Did you know?

Up to 90% of menstruating women experience some premenstrual symptoms. However, only about 20-30% suffer from clinically significant PMS that impairs daily function.

Premenstrual Syndrome (PMS)

Researched by:

Divine Aleru ID

Divine Aleru

I am a biochemist with a deep curiosity for the human microbiome and how it shapes human health, and I enjoy making microbiome science more accessible through research and writing. With 2 years experience in microbiome research, I have curated microbiome studies, analyzed microbial signatures, and now focus on interventions as a Microbiome Signatures and Interventions Research Coordinator.

May 19, 2025

Premenstrual Syndrome (MS) involves physical and emotional symptoms linked to hormonal fluctuations. Recent research highlights the role of heavy metals and gut microbiome imbalances in worsening these symptoms. Lifestyle changes, microbiome-targeted therapies, and toxin reduction show promise in effective MS management.

Research feed

Divine Aleru

I am a biochemist with a deep curiosity for the human microbiome and how it shapes human health, and I enjoy making microbiome science more accessible through research and writing. With 2 years experience in microbiome research, I have curated microbiome studies, analyzed microbial signatures, and now focus on interventions as a Microbiome Signatures and Interventions Research Coordinator.

Researched by:

Divine Aleru ID

Divine Aleru

I am a biochemist with a deep curiosity for the human microbiome and how it shapes human health, and I enjoy making microbiome science more accessible through research and writing. With 2 years experience in microbiome research, I have curated microbiome studies, analyzed microbial signatures, and now focus on interventions as a Microbiome Signatures and Interventions Research Coordinator.

Last Updated: May 14, 2025

Overview

Premenstrual Syndrome (PMS) is a common condition affecting women of reproductive age, characterized by a range of physical, psychological, and behavioral symptoms that occur in the luteal phase of the menstrual cycle. Symptoms typically subside after menstruation begins. It affects approximately 47.8% of women globally, with the most severe form, Premenstrual Dysphoric Disorder (PMDD), impacting 3-8% of women.^[1] Common symptoms include mood swings, irritability, bloating, fatigue, and breast tenderness.^[2] The exact etiology of PMS remains unclear, but hormonal fluctuations, particularly involving progesterone and estrogen, as well as neurotransmitter imbalances (including serotonin and GABA), play a central role in its development.^[3] The microbiome’s role in PMS has not been extensively explored, but some studies suggest that gut microbiota imbalances may influence hormonal regulation and mood disorders associated with PMS, suggesting a potential avenue for future research.^[4][5]

Causes

The exact cause of PMS remains unclear, but several theories attempt to explain the underlying mechanisms. The most widely accepted theory involves hormonal fluctuations, particularly changes in progesterone and estrogen levels during the luteal phase.^[6] These hormonal changes are thought to influence neurotransmitter systems, including serotonin and GABA, which regulate mood and behavior.^[7] More recent studies have highlighted the role of the neurosteroid allopregnanolone, a metabolite of progesterone, which modulates GABA-A receptors and may contribute to the mood symptoms of PMS.^[8] Research also suggests that women with PMS may have an abnormal response to normal hormonal fluctuations, possibly due to genetic predispositions or sensitivity to changes in hormone levels.

Diagnosis

Diagnosing PMS involves the identification of cyclic symptoms, which should appear in the luteal phase and resolve with menstruation.^[9] It is important to rule out other conditions that could mimic PMS, such as thyroid disorders or other psychiatric conditions. Microbiome signatures have shown promise in diagnosing PMS, with studies indicating that imbalances in gut microbiota may influence hormonal regulation and the severity of PMS symptoms.^[10] Other potential diagnostic methods include metabolomic and metallomic signatures, which could offer non-invasive diagnostic options for identifying PMS by tracking specific biomarkers associated with hormonal changes and neurotransmitter imbalances.

Associated Conditions

PMS is closely associated with Premenstrual Dysphoric Disorder (PMDD), a more severe form of PMS that significantly disrupts daily functioning.^[11] PMDD shares similar symptoms with PMS but includes more intense psychological manifestations, such as severe depression, irritability, and anxiety.^[12] Both conditions have been linked to hormonal fluctuations and neurotransmitter imbalances, particularly involving serotonin and GABA. Additionally, PMS and PMDD are often associated with other mood disorders, such as anxiety and depression, which may complicate diagnosis and treatment.^[13] These associations highlight the complex, multifactorial nature of PMS, involving not only hormonal changes but also psychological and social factors.

Primer

Premenstrual Syndrome (PMS) is a complex condition affecting women of reproductive age, characterized by a combination of physical, psychological, and behavioral symptoms that occur in the luteal phase of the menstrual cycle.^[14] These symptoms typically subside with the onset of menstruation. The pathophysiology of PMS is not fully understood, but hormonal fluctuations are central to the development of symptoms.^[15] Recent studies also highlight the potential role of the gut microbiota in influencing the severity of PMS.^[16] Alterations in the gut microbiome may affect hormone regulation, neurotransmitter function, and the body’s inflammatory response, potentially contributing to the mood swings, irritability, and physical discomfort observed in PMS.^[17] Research suggests that metallomic factors, such as exposure to heavy metals like copper, magnesium and zinc, may also play a role in regulating hormones and influencing PMS symptoms through oxidative stress pathways.^[18] Given these multifactorial influences, understanding the intersections between hormonal changes, the gut microbiome, and metallomic signature is crucial for developing a more comprehensive and personalized approach to treating PMS.

Metallomic Signature

Studies suggest that these metals influence hormonal regulation, immune function, and neurochemical pathways, which are disrupted in PMS, thereby exacerbating symptoms such as mood swings, irritability, fatigue, and physical discomfort. These metal imbalances are further complicated by environmental and lifestyle factors, notably smoking, which significantly increases the burden of these metals in the body.^[19][20] The presence and concentrations of these metals can directly affect neurotransmitter function and inflammation, key mechanisms in the pathophysiology of PMS. Both essential and toxic metals can influence various biological systems that regulate mood, immune function, and hormone production. For instance, zinc (Zn) and iron (Fe) are essential for metabolic processes but can become harmful when imbalanced, while metals like cadmium (Cd) and lead (Pb) are toxic and have been shown to disrupt hormonal balance and contribute to PMS severity.^[21] Tobacco consumption is a significant source of heavy metals, including cadmium, lead, manganese, and iron, all of which contribute to the metallomic signature of PMS.^[22][23] The heavy metals then accumulate in the body and can exacerbate the hormonal and neurochemical imbalances that define PMS. Other sources of exposure to these metals include environmental pollution, occupational hazards, contaminated food, water, and even household products.

Microbiome Signature: Premenstrual Syndrome (PMS)

Interventions

Intervention	MBTI Status	Mechanism of Action
Probiotics	Validated	Probiotics, which help balance the gut microbiota, are emerging as a potential option for managing premenstrual disorders (PMDs) by impacting microbial diversity, metabolic activity, and inflammation.^[24] Research suggests that specific probiotic strains can modulate cytokine levels, support immune tolerance, and ease symptoms linked to hormone-related conditions. Since conventional treatments can cause side effects and may not always work, probiotics offer a safer and possibly more effective alternative.^[25][26]
Prebiotics	Promising Candidate	Prebiotics, which include dietary fibers serve as food for beneficial gut bacteria. By promoting the growth of these bacteria, prebiotics improve the balance of the gut microbiome, leading to enhanced production of SCFAs like acetate, propionate, and butyrate. These SCFAs help regulate immune function, reduce gut inflammation, and influence hormonal signaling pathways, which may contribute to alleviating PMS symptoms such as bloating, irritability, and fatigue.[28]^[x][29]^[x]
Fecal Microbiota Transplantation (FMT)	Experimental	FMT aims to restore a healthy and diverse microbiome, which can reduce systemic inflammation, regulate immune responses, and potentially alleviate hormonal imbalances seen in PMS. By improving gut flora, FMT can enhance the gut-brain axis and mitigate symptoms such as mood swings and anxiety.[30]^[x]
Synbiotics	Promising Candidate	Synbiotics combine both probiotics and prebiotics to maximize gut microbiome modulation. The probiotics enhance the growth of beneficial bacteria, while the prebiotics provide nutrients that support their survival and activity. This combined effect helps restore microbiome balance, promote SCFA production, and improve gut permeability. Synbiotics may also enhance serotonin production and reduce inflammation, thus helping to alleviate both the physical and emotional symptoms of PMS.[31]^[x][32]^[x]
Dietary Interventions	Promising Candidate	Diets high in calcium, magnesium, vitamin D, B vitamins, zinc, and omega-3 fatty acids reduce PMS symptom severity by modulating neurotransmitter synthesis (e.g., serotonin), influencing hormone metabolism, and reducing oxidative stress and inflammation. Complex carbohydrates and tryptophan enhance serotonin availability. Western diets rich in sugar, salt, trans fats, and processed foods worsen symptoms. High-fiber, plant-based diets and regular, small meals stabilize blood glucose, improve mood, and reduce bloating and irritability.[33]^[x]
Short-Chain Fatty Acids (SCFAs) Supplementation	Under Investigation	SCFAs like acetate, propionate, and butyrate are produced by gut bacteria when they ferment dietary fibers. These SCFAs serve as an energy source for colonocytes and play a crucial role in regulating immune function and reducing inflammation. SCFAs also enhance the gut barrier function, preventing leaky gut, and modulating gut-brain communication. SCFA supplementation could help balance the microbiome, regulate hormonal levels, and reduce PMS symptoms such as mood disturbances and cramps. ^[34][35]
Excercise	Promising Candidate	Exercise helps alleviate PMS by temporarily increasing estrogen and progesterone, reducing hormonal withdrawal symptoms. It decreases fluid retention through lowered renin and aldosterone, relieves pain via prostaglandin production, and enhances mood and reduces stress through endorphin release.^[36][37]

FAQs

Why might traditional symptom-focused PMS treatments fall short without addressing underlying biochemical disruptions?

Conventional PMS treatments such as NSAIDs for pain, hormonal contraceptives to stabilize hormones, and SSRIs for mood symptoms primarily target the overt manifestations rather than the complex biochemical underpinnings of PMS. These therapies often provide only partial or temporary relief because they do not correct the oxidative stress, heavy metal toxicity, and microbiome imbalances that underlie many PMS symptoms. For instance, persistent exposure to heavy metals sustains inflammation and hormonal disruption, counteracting hormonal treatments’ effectiveness. Similarly, unresolved gut dysbiosis maintains systemic inflammation and neurotransmitter dysregulation despite SSRI use. Without restoring these foundational biochemical and immune pathways, symptoms can persist or relapse, leading to frustration and treatment resistance. Holistic approaches integrating toxin reduction (e.g., smoking cessation), nutritional optimization (antioxidants, essential minerals), microbiome-targeted therapies (probiotics, prebiotics), and lifestyle modifications (exercise, stress management) show greater potential for long-term symptom resolution by addressing root causes rather than merely masking symptoms.

Why is the gut-brain axis considered a key factor in the emotional and physical symptoms of PMS?

The gut-brain axis is a complex communication network linking the gastrointestinal tract and the central nervous system through neural, hormonal, and immune pathways. This axis plays a pivotal role in modulating mood, stress response, and systemic inflammation—core features affected in PMS. Dysbiosis or imbalance in gut microbiota can disrupt this axis, leading to altered neurotransmitter production (e.g., serotonin and GABA), increased intestinal permeability (“leaky gut”), and systemic inflammation. These changes manifest as anxiety, irritability, gastrointestinal discomfort, and heightened pain sensitivity commonly reported in PMS. Emerging evidence suggests that targeting the gut microbiome through probiotics and dietary interventions can modulate the gut-brain axis, offering promising avenues for mitigating both emotional and somatic PMS symptoms.

What is the potential impact of chronic exposure to environmental pollutants on PMS development and severity?

Chronic exposure to environmental pollutants, including heavy metals, endocrine-disrupting chemicals (EDCs), and air pollutants, can alter hormonal and immune system function, contributing to PMS development and symptom exacerbation. Heavy metals like lead, cadmium, and manganese accumulate in tissues and interfere with hormone receptors, increasing oxidative stress and systemic inflammation. EDCs mimic or block natural hormones, disrupting menstrual cycle regulation. These pollutants also impair mitochondrial function and increase neuroinflammation, affecting mood and cognitive functions central to PMS pathology. Epidemiological studies have linked higher pollutant exposure to increased PMS prevalence and severity, highlighting the importance of minimizing environmental toxin exposure as part of PMS management.

Research Feed

May 28, 2021

•

Premenstrual Dysphoric Disorder (PMDD) •

What was reviewed?

This paper is a review of the clinical literature concerning premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). It focuses on their symptoms, prevalence, risk factors, etiology, and current diagnostic criteria. The review examines treatment options ranging from lifestyle changes to pharmacological interventions, and it highlights the impact of PMS and PMDD on women's health.

Who was reviewed?

The review focuses on the clinical characteristics and findings related to PMS and PMDD in women of reproductive age. It draws from a wide range of studies to summarize the current understanding of these conditions, examining both epidemiological data and clinical treatments.

What were the most important findings?

The review identifies key characteristics of PMS and PMDD, noting that these disorders manifest during the luteal phase of the menstrual cycle and subside with menstruation. It was found that PMS affects a significant portion of the female population, with the prevalence ranging from 10% to 98%, while PMDD affects 2-8% of women. Symptoms can be physical, such as bloating and breast tenderness, or psychological, including mood swings, irritability, and anxiety. The pathogenesis of PMS and PMDD is linked to hormonal fluctuations, particularly estrogen and progesterone, and the interaction of these hormones with central neurotransmitter systems, notably serotonin, GABA, and beta-endorphins.

The review highlights serotonin’s role in the pathogenesis, with women experiencing PMS showing lower serotonin levels in various bodily fluids. Although the exact cause remains unclear, studies suggest that serotonin may be the key mediator of the mood symptoms seen in these disorders. The review also addresses the controversial role of vitamins and minerals in the treatment of PMS, with limited evidence supporting their efficacy over a placebo. Furthermore, it outlines various therapeutic approaches, such as selective serotonin reuptake inhibitors (SSRIs), combined oral contraceptives (COCs), and lifestyle changes, which have been shown to improve symptoms in many patients.

What are the greatest implications of this review?

This review underscores the importance of recognizing PMS and PMDD as significant health issues that can affect a woman’s quality of life. It suggests that, despite their prevalence, these disorders are often underdiagnosed. The review calls for better recognition and diagnosis, particularly using prospective symptom tracking over multiple cycles, as is recommended by the DSM-5 for diagnosing PMDD. Clinicians should consider both pharmacological and non-pharmacological treatments based on the severity of symptoms, as well as individualized care strategies, including SSRIs and COCs for more severe cases. Furthermore, the review suggests that future research should focus on understanding the complex hormonal and neurotransmitter interactions that underpin PMS and PMDD, potentially offering new avenues for treatment development.

April 23, 2024

•

What was reviewed?

This paper is a review of the etiology and treatment options for Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). It examines the underlying causes of these conditions, including hormonal fluctuations, neurotransmitter imbalances, and the role of neurosteroids like allopregnanolone. The review also analyzes a variety of treatment options, including pharmacological methods (SSRIs, hormonal therapies, neurosteroid treatments) and non-pharmacological interventions, to provide a comprehensive overview of how PMS and PMDD can be managed.

Who was reviewed?

The review focuses on women of reproductive age who experience PMS and PMDD, with special attention to those who suffer from severe symptoms that significantly impair their daily functioning. The article explores clinical data and findings from various studies to provide a thorough understanding of the disorder's impact on women's health, as well as the varying responses to treatment.

What were the most important findings?

The review highlights several key findings about the etiology and treatment of PMS and PMDD. One of the most significant insights is the role of hormonal fluctuations, particularly the progesterone metabolite allopregnanolone, in the onset of PMS symptoms. It is noted that this metabolite modulates the GABA-A receptor in the central nervous system (CNS), which may explain some of the mood and anxiety-related symptoms of PMS. The review also underscores the complexity of the disorder, as it involves multiple physiological systems, including the hypothalamic-pituitary-adrenal (HPA) axis and neurotransmitter pathways such as serotonin.

SSRIs, commonly used to manage mood symptoms, provide rapid relief and are considered the first-line pharmacological treatment for severe cases. Hormonal therapies, particularly those that stabilize estrogen and progesterone levels, are also effective but require careful selection to avoid exacerbating symptoms. The review suggests that therapies targeting neurosteroids like allopregnanolone may offer new avenues for treatment, although more research is needed. In terms of treatment strategies, the review emphasizes the importance of personalized care, where treatments are tailored to individual symptoms and underlying mechanisms. For instance, oral contraceptives containing drospirenone and ethinylestradiol are effective for controlling physical symptoms, while SSRIs are more beneficial for psychological symptoms.

What are the greatest implications of this review?

The greatest implication of this review is the need for a more nuanced approach to diagnosing and treating PMS and PMDD. By understanding the complex hormonal and neurochemical interactions involved, clinicians can better tailor treatments to individual patients. The review suggests that effective treatment goes beyond symptom alleviation to address the root causes of the disorders. Additionally, the paper points to the importance of considering non-pharmacological interventions alongside medications, particularly for patients who experience mild to moderate symptoms. Future research into the role of neurosteroids and their modulation in the CNS could lead to more targeted treatments with fewer side effects.

June 20, 2023

•

What was reviewed?

This narrative review examines the connection between Premenstrual Syndrome (PMS) and exercise. It explores the potential role of exercise in mitigating PMS symptoms and evaluates existing studies to understand how physical activity might alleviate both the physical and psychological impacts of PMS. The review also critiques the methodology of current research and emphasizes the need for further studies to refine exercise interventions for PMS management.

Who was reviewed?

The review targets women who experience PMS, particularly those suffering from physical, psychological, and behavioral symptoms that impact their quality of life. The study highlights the importance of understanding how exercise may serve as a complementary treatment for PMS. The aim is to improve the health outcomes and daily functioning of affected women.

What were the most important findings?

The review identifies key findings regarding the positive effects of exercise on PMS symptoms. PMS symptoms, which include fatigue, mood swings, bloating, and irritability, significantly impair women’s daily activities. The review suggests that exercise, especially aerobic and resistance exercises, can reduce these symptoms, improving both physical and psychological well-being. Regular physical activity helps decrease fatigue, relieve pain (including breast tenderness), and improve mood by regulating hormonal fluctuations. Studies reviewed show that exercise enhances estrogen and progesterone levels and promotes endorphin release, which further alleviates pain and stress.

Exercise improves overall well-being by stimulating the release of neurochemicals like endorphins, which play a crucial role in mood enhancement and pain reduction. Furthermore, exercise reduces the impact of PMS on daily life, including work performance and social engagement. However, the review highlights the inconsistency across studies regarding the optimal exercise prescription for PMS. It calls for more detailed research to determine the best exercise duration, intensity, and frequency needed to achieve maximum benefit.

What are the greatest implications of this review?

This review suggests that exercise is a cost-effective, accessible, and powerful non-pharmacological approach to managing PMS. It encourages clinicians to incorporate exercise recommendations into treatment plans, considering the physical and psychological benefits it offers. Regular physical activity can serve as a complementary treatment alongside pharmacological options, especially for women seeking a holistic management approach. The review also stresses the importance of personalized exercise prescriptions tailored to individual needs and symptom profiles. As research on exercise and PMS continues to evolve, clearer guidelines will emerge, allowing healthcare providers to better support women with PMS through structured exercise programs.

November 8, 2022

•

What was reviewed?

This article presents a systematic review and meta-analysis focusing on the effectiveness of herbal medicine and nutritional supplements in managing Premenstrual Syndrome (PMS). It reviews randomized controlled trials (RCTs) assessing the impact of various herbal remedies and supplements on both somatic and psycho-behavioral symptoms of PMS. The review highlights the safety, efficacy, and mechanisms of action of these treatments, while also addressing the limitations of current evidence.

Who was reviewed?

The review concentrates on women experiencing PMS, particularly those with both physical and psychological symptoms that significantly affect their daily functioning. It includes trials involving a wide range of herbal and nutritional interventions, aiming to provide clinicians with evidence of alternative therapies for managing PMS symptoms.

What were the most important findings?

The review reveals that herbal medicines and nutritional supplements can significantly reduce the severity of PMS symptoms, including physical, mood, and behavioral issues. It highlights specific interventions such as Vitex agnus castus (chaste tree), Zingiber officinale (ginger), and Crocus sativus (saffron) as particularly effective. The meta-analysis demonstrated a substantial reduction in Premenstrual Symptoms Screening Tool (PSST) scores, indicating notable symptom improvement. Additionally, the review found that certain interventions, such as Ginkgo biloba and vitamin B1, offered improvements in psychological symptoms like anxiety and depression.

Secondary findings also revealed positive effects on mood, physical symptoms, and behavior, with significant reductions in scores for physical symptoms and mood-related symptoms. The study concluded that herbal treatments, particularly when used over multiple cycles, have the potential to alleviate PMS symptoms significantly. However, it emphasized the need for high-quality trials to confirm these results and establish optimal treatment protocols. Importantly, the review also addressed the safety profile of these treatments, with most studies reporting mild adverse effects such as nausea or digestive discomfort.

What are the greatest implications of this review?

The greatest implication of this review is that herbal medicine and nutritional supplements represent a viable, non-pharmacological option for managing PMS symptoms, offering a safer alternative to traditional treatments with fewer side effects. This study provides clinicians with evidence-based recommendations for integrating these alternative therapies into PMS management, especially for patients who prefer natural treatments or experience adverse reactions to conventional medications. The review also underscores the need for more robust, high-quality studies to refine treatment guidelines, improve symptom assessment tools, and explore the mechanisms underlying the therapeutic effects of herbal interventions. Clinicians can consider incorporating these findings into patient care plans while awaiting further evidence from future studies.

February 3, 2014

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What was reviewed?

This paper presents a systematic review and meta-analysis of the global prevalence of Premenstrual Syndrome (PMS). It focuses on synthesizing existing studies to determine the overall rate of PMS occurrence among women, analyzing factors influencing its prevalence, and exploring variations in prevalence rates across different countries and regions. The review compiles data from multiple sources to estimate the global burden of PMS and identify trends over time, employing meta-regression to examine factors that might affect PMS prevalence.

Who was reviewed?

The review examines data from studies involving women of reproductive age, specifically those diagnosed with PMS based on various symptom screening tools, such as the Premenstrual Symptoms Screening Tool (PSST), and other diagnostic scales. The included studies span different regions and countries, offering a broad view of PMS prevalence across diverse populations.

What were the most important findings?

The systematic review and meta-analysis found that the pooled prevalence of PMS across 17 studies was 47.8%, with substantial variation between different countries. The lowest prevalence was reported in France (12%), while Iran had the highest (98%). This wide range of prevalence is indicative of various factors, such as different diagnostic criteria, sample populations, and cultural or environmental influences on PMS reporting and diagnosis. The review also highlighted a trend of increasing PMS prevalence between 1996 and 2011, though the correlation with the year of study was not statistically significant.

Meta-regression analysis revealed a significant correlation between the sample size and the reported prevalence of PMS, with larger studies tending to report lower prevalence rates. The review also noted that the differences in measurement tools used to diagnose PMS across studies could contribute to the observed variability in prevalence. The results underscore the need for standardized diagnostic criteria and more comprehensive studies to better understand the factors driving PMS prevalence globally.

What are the greatest implications of this review?

The findings of this review have significant implications for public health and clinical practice. The high global prevalence of PMS, with nearly half of reproductive-aged women affected, underscores the need for effective diagnostic and management strategies. Clinicians should be aware of the significant variation in PMS prevalence, influenced by geographical and methodological factors, which can impact patient care and treatment approaches. The review emphasizes the importance of further research to standardize diagnostic tools and explore the role of environmental, cultural, and genetic factors in PMS. Moreover, the findings suggest that larger, high-quality studies are needed to provide more reliable data on PMS prevalence, which can inform public health policies and interventions aimed at improving women's reproductive health globally.

May 27, 2022

•

What was studied?

The study investigated the characteristics of the gut microbiota in women experiencing premenstrual symptoms, focusing on the potential association between gut microbial composition and the severity of these symptoms. The research aimed to identify microbial differences between women with premenstrual disorders (PMDs) and healthy controls, and to explore how these differences might correlate with the severity of premenstrual syndrome (PMS) symptoms.

Who was studied?

The study involved 56 women, including 27 women with self-reported premenstrual symptoms and 29 women without significant symptoms. Among the 27 women reporting PMS, 21 were further identified as having premenstrual disorders (PMDs) due to the significant interference of their symptoms with their social life. The control group consisted of 22 women with no significant premenstrual symptoms. These participants were matched by age and other demographic factors.

What were the most important findings?

The study found that there were notable differences in the gut microbiota between women experiencing premenstrual disorders (PMDs) and healthy controls. At the phylum level, the abundance of Bacteroidetes was significantly lower in the PMDs group. At the genus level, several bacteria were found to be either more or less prevalent in the PMDs group. Specifically, the PMDs group had lower levels of beneficial bacteria such as Butyricicoccus, Megasphaera, and Parabacteroides, while Anaerotaenia was more prevalent in this group. However, after applying false discovery rate correction, these differences were no longer statistically significant. The abundance of certain microbes, such as Anaerotaenia, correlated positively with the severity of PMS as measured by the Premenstrual Symptoms Questionnaire (PSQ), while Parabacteroides and Megasphaera were negatively associated with symptom severity.

These findings suggest that the gut microbiota may play a role in the pathophysiology of premenstrual disorders, potentially influencing the severity of symptoms. However, the study also noted that there were no significant differences in inflammatory markers (such as CRP, LBP, and sCD14) between the PMDs and control groups, which means that the microbiota’s role might not be directly related to inflammation but may involve other mechanisms such as gut-brain communication.

What are the greatest implications of this study?

This study provides preliminary evidence that the gut microbiota could be linked to the severity of premenstrual symptoms, suggesting that microbiome-based interventions might be a potential therapeutic strategy for managing PMS and PMDs. However, due to the cross-sectional nature of the study, it is not possible to establish causality between microbiota characteristics and the severity of premenstrual symptoms. The study's findings highlight the need for future longitudinal studies to confirm these associations and determine the potential therapeutic role of gut microbiota modulation. Furthermore, the identification of specific microbial imbalances could help develop microbiome-based biomarkers for the diagnosis and treatment of PMS and PMDs, providing a more personalized approach to care.

PURPOSE: The present study aimed to characterize the gut microbiota of individuals with premenstrual syndrome. PATIENTS AND METHODS: The gut microbiota of 24 Japanese women with PMS (PMS group) and 144 healthy Japanese women (control group) were compared. Analysis of the α- and β-diversities and the gut microbial composition at the genus level were performed using 16S rRNA gene sequence data obtained from stool samples. RESULTS: A significant difference in age was observed between the PMS and control groups; however, no significant difference was observed in BMI. The α-diversity measured using the Simpson index was significantly higher in the PMS group than the control group. Visualization of the β-diversity using non-metric multidimensional scaling and permutational multivariate analysis of variance (PERMANOVA) showed that the distance of the gut microbiota between the PMS and control groups is significantly different. Furthermore, a significant difference in the composition of the gut microbiota was observed between the PMS and control groups. At the genus level, the abundances of Collinsella, Bifidobacterium, and Blautia were significantly higher in the PMS group than in the control group. In particular, the abundance of Collinsella in the PMS group was approximately 4.5 times higher than that in the control group. To rule out the confounding effect of age in the abundances of Bifidobacterium, Blautia, and Collinsella, the gut microbiota of the PMS and control groups were compared by age group. Results showed that Collinsella had the highest effect size in participants of 30-40 years of age (mean age: 36.39 ± 4.68 years). CONCLUSION: These results suggest that the PMS group possesses a characteristic gut microbiota. In particular, Collinsella was strongly associated with PMS. Since Collinsella has been reported to be associated with diet, dietary interventions such as prebiotics targeting Collinsella may be effective in preventing, improving, and alleviating PMS.

November 26, 2020

•

What was reviewed?

This meta-analysis systematically reviewed studies investigating the association between smoking and premenstrual syndrome (PMS). The authors sought to quantify the relationship between smoking behaviors and the risk of developing PMS or its more severe form, premenstrual dysphoric disorder (PMDD). Thirteen studies involving 25,828 participants were included in this analysis, which aimed to synthesize the results from multiple cohorts, case-control, and cross-sectional studies. The review specifically examined the effect of smoking on the likelihood of developing PMS, with a focus on the severity of symptoms and potential biological mechanisms.

Who was reviewed?

The studies reviewed in this meta-analysis involved a range of populations, including university students, general populations, and patients from different regions. Participants were primarily women of reproductive age, including those diagnosed with PMS or PMDD. The reviewed studies used varying methods for assessing smoking (e.g., self-reported smoking status, smoking quantity) and PMS (e.g., standardized questionnaires, prospective symptom tracking). The sample sizes ranged from smaller case-control studies with fewer than 100 participants to larger cross-sectional studies with over 3,000 participants.

What were the most important findings?

The meta-analysis found a statistically significant association between smoking and the increased risk of PMS. Specifically, smoking was linked to a moderate increase in the odds of developing PMS. This relationship was even stronger for PMDD. The results indicated that women who smoke are more likely to experience PMS, with a stronger association observed in women with the more severe form of PMS, PMDD. Interestingly, the study also identified that smoking behavior during the luteal phase of the menstrual cycle may be influenced by hormonal fluctuations, with nicotine intake potentially exacerbating mood disturbances commonly associated with PMS. Nicotine’s effects on the hypothalamic-pituitary-adrenal (HPA) axis, which is already compromised in PMS, may worsen the stress response, further complicating both PMS and Tobacco Use Disorder in this population.

What are the greatest implications of this review?

The findings suggest that smoking should be considered a modifiable risk factor for PMS and PMDD. The moderate increase in risk, particularly for PMDD, highlights the need for targeted interventions in women who smoke, particularly those suffering from PMS. Clinicians should be aware of the potential exacerbating effects of smoking on menstrual health and consider integrating smoking cessation strategies into the management plans for women with PMS or PMDD. Additionally, the review emphasizes the need for further research into the underlying biological mechanisms, including the role of nicotine in neurocircuitry and stress responses, to improve treatment strategies for both PMS and smoking dependence.

September 29, 2022

•

What was studied?

This study investigated the characteristics of the gut microbiota in Japanese women with Premenstrual Syndrome (PMS), aiming to compare the microbial composition between PMS-affected individuals and healthy controls. By analyzing stool samples using 16S rRNA gene sequencing, the study examined the diversity of the microbiome and sought to identify microbial genera potentially associated with the severity of PMS symptoms.

Who was studied?

The study involved a total of 168 women, including 24 diagnosed with PMS and 144 healthy controls. The participants were between the ages of 24 and 49, with the control group selected to match the PMS group in terms of age and other relevant demographic factors. Women with other health conditions, those who had recently used antibiotics, or those with major dietary restrictions were excluded from the study. The aim was to understand how differences in the gut microbiome between the two groups might correlate with PMS symptoms.

What were the most important findings?

The study found that the gut microbiota of women with PMS differed significantly from that of healthy controls. The PMS group exhibited higher α-diversity, which was assessed using the Simpson index, indicating a more varied microbial community. When comparing the overall microbial composition between the groups, there were notable differences in β-diversity and statistical tests. The study also identified several microbial genera that were more abundant in women with PMS. Notably, Collinsella was found to be significantly more abundant in the PMS group, particularly among women aged 30–40 years. This genus was found to be 4.5 times more abundant in the PMS group compared to the controls, and its presence correlated with the severity of PMS symptoms. Bifidobacterium and Blautia, known for their roles in carbohydrate metabolism, were also more prevalent in the PMS group, potentially linking microbiome composition with metabolic processes that could influence PMS symptoms.

What are the greatest implications of this study?

The findings from this study suggest that the gut microbiota may play a significant role in the development and severity of PMS. The identification of Collinsella as a key player in the microbial composition of PMS-affected individuals opens new potential avenues for intervention. The findings imply that microbiome modulation, particularly through dietary adjustments or prebiotics targeting Collinsella, could offer a therapeutic strategy for managing PMS symptoms. The study also emphasizes the importance of further research to confirm these associations and explore the underlying mechanisms connecting microbiome imbalances with PMS.

June 21, 2019

•

Premenstrual Dysphoric Disorder (PMDD) •

What was studied?

The study aimed to assess the relationship between tobacco smoking and premenstrual syndrome (PMS), including its more severe form, premenstrual dysphoric disorder (PMDD). It focused on understanding how smoking may contribute to the occurrence of these menstrual disorders. The study utilized a case-control design, comparing women with PMS and PMDD to age-matched controls.

Who was studied?

The study population consisted of women diagnosed with PMS, women diagnosed with PMDD, and control groups who did not have PMS or PMDD. Participants were recruited from three major public hospitals and one family counseling center in Santiago de Compostela, Spain, ensuring a sample that included women of various age groups and social backgrounds. All participants completed a self-administered questionnaire that gathered information on their smoking habits, socio-demographic factors, and menstrual health.

What were the most important findings?

The study found that tobacco consumption is significantly associated with both PMS and PMDD. Specifically, current smokers had a higher likelihood of experiencing PMS and PMDD compared to non-smokers. This association was evident even among ex-smokers, although the odds ratio was less precise due to the small sample size of this group. The findings also indicated a dose-response relationship: women who smoked more than 15 cigarettes per day or those with higher pack-years of tobacco consumption had an increased risk of developing PMS and PMDD, suggesting a potential cumulative effect of tobacco exposure. The results were confirmed by a cubic spline model, which further demonstrated a correlation between the amount of tobacco consumed and the likelihood of developing these menstrual disorders.

What are the greatest implications of this study?

The study’s findings suggest that tobacco consumption may be a modifiable risk factor for the development of PMS and PMDD. Given the high prevalence of tobacco use among women globally, particularly in Europe and the United States, these results highlight the need for public health strategies aimed at reducing smoking in women, particularly those in their reproductive years. Health professionals should be aware of the potential link between smoking and these menstrual disorders, as this could inform both prevention and treatment strategies. This study calls for further research to explore the long-term effects of smoking cessation and whether reducing tobacco exposure could lower the risk of developing PMS or PMDD in susceptible women.

References

Premenstrual Syndrome. 2023 Jul 17. Gudipally PR, Sharma GK.. (In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–)
Premenstrual syndrome, a common but underrated entity: review of the clinical literature. Dilbaz B, Aksan A.. (J Turk Ger Gynecol Assoc. 2021 May 28;22(2):139-148)
Premenstrual syndrome: New insights into etiology and review of treatment methods. Modzelewski, S., Oracz, A., Żukow, X., Iłendo, K., Śledzikowka, Z., & Waszkiewicz, N. (2024). (Frontiers in Psychiatry, 15, 1363875)
Characteristics of the gut microbiota in women with premenstrual symptoms: A cross-sectional study. Takeda T, Yoshimi K, Kai S, Ozawa G, Yamada K, Hiramatsu K.. (PLoS One. 2022 May 27;17(5):e0268466)
Characteristics of the Gut Microbiota in Japanese Patients with Premenstrual Syndrome. Okuma, K., Kono, K., Otaka, M., Ebara, A., Odachi, A., Tokuno, H., & Masuyama, H. (2022). (International Journal of Women’s Health, 14, 1435–1445)
Premenstrual syndrome, a common but underrated entity: review of the clinical literature. Dilbaz B, Aksan A.. (J Turk Ger Gynecol Assoc. 2021 May 28;22(2):139-148)
Premenstrual Syndrome and Exercise: A Narrative Review. Sanchez, B. N., Kraemer, W. J., & Maresh, C. M. (2023). (Women, 3(2), 348-364.)
Premenstrual syndrome: New insights into etiology and review of treatment methods. Modzelewski, S., Oracz, A., Żukow, X., Iłendo, K., Śledzikowka, Z., & Waszkiewicz, N. (2024). (Frontiers in Psychiatry, 15, 1363875)
Premenstrual dysphoric disorder. Lanza di Scalea T, Pearlstein T. (Med Clin North Am 103(4):613–628, 2019)
Characteristics of the Gut Microbiota in Japanese Patients with Premenstrual Syndrome. Okuma, K., Kono, K., Otaka, M., Ebara, A., Odachi, A., Tokuno, H., & Masuyama, H. (2022). (International Journal of Women’s Health, 14, 1435–1445)
Premenstrual disorders and PMDD - a review. Cary, E., & Simpson, P. (2023). (Best Practice & Research Clinical Endocrinology & Metabolism, 38(1), 101858)
Premenstrual syndrome, a common but underrated entity: review of the clinical literature. Dilbaz B, Aksan A.. (J Turk Ger Gynecol Assoc. 2021 May 28;22(2):139-148)
Premenstrual Syndrome, Anxiety, and Depression Among Menstruating Rural Adolescent Girls: A Community-Based Cross-Sectional Study. Mann P, Ts P.. (Cureus. 2023 Dec 12;15(12):e50385)
Premenstrual syndrome, a common but underrated entity: review of the clinical literature. Dilbaz B, Aksan A.. (J Turk Ger Gynecol Assoc. 2021 May 28;22(2):139-148)
Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study. Direkvand-Moghadam,A.Sayehmiri,K.Delpisheh,A.Kaikhavandi,S.(2014).. (J Clin of Diagn Res. 8(2), 106-109.)
Characteristics of the gut microbiota in women with premenstrual symptoms: A cross-sectional study. Takeda T, Yoshimi K, Kai S, Ozawa G, Yamada K, Hiramatsu K.. (PLoS One. 2022 May 27;17(5):e0268466)
Premenstrual Syndrome and Exercise: A Narrative Review. Sanchez, B. N., Kraemer, W. J., & Maresh, C. M. (2023). (Women, 3(2), 348-364.)
Is Premenstrual Syndrome Associated with Inflammation, Oxidative Stress and Antioxidant Status? A Systematic Review of Case-Control and Cross-Sectional Studie. Granda D, Szmidt MK, Kaluza J.. (Antioxidants (Basel). 2021 Apr 14;10(4):604)
Exposure to heavy metals and hormone levels in midlife women: The Study of Women's Health Across the Nation (SWAN). Wang, X., Ding, N., Harlow, S. D., Randolph, J. F., Mukherjee, B., Gold, E. B., & Park, S. K. (2023). (Environmental Pollution, 317, 120740.)
Effects of Endocrine-Disrupting Heavy Metals on Human Health. Liu D, Shi Q, Liu C, Sun Q, Zeng X.. (Toxics. 2023 Mar 29;11(4):322)
Effects of Cadmium, Lead, and Mercury on the Structure and Function of Reproductive Organs. Massányi, P., Massányi, M., Madeddu, R., Stawarz, R., & Lukáč, N. (2020). (Toxics, 8(4), 94)
Tobacco consumption and premenstrual syndrome: A case-control study. Fernández MDM, Montes-Martínez A, Piñeiro-Lamas M, Regueira-Méndez C, Takkouche B.. (PLoS One. 2019 Jun 21;14(6):e0218794)
Association Between Smoking and Premenstrual Syndrome: A Meta-Analysis. Choi SH, Hamidovic A.. (Front Psychiatry. 2020 Nov 26;11:575526)
The role of probiotics in managing premenstrual syndrome: insights into beneficial bacterial strains. R., P., & R., S. (2025). (International Journal of Basic & Clinical Pharmacology, 14(3), 418–422)
The role of probiotics in managing premenstrual syndrome: insights into beneficial bacterial strains. R., P., & R., S. (2025). (International Journal of Basic & Clinical Pharmacology, 14(3), 418–422)
Effect of Lactobacillus acidophilus and Bifidobacterium bifidum Administration on Colonic Microbiota and its Metabolic Activity in Premenstrual Syndrome. Minelli, E. B., Benini, A., Vicentini, L., Andreoli, E., Oselladore, M., & Cerutti, R. (1996). (Microbial Ecology in Health and Disease, 9(6), 247–260)
The role of probiotics in managing premenstrual syndrome: insights into beneficial bacterial strains. R., P., & R., S. (2025). (International Journal of Basic & Clinical Pharmacology, 14(3), 418–422)
New insights on the impact of gut microbiota on premenstrual disorders. Will probiotics solve this mystery?. Nabeh OA.. (Life Sci. 2023 May 15;321:121606)
Opportunities of prebiotics for the intestinal health of monogastric animals. Azad, M. A., Gao, J., Ma, J., Li, T., Tan, B., Huang, X., & Yin, J. (2020). (Animal Nutrition, 6(4), 379-388)
Microbiota Transplant and Gynecological Disorders: The Bridge between Present and Future Treatments. Microorganisms. Martinelli S, Nannini G, Cianchi F, Staderini F, Coratti F, Amedei A.. (2023 Sep 27;11(10):2407)
Synbiotics as potent functional food: recent updates on therapeutic potential and mechanistic insight. Yadav M, Sehrawat N, Sharma AK, Kumar S, Singh R, Kumar A, Kumar A.. (J Food Sci Technol. 2024 Jan;61(1):1-15)
Microbiota–gut–brain axis and its therapeutic applications in neurodegenerative diseases. Loh, J.S., Mak, W.Q., Tan, L.K.S. et al.. (Sig Transduct Target Ther 9, 37 (2024))
Relationships between Premenstrual Syndrome (PMS) and Diet Composition, Dietary Patterns and Eating Behaviors. Oboza P, Ogarek N, Wójtowicz M, Rhaiem TB, Olszanecka-Glinianowicz M, Kocełak P.. (Nutrients. 2024; 16(12):1911)
Role of Gut Microbiota Derived Short Chain Fatty Acid Metabolites in Modulating Female Reproductive Health. Acharya, Ashwitha, Shilpa S. Shetty, and Suchetha Kumari N.. (Human Nutrition & Metabolism 36, (2024): 200256. Accessed May 17, 2025)
Role of Dietary Fiber and Short-chain Fatty Acids in Preventing Neurodegenerative Diseases through the Gut-brain Axis. Choe Uyory. (Journal of Functional Foods 129, (2025): 106870. Accessed May 17, 2025)
Premenstrual Syndrome and Exercise: A Narrative Review. Sanchez, B. N., Kraemer, W. J., & Maresh, C. M. (2023). (Women, 3(2), 348-364.)
Exercise for Premenstrual Syndrome: A Systematic Review and Meta-analysis of Randomised Controlled Trials. Pearce, Emma, Kate Jolly, Laura L. Jones, Gemma Matthewman, Mandana Zanganeh, and Amanda Daley. (BJGP Open 4, no. 3 (2020): bjgpopen20X101032. Accessed May 17, 2025)

Associated Conditions
- Premenstrual Dysphoric Disorder (PMDD)

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