Contemplative-based interventions for premenstrual syndrome: a systematic review of psychobiological outcomes

Premenstrual syndrome (PMS) is a cyclically recurring psychobiological condition affecting up to 47.8% of women of reproductive age, with considerable impact on daily functioning, quality of life and a documented economic burden linked to work absenteeism. Despite its prevalence, PMS remains substantially undertreated, and pharmacological approaches are often associated with undesirable side effects.

This systematic review was conducted following PRISMA 2020 guidelines and evaluated the efficacy of contemplative practices (CPs), specifically mindfulness-based programs, yoga, and qigong, across psychobiological outcome domains in women with PMS. A comprehensive search of PubMed, Scopus, and Web of Science (2015-2026) identified 18 studies comprising 15 independent trials (n = 1,080).

Across studies, CPs were associated with improvements in mood, stress, and anxiety, reductions in somatic complaints, and enhanced sleep quality. Movement-based CPs (yoga and qigong) produced broader physiological effects including reductions in blood pressure, preliminary evidence of hormonal modulation, and cardiopulmonary improvements, while non-movement mindfulness-based interventions more selectively targeted psychological and emotional domains. Methodological quality was moderate (PEDro median = 7), and most trials were rated as having some concerns on RoB 2.0.

These findings are interpreted within a dual-axis modulation framework, in which CPs may simultaneously attenuate HPA-driven suppression of reproductive function and support HPO axis activity via autonomic and anti-inflammatory pathways. Future research should prioritize luteal phase-confirmed designs, objective biomarkers including heart rate variability and hormonal profiles, and adequately powered trials to elucidate mechanisms and optimal dosing.

https://osf.io/hdpyf/overview.