Table 1.

Overview of study characteristics

Author(s)	Study participants	Sample size	Age (range/mean ± SD)	Research design	Measurement/instruments (Sleep)	Measurement/instruments (Menstrual disturbances)			Results	Quality Assessment
						PMS (including premenstrual dysphoria, premenstrual related negative affect symptoms, PMDD)	Dysmenorrhea	Menstrual cycle/bleeding during period
Abdel-Salam et al. [15]	Female university students	321	18–28y	Cross-sectional	Simple question asking whether having sleep disturbances as associated symptoms of dysmenorrhea	n/a	Simple question asking whether having lower abdominal pain connected with menstrual periods	n/a	43% of women with dysmenorrhea, experienced sleep disturbance as one of dysmenorrhea-related symptoms.	Low
Baker et al. [37]	∙ Women with primary dysmenorrhea ∙ Normal controls	∙ Total: 18 ∙ Primary dysmenorrhea: 10 ∙ Normal controls: 8	∙ Primary dysmenorrhea: 23.0 ± 5.0 ∙ Normal controls: 20.0 ± 1.0	Cross-sectional	∙ Sleep architecture (polysomnography) ∙ 100 mm VAS for sleep quality with anchor points of “worst possible” and “best ever”	n/a	Having painful uterine cramps, near and during menstruation without any menstrual-associated mood disturbances	n/a	∙ Women with primary dysmenorrhea had worse sleep quality than normal controls. ∙ Women with primary dysmenorrhea had decreased sleep efficiency than normal controls.	Moderate
Baker et al. [39]	∙ Women with severe PMS ∙ Normal controls	∙ Total: 21 ∙ Severe PMS: 9 ∙ Normal controls: 12	∙ Severe PMS: 28.0 ± 6.0 ∙ Controls: 31.0 ± 5.0	Cross-sectional	∙ Sleep architecture (polysomnography) ∙ PSD (subjective sleep quality)	∙ Penn DSR Form ≥ 80 or at least 50% of an increase in Penn DSR scores during premenstrual phase (Severe PMS)	n/a	n/a	∙ Women with severe PMS reported worse sleep quality than normal controls. ∙ Women with severe PMS had a decreased delta incidence, and increased theta incidence and amplitude in sleep architecture compared with normal controls.	High
Baker et al. [42]	∙ Women with severe PMS ∙ Women with minimal symptoms	∙ Total: 36 ∙ Severe PMS: 18 ∙ Minimal symptoms: 18	∙ Severe PMS: 30.5 ± 7.6 ∙ Minimal symptoms: 29.2 ± 7.3	Cross-sectional	∙ Sleep architecture (polysomnography) ∙ Modified version of the PSD (subjective sleep quality) ∙ 100 mm VAS for sleep quality with anchor points of “very bad” and “very good” ∙ 100 mm VAS for restless of sleep with anchor points of “very restless” and “not at all restless” ∙ 100 mm VAS for refreshing feeling on awakening with anchor points of “not at all refreshed” and “very refreshed” ∙ 100 mm VAS for morning alertness with anchor points of “not at all alert” and “extremely alert.”	∙ Penn DSR Form ≥ 80 or at least 50% of an increase in DSR scores during premenstrual phase (Severe PMS) ∙ Met the diagnostic criteria (DSM-IV) for PMDD	n/a	n/a	Women with severe PMS had more SWS and slow wave activity than those with minimal symptoms.	High
Çaltekin et al. [31]	∙ Women with primary dysmenorrhea ∙ Normal controls	∙ Total: 102 ∙ Primary dysmenorrhea: 55 ∙ Normal controls: 47	∙ Primary dysmenorrhea: 23.0 ± 5.0 ∙ Normal controls: 20.0 ± 1.0	Cross-sectional	∙ ESS (daytime sleepiness) ∙ ISI (insomnia severity) ∙ PSQI (subjective sleep quality) ∙ Berlin Questionnaire (obstructive sleep apnea) ∙ International Restless Legs Syndrome Study Group diagnostic criteria (restless leg syndrome)	n/a	∙ Having history of painful menstruation ∙ Severity of dysmenorrhea: VAS	n/a	∙ Women with primary dysmenorrhea experienced worse sleep quality, greater daytime sleepiness, and greater insomnia symptoms than normal controls. ∙ Among women with primary dysmenorrhea, poor sleep quality and daytime sleepiness were risk factors of insomnia. ∙ Severity of pain was significantly correlated with sleep quality, insomnia severity in women with primary dysmenorrhea.	High
Cheng et al. [43]	∙ PMS patients ∙ Normal controls	1,699	∙Total: 21.58 ± 4.00 ∙PMS patients: 21.67 ± 3.80 ∙Normal controls: 21.51 ± 4.13	Cross-sectional	PSQI ≥ 6 (subjective poor sleep quality)	∙ PMS: at least one of symptoms in the following instrument are noted 1-week before menstruation and subside within a few days after onset of menstruation and disappear after menstruation: ∙ Premenstrual Symptom Questionnaire	n/a	n/a	∙ Poor sleep quality was found in the 60.5% of the PMS patients with PMS, and 40.7% of normal controls. ∙ Poor sleep quality significantly increased the risk of PMS (OR = 1.89; 95% CI [1.51–2.36]).	High
Chuong et al. [36]	∙ PMS patients ∙ Normal controls	∙ Total: 9 ∙ PMS patients: 3 ∙ Normal controls: 6	∙ PMS patients: 32.0 ± 1.2 ∙ Normal controls: 30.5 ± 1.6	Cross-sectional	Sleep architecture (polysomnography)	Symptomatic: at least 30% of an increase in scores for one of the mood-related symptoms and one of the somatic symptoms of PMTS during premenstrual phase	n/a	n/a	There were no significant differences in sleep architecture between PMS patients and normal controls.	High
Conzatti et al. [53]	∙ PMS patients ∙ Normal controls	∙ Total: 121 ∙ PMS: 69 ∙ Normal controls: 52	24–38y	Cross-sectional	∙ ESS > 10 (excessive daytime sleepiness) ∙ PSQI > 5 (subjective poor sleep quality)	∙ PSST for the screening of PMS ∙ DRSP to confirm PMS diagnosis	n/a	n/a	∙ The risk of poor sleep quality was two times higher in women with PMS than normal controls (OR = 3.057; 95% CI 1.44–6.45). ∙ Women with PMS had greater scores in ESS than normal controls.	High
Erbil and Yucesoy [51]	Female university students	313	20.5 ± 1.7	Cross-sectional	PSQI > 5 (subjective poor sleep quality)	PMSS	n/a	n/a	∙ Poor sleep quality was associated with multiple symptoms of PMS including depressive feelings, irritability, appetite changes, and sleep changes ∙ Among multiple PMS symptoms, sleep changes were the strongest predictor of poor sleep quality, followed by depressive thoughts, depressive mood, bloating. ∙ Greater PMSS scores was associated with poor sleep quality.	High
Jang et al. [55]	Female undergraduate nursing school students	304	19 − 21y 20.6 ± 1.7	Cross-sectional	∙ Sleep duration ∙ PSQI (subjective poor sleep quality)	S-PAF	n/a	n/a	∙ Sleep quality was positively correlated with PMS symptoms. ∙ The correlation between sleep duration and PMS symptoms was not significant.	High
Kamel et al. [32]	Women in the reproductive age	688	25.6 ± 7.7	Cross-sectional	PSQI > 5 (subjective poor sleep quality)	PSS ≥ 80 points or above	n/a	n/a	∙ Poor sleep quality increased the severity of PMS. ∙ 92.3% of women with PMS experienced poor sleep quality, whereas only 7.6% of woman without PMS experienced poor sleep.	High
Kang et al. [11]	Newly employed female nurses working shifts who had the menstrual cycle regularity at baseline	287	Approximately 24	Prospective longitudinal	ISI > 7 (having insomnia)	n/a	n/a	Simple question for menstrual cycle (Yes/No): “Has your menstruation cycle period ever been shorter than 21 days or longer than 35 days, at least once during the last 6 months?” (Menstrual cycle < 21 days or > 35 days: menstrual cycle irregularity)	∙ The incidence of menstrual cycle irregularity in women with insomnia at baseline was 2-times greater than those without insomnia at baseline (OR = 2.05, 95% CI [1.12–3.77]). ∙ The prevalence of menstrual cycle irregularity in women with insomnia at baseline was 3-times greater than those without insomnia at baseline (OR = 3.05, 95% CI [1.81 − 5.13]).	High
Kennedy et al. [10]	Women who had experienced menstrual cycle within the last 12 months	579	22–60y 32.4 ± 5.6	Cross-sectional	∙ ESS (daytime sleepiness) ∙ ISI (insomnia severity) ∙ PSQI (subjective sleep quality) ∙ Sleep duration (≤ 6 h; 6–8 h; ≥ 9 h)	n/a	n/a	∙ Simple question for menstrual cycle: “How regular is your period?” (very regular; mostly regular; fairly regular; not regular) ∙ Simple question for amount of bleeding during menstruation: “How much bleeding do you usually experience during your period?” (very heavy; heavy; medium; light; very light)	∙ Compared to the students who slept between 6 to 8 h, ≤ 6 h was associated with heavier bleeding (OR 1.46, p = 0.026), and greater cycle irregularity (OR 1.44, p = 0.031). ∙ Worse sleep quality was associated with greater cycle irregularity (OR 1.05, p = 0.022). ∙ Long sleep duration insomnia severity, and daytime sleepiness were not associated with menstrual regularity and amount of bleeding during menstruation.	Moderate
Khazaie et al. [48]	∙ PMDD patients ∙ Normal controls	262	∙ PMDD: 23.4 ± 4.1 ∙ Normal controls: 23.7 ± 4.7	Cross-sectional	PSQI > 5 (subjective poor sleep quality)	Affirmative response on PSST questions for PMDD following the diagnostic criteria (DSM-IV-TR)	n/a	n/a	Women with PMDD experienced greater level of poor sleep quality than normal controls.	High
Kim et al. [49]	∙ Women with menstrual cycle irregularity ∙ Women without menstrual cycle irregularity	4,445	∙ Menstrual cycle irregularity: 32.3 ± 0.5 ∙ Without menstrual cycle irregularity: 34.9 ± 0.2	Cross-sectional	Simple question for sleep duration: “How many hours do you sleep on average?” (≤ 5 h; 6–7 h; ≥ 8 h)	n/a	n/a	∙ Simple question for menstrual cycle (Yes/No): “Is your menstrual cycle currently regular?“ ∙ Severe menstrual irregularity indicates the interval between menstruations of greater than 3 months	Short sleep duration (≤ 5 h) increases the risk of having severe menstrual cycle irregularity as two times higher than regular sleep duration (6–8 h; OR = 2.67, 95%CI [1.35–5.27]).	Moderate
Lee et al. [35]	Healthy and presumably ovulating women	13	25–35y	Cross-sectional	Sleep architecture (polysomnography)	Symptomatic: at least 30% of an increase in score of following instruments during premenstrual phase: ∙ Profile of Mood States ∙ Modified Woods Women’s Health Diary	n/a	n/a	Women with premenstrual related negative affect symptoms reported significantly less delta sleep than those without premenstrual related negative affect symptoms.	Moderate
Lim et al. [47]	Female healthcare workers, healthy referral patients	231	21–45y 31.6 ± 5.6	Cross-sectional	Sleep duration (< 6 h; ≥ 6 h)	n/a	n/a	∙ Short menstrual cycle: <25 days ∙ Normal menstrual cycle: 25–34 days ∙ Long menstrual cycle: 35 days	Women reporting fewer than 6 h of sleep were more likely to report abnormal (short or long) menstrual cycle lengths (OR = 2.1; 95% CI [1.1 to 4.2]).	Moderate
Lin et al. [52]	∙ PMDD patients ∙ Normal controls	∙ Total: 196 ∙ PMDD: 100 ∙ Normal controls: 96	∙ PMDD: 24.8 ± 3.3 ∙ Normal controls: 24.8 ± 3.4	Cross-sectional	PIRS > 20 (having insomnia)	PMDD: Affirmative response on PSST questions for PMDD following the diagnostic criteria (DSM-IV-TR) + at least 30% of an increase in scores for PMDDSQ during premenstrual phase	n/a	n/a	∙ Women with PMDD had a higher incidence of insomnia than normal controls. ∙ The exacerbation of insomnia in women with PMDD was greater in the premenstrual phases than in control groups ∙ PMDD severity was positively associated with insomnia severity in women with PMDD.	High
Maher et al. [54]	Women in the reproductive age	1,335	29–38y 34	Cross-sectional	PSQI ≥ 5 (subjective poor sleep quality)	n/a	n/a	Unknown	∙ Sleep quality was associated with the change of overall menstrual cycle (OR 1.11, 95% CI 1.048–1.178), and the increase of missed periods during pandemic (OR 1.11, 95% CI 1.029–1.189). ∙ Worse sleep quality was associated with the number of painful periods during pandemic (OR 1.07, 95% CI 1.005–1.130).	Moderate
Matsumoto et al. [56]	Female college student	22	20.5 ± 1.1	Cross-sectional	Sleep duration (< 6 h; ≥ 6 h	Moos MDQ	n/a	n/a	< 6 h of sleep at night is associated with worse PMS symptoms.	High
Mauri et al. [34]	∙ PMS patients ∙ Controls with a significant premenstrual disturbance ∙ Controls without premenstrual disturbance	∙ Total: 40 ∙ PMS patients: 14 ∙ Controls with disturbance: 15 ∙ Controls without disturbance: 11	∙ PMS patients: 35.4 ± 6.5 ∙ Controls with disturbance: 34.2 ± 4.8 ∙ Controls without disturbance: 32.2 ± 8.2	Cross-sectional	PSI (subjective sleep quality, difficulty initiating and/or maintaining sleep, early morning awakenings)	∙ PMS: Seeking medical help d/t severe PMS from PMS clinic ∙ Premenstrual Tension Syndrome Self Rating Scale ≥ 14 (Significant premenstrual disturbance)	n/a	n/a	∙ PMS patients experienced more frequent awakening during sleep and took more time to go back to sleep after an awakening than control groups with/without disturbance. ∙ PMS patients failed to wake up at the expected time and more tired than control groups with/without disturbance in the morning.	High
Mishra et al. [46]	∙ PMDD patients ∙ Normal controls	179	∙ Total: 22.9 ± 2.9 ∙ PMDD: 24.49 ± 2.34 ∙ Normal controls: 21.98 ± 2.85	Cross-sectional	Sleep duration (total number of hours of sleep obtained per 24 h)	Affirmative response on SSQ questions for PMDD following the diagnostic criteria (DMV-IV-TR)	n/a	n/a	∙ Women who had PMDD had significantly shorter sleep duration.	Moderate
Molugulu et al. [59]	Female college student	110	≥ 18y	Cross-sectional	Simple question asking whether having sleep problems	∙ PMS: at least one of somatic/affective/psychological symptoms in the following instrument during premenstrual phase with regular monthly menses: ∙ PMDD: Psychological symptoms following instrument rated as severe and others rated as moderate to severe in addition with at least one somatic symptom rated as severe to moderate: ∙ Pre-Menstrual Severity Screening Tool	n/a	n/a	∙ 57% of women who diagnosed with PMS had sleeping problems. ∙ PMS severity was associated with sleep problems.	Low
Momma et al. [22]	Women with no history of a previous pregnancy and/or childbirth	∙ Athletes: 605 ∙ Non-athletes: 295	19–20y ∙ Athletes: 20.0 ∙ Non-athletes: 20.0	Cross-sectional	Sleep duration	n/a	Dysmenorrhea severity: “none = 0 to heavy pain = 10” (none/mild = 0 to 3; moderate = 4 to 6; severe = 7 to 10)	n/a	Sleep duration was not associated with dysmenorrhea severity in both athletes and non-athletes.	Moderate
Nicolau et al. [50]	∙ PMS patients ∙ Normal controls	230	∙ PMS: 36.1 ± 0.6 ∙ Normal controls: 37.6 ± 1.0	Cross-sectional	∙ PSQI (subjective sleep quality) ∙ ESS (daytime sleepiness) ∙ ISI (insomnia severity) ∙ General sleep questionnaire ∙ Sleep architecture (polysomnography)	Simple question for PMS (Yes/No): “Do you have PMS?”	n/a	n/a	∙ PMS patients experienced poorer sleep quality, a higher perception of unrefreshing sleep, a higher total sleep time, and having threshold insomnia than normal controls ∙ PMS patients has longer sleep duration than those without PMS. ∙ Longer sleep duration and having subthreshold insomnia were associated with PMS. ∙ Daytime sleepiness, sleep latency, time after sleep onset, and sleep efficiency were not associated with PMS.	High
Ozisik Karaman et al. [58]	Medical academy female students	178	No information	Cross-sectional	PSQI > 5 (subjective poor sleep quality)	PSS ≥ 102 points or above	n/a	n/a	Poor sleep quality was found in the 75.6% of the women with PMS, and 58.8% of the women without PMS (p < 0.05).	Low
Prabhavathi et al. [13]	Female nursing school students	100	No information	Cross-sectional	∙ PSQI (subjective sleep quality) ∙ ISI (insomnia severity)	Modified Moos MDQ (Mild vs. Moderate)	n/a	n/a	∙ Women with moderate severity of PMS experienced worse sleep quality than those with mild severity of PMS	Moderate
Prabhavathi et al. [57]	Female nursing school students	60	18–20y	Cross-sectional	∙ PSQI (subjective sleep quality) ∙ ISI (insomnia severity)	Modified Moos MDQ (No vs. Mild vs. Moderate)	n/a	n/a	Women with moderate severity of PMS experienced worse sleep quality and had greater insomnia severity than those with mild severity of PMS or without PMS	Moderate
Shao et al. [40]	Female Shift-work nurses	435	29.50 ± 5.43	Cross-sectional	PSQI (subjective sleep quality)	Having premenstrual dysphoria (Yes/No)	Having pain during period (Yes/No)	n/a	∙ Women with premenstrual dysphoria had worse sleep quality than those without. ∙ Women with pain during period had worse sleep quality than those without.	Moderate
Shechter et al. [41]	∙ PMDD patients who indicated insomnia during premenstrual phase ∙ Normal controls	∙ Total: 12 ∙ PMDD patients: 7 ∙ Normal controls: 5	∙ PMDD patients: 32.0 ± 5.72 ∙ Normal controls: 30.4 ± 8.20	Cross-sectional	Sleep architecture (polysomnography)	∙ PMDD: at least 200% of an increase in score of one symptom or at least 100% of an increase in scores of two or more symptoms during premenstrual phase in following instruments: ∙ 100-mm VAS for depressed mood, tension, affective liability, irritability	n/a	Simple question for menstrual cycle length	∙ SWS was significantly increased in PMDD patients than normal controls. ∙ Menstrual cycle length did not differ between PMDD patients and normal controls.	High
Strine et al. [38]	Noninstitutionalized U.S women	11,648	18–55y	Cross-sectional	∙ Simple question for insomnia (Yes/No): “Have you regularly had insomnia or trouble sleeping?” ∙ Simple question for daytime sleepiness (Yes/No): “Have you had excessive sleepiness during the day?”	Simple question for premenstrual syndrome/bothersome cramping/heavy bleeding (Yes/No): “During the past 12 months, have you had any menstrual problems, such as heavy bleeding, bothersome cramping, or premenstrual syndrome (also called PMS)?”			Women with menstrual-related problems were significantly more likely to report frequent insomnia, excessive sleepiness than those without menstrual-related problems over the past 12 months.	Moderate
Unver et al. [33]	Female university students	353	18–31y 21.1 ± 1.8	Cross-sectional	∙ Questionnaire asking sleep latency, frequency of awakening after falling asleep, sleep duration, sleep quality, feeling rested in the morning of the last three days. ∙ ISI ≥ 10 (having insomnia)	n/a	Pain in the waist, inguinal, or abdominal regions which starts in the first six to 12 h of menstruation and lasts for eight to 72 h	n/a	∙ Women with dysmenorrhea experienced greater insomnia symptoms, shorter sleep duration, worse sleep quality and greater feeling of unrested in the morning than those without. ∙ Women with severe dysmenorrhea experienced higher frequency of awakening after falling asleep, worse sleep quality and greater feeling of unrested in the morning than those mild or moderate dysmenorrhea.	Moderate
Woosley and Lichstein [44]	Undergraduate female students	89	18–24y 18.63 ± 0.93	Cross-sectional	∙ PSQI > 5 (subjective poor sleep quality) ∙ ISI (insomnia severity, ≥ 7 indicates having clinical insomnia) ∙ Diagnostic criteria of insomnia following ICSD-II ∙ CSD (sleep latency, wake time after sleep onset, number of awakenings, total sleep time, and sleep efficiency)	n/a	Brief Pain Inventory	n/a	∙ Women with insomnia had worse dysmenorrhea and experienced more interference with daily activities due to dysmenorrhea than those without insomnia. ∙ Insomnia severity was directly associated with dysmenorrhea severity ∙ Insomnia severity and sleep quality was associated with greater interference with daily activities due to dysmenorrhea. ∙ Women with severe dysmenorrhea had longer sleep latency and lower sleep efficiency than those with mild dysmenorrhea. ∙ Women with mild dysmenorrhea had better sleep quality than those with moderate or severe dysmenorrhea.	High
Yasir et al. [45]	Female medical students	356	18–25y 21.01 ± 1.54	Cross-sectional	Simple question asking whether having sleep disturbances as associated symptoms of dysmenorrhea	n/a	Simple question asking whether having dysmenorrhea	n/a	64% of women with dysmenorrhea were affected by sleep disturbance.	Low
Zeru et al. [21]	Female undergraduate students	620	18–26y 20.6 ± 1.4	Cross-sectional	Sleep duration (≤ 5 h; 6–7 h; ≥ 8 h)	n/a	n/a	Outside the regular menstrual cycle limit as follow: ∙ Frequency of menstruation: 24–38 days, ∙ Duration of bleeding ≤ 8 days ∙ Cycle to cycle variation over the last one year < 10 days ∙ The individual perception on the amount is normal	Compared to the students who slept ≥ 8 h, ≤ 5 sleep hours increased 5 times risk of having menstrual irregularity (AOR = 5.4, 95% CI [2.98–9.98]), and 6–7 sleep hours increased 1.9 times risk of having menstrual irregularity (AOR = 1.9. 95% CI [1.29 − 2.91]).	Moderate

Note. Abbreviations: SD = Standard deviation, PMS = Premenstrual syndrome, PMDD = Premenstrual dysphoric disorder, n/a = Not applicable, VAS = Visual analog scale, PSD = Pittsburgh Sleep Diary, DSR = Daily Symptom Rating, DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, fourth edition, SWS = Slow wave sleep, ESS = Epworth Sleepiness Scale, ISI = Insomnia Severity Index, PSQI = Pittsburgh Sleep Quality Index, OR = Odds ratio, CI = Confidence interval, PMTS = Premenstrual Tension Observer Rating Scale, PSST = Premenstrual Symptoms Screen Tool, DRSP = Daily Record of Severity of Problems, PMSS = Premenstrual Syndrome Scale, S-PAF = Shortened Premenstrual Assessment Form, PSS = Premenstrual Syndrome Scale, DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision, PIRS = Pittsburgh Insomnia Rating Scale, PMDDSQ = Premenstrual Dysphoric Disorder Severity Questionnaire, MDQ = Menstrual Distress Questionnaire, PSI = Post-Sleep Inventory, SSQ = Self-screening Quiz, ICSD-II = International Classification of Sleep Disorders, second edition, CSD = Consensus Sleep Diary, AOR = Adjusted odds ratio