Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review
Abstract
We systematically reviewed empirical studies that investigated the use of cognitive-behavioral therapy (CBT) for premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). Our multi-database search identified seven published empirical reports. Three were identified as randomized controlled trials (RCTs). The methods utilized to investigate therapeutic efficacy of CBT in these studies varied widely from case reports to RCTs with pharmacotherapy comparison groups. Initially we provide a brief overview of CBT and justifications for its potential use to treat PMS/PMDD. Next, we provide critical evaluations of the analyses used in each study focusing on the detection of intervention effects assessed by statistically significant time by group interactions. When possible we calculate effect sizes to elucidate the clinical significance of results. Our review revealed a dearth of evidence providing statistically significant CBT intervention effects. Issues such as overall time investment, latency to treatment effects, and complementary and combined therapies are considered. We present a theoretical argument for applying mindfulness- and acceptance-based CBT interventions to PMS/PMDD and suggest future research in this area. In conclusion, to produce the necessary evidence-base support for PMS/PMDD given the limited empirical evidence reported here, researchers are called on to produce methodologically rigorous investigations of psychosocial interventions for PMS/PMDD.
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CBT can reduce interference of premenstrual symptoms on daily living.
“The results of systematic review [10] and meta-analysis of randomized controlled trials [13, 14] suggest that cognitive behaviour therapy (CBT) can reduce premenstrual anxiety and depression, have a beneficial impact on behavioural change, and reduce interference of premenstrual symptoms on daily living [15, 16–18].”
CBT can reduce premenstrual anxiety and depression.
“The results of systematic review [10] and meta-analysis of randomized controlled trials [13, 14] suggest that cognitive behaviour therapy (CBT) can reduce premenstrual anxiety and depression, have a beneficial impact on behavioural change, and reduce interference of premenstrual symptoms on daily living [15, 16–18].”
CBT has a beneficial impact on behavioural change.
“The results of systematic review [10] and meta-analysis of randomized controlled trials [13, 14] suggest that cognitive behaviour therapy (CBT) can reduce premenstrual anxiety and depression, have a beneficial impact on behavioural change, and reduce interference of premenstrual symptoms on daily living [15, 16–18].”
Previous research on the efficacy of CBT in reducing premenstrual distress has been criticised for the absence of wait-list control groups, small sample size, absence of random group assignment, and failure to use repeated measures ANOVA to assess main effects of group, main effects of time, and time by group interactions.
“Previous research on the efficacy of CBT in reducing premenstrual distress has also been criticised for the absence of wait-list control groups, small sample size, absence of random group assignment, and failure to use using repeated measures ANOVA to assess main effects of group, main effects of time, and time by group interactions [10].”
Taking part in an intervention for PMDs can reduce psychological premenstrual symptoms and premenstrual distress.
“The finding of significant differences across time when the groups are collapsed (ignoring the intervention group assignment), confirms previous reports [10, 13, 14] that taking part in an intervention for PMDs can reduce psychological premenstrual symptoms and premenstrual distress [15, 16, 18, 20, 72, 73].”
CBT may be more costly than bio-medical treatments in the short term, as it requires more intensive clinician time and trained personnel.
“Whilst CBT may be more costly than bio-medical treatments in the short term, as it requires more intensive clinician time and trained personnel [10]”
Attrition was lower than that reported in previous CBT RCTs for PMDs.
“attrition was lower than that reported in previous CBT RCTs for PMDs [10]”
CBT can have a preventative effect for PMDs by preventing the premenstrual increases in negative symptomatology or changing the way women come to relate to and report those symptoms.
“These findings support the argument that CBT can have a preventative effect for PMDs [10], by preventing the premenstrual increases in negative symptomatology or changing the way women come to relate to and report those symptoms.”
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Premenstrual syndrome: etiology, diagnosis and treatment. A mini literature review
Nworie, K. M. (2018) · Journal of Obstetrics and Gynecological Investigations · doi:10.5114/jogi.2018.78010 · Cited by 11 · see citing works
“A meta-analysis review of seven trials showed improvement in depression and functioning for women with PMS [48].”
MethodChocano-Bedoya, P. O., & Bertone‐Johnson, E. R. (2012) · Elsevier eBooks · doi:10.1016/b978-0-12-384978-6.00013-3 · Cited by 11 · see citing works
Remote intervention using smartphone for rural women suffering from premenstrual syndrome
Chai, N., Wu, Y., Zhang, M., Wu, W., Zhang, H., Kong, F.-W., & Zhang, Y. (2018) · Medicine · doi:10.1097/md.0000000000011629 · Cited by 11 · see citing works
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“Formal treatments, such as cognitive therapy, have been shown to be effective in mitigating the impact of PMS [46].”
Pokharel, P., Rana, J., Moutchia, J., Uchai, S., Kerri, A., Gutierrez, P. L., & Islam, R. M. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-039274 · Cited by 10 · see citing works
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Beyond abjection: Exploring narratives after premenstrual dysphoric disorder
Buys, M. E. (2024) · Feminism & Psychology · doi:10.1177/09593535231223915 · Cited by 9 · see citing works
“All treatment options present mixed results in terms of ef fi cacy, with treatment guides for PMDD highlighting multiple research area gaps (International Association for Premenstrual Disorders, 2020; Kleinstäuber et al., 2012; Lustyk et al., 2009; Pearlstein & Steiner, 2012; Steiner, 2000).”
BackgroundThe impact of pharmacotherapy for premenstrual dysphoric disorder on sleep
Meth, E. M. S., Nôga, D. A., Dubol, M., Xue, P., Poromaa, I. S., & Benedict, C. (2025) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2025.102069 · Cited by 9 · see citing works
“Specifically, the application of cognitive behavioral therapy for insomnia to improve both subjective sleep quality and overall PMDD symptoms represents a crucial area for future research, given the current lack of high-quality studies in this field [127].”
Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder
Mendiratta, V., & Lentz, G. M. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-65399-2.00044-9 · Cited by 9 · see citing works
Clinicians’ Perceptions of Norwegian Women’s Experiences of Infertility Diseases
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“This is particularly poignant among those that are most difficult to diagnose and treat, namely polycystic ovary syndrome [16], premenstrual dysphoric disorder [17], endometriosis [18], premature ovarian failure [19], vulvodynia [20], and chronic pelvic pain [21].”
BackgroundPatterns of premenstrual syndrome in collegiate women: A cross-sectional study
Morino, S., Hirata, H., Egawa, M., Matsumoto, D., Yokota, I., & Aoyama, T. (2022) · Medicine · doi:10.1097/md.0000000000030186 · Cited by 8 · see citing works
“[20,21] Furthermore, the lower serum magnesium of PMS subjects was observed and various treatment items recommended magnesium supplementation for anxiety-related symptoms,[22,23] selective serotonin reuptake inhibitors (SSRIs) for predominantly emotional symptoms such as irritability and anxiety,[24] cognitive behavio…”
BackgroundKiyumi, M. H. A. (2020) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12532 · Cited by 8 · see citing works
Yoshimi, K., Inoue, F., Odai, T., 白土, な., Watanabe, Z., Otsubo, T., Terauchi, M., & Takeda, T. (2024) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.234 · Cited by 7 · see citing works
The pharmacotherapeutic management of premenstrual dysphoric disorder
Ciccone, N., Kovacheff, M. B., & Frey, B. N. (2022) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2022.2114345 · Cited by 7 · see citing works
“Three randomized controlled trials showed improvement in functioning and depression scores for patients with PMDD in CBT, which were typically delivered in approximately 12 sessions [34].”
MethodBabajani, S., Asgari, K., Orayzi, H. R., & Ghasemi, N. (2017) · Zahedan Journal of Research in Medical Sciences · doi:10.5812/zjrms.12537 · Cited by 7 · see citing works
“, pain and anxiety) played a key role in proposing a theoretical framework for the treatment of the premenstrual syndrome [14].”
BackgroundViews of Dutch general practitioners about premenstrual symptoms: A qualitative interview study
Labots-Vogelesang, M. S., Teunissen, D. A. M., Kranenburg, V., & Lagro‐Janssen, A. L. M. (2021) · European Journal of General Practice · doi:10.1080/13814788.2021.1889505 · Cited by 7 · see citing works
Smiley: Designing Smile Recognition Smart Mirror for Premenstrual Syndrome
Ahn, S., & Choi, Y. (2022) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2022.2075638 · Cited by 7 · see citing works
“Some previously published studies have claimed that positive emotions reduce PMS (Blake et al., 1998, Lustyk et al., 2009).”
BackgroundHoppe, J. M., Weise, C., Kleinstäuber, M., Skalkidou, A., Vegelius, J. R., Comasco, E., Gröndal, M., Kaltsouni, E., Sundström, F., Sampaio, F., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-091649 · Cited by 7 · see citing works
Chiaramonte, D. R., Ring, M. R., & Locke, A. (2017) · Medical Clinics of North America · doi:10.1016/j.mcna.2017.04.010 · Cited by 6 · see citing works
“Cognitive behavioral therapy (CBT) is effective, particularly for acceptance-based CBT and mindfulness.(58) CBT is as effective as fluoxetine in PMDD.”
BackgroundErgenlerde Premenstrüel Sendrom ile Ruh Sağlığı Değişkenleri Arasındaki İlişki
Uzunoğlu, G., & AKTAN, Z. D. (2019) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.521549 · Cited by 6 · see citing works
Premenstrual Experience Premenstrual Syndrome and Dysphoric Disorder
Santamaría, M., & Lago, I. (2014) · Springer eBooks · doi:10.1007/978-3-319-05870-2_18 · Cited by 8 · see citing works
Verma, S., Singh, G., & Kothiyal, S. (2024) · Advances in Rehabilitation · doi:10.5114/areh.2024.141104 · Cited by 5 · see citing works
Menstruation and Premenstrual Dysphoric Disorder: Its Impact on Mood
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Psychotherapy outcome research: Implications of a new clinical taxonomy
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Transtorno disfórico pré-menstrual: um breve panorama
Demarque, R., Rennó, J., Ribeiro, H. L., Cavalsan, J. P., Rocha, R., Cantilino, A., Ribeiro, J. D. A. M., Valadares, G. C., & da Silva, A. G. (2013) · Debates em Psiquiatria · doi:10.25118/2763-9037.2013.v3.379 · Cited by 4 · see citing works
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Micronutrient Intake and Premenstrual Syndrome
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Okajima, J., & Okajima, I. (2025) · BioPsychoSocial Medicine · doi:10.1186/s13030-025-00327-x · Cited by 3 · see citing works
Depressive Disorders: Premenstrual Dysphoric Disorder
Pearlstein, T. B. (2015) · Wiley eBooks · doi:10.1002/9781118753378.ch51 · Cited by 2 · see citing works
Premenstrual Disorders in Adolescents: An Updated Review
Rome, E. S., Kaznoch, D., & Issac, V. E. (2026) · Journal of Pediatric and Adolescent Gynecology · doi:10.1016/j.jpag.2026.06.003 · Cited by 2 · see citing works
Premenstrual dysphoric disorder: A new psychological entity
Cope, G. F. (2019) · Independent Nurse · doi:10.12968/indn.2019.5.28 · Cited by 2 · see citing works
Premenstrual Dysphoric Disorder and Peripartum Depression
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The Relationship Between Premenstrual Syndrome and Menstrual Attitude
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Mind over PMDD: A Glimpse into the Process of Pharmacotherapy-Psychotherapy Combination Treatment.
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Premenstrual Syndrome in Children with Type 1 Diabetes Mellitus
Machfudhoh, Y., Sari, S. Y. I., & Novina, N. (2020) · Pediatric Oncall · doi:10.7199/ped.oncall.2020.26 · Cited by 2 · see citing works
Considering the Role of the Menstrual Cycle on Increased Suicidality in Adolescent Females
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“Firstly, both CBT and dialectical behavioral therapy (DBT) techniques [22] are considered one of the most effective interventions for treating mood symptoms in youth.”
BackgroundHPA axis dysfunction in women with premenstrual syndrome: A meta-analysis based on cortisol levels
Zhang, T., Zhang, K., & Zhou, R. (2023) · Advances in Psychological Science · doi:10.3724/sp.j.1042.2023.00988 · Cited by 2 · see citing works
“…1 1 引言 女性月经周期会伴随相应的心理、躯体和植物性症状的周期性变化，这些症状会给女 性的身心健康带来严重伤害 (Halbreich et al., 2003)。具体症状包括：心理变化，如抑郁、 焦虑、情绪低落、注意力难以集中和感觉失控；身体变化，如痉挛、乳房疼痛、背部和关 节疼痛、胃肠道症状和痤疮；以及涉及睡眠和食欲的植物性症状 (Hartlage et al., 2012)。这 些症状达到一定严重程度时，会导致经前期综合征 (Premenstrual Syndrome, PMS; Yonkers et al., 2008)…”
Parveen, S., Kanthi, J. M., & Bhaskaran, R. (2024) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20241773 · Cited by 1 · see citing works
CONCEPT AND MANAGEMENT OF PREMENSTRUAL SYNDROME (MUTLAZIMA QABL HAIZ ) IN UNANI SYSTEM OF MEDICINE
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Psychotherapy Modalities for Premenstrual Change: A Systematic Review
Buys, M. E. (2025) · Women & Therapy · doi:10.1080/02703149.2025.2534636 · Cited by 1 · see citing works
“CBT is one of a myriad of other under-explored options potentially available, and despite the widespread use of the modality, suggestions for alternative or integrative psychotherapeutic options for PMC have been made (Lustyk et al., 2009).”
InfluentialManagement of Premenstrual Disorders
Nakulan, A. (2017) · DOAJ (DOAJ: Directory of Open Access Journals) · doi:10.30834/kjp.30.1.2017.64 · Cited by 1 · see citing works
Primary and Secondary Dysmenorrhea, Premenstrual Syndrome, and Premenstrual Dysphoric Disorder
Lentz, G. M. (2012) · Elsevier eBooks · doi:10.1016/b978-0-323-06986-1.00036-6 · Cited by 1 · see citing works
Diagnosis and Treatment of Premenstrual Syndrome
Anderson, Z. G. (2023) · Springer eBooks · doi:10.1007/978-3-031-14881-1_33 · Cited by 1 · see citing works
- Authors
- Lustyk, M. K. B., Gerrish, W. G., Shaver, S., & Keys, S. L.
- Affiliations
- Seattle Pacific University (US)
- Corresponding author
- Gerrish, Winslow G.
- Venue
- Archives of Women s Mental Health
- Published
- 2009-02-27
- Volume
- 12
- Issue
- 2
- Pages
- 85-96
- ISSN
- 1434-1816 (ISSN-L)
- 1435-1102
- OpenAlex
- W2076474294
- Cited by
- 133
- References
- 48
- Citations by year
- 2026: 11 · 2025: 9 · 2024: 11 · 2023: 8 · 2022: 6 · 2021: 9 · 2020: 9 · 2019: 10 · 2018: 6 · 2017: 10 · 2016: 5 · 2015: 9 · 2014: 5 · 2013: 9 · 2012: 5
- FWCI
- 0.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Archives of Women s Mental Health (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy, premenstrual syndrome, premenstrual dysphoric disorder, psychosocial interventions, mindfulness-based interventions, acceptance-based therapy, treatment efficacy, menstrual disorders, effect size
- MeSH terms
- Adult, Female, Humans, Premenstrual Syndrome, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome
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