Menstrual cycle disorders and related symptoms are common among female athletes, and this large systematic review looked at how often various conditions — including PMDD — occur in this population. The review analyzed 60 studies covering 6,380 athletes across many sports and competition levels.
For PMDD specifically, prevalence ranged from about 1% to 13% depending on the study and how it was measured. Studies that used the gold-standard method of tracking symptoms daily for at least two menstrual cycles found higher rates than those relying on one-time questionnaires. PMS was more common, ranging from about 9% to 60%. These figures are broadly similar to what is seen in non-athlete populations, suggesting that being an athlete does not necessarily protect against premenstrual disorders. The most frequently reported premenstrual symptoms among athletes included food cravings, anger and irritability, anxiety, difficulty concentrating, and mood changes.
One important finding is that many athletes reported worse symptoms during the first few days of their period rather than just before it. Affective (mood-related) symptoms were generally more common than physical symptoms. Dysmenorrhea — painful periods — was the single most common menstrual disorder, affecting roughly one in three athletes surveyed.
The review also found that research quality in this area needs improvement. Most studies used retrospective questionnaires rather than prospective daily tracking, and definitions of disorders varied widely, making it harder to compare results. The authors recommend that athletes and their support teams track menstrual cycles prospectively — including symptoms throughout the entire cycle — and that standardized diagnostic criteria like those in the DSM-5 be used when screening for PMDD. This kind of monitoring could help identify problems earlier and lead to better support.
Key findings
- Dysmenorrhea was the most prevalent menstrual cycle disorder among female athletes with a mean pooled prevalence of 32.3% (range 7.8%–85.6%)
- PMDD prevalence in female athletes ranged from 1.3% to 13.3% across 5 studies involving 888 athletes, consistent with general population estimates of 2%–10%
- PMS prevalence ranged from 8.6% to 59.6% across 7 studies involving 1,075 athletes, with higher prevalence (48.9%–59.6%) when gold-standard prospective charting was used
- Affective symptoms (e.g., anger/irritability at 49.2%, anxiety/tension at 45.9%) were more prevalent than physical symptoms during premenstrual and menstruation phases
- 90% of studies assessed menstrual cycle disorders retrospectively using self-report methods, and 76.7% of the 60 included studies were rated as moderate methodological quality with none rated as high quality
- An upward trend in prevalence of oligomenorrhea and amenorrhea was observed from trained/developmental athletes to elite/international level athletes
Methods, briefly
Systematic review following PRISMA guidelines, registered in PROSPERO (CRD42021268757). Six databases searched from inception to September 2022. N=60 studies involving 6,380 female athletes of reproductive age (13–39 years) not using hormonal contraceptives. 48 studies included in quantitative synthesis; 12 included only in qualitative synthesis due to differing definitions. Prevalence data were pooled for disorders with consistent definitions (amenorrhea, oligomenorrhea, dysmenorrhea) and narratively reported for disorders with varying diagnostic criteria (HMB, PMS, PMDD). Methodological quality assessed using modified Downs and Black checklist. Subgroup analyses by age group, sport classification, and athletic calibre.
Limitations to keep in mind
- Substantial methodological heterogeneity between studies precluded meta-analysis; definitions and assessment methods varied widely
- 90% of included studies relied on retrospective self-report methods, introducing recall bias
- No studies achieved a high methodological quality rating
- Exclusion of hormonal contraceptive users may have led to underrepresentation of athletes with menstrual cycle disorders, since HCs are sometimes used to manage these conditions
- Small number of studies within each disorder and subgroup limited the ability to make meaningful comparisons across sports, age groups, and athletic calibres
- Cultural factors affecting reporting of menstrual disorders and societal normalisation of menstrual pain may have led to underreporting
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