Cognition and behaviour across the menstrual cycle in individuals with Premenstrual Dysphoric Disorder – a systematic review

Background: Premenstrual Dysphoric Disorder (PMDD) is a cyclical mood disorder whereby symptoms are triggered by normal hormonal changes during the menstrual cycle. A better understanding of psychological changes that occur with PMDD can inform non-pharmacological and non-invasive treatment interventions.

Methods: A systematic review was conducted of quantitative studies that measured any aspect of cognition or behaviour at a minimum of two time points in the menstrual cycle in those with and without PMDD. A narrative synthesis is reported.

Results: 94 outcome measures were extracted from 21 papers and a total participant sample of 1222. Risk of bias was noted in relation to lack of power analysis and inappropriate statistical methods. Cognitive performance was most often tested but evidence of change with PMDD was limited and inconsistent. Findings of studies exploring cognitive processes and content suggest that a negative attentional bias is central to the psychological experience of PMDD.

Limitations: A quantitative synthesis could not be conducted due to limited reporting of key data.

Conclusions: Cognitive process, content, and behaviour are likely to be more informative in understanding PMDD than absolute cognitive abilities. Future studies should aim to investigate such in real-time and within the context of daily living.