Premenstrual disorders linked to reduced quality of life

Premenstrual disorders (PMDs), including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), are associated with a reduction in quality of life (QOL), according to findings from a population-based study published in JAMA Network Open.¹

PMDs are characterized by affective, behavioral, and physical symptoms occurring in the late luteal phase of the menstrual cycle, with resolution after menstruation begins. PMS affects approximately 20% to 30% of women of reproductive age, while PMDD, a more severe subtype, is experienced by an estimated 1.2% to 6.4%.² Women with PMDD demonstrate impairments comparable with those observed in chronic depression, and both PMS and PMDD have been linked to adverse health outcomes, including hypertension and suicidal behavior.¹

Linking PMDs with QOL

The study used data from LifeGene, a large prospective Swedish cohort, with linkage to national registers including the National Patient Register, Stockholm Primary Care Register, and the National Prescribed Drug Register. Researchers included 17,284 women aged 15 to 60 years who had menstruated in the past year. PMDs were identified either through a modified version of the Premenstrual Symptom Screening Tool (PSST) completed at enrollment or through diagnoses and prescription data in health care registers.

QOL was measured using the EuroQol 5-Dimensions 3-Levels (EQ-5D-3L) instrument, which assesses health-related QOL across 5 domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Responses were aggregated into total scores, with higher scores reflecting lower QOL.

Of the 17,284 women included, 1813 (10.5%) met the criteria for PMDs. Compared to women without PMDs, those affected were slightly older, more likely to smoke, and more frequently reported childhood abuse or stressful life events. Psychiatric and somatic comorbidities were also more common among women with PMDs.

Lower QOL reported

Women with PMDs had lower overall QOL, with a fully adjusted mean z score difference of 0.21. The association remained significant when the pain/discomfort dimension was excluded and was attenuated, though still significant, when anxiety/depression was excluded. In a prospective subgroup analysis of 339 women with PMD diagnoses made before cohort enrollment, the association with lower QOL was comparable and somewhat stronger , woth a mean z score difference of 0.34.

When examining individual EQ-5D-3L dimensions, women with PMDs had significantly higher prevalence ratios for anxiety/depression and pain/discomfort, with prevalence ratios of 1.31 and 1.14, respectively. No significant associations were found with mobility, self-care, or usual activities.

Both PMS and PMDD were associated with reduced QOL, though the association was stronger for PMDD. After excluding the anxiety/depression dimension, the association remained significant for PMDD but not PMS.

Comorbidity and subgroup analyses

Stratified analyses showed that women with both PMDs and psychiatric or somatic comorbidities had lower QOL compared with women without either condition. While no statistically significant interactions were found in most models, interaction between PMDs and somatic comorbidities reached significance when the anxiety/depression dimension was removed from total scores.

Supplementary analyses using the visual analogue scale of health status and complete-case data confirmed the robustness of the findings.

The study provides evidence that PMDs, particularly PMDD, are associated with significant impairment in health-related QOL, especially in the domains of anxiety/depression and pain/discomfort. The authors noted that some assessments were made outside symptomatic phases, suggesting the true impact of PMDs on QOL may be underestimated.

“While future research using prospective data are warranted to further clarify these associations, our findings underscore the substantial burden of PMDs and highlight the need to further improve the disease management and enhance women’s well-being,” wrote investigators.

References

1. Wang Q, Keijser R, Chen Y, et al. Premenstrual disorders and quality of life in Sweden. JAMA Netw Open. 2025;8(9):e2533823. doi:10.1001/jamanetworkopen.2025.33823
2. Yonkers KA, Simoni MK. Premenstrual disorders. Am J Obstet Gynecol. 2018;218(1):68-74. doi:10.1016/j.ajog.2017.05.045