Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in India: A systematic review and meta-analysis

Background: The burden and impact of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is not well characterised among Indian population. Therefore, we conducted this systematic review and meta-analysis to estimate the prevalence of PMS and PMDD among females of reproductive age group living in India. Methods: We searched PubMed, Cochrane Library, Scopus and IndMed for studies reporting the prevalence of PMS and/ or PMDD from any part of India, published from 2000 up to Aug 2020. We performed random-effects meta-analyses evaluated using I2 statistic, subgroup analyses, sensitivity analyses and assessed study quality. Estimated prevalence along with 95% confidence intervals (CIs) were reported for each outcome of interest. The quality of each study was evaluated using modified Newcastle Ottawa Scale (NOS). This review was conducted following the standard of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. The protocol was registered prospectively in PROSPERO (CRD42020199787). Results: Our search identified 524 citations in total, of which 25 studies (22 reported PMS, and 11 reported PMDD) with 8542 participants were finally included. The pooled prevalence of PMS and PMDD were 43% (95% CI: 0.35-0.50) and 8% (95% CI: 0.60-0.10) respectively. The estimated prevalence of PMS in adolescence was higher and account to be 49.6% (95% CI: 0.40-0.59). The heterogeneity for all the estimates was very high and could be explained through several factors involved within and between studies. Conclusion: This study identified a substantially high prevalence of PMS and PMDD in India. To identify potentially related factors, more focused epidemiological research is warranted. However, noticing the fact of significant prevalence and its potential impact on the population, stakeholders and policymakers need to address this problem at the community and individual level.