Biological rhythms in premenstrual syndrome and premenstrual dysphoric disorder: a systematic review Original paper

What was reviewed?

This paper systematically reviewed the existing literature on biological rhythm disruptions in women with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). The focus was on circadian and other biological rhythms, including sleep–wake cycles, melatonin secretion, core body temperature, cortisol, prolactin, and thyroid-stimulating hormone levels. The review synthesized findings from 25 studies that compared women diagnosed with PMS/PMDD to healthy controls, assessing both subjective and objective markers of biological rhythms to clarify their association with premenstrual symptoms and the underlying pathophysiology.

Who was reviewed?

The review analyzed studies published between 1989 and 2022 across multiple countries, involving women aged 18 to 45 diagnosed with PMS or PMDD using standardized criteria, mostly DSM-III-R to DSM-5. The total sample sizes varied widely, with some studies including over 600 participants. Healthy control groups consisted of women without PMS/PMDD or psychiatric disorders. Studies included diverse methodologies such as polysomnography, actimetry, hormonal assays, core body temperature measurements, and subjective sleep quality assessments, enabling comprehensive evaluation of biological rhythms in the premenstrual context.

What were the most important findings?

The review found consistent evidence that women with PMS/PMDD exhibit significant disruptions in biological rhythms compared to healthy controls. Notably, they present with lower nocturnal melatonin levels, elevated nighttime core body temperature, and poorer subjective sleep quality, all indicating altered circadian regulation. While objective sleep parameters and activity rhythms showed mixed or nonsignificant differences, hormonal rhythms such as cortisol and prolactin demonstrated inconsistent findings across studies. These rhythm disturbances likely contribute to the psychological and physiological symptoms experienced during the luteal phase. The review highlights melatonin dysregulation as a potential key factor in PMS/PMDD pathophysiology and calls for further research into circadian-based mechanisms and their therapeutic implications.

What are the greatest implications of this review?

This review highlights the importance of biological rhythm disruptions in PMS and PMDD, positioning circadian dysfunction, especially melatonin alterations, as a promising target for understanding symptom development and designing novel interventions. Clinicians should recognize that sleep complaints and temperature regulation abnormalities in these disorders reflect deeper circadian disturbances rather than isolated symptoms. The review advocates for integrating chronobiological assessments into clinical evaluations and exploring circadian-modulating treatments, such as light therapy or melatonin supplementation, to improve patient outcomes. It also calls for future research to clarify inconsistent findings in hormonal rhythms and to investigate the potential of personalized circadian therapies tailored to premenstrual symptom profiles.