Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Narrative Review of Recent Evidence on Physical Activity as an Adjunctive Management Strategy
DOI:
https://doi.org/10.12775/QS.2026.74.74612Keywords
premenstrual syndrome, premenstrual dysphoric disorder, physical activity, aerobic exercise, narrative reviewAbstract
Background Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) affect substantial proportions of women of reproductive age, imposing significant burdens on quality of life, work productivity, and psychological wellbeing. Evidence suggests that physical activity may improve symptoms of these conditions.
Aim. To synthesise current evidence on physical activity and structured exercise as adjunctive interventions in the management of premenstrual disorders, examining mechanistic pathways, exercise modalities, and clinical implications.
Material and methods. A narrative review was conducted, focusing in particular on premenstrual syndrome and premenstrual dysphoric disorder, as well as the impact of physical activity on alleviating their symptoms. Randomized controlled trials, systematic reviews, and meta-analyses were prioritized and appraised qualitatively.
Results. Systematic reviews and meta-analyses demonstrate that physical activity, particularly aerobic exercise at moderate intensity, reduces both physical and psychological premenstrual symptoms. Identified mechanisms include modulation of ovarian hormone profiles, enhancement of endogenous opioid systems, regulation of neuroendocrine stress responses, fluid-electrolyte balance, and prostaglandin metabolism. Alternative modalities including Pilates and kinesio taping demonstrate comparable efficacy. Strength training performance fluctuates across menstrual cycle phases, with optimal performance during the late follicular phase.
Conclusions. Regular, preference-sensitive exercise provides a practical and sustainable method for managing PMS symptoms; however, it should not replace prospective diagnosis or appropriate treatment. Further research employing prospective symptom monitoring, standardized outcome measures, and mechanistic biomarkers is essential to refine personalized recommendations and identify optimal exercise prescriptions for individual women.
References
1. Wieczorek K, Targonskaya A, Maslowski K. Reproductive hormones and female mental wellbeing. Women. (2023) 3(3):432–44. https://doi.org/10.3390/women3030033
2. Handy AB, Greenfield SF, Yonkers KA, Payne LA. Psychiatric symptoms across the menstrual cycle in adult women: a comprehensive review. Harv Rev Psychiatry. (2022) 30(2):100–17. https://doi.org/10.1097/HRP.0000000000000329
3. Ayyub S, Agrawal M, Sharma V, Aravind A. The Effect of Physical Activity on Premenstrual Syndrome: A Systematic Review. Ann Neurosci. 2024 Dec 16;32(4):315-320. doi: 10.1177/09727531241297012. PMID: 39691311; PMCID: PMC11647822. https://doi.org/10.1177/09727531241297012
4. Ryman Augustsson S, Findhé-Malenica A. Power in the flow: how menstrual experiences shape women's strength training performance. Front Sports Act Living. 2025 Feb 26;7:1519825. https://doi.org/10.3389/fspor.2025.1519825
5. Draper CF, Duisters K, Weger B, Chakrabarti A, Harms AC, Brennan L, et al. Menstrual cycle rhythmicity: metabolic patterns in healthy women. Sci Rep. (2018) 8(1):14568. https://doi.org/10.1038/s41598-018-32647-0
6. Hawkins SM, Matzuk MM. The menstrual cycle: basic biology. Ann N Y Acad Sci. (2008) 1135:10–8. https://doi.org/10.1196/annals.1429.018
7. Reed BG, Carr BR. The normal menstrual cycle and the control of ovulation. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, et al., editors. Endotext. South Dartmouth (MA): MDText.com, Inc. Copyright © 2000-2024, MDText.com, Inc. (2000).
8. Barbieri RL. The endocrinology of the menstrual cycle. Methods Mol Biol. (2014) 1154:145–69. https://doi.org/10.1007/978-1-4939-0659-8_7
9. Liguori F, Saraiello E, Calella P. Premenstrual Syndrome and Premenstrual Dysphoric Disorder’s Impact on Quality of Life, and the Role of Physical Activity. Medicina. 2023; 59(11):2044. https://doi.org/10.3390/medicina59112044
10. Dilbaz, B.; Aksan, A. Premenstrual syndrome, a common but underrated entity: Review of the clinical literature. J. Turk. Ger. Gynecol. Assoc. 2021, 22, 139–148. https://doi.org/10.4274/jtgga.galenos.2021.2020.0133
11. Lopez, L.M.; Kaptein, A.A.; Helmerhorst, F.M. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst. Rev. 2012, CD006586. https://doi.org/10.1002/14651858.CD006586.pub4
12. Ryu, A.; Kim, T.-H. Premenstrual syndrome: A mini review. Maturitas 2015, 82, 436–440. https://doi.org/10.1016/j.maturitas.2015.08.010
13. Mazza M, Marano G. Unmasking the cycle: Premenstrual and menstrual exacerbation of psychiatric disorders and impact on female mental health. World J Psychiatry. 2025 Aug 19;15(8):107132. https://doi.org/10.5498/wjp.v15.i8.107132
14. Biggs, W.S.; Demuth, R.H. Premenstrual syndrome and premenstrual dysphoric disorder. Am. Fam. Physician 2011, 84, 918–924. https://www.ncbi.nlm.nih.gov/pubmed/22010771
15. Epperson CN, Steiner M, Hartlage SA, Eriksson E, Schmidt PJ, Jones I, et al. Premenstrual dysphoric disorder: evidence for a new category for DSM-5. Am J Psychiatry. (2012) 169:465–75. https://doi.org/10.1176/appi.ajp.2012.11081302
16. Dilbaz B, Aksan A. Premenstrual syndrome, a common but underrated entity: review of the clinical literature. J Turk Ger Gynecol Assoc. (2021) 22:139–48. https://doi.org/10.4274/jtgga
17. Modzelewski S, Oracz A, Żukow X, Iłendo K, Śledzikowka Z and Waszkiewicz N (2024) Premenstrual syndrome: new insights into etiology and review of treatment methods. Front. Psychiatry 15:1363875. https://doi.org/10.3389/fpsyt.2024.1363875
18. Dennerstein L, Lehert P, Heinemann K. Epidemiology of premenstrual symptoms and disorders. Menopause Int. (2012) 18:48–51. https://doi.org/10.1258/mi.2012.012013
19. Kundakovic, M.; Rocks, D. Sex hormone fluctuation and increased female risk for depression and anxiety disorders: From clinical evidence to molecular mechanisms. Front. Neuroendocr. 2022, 66, 101010. https://doi.org/10.1016/j.yfrne.2022.101010
20. Beddig T, Kühner C. [Current Aspects of Premenstrual Dysphoric Disorder - A Review]. Psychother Psychosom Med Psychol 2017; 67: 504-513 https://dx.doi.org/10.1055/s-0043-113816
21. Epperson CN, Steiner M, Hartlage SA, Eriksson E, Schmidt PJ, Jones I, Yonkers KA. Premenstrual dysphoric disorder: evidence for a new category for DSM-5. Am J Psychiatry 2012; 169: 465-475 https://dx.doi.org/10.1176/appi.ajp.2012.11081302
22. Hamidovic A, Mumford S, Schisterman E, Davis J, Soumare F. Neuroactive steroid hormone trajectories across the menstrual cycle in premenstrual dysphoric disorder (PMDD): the PHASE study. Mol Psychiatry 2024; 29: 3056-3063 https://dx.doi.org/10.1038/s41380-024-02566-w
23. Dunphy L, Boyle S, Wood F. The multifactorial aetiology and management of premenstrual dysphoric disorder with leuprorelin acetate. BMJ Case Rep 2023; 16: e258343 https://dx.doi.org/10.1136/bcr-2023-258343
24. Meyer JH. A Role for the Serotonin Transporter in the Largely Unknown Molecular Pathophysiology of Premenstrual Dysphoric Disorder. Biol Psychiatry 2023; 93: 1054-1055 https://dx.doi.org/10.1016/j.biopsych.2023.04.013
25. Ko CH, Wong TH, Suen JL, Lin PC, Long CY, Yen JY. Estrogen, progesterone, cortisol, brain-derived neurotrophic factor, and vascular endothelial growth factor during the luteal phase of the menstrual cycle in women with premenstrual dysphoric disorder. J Psychiatr Res 2024; 169: 307-317 https://dx.doi.org/10.1016/j.jpsychires.2023.11.019
26. Dhingra, V.; Magnay, J.L.; O’Brien, P.M.S.; Chapman, G.; Fryer, A.A.; Ismail, K.M.K. Serotonin Receptor 1A C(-1019)G Polymorphism Associated With Premenstrual Dysphoric Disorder. Obstet. Gynecol. 2007, 110, 788–792. https://doi.org/10.1097/01.AOG.0000284448.73490.ac
27. Huo, L.; Straub, R.E.; Roca, C.; Schmidt, P.J.; Shi, K.; Vakkalanka, R.; Weinberger, D.R.; Rubinow, D.R. Risk for Premenstrual Dysphoric Disorder Is Associated with Genetic Variation in ESR1, the Estrogen Receptor Alpha Gene. Biol. Psychiatry 2007, 62, 925–933. https://doi.org/10.1016/j.biopsych.2006.12.019
28. Steinberg, H.; Sykes, E.A. Introduction to symposium on endorphins and behavioural processes; Review of literature on endorphins and exercise. Pharmacol. Biochem. Behav. 1985, 23, 857–862. https://doi.org/10.1016/0091-3057(85)90083-8
29. Dunn, A.L.; Trivedi, M.H.; ONeal, H.A. Physical activity dose-response effects on outcomes of depression and anxiety. Med. Sci.Sports Exerc. 2001, 33, S587–S597. https://doi.org/10.1097/00005768-200106001-00027
30. Ravichandran H, Janakiraman B. Effect of Aerobic Exercises in Improving Premenstrual Symptoms Among Healthy Women: A Systematic Review of Randomized Controlled Trials. Int J Womens Health. 2022;14:1105-1114
https://doi.org/10.2147/IJWH.S371193
31. Mohebbi Dehnavi, Z., Jafarnejad, F. & Sadeghi Goghary, S. The effect of 8 weeks aerobic exercise on severity of physical symptoms of premenstrual syndrome: a clinical trial study. BMC Women's Health 18, 80 (2018).
https://doi.org/10.1186/s12905-018-0565-5
32. Johnson S. Premenstrual syndrome, premenstrual dysphoric disorder, and beyond: a clinical primer for practitioners. Obstet Gynecol. 2004;104(4):845 – 59. https://doi.org/10.1097/01.aog.0000140686.66212.1e
33. Stoddard JL, Dent CW, Shamcs L, Bernstein L. Exercise training effects on premensterual distress and ovarian steroid hormones. Euro J Appl Physiol. 2007;99(1):27 – 37. https://doi.org/10.1007/s00421-006-0313-7
34. Daley A. Exercise and premenstrual symptomatology: a comprehensive review. J Women's Health (Larchmt). 2009;18(6):895 – 9. https://doi.org/10.1089/jwh.2008.1098
35. Charkoudian N, Joyner M. Physiologic considerations for exercise performance in women. Clin Chest Med. 2004;25(2):247 – 55. https://doi.org/10.1016/j.ccm.2004.01.001
36. Saglam H, Orsal O. Effect of exercise on premenstrual symptoms: a systematic review. Complement Ther Med. 2020;48:102272. https://doi.org/10.1016/j.ctim.2019.102272
37. Pearce E., Jolly K., L Jones L., Matthewman G., Zanganeh M., Daley A,. Exercise for premenstrual syndrome: a systematic review and meta-analysis of randomised controlled trials. BJGP Open 2020; 4(3): bjgpopen20X101032.
https://doi.org/10.3399/bjgpopen20X101032
38. El-Lithy A, El-Mazny A, Sabbour A, El-Deeb A. Effect of aerobic exercise on premenstrual symptoms, haematological and hormonal parameters in young women. J Obstet Gynaecol. 2015;35(4):389 – 92.
39. Elbandrawy, A.M., Yousef, A.S.A., Osman, D.A. et al. Effect of kinesio taping versus tele-pilates intervention on pre-menstrual syndrome. Bull Fac Phys Ther 30, 57 (2025). https://doi.org/10.1186/s43161-025-00321-y
40. Maged AM, Abbassy AH, Sakr HRS et al (2018) Effect of swimming exercise on premenstrual syndrome. Arch Gynecol Obstet 297:951–959. https://doi.org/10.1007/s00404-018-4664-1
41. Koçak M, Şevgin Ö. The effect of exercise on menstrual symptoms: a randomized controlled trial. BMC Womens Health. 2025 Aug 23;25(1):406. https://doi.org/10.1186/s12905-025-03940-8
42. Kroll-Desrosiers AR, Ronnenberg AG, Zagarins SE, Houghton SC, Takashima-Uebelhoer BB, Bertone-Johnson ER (2017) Recreational Physical Activity and Premenstrual Syndrome in Young Adult Women: A Cross-Sectional Study. PLoS ONE 12(1): e0169728. https://doi.org/10.1371/journal.pone.0169728
43. Carmichael MA, Thomson RL, Moran LJ, Wycherley TP. The impact of menstrual cycle phase on athletes’ performance: a narrative review. Int J Environ Res Public Health. (2021) 18(4):1667. https://doi.org/10.3390/ijerph18041667
44. Sung E, Han A, Hinrichs T, Vorgerd M, Manchado C, Platen P. Effects of follicular versus luteal phase-based strength training in young women. Springerplus. (2014) 3:668. https://doi.org/10.1186/2193-1801-3-668
45. Janse de Jonge XA. Effects of the menstrual cycle on exercise performance. Sports Med. (2003) 33(11):833–51. https://doi.org/10.2165/00007256-200333110-00004
46. Blagrove RC, Bruinvels G, Pedlar CR. Variations in strength-related measures during the menstrual cycle in eumenorrheic women: a systematic review and meta-analysis. J Sci Med Sport. (2020) 23(12):1220–7. https://doi.org/10.1016/j.jsams.2020.04.022
47. Kenney W, Wilmore W, Costill D. Physiology of Sport and Exercise. 6 ed. Champaign, IL: Human Kinetics (2015).
48. Mihm M, Gangooly S, Muttukrishna S. The normal menstrual cycle in women. Anim Reprod Sci. (2011) 124(3-4):229–36. https://doi.org/10.1016/j.anireprosci.2010.08.030
49. Romero-Moraleda B, Coso JD, Gutierrez-Hellin J, Ruiz-Moreno C, Grgic J, Lara B. The influence of the menstrual cycle on muscle strength and power performance. J Hum Kinet. (2019) 68:123–33. https://doi.org/10.2478/hukin-2019-0061
50. Li X, Ding F, Ma X, Wang X, Chen J, Chen L. A systematic review of exercise interventions on negative affect, pain, and fatigue in women with premenstrual syndrome. BMC Womens Health. 2026;26:75. https://doi.org/10.1186/s12905-025-04242-9
51. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462. https://doi.org/10.1136/bjsports-2020-102955
52. American College of Obstetricians and Gynecologists. Management of premenstrual disorders: ACOG Clinical Practice Guideline No. 7. Obstet Gynecol. 2023;142(6):1516-1533. https://doi.org/10.1097/aog.0000000000005426
53. Prasad D, Wollenhaupt-Aguiar B, Kidd KN, de Azevedo Cardoso T, Frey BN. Suicidal risk in women with premenstrual syndrome and premenstrual dysphoric disorder: a systematic review and meta-analysis. J Womens Health (Larchmt). 2021;30(12):1693-1707. https://doi.org/10.1089/jwh.2021.0185
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Copyright (c) 2026 Wioleta Pluta, Roksana Milaniuk, Aleksandra Drzewiecka, Beata Surówka, Izabela Czerny, Szymon Daniszewski, Krzysztof Talarowski, Piotr Tylec, Jakub Bryl, Aleksandra Pacek, Arkadiusz Ściubak
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