Do women with PMS or PMDD report lower quality of life than women without these conditions?

Importance: Premenstrual disorders (PMDs), including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), are associated with significant physical and psychological burdens. However, their associations with quality of life (QOL) remain insufficiently studied, particularly with limited consideration of comorbidities and potential confounders. Objective: To assess the QOL among women with PMDs compared with women without PMDs in Sweden. Design, setting, and participants: This cross-sectional study included participants from the LifeGene cohort, a population-based longitudinal study with linkage to national health care registers. Participants were women aged 15 to 60 years. Data were collected from October 2009 to May 2018 and analyzed from June 2024 to January 2025. Exposures: PMDs were ascertained using a modified Premenstrual Symptoms Screening Tool, supplemented by diagnoses recorded in Swedish health care registers. Main outcomes and measures: QOL was assessed using the EuroQol 5-Dimensions 3-Levels scale including 5 dimensions: mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. The primary outcome was the total QOL score, with additional analyses excluding the anxiety or depression and pain or discomfort dimensions. Associations between PMDs and total QOL score were evaluated using linear regression models, adjusting for age, socioeconomic status, and potential confounders. Analyses were further stratified by the history of comorbidities. PMS, PMDD, and each QOL dimension were also examined separately. Results: In this study of 17 284 women, at a mean (SD) age of 32.4 (8.1) years, 1813 women (10.5%) met the criteria for PMDs. Women with PMDs had significantly lower QOL compared with those without PMDs (mean z score difference: 0.21; 95% CI, 0.17-0.26). This association persisted in the prospective analysis (mean z score difference: 0.34; 95% CI, 0.24-0.45) or after excluding the anxiety or depression and pain or discomfort dimension. PMDD appeared to have a stronger association with reduced QOL than PMS. In the analysis of individual QOL dimensions, PMDs were strongly associated with endorsing anxiety or depression (PR, 1.31; 95% CI, 1.25-1.37) and pain or discomfort (PR, 1.14; 95% CI, 1.08-1.21). Conclusions and relevance: In this cross-sectional study of women in Sweden, PMDs, particularly PMDD, were significantly associated with reduced QOL, independent of potential confounders and comorbidities. These findings highlighted the need for both health care and social support to better manage the disease and improve the overall QOL of affected women.

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