Premenstrual Dysphoric Disorder and Sleep Quality: A Systematic Review

Objective To synthesise existing evidence on the association between premenstrual dysphoric disorder (PMDD) and sleep quality, and to examine how sleep disturbance relates to mood, cognition and daily functioning across the menstrual cycle. Methods This review followed PRISMA 2020 guidelines. OVID MEDLINE, Embase and the Cochrane Library were searched for English‐language studies published between January 2013 and December 2024. Eligible studies examined sleep in menstruating individuals with PMDD diagnosed by DSM criteria, prospective symptom charting, validated screening instruments or clinician assessment. Two reviewers independently screened records and resolved disagreements by consensus. Methodological quality was appraised using the Mixed Methods Appraisal Tool. Results Six studies published between 2015 and 2022, comprising 1081 participants across Taiwan, India and Canada met inclusion criteria. Poor sleep quality was consistently associated with greater PMDD symptom severity, co‐occurring with fatigue, insomnia, impaired emotional regulation and reduced executive functioning, particularly in the late luteal phase. Lifestyle factors and comorbid bipolar disorder were also associated with symptom expression. All studies were rated negatively for participant representativeness, and most used self‐reported sleep measures and observational designs, precluding conclusions regarding directionality. Conclusion Sleep disturbance is consistently associated with PMDD symptom burden and may warrant routine clinical assessment. Sleep‐targeted interventions represent a plausible adjunct to management, but higher‐quality longitudinal and interventional studies are required.