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. 2025 Oct 3;104(40):e45001. doi: 10.1097/MD.0000000000045001

A global perspective: Trends and insights in premenstrual disorder comorbidity research by bibliometric analysis (1999–2023)

Xunshu Cheng a, Huihao Li b, Mingzhou Gao c, Xiaoying Liu a, Peijuan Wu a, Xingping Ni d,*
PMCID: PMC12499713  PMID: 41054104

Abstract

Background:

Premenstrual disorders represent a constellation of incapacitating gynecological disorders with numerous coexisting conditions. The identification and comprehension of disease-related comorbidities are of paramount importance in the medical field. This study aims to systematically review existing research and identify potential focus areas through bibliometric analysis.

Methods:

One hundred forty-nine publications on comorbidity in psychotic mood disorders between 1999 and 2023 were retrieved from the Web of Science Core Collection. The data was analyzed using bibliometric tools such as CiteSpace 6.1.R2 and VOSviewer. Specifically, the study examined the annual publication count, contributions by country and institution and details on journals, authors, citation counts, and keywords.

Results:

The data were retrieved on August 3, 2023. The annual number of publications showed an upward trend from 1999 to 2023. Globally, the US and Canada presented the highest publication counts and served as core research regions. Meanwhile, McMaster University and Harward University exhibited the highest output and influence by institution. In terms of author, Frey BN (McMaster University, Canada) was the most prolific with leading academic influence, while Lieb R (University of Basel, Switzerland) and Wittchen HU (Technical University Dresden, Germany) were the most cited authors. The American Journal of Psychiatry (impact factor = 17.7, 2023) was the most frequently cited journal. Furthermore, significant overlapping between premenstrual syndrome and premenstrual dysphoric disorder warrants further investigation, and the intrinsic connection between premenstrual dysphoric disorder and bipolar disorder is a rising focus. Temporally, research shifted from prevalence surveys to diagnostic and mechanistic studies.

Conclusions:

This bibliometric study comprehensively analyzes the current state of research on physical and mental health comorbidities. North America became a prominent leader in contributions from countries, institutions, authors, and journals. Additionally, the study underscores the potential for further exploration of comorbidity between physiological and psychiatric conditions, suggesting a promising avenue for future research efforts.

Keywords: bibliometric analysis, bipolar disorder, citespace, comorbidity

1. Introduction

Premenstrual disorders (PMDs) serve as a group of severe mood and behavioral disorders affecting women’s health worldwide. Mainly, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are the primary manifestations, complicated with numerous physiological, mental, and behavioral distress related to the menstrual cycle.[1,2] Among PMDs, PMDD, as a severe form of PMS, was initially categorized as “depressive disorders not otherwise specified” in Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and has since been reclassified as a distinct diagnostic entity under the “Depressive Disorders” category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).[3,4] It was also included as a part of gynecological diagnosis in the World Health Organization’s International Classification of Diseases, 11th Revision since 2019.[5] Epidemiological surveys show global variations in PMD prevalence: PMS affects 12% to 98% of women worldwide,[6,7] while PMDD ranges from 3% to 8% globally, with regional peaks up to 48.0%.[8] Also, Many PMD cases report suicidal ideation in the late luteal phase,[9,10] implying a significant socioeconomic burden.

Various psychiatric and somatic comorbidities were previously reported in PMD patients.[11,12] A study on Han Chinese women with bipolar disorder (BD) showed that incidence rates of PMS and PMDD in BD are 57.6% and 20.6%, respectively. Younger patients in this cohort tended to exhibit higher scores on the Hamilton Rating Scale for Depression (17-item version) including its anxiety subscales, somatization, cognitive deficits, psychomotor delays, increased appetite, and lead-induced paralysis.[13] Moreover, a genetic association study indicated that PMDs symptoms were associated with the polygenic risk scores for major depression, bipolar disorder, attention-deficit/hyperactivity disorder, schizophrenia, and autism spectrum disorder, representing an overlapping genetic cause between PMDs and psychiatric disorders.[14] Comorbidities for PMDD covered a range of diseases, including female sexual dysfunction,[15] eating disorder,[16] irritable bowel syndrome,[17] and diabetes mellitus.[18]

Despite growing reports of PMD comorbidities, existing research primarily focuses on single comorbidity pairs and lacks a global overview of research trends, core contributors, or evolving priorities. Bibliometrics serves as a quantitative analysis to examine scientific literature, focusing on evaluating publication and citation data, with the primary goal of gaining a deeper understanding of the structure, development, and dynamics of scientific disciplines.[19] Bibliometrics addresses this gap by quantitatively analyzing publication/citation data to: map the structure of the field (e.g., core countries, institutions, and journals); track temporal evolution; identify knowledge gaps; and clarify conceptual relationships between themes. Citation metrics (e.g., citation counts, h-index, journal impact factor) further help prioritize high-impact, reproducible research—critical for guiding clinical practice and future funding.

2. Methods

2.1. Data source and retrieval strategy

A systematic literature search was conducted from the Web of Science Core Collection (WOSCC) covering the period 1999 to 2023. A total of 149 literatures were retrieved on August 3, 2023 (single search day to avoid bias from database updates). The following specific retrieval formula for the advanced search was used: (TS = (“Premenstrual Syndrome” OR “Premenstrual Dysphoric disorder” OR “late luteal phase dysphoric disorder” OR “Premenstrual disorder”) AND (TS = multimorbid* OR comorbid* OR polymorbid* OR multimorbid* OR comorbid* OR polymorbid*). The document types were restricted to articles and review articles, and the language was limited to English. By combining it with manual screening, irrelevant documents were excluded. The scientometric research process is shown in Figure 1.

Figure 1.

Figure 1.

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Flowchart of the screening process.

2.2. Data analysis and visualization

All eligible documents retrieved in WOSCC were exported in plain text format, then imported into the R package “Bibliometric” (Boston), CiteSpace 6.1.R2 software (Philadelphia), and VOSviewer (Leiden, Netherlands) for bibliometric analysis. The descriptive information on the country, institution, and author of the research topic was generated by WOOSC, and the graphics were developed based on the software’s output. Parameters in CiteSpace were set as follows: time range = 1999–2023, yearly slicing interval = 1, selection criteria = top 30 cited references per year for co-citation and keywords analysis. Node size represents the frequency of an entity. Cluster color distinguishes thematic groups. Node distance indicates the strength of association. Besides, the h-index, m-index, and g-index are metrics utilized to assess researchers’ productivity and impact in academia. The h-index signifies the number of articles a researcher cites at least h times. The g-index is a modification of the h-index, reflecting the average number of citations per article. While the h-index provides a cumulative assessment of a researcher’s output, it may disadvantage those with shorter academic careers. The m-index, the other hand, calculates the annual h-index of researchers since their initial publication.

3. Results

3.1. Annual publication outputs trend

A total of 149 publications were retrieved from the WOSCC database. Each publication in this field has an average of 34.68 citations, and 4162 related references were involved. Figure 2 illustrates the number of annual publications and citation frequency on PMDs and comorbidity research. Since 1999, the output of PMDs and comorbidity research and the frequency of citations have gradually increased. According to the WOSCC database, an early representative publication could be traced back to “Depression in Women: Diagnostic and Treatment Considerations” Field.[20] Meanwhile, the latest publication was “Premenstrual Dysphoric Disorder and sexual function: A Narrative Review,”[15] the author has proposed that PMDD and female sexual dysfunction were the 2 prevalent illnesses in women.

Figure 2.

Figure 2.

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Number and citations of annual publications on PMDs and comorbidity research. PMDs = premenstrual disorders.

3.2. Analysis of productive country or region

A total of 38 countries were included in the PMDs and comorbidities research. Fifty-nine publications originated from the US, followed by Canada (28 publications), Brazil (12 publications), Italy (11 publications), England (8 publications), Turkey (6 publications), Australia (5 publications), Germany (5 publications), China Taiwan (5 publications), and Sweden (4 publications) among the top 10 productive countries (Fig. 3A). In terms of international collaboration, the US (centrality 0.82) and England (centrality 0.42) served as the 2 major research cores, with the US taking the leading position (Fig. 3C).

Figure 3.

Figure 3.

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Analysis of country or regions on PMDs and comorbidity research. PMDs = premenstrual disorders.

Interestingly, premenstrual tension was first proposed in 1931 by New York in the US, later called premenstrual syndrome.[20] Since then, women with PMS or PMDD have gradually received attention, and research in this field has slowly developed. Thus, the US and Canada have steadily become high-yield countries and core regions for PMDD research, leading the research direction of the clinical condition.

3.3. Analysis of productive institution

Two hundred ninety-two institutions have been included in PMDs and comorbidity research. The top 10 most productive institutions are listed in Figure 4. Among the top 5 productive institutions, McMaster University (24 publications) was the leading institution, followed by Yale University (11 publications), Harvard University (8 publications). Analysis of centrality via Citaspace indicated that McMaster University in Canada and Harvard University in the US were the 2 most influential institutions in the world. Universities were major research institutions in this field (Fig. 4A).

Figure 4.

Figure 4.

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Analysis of institutions and authors on PMDs and comorbidity research. PMDs = premenstrual disorders.

3.4. Analysis of authors

Six hundred twelve authors were included in this study, with high-yield and highly cited authors being distinguished in the current analysis, respectively. In terms of the number of publications, Frey BN (9 publications) from McMaster University in Canada delivered the highest output, followed by Minuzzi L (5 publications), Bertone-Johnson ER (4 publications), Kornstein SG (4 publications), Pilver CE (4 publications), Allega OR (3 publications), Cardoso TD (3 publications), Endicott J (3 publications), Halbreich U (3 publications), and Levy BR (3 publications) (Fig. 3B). Among the authors, Frey BN ranked first in academic influence (i.e., H_index 6, G_index 9, M_index 0.429). Meanwhile, Lieb R from the University of Basel, the oldest university in Switzerland, and Wittchen HU from Tech University Dresden and Ludwig Maximilians University Munchen in Germany were the most cited authors (Table 1).

Table 1.

Top 10 authors with the most publications, citations, and influential impact in the field of comorbidities in premenstrual disorders.

Rank Authors Country/affiliation Articles Cited author Citations Authors impact h_index g_index m_index
1 Frey BN Canada/McMaster University 9 Lieb R 57 Frey BN 6 9 0.429
2 Minuzzi L Brazil/Universidade de São Paulo 5 Wittchen HU 57 Kornstein SG 4 4 0.174
3 Bertone-Johnson ER U.S./University of Massachusetts Amherst 4 Becker E 39 Pilver CE 4 4 0.308
4 Kornstein SG U.S./Virginia Commonwealth University 4 Krause P 39 Bertone-Johnson ER 3 4 0.3
5 Pilver CE U.S./New York University 4 Frey BN 31 Cardoso TD 3 3 0.5
6 Allega OR U.S./Harvard University 3 Dias RS 24 Endicott J 3 3 0.13
7 Cardoso TD Brazil/Universidade de São Paulo 3 Lafer B 24 Halbreich U 3 3 0.158
8 Endicott J U.S./Columbia University 3 Nierenberg AA 24 Levy BR 3 3 0.231
9 Halbreich U U.S./State University of New York 3 Sachs GS 24 Minuzzi L 3 5 0.273
10 Levy BR U.S./Yale University 3 Endicott J 22 Soares CN 3 3 0.158
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From the publication of Frey BN, the primary focus was on comorbid bipolar disorder and premenstrual dysphoric disorder.[21–23] His recent publication provided an update on the pharmacotherapeutic management of PMDD and proposed promising compounds blocking the synthesis of allopregnanolone treating PMDD.[24] Further, FREY BN generally had the highest academic influence (i.e., H_index 6, G_index 9, M_index 0.429). Lieb R from the University of Basel, the oldest university in Switzerland, and Wittchen HU from Tech University Dresden and Ludwig Maximilians University Munchen in Germany are the most cited authors.

3.5. Analysis of productive disciplines and journals

Among the publications, Psychiatry (61.745%), Clinical Neurology (23.49%), Neurosciences (19.463%), Medicine General Internal (10.067%), and Pharmacology Pharmacy (10.067%) were the top 5 disciplines (Table 2). Among these subjects, 100 journals were identified in this research field. Bipolar Disorders (11 publications) ranked first as the most published journal (Table 3). American Journal of Psychiatry is the most frequently cited journal and the tenth most published journal. American Journal of Psychiatry’s Latest Impact Factor is 17.7, which is widely read in psychiatric journals worldwide. Many influential publications have been featured in the journal previously.[25]

Table 2.

Top 10 categories in the field of comorbidities in premenstrual disorders.

Rank Record Web of science categories % of 149
1 Psychiatry 92 61.745
2 Clinical Neurology 35 23.49
3 Neurosciences 29 19.463
4 Medicine General Internal 15 10.067
5 Pharmacology Pharmacy 15 10.067
6 Psychology Clinical 13 8.725
7 Obstetrics Gynecology 12 8.054
8 Psychology 9 6.04
9 Public Environmental Occupational Health 9 6.04
10 Women S Studies 6 4.027
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Table 3.

Top 10 productive Journals and cited journals in the field of comorbidities in premenstrual disorders.

Rank Journal Count % of 149 Cited journal Frequency Centrality
1 Bipolar Disorders 11 7.383 American Journal of Psychiatry 88 0.07
2 Archives of Women Mental Health 8 5.369 Journal of Affective Disorders 82 0.03
3 Journal of Clinical Psychiatry 7 4.698 Archives of General Psychiatry 74 0.12
4 European Psychiatry 5 3.356 Journal of Clinical Psychiatry 69 0.01
5 Journal of Affective Disorders 5 3.356 Psychological Medicine 69 0.01
6 Journal of Womens Health 4 2.685 Acta Psychiatrica Scandinavica 60 0.13
7 Cephalalgia 3 2.013 Psychiatry Research 59 0.01
8 Frontiers in Psychiatry 3 2.013 Archives of Womens Mental Health 55 0.01
9 Acta Psychiatrica Scandinavica 2 1.342 Biological Psychiatry 50 0.12
10 American Family Physician 2 1.342 Psychosomatic Medicine 49 0.07
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A dual-map overlay analysis was adopted to visualize the citation relationship between journals and reveal the interdisciplinary crossover. Furthermore, the dual-map overlay of journals demonstrated the relationship distribution among journals, citing journals on the left and the right.[26] A green path in Figure 5 gained from Citespace indicated that documents published in health/ nursing/ medicine, dermatology/dentistry/surgery, and psychology/education/social, economics/economic/political journals are often cited by psychology/education/health journals.

Figure 5.

Figure 5.

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Dual-map of PMDs and comorbidity research. PMDs = premenstrual disorders.

3.6. Analysis of highly cited papers and co-cited reference

One hundred forty-nine publications were sorted based on their citation frequency, and the top 10 most cited publications were also identified, both were shown in Table 4. The publication timeline of the articles was primarily near the year 2000. Furthermore, the top 10 cited references about frequency and centrality are shown in Table 5. The top 2 papers were “Diagnostic and Statistical Manual of Mental Disorders”[27] and “Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (DSM-5).”[28] The American Psychiatric Association’s DSM was an authoritative book for the classification of PMDD. Though controversies were raised regarding this diagnostic standard,[3,29] the precise classification of PMDD as a depressive disorder undoubtedly confirmed its type as a mental illness. Besides, “comorbid bipolar and premenstrual dysphoric disorder” was the most researched topic and frequently discussed.[23] BD is a mood disorder that combines depressive episodes with manic or hypomanic episodes. BD exhibited a high comorbidity rate with other psychiatric disorders under a lifetime comorbidity rate of 50% to 70%.[30]

Table 4.

Top 10 articles with the most citations in the field of comorbidities in premenstrual disorders.

Rank Title Source title Publication year Total citations
1 Prevalence, Incidence and Stability of Premenstrual Dysphoric Disorder in the Community Psychological Medicine 2002 358
2 Factors Predisposing Women to Chronic Pelvic Pain: Systematic Review BMJ—British Medical Journal 2006 341
3 Reproductive Hormone Sensitivity and Risk for Depression Across the Female Life Cycle: A Continuum of Vulnerability? Journal of Psychiatry and Neuroscience 2008 249
4 Sex, Steroids, and Sleep: A Review Sleep 1999 217
5 Depression in Women Metabolism-Clinical and Experimental 2005 212
6 The Epidemiology of Perimenstrual Psychological Symptoms Acta Psychiatrica Scandinavica 2001 195
7 Epidemiology of Depression Throughout the Female Life Cycle Journal of Clinical Psychiatry 2002 179
8 Anxiety and Depression as Bidirectional Risk Factors for One Another: A Meta-Analysis of Longitudinal Studies Psychological Bulletin 2017 161
9 Somatic Symptoms and Physiologic Responses in Generalized Anxiety Disorder and Panic Disorder: An Ambulatory Monitor Study Archives of General Psychiatry 2004 143
10 Plasma Cytokine Profiles in Females With Irritable Bowel Syndrome and Extraintestinal Comorbidity American Journal of Gastroenterology 2010 128
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Table 5.

Top 10 cited references in the field of comorbidities in premenstrual disorders.

Rank Cited reference Year Count Centrality
1 Diagnostic and Statistical Manual of Mental Disorders 2011 19 0.17
2 Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (DSM-5) 2013 12 0.3
3 Increased Illness Burden in Women With Comorbid Bipolar and Premenstrual Dysphoric Disorder: Data From 1099 Women From STEP-BD Study 2017 10 0.01
4 Premenstrual Disorders 2018 7 0
5 Suicidality in Women With Premenstrual Dysphoric Disorder: A Systematic Literature Review 2021 5 0
6 Prevalence and Factors Associated With Premenstrual Dysphoric Disorder: A Community Sample of Young Adult Women 2018 5 0.01
7 Toward the Reliable Diagnosis of DSM-5 Premenstrual Dysphoric Disorder: The Carolina Premenstrual Assessment Scoring System (C-PASS) 2017 5 0
8 Examination of Premenstrual Symptoms as a Risk Factor for Depression in Postpartum Women 2013 5 0.07
9 Premenstrual Dysphoric Disorder Symptoms Following Ovarian Suppression: Triggered by Change in Ovarian Steroid Levels But Not Continuous Stable Levels 2017 4 0
10 Effects of the Menstrual Cycle on Bipolar Disorder 2017 4 0.07
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Moreover, BD and PMS patients may experience periodic emotional changes, such as irritability, irritability, anxiety, and low mood. Their ability to control emotions may decrease. Physiological symptoms, such as headaches, chest tightness, and sleep disorders, may occur concurrently. Understanding their common pathogenesis could be an important direction for future research.

3.7. Keyword analysis

The objective of co-occurring keyword analysis served to identify research hotspots. Figure 6 and Table 6 show the top 10 keywords by frequency and centrality. The most frequently occurring keyword is premenstrual dysphoric disorder (n = 49), followed by prevalence (n = 40), women (n = 37), premenstrual syndrome (n = 33), symptom (n = 30), menstrual cycle (n = 29), depression (n = 23), double-blind (n = 15), dysphoric disorder (n = 14), and bipolar disorder (n = 12). Figure 7 presents the top 22 keywords with citation bursts. The blue line indicated the time interval, while the red line indicated the period when a keyword had a burst. The keywords “national comorbidity survey” with the most robust citation bursts appeared in 2007, indicating the importance of the comorbidity survey. The most recent keywords with citation bursts were diagnosis (2017–2023), bipolar disorder (2017–2023), menstrual cycle (2020–2023), women (2021–2023), premenstrual dysphoric disorder (2021–2023), and mood (2022–2023).

Figure 6.

Figure 6.

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Analysis of research hotspots on PMDs and comorbidity research. PMDs = premenstrual disorders.

Table 6.

Top 10 keywords in terms of frequency and centrality in the field of comorbidities in premenstrual disorders.

Rank Frequency Keywords Centrality Keywords
1 49 Premenstrual dysphoric disorder 0.25 Menstrual cycle
2 40 Prevalence 0.25 Double-blind
3 37 Women 0.24 Premenstrual dysphoric disorder
4 33 Premenstrual syndrome 0.22 Premenstrual syndrome
5 30 Symptom 0.21 Depression
6 29 Menstrual cycle 0.15 Prevalence
7 23 Depression 0.15 Gender difference
8 15 Double-blind 0.13 National comorbidity survey
9 14 Dysphoric disorder 0.12 Dysphoric disorder
10 12 Bipolar disorder 0.12 Association
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Figure 7.

Figure 7.

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Top 22 keywords with the strongest citation bursts.

4. Discussion

4.1. Summary of findings

This study focuses on comorbidities in PMDs research, with 149 publications between 1999 and 2023 were retrieved from the WOSCC database. Over the years, more research effort has been dedicated to the field. Thirty-eight countries, 292 institutions, and 612 authors contributed to PMDs and its comorbidities research. The US was the leading country in this field. Still, McMaster University from Canada delivered the highest publication output, and Frey BN from McMaster University ranked first in academic outputs and influence. Beyond core contributors, citation metrics further highlight the field’s influential work: the American Journal of Psychiatry (impact factor = 17.7, 2023) was the most frequently cited journal (88 citations; Table 3), reflecting its role in disseminating high-quality research on PMD comorbidities. High-cited studies (e.g., Wittchen et al, 2002, 358 citations; Table 4) focused on population-based PMDD prevalence, while recent high-impact work centers on comorbidity mechanisms (e.g., PMDD–BD neurobiology)—indicating a shift from descriptive to translational research.

4.2. Research hotspots and emerging areas

PMDs remained inadequately understood, and women with PMDs were more prone to related comorbidity. One hundred forty-nine relevant literatures, as an adequate sample size of global publications, were utilized in the current study to outline and project the trend of this field (Fig. 8).

Figure 8.

Figure 8.

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PMDs and comorbidities. PMDs = premenstrual disorders.

4.2.1. Temporal evolution of core research hotspots

4.2.1.1. 1999–2010: Foundational prevalence and phenotypic description

This phase focused on establishing the scope of PMD comorbidities through population-based surveys. The keyword “national comorbidity survey” exhibited the strongest citation burst (strength = 3.07, 2007–2011; Fig. 7), reflecting efforts to quantify comorbidity rates at the community level. A landmark 2002 study (Wittchen et al, 358 citations; Table 4) reported the first large-scale data on PMDD prevalence (lifetime stability: 60% over 12 months) and its comorbidity with anxiety (47.4%) and mood disorders (22.9%)—findings that remain foundational for clinical screening.[31] Early work also began linking PMDs to somatic conditions, such as irritable bowel syndrome, though these associations were primarily descriptive.

4.2.1.2. 2011–2016: Diagnostic standardization and comorbidity classification

With the publication of DSM-5 in 2013 (a top-cited reference, 12 citations, centrality = 0.3; Table 5), research shifted to aligning PMD comorbidity criteria with global diagnostic frameworks. The reclassification of PMDD as a distinct “Depressive Disorder” (instead of “not otherwise specified” in DSM-IV) prompted studies to refine comorbidity subtypes—distinguishing psychiatric from somatic comorbidities. Keyword analysis showed rising frequency of “comorbidity” (centrality = 0.12; Table 6) and “association” (centrality = 0.12; Table 6), indicating efforts to map relationships between PMDs and other conditions rather than just documenting their co-occurrence.

4.2.1.3. 2017–2023: Mechanistic exploration and translational research

The most recent phase is defined by a shift from “what co-occurs” to “why it co-occurs,” driven by citation bursts in mechanistically focused keywords: “diagnosis” (2017–2023), “bipolar disorder” (2017–2023), “premenstrual dysphoric disorder” (2021–2023), and “mood” (2022–2023; Fig. 7). High-impact studies in this phase include:

Neurobiological investigations linking comorbid PMDD–BD to disrupted biological rhythms, supported by neuroimaging evidence of shared brain structural abnormalities.[32] BD, and schizophrenia—suggesting shared genetic vulnerabilities. Pharmacotherapeutic advances proposing allopregnanolone synthesis inhibitors as targeted treatments for PMDD, with implications for comorbid mood disorders.[24] The American Journal of Psychiatry (most cited journal, 88 citations; Table 3) played a key role in disseminating this translational work, including debates on PMDD’s diagnostic validity and its mechanistic overlap with BD.[33]

4.2.2. PMS/PMDD: core entities and diagnostic nuance

PMS and PMDD remain the primary focus of PMD comorbidity research, with “premenstrual dysphoric disorder” (frequency = 49, Table 6) and “premenstrual syndrome” (frequency = 33, Table 6) as the top 2 keywords. Existing bibliometric analysis[34,35] indicated that PMDD was first discovered in the gynecological population at the beginning of menarche and last seen during menopause. The disorder is also complicated by mental illness, implying significant suffering among patients. A strong correlation between the disorder and the sensitivity of ALLO fluctuations was also unveiled in previous studies.[36,37] In the future, PMDD may be a useful entry point for PMD comorbidity research.

4.2.3. Association, prevalence, and population-specific risks

“Prevalence” (frequency = 40, Table 6) and “women” (frequency = 37, Table 6) are among the most frequent keywords, reflecting the field’s commitment to understanding population-level burden and disparities. The prevalence of PMDD morbidity rates could be up to 73.5%, including a comorbid rate of 47.4%, 22.9%, and 28.4% with anxiety disorder, mood disorder, and somatoform disorder, respectively.[31] Another epidemiology study also pointed out a correlation between the severity of PMS/PMDD and natural disaster-induced PTSD.[38] Based on previous research, several mental and physiological disorders have also been revealed to be associated with PMDD, including bipolar disorder,[39] generalized anxiety disorder,[40] perimenstrual symptoms/syndrome,[41] personality disorders,[42] sexual function, etc. A point to note is that the prevalence of depression in women generally was found to be higher than in men, and comorbidity with PMDs would bring additional harm to patients, which could be difficult to prevent or treat effectively.[43,44] Therefore, it was equally crucial to investigate and sort out the comorbidity relationship and incidence of the disease to develop preventive measures.

4.2.4. Bipolar disorder: the most impactful psychiatric comorbidity

BD has served as a disabling and severe form of psychotic disorder. Clinically, there are 3 subtypes, that is, BD-I, BD-II, and cyclic mood disorder.[45] Epidemiological surveys in China demonstrated that the lifetime prevalence of BD was approximately 0.5%.[46] PMS/PMDD and BD have shown similarities in clinical symptoms and disease course and often co-occurred, severely impacting the social functioning of patients.[47] In clinical practice, both BD patients and PMS patients may experience periodic emotional changes, such as irritability, irritability, anxiety, and low mood. The ability to control emotions was reduced, and a series of physical symptoms such as headache, chest tightness, and sleep disorders may coexist, suggesting a possible pathological and physiological connection between the 2 disorders.[13] In addition, the occurrence of PMS is related to the cyclical fluctuations of sex hormones. The period of rapid changes in estrogen and progesterone, such as adolescence, premenstrual period, postpartum period, and menopause, was also identified as the risky period of BD onset.[48] However, the current research on the common pathogenesis of the 2 may not be adequate and warrants further research in the comorbid conditions.

5. Strengths and limitations

To the author’s knowledge, the current study is the first investigation to use bibliometric analysis to study the comorbidities of PMDs. Based on the result, key information, including core authors, countries, and institutions of research in this field, as well as future research trends, were identified. However, due to the limited number of literatures, future research on keyword emergence analysis may be warranted.

6. Conclusions

An emerging prevalence of PMS/PMDD, along with its comorbidity, has brought increasing impact on patients. Key information on PMDs comorbidity was thoroughly identified in the current study. The US and Canada were core high-yield countries, and McMaster University and Harvard University were the most influential institutions. Frey BN has made outstanding contributions to the development of this field. In the future, investigation of disease comorbidity epidemiology and psychosomatic diseases may serve in new, meaningful directions.

Author contributions

Conceptualization: Xunshu Cheng.

Data curation: Xunshu Cheng, Xiaoying Liu.

Funding acquisition: Xiaoying Liu.

Investigation: Peijuan Wu.

Methodology: Huihao Li, Peijuan Wu.

Project administration: Huihao Li.

Supervision: Mingzhou Gao, Xingping Ni.

Visualization: Xunshu Cheng, Xingping Ni.

Writing – original draft: Xunshu Cheng.

Writing – review & editing: Mingzhou Gao.

Abbreviations:

BD
bipolar disorder
DSM
Diagnostic and Statistical Manual of Mental Disorders
PMDD
premenstrual dysphoric disorder
PMDs
premenstrual disorders
PMS
premenstrual syndrome
WOSCC
Web of Science Core Collection

This study was sponsored by Project of Sichuan Provincial Clinical Research Center for Imaging Medicine (YXYX2503), Horizontal Project for R&D of TCM Health Preservation Products (2025HX002), Research Fund of Dazhou Grassroots Governance Center (ZL2024-15), Fund of Sichuan University of Arts and Science (2023RC010Z), National Natural Science Foundation of China (No. 82204958, 82305065), Natural Science Foundation of Shandong Province (No. ZR2020ZD17), and Shandong Provincial Higher Education Institutions Youth Innovation Team Program (Nos. 2023KJ191, 2024KJJ061).

This study is a bibliometric analysis of publicly available, de-identified literature. No human subjects, personal data, or identifiable information were involved. Thus, ethical approval from an institutional review board and informed consent were not required.

The authors have no conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

How to cite this article: Cheng X, Li H, Gao M, Liu X, Wu P, Ni X. A global perspective: Trends and insights in premenstrual disorder comorbidity research by bibliometric analysis (1999–2023). Medicine 2025;104:40(e45001).

Contributor Information

Xunshu Cheng, Email: c1017532119@qq.com.

Huihao Li, Email: fata1230@163.com.

Mingzhou Gao, Email: gmingzhou@163.com.

Xiaoying Liu, Email: 1107658885@qq.com.

Peijuan Wu, Email: drgaolight@163.com.

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