Emotion regulation in Premenstrual Dysphoric Disorder and Premenstrual Syndrome: a systematic review

Premenstrual Dysphoric Disorder (PMDD) and severe cases of Premenstrual Syndrome (PMS) are characterised by fluctuations in mood and behaviour across the menstrual cycle and cause severe and disabling symptoms for some females. Difficulties with emotion regulation (ER) are considered key experiences of people with PMDD and severe PMS. The present review aims to summarise relevant research on ER in PMDD and PMS and integrate results in the extended process model (EPM) of ER. We aimed to answer whether group differences in ER exist between people with and without PMDD and PMS, and whether variations in ER exist across menstrual phases.

A systematic literature search was conducted following PRISMA guidelines in MEDLINE, PsycInfo, EMBASE, PubMed, CINAHL and CENTRAL until 11th April 2024. Articles were included that administered an ER questionnaire or related experimental task, examined people with PMDD or PMS confirmed via prospective ratings of symptoms over 1 + months, and which compared the target sample with healthy controls or within the same individual at least twice over 2 cycle phases. Study quality was assessed using the Newcastle Ottawa Scale and a Menstrual Quality Assessment tool developed for the review.

After full text screening and systematic quality assessment, 22 studies (n = 1529 participants) were included. Findings suggest possible difficulties in the identification and selection stages of ER in individuals with PMDD and PMS, such as heightened emotional reactivity and challenges with emotional clarity. There was also some evidence indicating a reliance on less adaptive ER strategies, including increased rumination, particularly in the late-luteal phase. However, the evidence regarding difficulties in ER implementation remains limited and inconsistent, with few experimental studies available.

While there is some indication that individuals with PMDD and PMS may experience difficulties in emotion identification and strategy selection, these findings should be interpreted with caution. Further research is necessary to clarify these processes and their potential variability across the menstrual cycle. Future studies should prioritise longitudinal and experimental designs to gain a deeper understanding of ER in PMDD and PMS and inform the development of phase-sensitive therapeutic strategies.