Factors influencing premenstrual syndrome and premenstrual dysphoric disorder in different countries

Abstract

Background: Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are cyclical conditions affecting a substantial proportion of women of reproductive age, marked by a range of emotional, behavioral, and physical symptoms. While the global prevalence of PMS ranges from 30% to 90%, PMDD affects a smaller yet clinically significant proportion of women. Variations in prevalence and severity across countries suggest that biological, psychological, and sociocultural factors play influential roles. This study explores the multifactorial determinants of PMS and PMDD in different national contexts, focusing on both physiological mechanisms and environmental influences.

Methods and Materials: A narrative review approach was used to synthesize findings from peer-reviewed literature published between 2009 and 2025. Studies included were cross-sectional, systematic reviews, meta-analyses, and public health reports that assessed prevalence, risk factors, and management strategies for PMS and PMDD across countries. Emphasis was placed on hormonal imbalances, neurotransmitter dysregulation, genetic predispositions, stress, lifestyle, and cultural stigma. Comparative data from countries such as Ethiopia, India, Malaysia, Jordan, and the United States were included.

Results: Hormonal fluctuations, particularly in estrogen and progesterone, as well as serotonergic sensitivity, were identified as core biological factors contributing to PMS and PMDD. Lifestyle factors including high stress levels, poor diet, lack of physical activity, and sleep disturbances were found to exacerbate symptoms. Sociocultural influences—such as menstrual stigma, limited mental health literacy, and healthcare access—significantly shaped symptom reporting and treatment-seeking behavior. Countries with stronger public health infrastructure showed better awareness, diagnosis, and support mechanisms.

Conclusion: PMS and PMDD are complex, multifactorial disorders influenced by an interplay of physiological, environmental, and cultural factors. Cross-national differences highlight the need for culturally sensitive diagnostic tools and integrative care models. Future interventions should focus on improving awareness, reducing stigma, and promoting early screening, particularly in low-resource settings.