The prevalence of traumatic exposure in women with premenstrual dysphoric disorder (PMDD): a systematic review

Background and purpose: Premenstrual dysphoric disorder (PMDD) is a debilitating illness that affects 3-8% of women worldwide. There are multiple factors underlying the aetiology of PMDD, ranging from neuroendocrine changes to psychosocial factors such as exposure to trauma. This systematic review aims to assess the prevalence of traumatic exposure in women with PMDD.

Methods: A literature search of MEDLINE, EMBASE and PsycInfo was conducted following PRISMA guidelines. Of the 369 studies identified for abstract and full-text screening, 27 were included for review and 16 studies for the quantitative calculation of average prevalence and 95% confidence intervals. Data extracted included study details, sampling details, demographic details, type of traumatic exposure reported, diagnostic tools used, the prevalence of PMDD (total) and the prevalence of self-reported traumatic exposure in PMDD patients.

Results: The reported prevalence of traumatic exposure in PMDD ranged from 18.03 to 90.5%. Using a random effects model, the pooled prevalence was 61% (95%CI, 46-74%). The level of heterogeneity (I²) was 95%, showing considerable variability in the data. Amongst only those studies with a control group, it was shown that those with PMDD are 1.99 times more likely to have a history of traumatic exposure than those without PMDD.

Conclusion: Our findings suggest that a history of traumatic exposure is highly represented in women living with PMDD. Trauma exposure may be a risk factor for PMDD and could inform this condition's aetiology. A trauma-informed approach should be considered when assessing and managing women presenting with PMDD.