Premenstrual symptoms and academic difficulties: an association, not proven causation

What the researchers examined

The review brings together studies published between January 2014 and December 2024 on premenstrual syndrome and premenstrual dysphoric disorder among female medical and health sciences students. Of 317 references identified, 11 studies were included. The total number of participants is not specified in the available abstract.

The studies examine the prevalence of these conditions and their links with academic outcomes, psychological health and well-being. Their cross-sectional design provides a snapshot of the observed associations, without tracking how they change over time.

Reported difficulties, without an established causal effect

Premenstrual symptoms were associated with impaired concentration, greater absenteeism, lower class participation, perceived poorer academic performance and poorer psychological well-being. However, perceived performance should not be confused with an objectively measured decline in grades.

The abstract provides no overall effect size to quantify the strength of these associations. It therefore cannot tell us to what extent symptoms change academic outcomes, or which students are most affected.

Academic stress, severe menstrual pain, family history, irregular or shorter cycles and low physical activity were among the associated factors. These observations do not demonstrate that addressing any one of these factors would reduce symptoms.

Prevalence estimates to interpret with caution

The proportion of students with premenstrual syndrome ranged from 37.0% to 86.2% across studies. For probable premenstrual dysphoric disorder, estimates ranged from 13.8% to 66.9%. These wide variations come alongside heterogeneous diagnostic criteria and outcome measures.

Crucially, all estimates of premenstrual dysphoric disorder were based on screening questionnaires, without prospective diagnostic confirmation. A positive screening result is not the same as a confirmed diagnosis: these figures therefore do not describe the prevalence of formally diagnosed disorders.

What this review changes

The authors suggest that universities consider providing menstrual health information, access to healthcare and psychological support, and proportionate academic or social support. However, the review does not test the effectiveness of these measures.

The useful finding is the recognition of an association between premenstrual symptoms, study difficulties and well-being, without turning that association into a single explanation. These data from female health sciences students also cannot automatically be generalized to all female students.

What we can take away

Premenstrual symptoms are associated with academic and psychological difficulties among female health sciences students. This review demonstrates neither causation nor the effectiveness of any intervention.