A large-scale analysis of global health data from 1990 to 2021 sheds light on the burden of premenstrual syndrome and 12 other gynecological conditions in women aged 15 to 49. Among the key findings relevant to premenstrual disorders: PMS was the single most prevalent gynecological condition studied, with roughly 890 million cases worldwide in 2021 — accounting for about 41% of all combined gynecological disease prevalence. It was also the second leading cause of disability among these conditions, behind only HIV/AIDS.
Importantly, this study examined PMS as defined by the Global Burden of Disease database, which does not separately track PMDD. So while the numbers here capture a broad category of premenstrual conditions, they underscore just how widespread premenstrual suffering is on a global scale. The study found a slight but consistent upward trend in PMS burden over the 32-year period. PMS-related disability was highest among women aged 35 to 39, though incidence was also notable in adolescents, which the authors linked to hormonal sensitivity during that developmental stage.
The study also found that the overall burden of gynecological diseases was significantly higher in lower-income countries and that younger women (ages 15 to 24) showed the steepest increases in disease burden over time. Risk factors mentioned for PMS included stress, obesity, smoking, high sugar intake, and hereditary factors, though detailed risk factor analysis was limited by the available data.
While this research does not focus on PMDD specifically, it provides important context about how common and impactful premenstrual conditions are worldwide, and it highlights the need for greater attention and resources directed at menstrual health across all age groups and income levels.
Key findings
- From 1990 to 2021, the global age-standardized DALYs rate (ASDR) and mortality rate (ASMR) of combined gynecological diseases in women aged 15-49 increased by AAPC of 0.28% (95% CI 0.19-0.36) and 0.53% (95% CI 0.25-0.82), respectively.
- In 2021, PMS accounted for approximately 41% of all combined gynecological disease prevalence (889.97 million prevalent cases) and was the second leading cause of DALYs (7.43 million) after HIV/AIDS (16.38 million).
- HIV/AIDS, PCOS (AAPC=0.79%), female infertility (AAPC=0.68%), and PMS (AAPC=0.04%) were the key drivers behind the increased ASDR of combined gynecological diseases.
- Women aged 15-24 years showed the most significant rise in combined gynecological disease burdens, with the 15-19 age group showing the highest increase in DALYs rate (AAPC=0.52%) and death rate (AAPC=1.2%).
- Combined gynecological disease burdens were negatively correlated with Socio-demographic Index (SDI), with low SDI countries having the highest ASDR (4309.35/100,000) versus high SDI countries (1304.84/100,000).
- Projections to 2031 showed ASDR and ASMR declining by 11.06% and 25.23% respectively, while incidence and prevalence rates were projected to rise by 1.39% and 2.75%, likely due to improved screening.
Methods, briefly
Population-level analysis using Global Burden of Disease (GBD) 2021 data for 204 countries from 1990 to 2021. Analyzed DALYs, deaths, incidence, and prevalence for 13 gynecological conditions in women aged 15-49 years across 7 age subgroups. Age-standardized rates were calculated using direct standardization. Temporal trends assessed using Joinpoint regression (APC/AAPC). Projections to 2031 used Bayesian age-period-cohort (BAPC) model with Nordpred model for sensitivity analysis. Pearson correlation assessed association between disease burden and Socio-demographic Index (SDI).
Limitations to keep in mind
- Relies solely on GBD 2021 data, which may have underreporting biases especially in low-income countries where data collection is challenging.
- The 13 conditions analyzed may not be exhaustive — some gynecological conditions like menstruation-related issues could not be estimated in GBD, potentially underestimating the total burden.
- Diagnosis of certain gynecological diseases relies on subjective clinical judgment, which may introduce diagnostic biases across regions.
- Limited attributable risk factor data available in GBD 2021 for gynecological diseases, preventing comprehensive risk factor analysis.
- PMS is studied rather than PMDD specifically — GBD does not separately estimate PMDD burden.
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