included. Clinical guidelines and treatment studies were eligible irrespective of income level. All primary research study types were included. Data Collection and Analysis This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Two reviewers independently screened titles/abstracts/full texts and performed data extraction. Main Results: Overall, 23,435 records were identified, with 504 included . Prevalence rates ranged from 5.5% to 98.2% for PMS and 0.5% to 65.7% for PMDD. Included studies used twelve different diagnostic tools for PMS. Treatment studies were primarily conducted in high-income countries (HICs) with all three clinical guidelines being from HICs. Conclusion: Despite their prevalence, there is a lack of a standardized diagnostic criteria for PMS and guidance on management for both conditions. Further studies are needed to address the burden of PMS and PMDD and to identify effective treatment in LMICs. Keywords: premenstrual disorders, menstruation, gynaecology, treatment FUNDING This study did not receive any funding. INTRODUCTION Premenstrual Syndrome (PMS) refers to an extensive group of physical, emotional, behavioural, and/or cognitive symptoms that occur during the luteal phase of the menstrual cycle. 1 PMS has been associated with over 200 symptoms, ranging from breast tenderness and abdominal cramps, to anxiety and low mood. 2 Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS that involves more intense symptoms, mental health co-morbidities, and functional impairment. 3 Both PMS and PMDD (known collectively as premenstrual disorders (PMD)) can have devastating consequences on a woman’s wellbeing and quality of life. 4-6 These conditions are associated with mental health disorders including depression, bipolar disorder and postpartum depression. 7-9 As the severity of PMD symptoms worsen, its consequences become increasingly debilitating, and can lead to difficulties completing daily tasks, challenges maintaining relationships, severe anxiety and in some cases, suicide. 10 While a standardized diagnostic criterion for PMS does not yet exist, a diagnostic criterion for PMDD is included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). 11 Despite the substantial health impacts of PMS and PMDD, there is limited knowledge on the prevalence and burden of these conditions, particularly in low- and middle-income countries (LMICs). A 2014 systematic review estimated the global prevalence of PMS among menstrual-age women at 47.8% (95% CI: 32.6;62.9; 17 studies, 18,803 women), but found few studies from LMICs. 12 Similar limitations present difficulties estimating the prevalence of PMDD. Recommended treatments for PMS and PMDD include lifestyle modifications (exercise and healthy eating), complementary treatments (herbal remedies), or medications such as antipsychotics or hormonal therapies. 13,14 At its most severe, patients may require temporary ovarian suppression therapy or surgery, significantly impacting fertility. 15 For many patients, finding an effective treatment can be an arduous trial-and-error process spanning many years. 2 In the past two decades, systematic and scoping reviews on PMS and PMDD have explored its prevalence, 12,16-19 etiology, 20,21 associated mental health comorbidities, 9,21-24 and treatment. 25-30 However, no previous reviews have focused on these conditions in LMIC, and no previous reviews have explored the burden, encompassing not just the impact to physical health but also emotional, social, and mental health, as well as factors like education and employment of PMS and PMDD specifically in LMICs. The current recommended treatments in LMICs, and their accessibility, is also unknown. CORE OUTCOMES The aims of this scoping review were to systematically summarize the evidence on 1) the prevalence and burden of PMS and PMDD in LMICs; 2) current treatments used globally; and 3) the barriers to accessing PMS/PMDD treatments in LMICs. This review was guided by a process for conducting scoping reviews developed by Arksey and O’Malley and further described by Levac et al. 31,32 The results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist (Appendix A). 33 Ethics approval was not required for this scoping review, as it includes publicly available data. The review protocol was registered on the Open Science Framework (OSF) available at https://doi.org/10.18702/OSF.IO/U3JR9. Eligibility Criteria A detailed description of the pre-specified eligibility criteria can be found in Appendix B. For studies providing data on prevalence, burden or barriers to treatment, we only included studies from low-, lower-middle or upper-middle-income countries according to the 2022 World Bank classification of countries by income level. 34 Studies providing data on treatment were eligible irrespective of income level, in order to identify all possible PMS and PMDD treatment options. We opted to restrict the scope of this review to drug and supplement treatments and excluded studies involving psychotherapy treatments. All primary research studies - interventional trials (randomized and non-randomized); observational studies (prospective and retrospective cohort, cross-sectional, and case-control studies); qualitative studies; mixed methods studies; and reviews of primary research (systematic reviews and meta-analyses) and clinical guidelines - were eligible. Other types of reviews, case studies, case reports, conference abstracts, clinical trial protocols/registries and editorial articles were excluded. Search Strategy An information specialist (LR) was consulted to assist in the development of the search strategy (Appendix 2). We searched nine databases (Medline, Embase, Emcare, CINAHL, PsycInfo, Global Index Medicus, Web of Science, Global Health and Scopus). Results were limited to papers published from 1 January 2000 to 13 June 2024 to include only the latest evidence-based and clinically relevant information. A grey literature search was also conducted from 12 – 16 May 2023 and 12 – 13 June 2024 to identify clinical management guidelines that were not retrieved through systematic database searches. The websites of three international bodies (the International Federation of Gynaecology and Obstetrics (FIGO), The World Psychiatric Association (WPA) and World Organization of Family Doctors (WONCA)) were manually searched for published guidelines on PMS and/or PMDD treatment. FIGO represents the gynaecological and obstetrics organizations and societies from 134 countries, WPA consists of 145 psychiatric societies from 121 countries, and WONCA consists of 133 organizations from 111 countries. Eligibility criteria, data extraction and analysis Covidence TM was used to manage screening and eligibility assessment. Title/abstract screening was completed independently by two reviewers (MP and either EK or TG). Full texts of eligible studies were retrieved and screened independently by two reviewers (MP and either KM, LA, or TG). Any discrepancies during screening were resolved via discussion or by consultation with a third reviewer (either AMcD or MM). A standardized data extraction template was developed on Excel, and pilot tested against five studies to ensure validity of the form. Categories were modified and the data extraction template was revised after piloting. Data extracted included study characteristics (study design, country, year), the condition of interest (PMS, PMDD or both), and the data reported by the study (prevalence, burden, treatment and/or barriers to accessing treatment of PMS and/or PMDD). Data extraction was conducted by two independent reviewers (MP, TG) with discrepancies resolved via discussion with a third reviewer (AMcD, MM). Descriptive statistics were used to summarize the findings on prevalence, treatment, and barriers to accessing treatment. For data on burden, the scores, based on various tools, assessing health-related quality of life (HRQOL), quality of life (QoL), disability-adjusted life year (DALY), and quality-adjusted life-year (QALY) were descriptively analysed and tabulated. For prevalence, data were organized and analysed based on the geographical regions outlined by the World Bank, and by sample size of included studies. 34 Treatment-related data was organized and analysed based on treatment type, location of study and whether the study was conducted in a PMS and/or PMDD population. Results were presented visually, using tables and charts, as appropriate. RESULTS Study selection The initial search yielded a total of 23,423 records from nine databases with 14,494 duplicates removed (Figure 1). The title/abstracts of 8,929 records were screened, and 1,711 records underwent full-text screening. Of these, 40 records could not be retrieved and 1170 were excluded, leaving 501 included studies. The most common reasons for exclusion included wrong study design (n=611), intervention (n=183), outcome (n=139), or patient population (n= 117). Three records were identified from grey literature searches (FIGO) resulting in a total of 504 included records. Characteristics of included studies Of the 503 studies, 136 (27.0%) were intervention studies, 331 (65.8%) were observational studies, one (0.2%) was mixed methods, 33 (6.6%) were systematic reviews and three were clinical guidelines (0.4%). The intervention studies included randomized controlled trials (RCTs) (121, 89%), non-randomized trials (2, 1.5%), quasi-experimental studies (5, 3.7%) and intervention studies without concurrent controls (8, 5.9%) (Supplementary Table 1). Observational studies included cross-sectional (316, 95.5%), cohort (10, 3.0%) and case-control (5,1.5%) designs. Prevalence of PMS and PMDD in LMICs In total, 282 studies (56.1%) from 23 countries reported the prevalence of PMS and/or PMDD in LMICs. The majority were from India (70 studies, 24.8%), Türkiye (38 studies,13.5%), Iran (29 studies, 10.3%), and Brazil (27 studies, 9.6%). Sample sizes of prevalence studies ranged from 31 35 to 22,021 women 36 . The reported prevalence of PMS ranged from 5.5% to 98.2%, and that of PMDD from 0.5% to 65.7% (Table 1). Twelve different diagnostic tools were used to define PMS, including ACOG guidelines, 37 Premenstrual Syndrome Scale (PMSS), 38 Shortened Premenstrual Assessment Form (SPAF), 39 Premenstrual Symptoms screening tool (PSST), 40 Premenstrual Assessment Form (PAF), 41 Daily Record of Severity of Problem (DRSP), 42 Menstrual Distress Questionnaire (MDQ), 43 Menstrual Attitude Questionnaire (MAQ), 44 Premenstrual Tension Syndrome Rating Scale (PMTS), 45 International Classification of Diseases, Tenth Revision (ICD-10), 46 Modified Abraham’s Menstrual Symptom Questionnaire (MSQ) 47 and Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. 11 The most commonly used tools were PSST(n= 38), DSM criteria (n=29), PMSS (n=25) and ACOG guidelines (n=21). A further 88 studies (31.2%) used modified versions of these scales or created their own. Only 22 prevalence studies (7.9%) had a sample size of more than 1000 participants, of which 21 reported the prevalence of PMS (24.6%- 97.4%) and 6 studies reported the prevalence of PMDD (2.1% - 48%) (Supplementary Table 2). Burden of PMS and PMDD in LMICs Twenty-three studies (4.6%) reported on the burden of PMS and/or PMDD – all were cross-sectional studies, ranging from 89 to 1008 participants. These were from eight countries, most commonly Türkiye (five studies, 22.7%) and Brazil (five studies, 22.7%). They reported on different measures of burden: DALY (two studies, 8.7%), WRQoL (one study, 4.3%), QoL (14 studies, 60.9%) and HRQoL (seven studies, 30.4%) (Supplementary Table 3). No studies were identified that reported QALYs. The burden of PMS was reported in 18 studies. Overall, four (22.2%) reported that women with PMS (compared to those without) experienced declines in QoL domains of physical, psychological, social, and environmental relationships. 48-51 (Table 2). Of the three studies measuring the QoL domain of spirituality, two (11.1%) found it was lower with PMS 52,53 . One study (Thailand, 114 women), reported no clear differences across all QoL domains (Table 3). 54 Five of eight HRQoL domains (social functioning, role limitation-physical health, mental health, vitality, and general health) were lower in all seven studies of women with PMS. One study (Türkiye, 1008 women) found lower scores across all eight domains in a PMS population. 55 Mixed results were reported for the remaining three HRQoL domains (emotional role, bodily pain and physical functioning). WRQoL was assessed only by one study (Türkiye, 134 women); WRQoL decreased as PMS severity increased. 56 Eight studies reported on the burden of PMDD. DALY was assessed by one study (Türkiye, 89 women) and reported a reduction in all disability domains in women with PMDD. 57 QoL was measured by four studies (50%) - one study found lower results for women with PMDD across physical, psychological, social relationships, and environment domains. 50 Mixed results were reported in PMDD populations for general and physical health, however for the remaining HRQoL domains, women with PMDD reported a higher burden. Two studies compared the burden of PMS to that of PMDD. One study (India, 654 women), reported no significant differences in DALYs between the two groups. 58 However, one study (Türkiye, 89 women) reported lower HRQoL across all eight domains in women with PMDD when compared to women with PMS. 57 Treatment of PMS and PMDD We identified three clinical management guidelines. They were from the UK Royal College of Obstetricians and Gynaecologists (RCOG, 2016), the American College of Obstetricians and Gynecologists (ACOG, 2023) and the European Union (EU, 2012). 13,14,59 Guidelines from the UK and USA, focused on PMS and PMD respectively and recommended the use of Vitamin B6, combined oral contraceptives (COC) or the progestin-only contraceptive pill and selective serotonin reuptake inhibitors (SSRI) as first and/or second line management. Gonadotropin hormone-releasing hormone (GnRH) analogues combined with hormone replacement therapy (HRT) and surgery were recommended for severe cases when other treatments options had been ineffective. The RCOG guideline also included estradiol combine with progesterone, either micronized or 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) for treating PMS. 11 The ACOG guideline recommended the use of calcium supplementation and nonsteroidal anti-inflammatory drugs (NSAIDs) for treating PMD. 12 The guideline from the EU, focused on PMDD and recommended hormonal therapies (GnRH, COC, oestradiol) and psychiatric medication (SSRI). 59 We identified 166 (33%) studies that evaluated the efficacy of treatments for PMS and/or PMDD. Treatments were across five categories: psychiatric medications (53 studies, 31.9%), hormonal therapies (44 studies, 26.5%), dietary supplements (53 studies, 31.9%), surgical interventions (two studies, 1.2%), and others (drugs that don’t fall into the categories of psychiatric or hormonal) (19 studies,11.4%) (Figure 3 and Supplementary Table 4). Six subcategories of psychiatric medications (SSRI, serotonin and norepinephrine reuptake inhibitors (SNRIs), serotonin-norepinephrine-dopamine reuptake inhibitor (SNDRI), anxiolytics, anti-depressants, atypical antipsychotics), two hormonal therapies (COCs and GnRH agonists) and 15 dietary supplements (Vitamin: B6, D, B1, E and/or supplements:, magnesium, calcium, zinc, omega-3, Neptune krill oil, essential fatty acids, PMS50, oxaloacetate, L-tryptophan, micronutrient formulation and inositol) were identified (Supplementary Table 5). Two studies, both conducted in high-income countries (HICs), reported on surgical management of severe PMS and PMDD including NovaSure endometrial ablation (one study, 36 women) 60 and total abdominal hysterectomy/bilateral salpingo-oophorectomy (one study, 47 women). 61 Psychiatric (41 studies, 77.4%) and hormonal medications (30 studies, 68.2%) were more frequently investigated in HICs and upper-middle income countries (UMICs), with studies into psychiatric medications focused predominately on PMDD populations (34 studies, 64.2%) (Figure 2&3). Dietary supplements were more frequently investigated in LMICs (34 studies, 64.2%) and in PMS populations (48 studies, 90.6%) (Figure 2). No studies evaluating treatments were identified from low-income countries (LICs). Barriers to accessing treatments for PMS/PMDD Thirty-two (6.4%) studies reported on barriers to accessing treatment for PMS and/or PMDD in LMICs. Sample sizes ranged from 137 to 1295 participants. Two major barriers were identified: “lack of women’s awareness/knowledge” about the conditions (11 studies, 34.4%) and “not seeking medical help” (17 studies, 53.1%). Four studies explored both barriers (Supplementary Table 6). In all studies, data was reported quantitatively. Lowest rates of awareness for PMS were reported in Nepal (one study, 4.5-10%) and the highest in Sri Lanka (one study, 96.4%). Only one study, conducted in Pakistan, reported the rate of awareness of PMDD (19%). One study from Thailand reported the lowest percentages for women that sought medical support (one study, 3.1%) and Türkiye (5 studies, 70.6%) reported the highest. DISCUSSION Main findings To the best of our knowledge this is the first scoping review on the PMS/PMDD research landscape focusing on the prevalence, burden, treatment options and barriers to treatment, for women in LMICs. While we identified a wealth of evidence (501 studies and three clinical guidelines) there are significant knowledge gaps on these common and debilitating conditions. First, there are currently no agreed diagnostic criteria for PMS. Due in part to the inconsistent diagnostic criteria, prevalence estimates of PMS/PMDD in LMICs vary widely despite many studies on this topic existing. Second, there are no clinical guidelines on the treatment of PMS or PMDD from international bodies or LMICs. Third, there are few data on the burden of these conditions in LMICs, though available evidence indicates that women with PMS/PMDD in LMICs endure wide-ranging social, emotional, physical, and mental health impairments. Finally, there are few studies investigating PMS/PMDD treatments in LMICs, and on the barriers women face to accessing PMS/PMDD treatments. Interpretation As expected, PMS is more prevalent than PMDD. A 2022 systematic review of 25 studies spanning seven countries (one HIC and six LMICs) drew a similar conclusion, finding a higher pooled prevalence for PMS (51.3%) compared to PMDD (17.7%). 62 This and other systematic reviews of PMD prevalence have encountered wide differences across studies. For example, a 2022 systematic review on studies from India found PMS prevalence from 7% to 85.2%,and PMDD from 1.5% to 12%. 16 Three factors contribute to this – the ongoing diagnostic ambiguity of PMS due to the lack of consensus regarding the diagnostic criteria, the lack of prevalence data from many countries as incomplete data can skew prevalence calculations of regions and small sample sizes (89% of our studies had fewer than 1000 women) as this can lead to inaccurately represent populations, increasing the likelihood of random variation or outliers. The lack of consensus on how best to diagnose PMS means that multiple, different diagnostic tools are in common use. 63 We summarized prevalence data from 48 different instruments – 12 were diagnostic tools from official bodies, and a further 36 were modified from these, or created for research. However, prevalence ranges remained wide even among studies where official tools were used, highlighting the impact of small sample sizes, incomplete representation and varying study quality on the data. A 2019 study showed how different diagnostic tools complicate prevalence estimation, finding a 20% difference (88% vs 66%) in PMS prevalence when using PSST or ACOG criteria. 64 The lack of standardized diagnostic criteria increases the likelihood of misdiagnosing or misclassifying women with PMS, and contributes to underuse (or misuse) of treatments. 65 For example, a 2021 study in Türkiye found that introducing the standardised DSM-V criterion for PMDD resulted in a 10% drop in prevalence. 66 Accurate prevalence estimation and optimal treatment use will remain out of reach until a single, standard set of PMS diagnostic criteria is implemented. PMS and mainly PMDD are complex conditions, requiring treatment and monitoring of menstrual and psychiatric symptoms, and often need multi-disciplinary care. However, we found only three clinical guidelines for PMS or PMDD treatment, from the UK, USA and EU. 13,14,59 there are currently no such guidelines from LMICs, nor from international organizations. Furthermore, studies of healthcare professionals treating PMS and PMDD patients have found variable knowledge of these conditions and how best to treat them. 67,68 Clinical guidelines, particularly those tailored to LMIC settings, is an important step towards improving and standardizing clinical care for women with PMS/PMDD. Standardized guidelines and policies for the diagnosis and treatment of PMDs are urgently needed. Research attention needs to be drawn to the efficacy of treatments, particularly for women living in LMICs. While numerous medications were used for PMS and PMDD, our review reported that studies on pharmacological therapeutics were primarily conducted in high- and upper-middle-income settings, with few studies from low-middle and low-income countries. This is likely related to research barriers identified in the wider literature, such as inadequate funding, research workforce shortages, ethical and regulatory obstacles, and limited research infrastructure. 69 Lack of funding and research is significantly more pronounced for female-specific conditions. 70 While these disparities have not been studied in the context of PMS or PMDD specifically, they highlight some of the broader challenges to women’s health research. To correct this, significant research funding investments and advocacy are required to overcome the current lack of high-quality evidence regarding PMS/PMDD treatment options. Without these, progress in addressing the complex healthcare needs of women will likely remain stagnant. The recent Women’s Health Initiative, the largest long-term national women’s health prevention study, in the United States is particularly welcomed for its comprehensive approach to addressing gender-specific health issues, promoting research on women’s health, improving access to evidence-based treatments, and preventive care tailored to women’s unique needs. Strengths and limitations The strengths include that this scoping review focused on women with PMS or PMDD in LMICs - the prevalence and burden of these conditions, the treatments under research and the barriers women face to accessing treatments. We included studies of varying designs, recruitment strategies and languages to ensure we captured all available data. In addition, a grey literature search across 412 organizations means we are confident no other national or international guidelines currently exist. Some limitations must be acknowledged. Forty articles could not be retrieved, however given this constitutes 8% of studies we ultimately included and were primarily studies related to prevalence it is unlikely that the conclusions would be substantively different. Secondly, cognitive behavioural therapy is often recommended alongside hormonal and psychiatric medicines to manage PMDs. 13,14 While this is an important intervention, we opted to restrict the scope of this review to drug and supplement treatments. Conclusions Our review systematically mapped the available literature on the prevalence and burden, treatments, and barriers to accessing treatment in LMICs for PMS and PMDD, identifying substantial research and clinical practice gaps. Consensus on the diagnostic definition of PMS is urgently required, both to guide clinical practice and ensure accurate prevalence data can be obtained in the future. We found no international or LMIC-based clinical guidelines for PMS and PMDD, and few high-quality clinical studies on PMS/PMDD medications conducted in LMICs. While there were limited data on the burden of PMS and PMDD in LMICs and barriers to accessing treatment, the available evidence shows that women affected by PMS/PMDD in LMICs experience wide-ranging impairments and face considerable barriers to effective treatments. Standard diagnostic criteria and measurement strategies, the creation of high-quality clinical guidelines tailored to limited-resource settings, and the development of innovative therapeutic options that can meet the needs of women with PMS and PMDD in LMICs are major research priorities. Declaration Acknowledgements We would like to acknowledge Lorena Romero (Alfred Library, Melbourne, Australia) for her assistance with the search strategy. Contributions AMcD, JPV and MM led the conceptualisation and supervision of the project. AMcD, MM, JPV and MP were involved development of the methodology. MP, MM, AMcD, EK, TG, LA and KM performed collection and management of all the data. MP performed visualisation and analysis of all data. MP, AMcD, MK were involved in interpretation of data. MP wrote the original draft of the manuscript, and all authors contributed to writing and editing and had full access to the data. MP has accessed and verified all the data in this study. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Ethics approval This protocol did not require human or animal ethics approval. Data availability All data relevant to the study are included in the article or uploaded as supplementary information. Funding This study did not receive any funding. REFERENCES 1. Gudipally PR, Sharma GK. Premenstrual Syndrome. StatPearls. Treasure Island (FL); 2022.2. Dickerson LM, Mazyck PJ, Hunter MH. Premenstrual syndrome. Am Fam Physician 2003; 67 (8): 1743-52.3. Hantsoo L, Epperson C, Epperson CN. Premenstrual Dysphoric Disorder: Epidemiology and Treatment. Current Psychiatry Reports 2015; 17 (11): 1-9.4. Firoozi R, Kafi M, Salehi I, Shirmohammadi M. The Relationship between Severity of Premenstrual Syndrome and Psychiatric Symptoms. Iran J Psychiatry 2012; 7 (1): 36-40.5. Osborn E, Brooks J, O’Brien PMS, Wittkowski A. Suicidality in women with Premenstrual Dysphoric Disorder: a systematic literature review. Arch Womens Ment Health 2021; 24 (2): 173-84.6. Saunders KE, Hawton K. Suicidal behaviour and the menstrual cycle. Psychol Med 2006; 36 (7): 901-12.7. Eccles H, Sharma V. The association between premenstrual dysphoric disorder and depression: A systematic review. Journal of Affective Disorders Reports 2023; 12 : 100504.8. Sharma V, Mazmanian D, Eccles H. Relationship of Premenstrual Dysphoric Disorder With Bipolar Disorder: A Systematic Review. J Clin Psychiatry 2022; 83 (6).9. Pereira D, Pessoa AR, Madeira N, Macedo A, Pereira AT. Association between premenstrual dysphoric disorder and perinatal depression: a systematic review. Archives of Women’s Mental Health 2022; 25 (1): 61-70.10. Pearlstein T, Steiner M. Premenstrual dysphoric disorder: burden of illness and treatment update. J Psychiatry Neurosci 2008; 33 (4): 291-301.11. Williams JB, First M. Diagnostic and statistical manual of mental disorders. Encyclopedia of social work; 2013.12. A DM, K S, A D, Sattar K. Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study. J Clin Diagn Res 2014; 8 (2): 106-9.13. Management of Premenstrual Syndrome: Green-top Guideline No. 48. BJOG: An International Journal of Obstetrics and Gynaecology 2017; 124 (3): e73-e105.14. Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No. 7. Obstetrics and gynecology (New York 1953) 2023; 142 (6): 1516-33.15. Sundström I, Nyberg S, Bixo M, Hammarbäck S, Bäckström T. Treatment of premenstrual syndrome with gonadotropin-releasing hormone agonist in a low dose regimen. Acta Obstet Gynecol Scand 1999; 78 (10): 891-9.16. Dutta A, Sharma A. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in India: A systematic review and meta-analysis. Health Promot Perspect 2021; 11 (2): 161-70.17. Erbil N, Yücesoy H. Premenstrual syndrome prevalence in Turkey: a systematic review and meta-analysis. Psychology, Health & Medicine 2021: 1-11.18. Gao M, Zhang H, Gao Z, et al. Global and regional prevalence and burden for premenstrual syndrome and premenstrual dysphoric disorder: A study protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101 (1): e28528.19. Geta TG, Woldeamanuel GG, Dassa TT. Prevalence and associated factors of premenstrual syndrome among women of the reproductive age group in Ethiopia: Systematic review and meta-analysis. PLOS ONE 2020; 15 (11): e0241702.20. Dubol M, Epperson CN, Lanzenberger R, Sundström-Poromaa I, Comasco E. Neuroimaging premenstrual dysphoric disorder: A systematic and critical review. Frontiers in Neuroendocrinology 2020; 57 : 100838.21. Granda D, Szmidt MK, Kaluza J. Is Premenstrual Syndrome Associated with Inflammation, Oxidative Stress and Antioxidant Status? A Systematic Review of Case-Control and Cross-Sectional Studies. Antioxidants (Basel) 2021; 10 (4).22. Cirillo PC, Passos RB, Bevilaqua MC, López JR, Nardi AE. Bipolar disorder and Premenstrual Syndrome or Premenstrual Dysphoric Disorder comorbidity: a systematic review. Braz J Psychiatry 2012; 34 (4): 467-79.23. Osborn E, Brooks J, O’Brien PMS, Wittkowski A. Suicidality in women with premenstrual dysphoric disorder: A systematic literature review. Archives of Women’s Mental Health 2020: No Pagination Specified-No Pagination Specified.24. Sharma V, Mazmanian D, Eccles H. Relationship of Premenstrual Dysphoric Disorder With Bipolar Disorder: A Systematic Review. The journal of clinical psychiatry 2022; 83 (6).25. Brown J, O’ Brien PMS, Marjoribanks J, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. The Cochrane database of systematic reviews 2009; (2): CD001396.26. Mohammadi MM, Dehghan Nayeri N, Mashhadi M, Varaei S. Effect of omega-3 fatty acids on premenstrual syndrome: A systematic review and meta-analysis. Journal of Obstetrics and Gynaecology Research 2022; 48 (6): 1293-305.27. Reilly TJ, Wallman P, Clark I, Knox C-L, Craig MC, Taylor D. Intermittent selective serotonin reuptake inhibitors for premenstrual syndromes: A systematic review and meta-analysis of randomised trials. Journal of Psychopharmacology ; 0 (0): 02698811221099645.28. Arshiya S, Heyat MBB, Khaleequr R, et al. A systematic review and meta-analysis of premenstrual syndrome with special emphasis on herbal medicine and nutritional supplements. Pharmaceuticals 2022; 15 (11).29. Carlini SV, Di Scalea TL, McNally ST, Lester J, Deligiannidis KM. Management of Premenstrual Dysphoric Disorder: A Scoping Review. International Journal of Women’s Health 2022; 14 : 1783-801.30. Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database of Systematic Reviews 2012; (2).31. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology 2005; 8 (1): 19-32.32. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci 2010; 5 : 69.33. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 2018; 169 (7): 467-73.34. World Bank Country and Lending Groups.35. David AM, Di Bella ZJ, Berenstein E, Lopes AC, Vaisberg M. Incidência da sindrome pré-menstrual na prática de esportes. Revista Brasileira de Medicina do Esporte 2009; 15 .36. AbdelQadir YH, Assar A, Abdelghafar YA, et al. Prevalence and patterns of premenstrual disorders and possible association with sexual harassment: a cross-sectional study of young Arab women. BMC Women’s Health 2022; 22 (1): 536.37. ACOG practice bulletin - Premenstrual syndrome - Number 15, April 2000 - Clinical management guidelines for obstetrician-gynecologists. INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS 2001; 73 (2): 183-90.38. Gencdogan B. A new scale for premenstrual syndrome. Psychiatry Turkey 2006; 8 (2): 81-7.39. Allen S, McBride C, Pirie P. The Shortened Premenstrual Assessment Form. The Journal of reproductive medicine 1991; 36 : 769-72.40. Steiner M, Macdougall M, Brown E. The premenstrual symptoms screening tool (PSST) for clinicians. Archives of women’s mental health 2003; 6 (3): 203-9.41. Halbreich U, Endicott J, Schacht S, Nee J. The diversity of premenstrual changes as reflected in the Premenstrual Assessment Form. Acta Psychiatrica Scandinavica 1982; 65 (1): 46-65.42. Endicott J, Nee J, Harrison W. Daily Record of Severity of Problems (DRSP): reliability and validity. Arch Womens Ment Health 2006; 9 (1): 41-9.43. Vannuccini S, Rossi E, Cassioli E, et al. Menstrual Distress Questionnaire (MEDI-Q): a new tool to assess menstruation-related distress. Reprod Biomed Online 2021; 43 (6): 1107-16.44. Brooks-Gunn J, Ruble DN. The menstrual attitude questionnaire. Psychosom Med 1980; 42 (5): 503-12.45. Steiner M, Peer M, Macdougall M, Haskett R. The premenstrual tension syndrome rating scales: an updated version. Journal of affective disorders 2011; 135 (1-3): 82-8.46. Guo Y, Chen Z, Xu K, et al. International Classification of Diseases, Tenth Revision, Clinical Modification social determinants of health codes are poorly used in electronic health records. Medicine (Baltimore) 2020; 99 (52): e23818.47. Chesney MA, Tasto DL. The development of the menstrual symptom questionnaire. Behav Res Ther 1975; 13 (4): 237-44.48. Mirian da Silva M, Maria Isis Freire de A, Emília Soares C, Isaura Letícia Tavares Palmeira R. Qualidade de vida de mulheres com tensão pré-menstrual a partir da escala WHOQOL-Bref DOI: 10.4025/cienccuidsaude.v13i2.15759. Ciência, Cuidado e Saúde 2014; 13 (2).49. Pinar G, Colak M, Oksuz E. Premenstrual Syndrome in Turkish college students and its effects on life quality. Sex Reprod Healthc 2011; 2 (1): 21-7.50. Câmara RA, Köhler CA, Frey BN, Hyphantis TN, Carvalho AF. Validation of the Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST) and association of PSST scores with health-related quality of life. Braz J Psychiatry 2017; 39 (2): 140-6.51. Bharti P, Mittal A, Gupta A, Gupta P, Jain N. Premenstrual Syndrome and Associated Factors among Health Care Professionals: A Cross-sectional Study. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH 2019.52. Farrokh-Eslamlou H, Oshnouei S, Heshmatian B, Akbari E. Premenstrual syndrome and quality of life in Iranian medical students. Sex Reprod Healthc 2015; 6 (1): 23-7.53. Vijay Pandian M SPS, Anto FerdineVaik and Franc Oumanath. Premenstrual Symptoms-Prevalence, Coping Behaviors and Related Quality of Life. International Journal of Interdisciplinary and Multidisciplinary Studies (IJIMS) 2016; 3 (3): 27-33.54. Prungsin T, Taneepanichskul S. Prevalence and Quality of Life (QOL) with Premenstrual Syndrome (PMS) among the Working Women in Reproductive Age Group in Bangkok, Thailand. Journal of Health Research 2017; 30 (Suppl. 2): S139-S45.55. Sahin S, Ozdemir K, Unsal A. Evaluation of premenstrual syndrome and quality of life in university students. JPMA The Journal of the Pakistan Medical Association 2014; 64 (8): 915-22.56. Kahyaoglu Sut H, Mestogullari E. Effect of Premenstrual Syndrome on Work-Related Quality of Life in Turkish Nurses. Saf Health Work 2016; 7 (1): 78-82.57. Balık G, Hocaoğlu Ç, Kağıtcı M, Güvenda Güven ES. Comparison of the effects of PMDD and pre-menstrual syndrome on mood disorders and quality of life: a cross-sectional study. J Obstet Gynaecol 2015; 35 (6): 616-20.58. Thakrar P, Bhukar K, Oswal R. Premenstrual Dysphoric Disorder: Prevalence, Quality of life and Disability due to illness among medical and paramedical students. 2021; 4 : 100112.59. (CHMP) EUCfMPfHU. Guideline on the treatment of premenstrual dysphoric disorder (PMDD) 2011.60. Lukes AS, McBride RJ, Herring AH, Fried M, Sherwani A, Dell D. Improved premenstrual syndrome symptoms after NovaSure endometrial ablation. J Minim Invasive Gynecol 2011; 18 (5): 607-11.61. Cronje WH, Vashisht A, Studd JW. Hysterectomy and bilateral oophorectomy for severe premenstrual syndrome. Hum Reprod 2004; 19 (9): 2152-5.62. Maity S, Wray J, Coffin T, et al. Academic and Social Impact of Menstrual Disturbances in Female Medical Students: A Systematic Review and Meta-Analysis. Frontiers in Medicine 2022; 9 .63. Kwan I, Onwude JL. Premenstrual syndrome. BMJ clinical evidence 2007; 2007 ((Kwan, Onwude) Royal College of obstetricians and gynaecologists, London, UK).64. Rathi AK, Agrawal M, Baniya GC. A study of impact of stress: examinations on menstrual cycle among medical students. 2019; 7 .65. Committee on Diagnostic Error in Health C, Board on Health Care S, Institute of M, The National Academies of Sciences E, Medicine. In: Balogh EP, Miller BT, Ball JR, eds. Improving Diagnosis in Health Care. Washington (DC): National Academies Press (US)Copyright 2015 by the National Academy of Sciences. All rights reserved.; 2015.66. Daşıkan Z. Premenstrual disorders among young Turkish women: According to DSM-IV and DSM-V criteria using the premenstrual symptoms screening tool. Perspectives in Psychiatric Care 2021; 57 (2): 481-7.67. Hantsoo L, Sajid H, Murphy L, et al. Patient Experiences of Health Care Providers in Premenstrual Dysphoric Disorder: Examining the Role of Provider Specialty. Journal of women’s health (2002) 2022; 31 (1): 100-9.68. Chan K, Rubtsova AA, Clark CJ. Exploring diagnosis and treatment of premenstrual dysphoric disorder in the U.S. healthcare system: a qualitative investigation. BMC Womens Health 2023; 23 (1): 272.69. Alemayehu C, Mitchell G, Nikles J. Barriers for conducting clinical trials in developing countries- a systematic review. Int J Equity Health 2018; 17 (1): 37.70. Mirin AA. Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health. J Womens Health (Larchmt) 2021; 30 (7): 956-63. 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Keywords general gynaecology premenstrual syndrome: basic science premenstrual syndrome: clinical research Authors Affiliations Meghna Prasannan Ponganam 0009-0000-1043-3633 Burnet Institute View all articles by this author Maureen Makama 0000-0002-4164-3702 Burnet Institute View all articles by this author Evie Kayes Burnet Institute View all articles by this author Tahlia Guneratne Burnet Institute View all articles by this author Lily Aboud Burnet Institute View all articles by this author Kate Mills 0009-0003-6262-7220 Burnet Institute View all articles by this author Anne Ammerdorffer 0000-0002-1059-061X Concept Foundation View all articles by this author Lorena Romero Alfred Health Libraries View all articles by this author Luis Bahamondes Universidade Estadual de Campinas Faculdade de Ciencias Medicas View all articles by this author Jen Sothornwit 0000-0002-5985-7389 Khon Kaen University Faculty of Medicine View all articles by this author Pisake Lumbiganon Khon Kaen University Faculty of Medicine View all articles by this author Ahmet Gulmezoglu 0000-0003-4674-0998 Concept Foundation View all articles by this author Joshua P Vogel Burnet Institute View all articles by this author Annie McDougall 0000-0003-1182-6679 [email protected] Burnet Institute View all articles by this author Metrics & Citations Metrics Article Usage 649 views 372 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Meghna Prasannan Ponganam, Maureen Makama, Evie Kayes, et al. 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