Impact of women’s coping with premenstrual symptoms on dyadic adjustment and perceived social support: a cross-sectional study in Turkey

Abstract

Objective

To investigate the impact of women’s coping with premenstrual symptoms on dyadic adjustment and perceived social support.

Design

The study was conducted with a descriptive and cross-sectional design between October 2023 and February 2024.

Setting

The following instruments were administered online: the personal information form, the premenstrual symptom screening tool, the Dyadic Adjustment Scale (DAS), the Multidimensional Scale of Perceived Social Support (MSPSS) and the premenstrual coping measure.

Participants

The study was conducted with 395 women in Turkey.

Results

Overall, 58.5% of the women experienced mild premenstrual syndrome, including 9.6% with moderate/severe premenstrual syndrome (PMS) and 31.9% with probable premenstrual dysphoric disorder (PMDD). Among all participants, the mean scores for DAS and MSPSS were 113.05±20.52 and 63.51±15.13, respectively. Dyadic adjustment was significantly lower in women with probable PMDD compared with other groups (F=5.171, p=0.006). Dyadic satisfaction showed a positive correlation with ‘avoiding harm’ and ‘self-care’ subscales, but a negative correlation with ‘adjusting energy’. Furthermore, perceived social support increased as scores for ‘avoiding harm’ (r=0.15, p=0.002), ‘self-care’ (r=0.18, p<0.001) and ‘communicating’ (r=0.30, p<0.001) subdimensions increased.

Conclusions

Health professionals should consider routine screening for premenstrual syndrome and involving spouses or romantic partners in educational interventions to improve awareness of premenstrual symptoms and coping strategies.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This study used valid and reliable measurement tools to assess coping strategies, dyadic adjustment and perceived social support.

• The study included a well-characterised sample of women classified according to premenstrual symptom screening tool screening results, allowing comparisons across varying levels of premenstrual symptom severity rather than relying on clinically confirmed diagnoses.

• The cross-sectional design limits the ability to draw causal inferences between coping strategies and psychosocial outcomes.

• Data collection relied on online self-report questionnaires, which may lead to potential selection or response bias.

• Recruiting participants from a specific environment or region may limit the direct generalisability of findings to other populations.

Introduction

Premenstrual syndrome (PMS) is characterised by physical, psychological and behavioural symptoms that last from a week to a few days before menstruation.¹ While breast tenderness, weight gain, fatigue, skin problems and abdominal pain are among the physiological symptoms of PMS; irritability, emotional fluctuations, depressed mood, anxiety, decreased libido, appetite changes, social inhibition and a lack of self-confidence are among the psychological and behavioural symptoms of PMS.^2–4 Although the prevalence of PMS varies between countries, it ranges between 49% and 53% in Turkey.^5–7

Women’s social and family lives can be affected by PMS.^8–12 Maity et al conducted a study investigating the impact of menstrual illnesses, including PMS, on social life, revealing that numerous female students experienced declines in various facets of their quality of life, such as interactions with friends and connections with family and romantic partners.⁹ During the premenstrual period, women state that they react more to family members, and their perceptions of daily life stresses change before menstruation.⁸ Başağaç and Ege (2021) reported that premenstrual syndrome symptoms negatively affected marital adjustment in Turkey,¹³ while Farrokh-Eslamlou et al found that premenstrual symptoms did not affect the social relations in Iran.¹¹

Another factor affecting family relationships and emotional dimension is the severity of PMS symptoms.^13–15 Studies show that severe premenstrual symptoms often have a negative impact on social and emotional relationships.^{10 12 15} Tavassoli et al stated that 54.4% of women with PMS felt mild/moderate and 12.8% of women felt severe PMS symptoms, and having PMS symptoms negatively affected women’s marital satisfaction.¹⁴

The strategies employed to manage PMS symptoms may influence women’s familial and social interactions.¹⁶ Women employ several pharmaceutical and non-pharmacological strategies to manage PMS symptoms.^17–19 Studies have shown that the coping methods used by women include protecting themselves from the cold, taking a warm shower, applying heat, doing things to make themselves happy, sleeping, crying, using analgesics, resting, consuming hot drinks, preferring to be alone, massage and exercise.^19–21 Tavassoli et al reported that men’s awareness of premenstrual symptoms affects women’s marital satisfaction.¹⁴ Morowatisharifabad et al evaluated the marital satisfaction of couples by educating men about PMS in two different ways: text messages and leaflet, and showed that both education methods increased marital satisfaction.¹⁶ This shows that social support is an important factor in PMS. Therefore, the objective was to investigate the impact of women’s coping of premenstrual symptoms on dyadic adjustment and perceived social support. In this context, the study will evaluate how the emotional, cognitive and behavioural responses of women with premenstrual dysphoric disorder (PMDD) are reflected in their dyadic adjustment. In addition, it will investigate the role of coping strategies for premenstrual symptoms in both the level of adjustment within romantic relationships and perceived social support from their social environment. The study aims to provide a holistic perspective on the interaction between psychosocial variables experienced during the premenstrual period, relational dynamics and social support mechanisms.

The study sought to answer the following research questions:

Q1: Does the experience of premenstrual symptoms affect women’s dyadic adjustment?

Q2: Does the experience of premenstrual symptoms affect women’s perceived social support?

Q3: Are different coping methods (as measured by premenstrual coping measure (PMCM) subscales) significantly correlated with dyadic adjustment and perceived social support?

Methods

Study design and setting

The research was conducted using a descriptive, cross-sectional design. This cross-sectional study was reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. The study population included reproductive-age women in Turkey who were married or in romantic partnerships and were reached via online platforms between October 2023 and February 2024, provided they met the predetermined inclusion criteria. The sample size was calculated using the formula ‘the sample size from an unknown population’ (n = t².p.q/d²). The prevalence of PMS in Turkey is 52.2%.⁷ Accordingly, the preliminary sample size was calculated as 385. The final sample consisted of 395 women. Participants were recruited nationwide through various social media channels, including WhatsApp, Twitter, Instagram, Facebook, Pinterest and Snapchat. Data were collected online using ‘Google Forms’ from women who met all of the inclusion criteria.

The study’s inclusion criteria include being between the ages of 18 and 49 (reproductive period), being married or romantically paired, having regular menstruation every 24–35 days,²² being literate in Turkish and volunteering to participate. Participants were mandated to evaluate a minimum of one of the initial 14 questions of the premenstrual symptom screening tool (PSST) as ‘mild,’ ‘moderate’ or ‘severe’ to qualify for inclusion in the study. Consequently, women reporting no premenstrual symptoms were not included, as the study was designed to compare psychosocial outcomes across different levels of premenstrual symptom severity rather than to estimate the prevalence of PMS or PMDD. Exclusion criteria from the sample: being in menopause, being pregnant or lactating in the last 12 months, using oral contraceptives, having a diagnosed psychiatric disease (depression, panic attack, schizophrenia, etc) and filling out data collection forms incompletely.

Tools

Personal information form

The researchers created a form with eight questions about women’s sociodemographic features. The content of the form was informed by previous studies investigating premenstrual syndrome among women from populations with sociocultural characteristics similar to those of the present study.^{7 13 23}

Premenstrual symptoms screening tool (PSST)

Steiner et al developed the PSST as a simple, practical and effective screening tool intended to serve as an important starting point for further clinical assessment.²⁴ The 22-item four-point Likert scale measures premenstrual symptoms’ severity and impact on daily life. Any of the first 14 items on the scale marked ‘mild,’ ‘moderate’ or ‘severe’ indicates premenstrual symptoms.²⁴ In a Turkish validity and reliability study, Özdel et al found a Cronbach alpha reliability coefficient of 0.92 for the scale.²⁵ The present study Cronbach alpha was 0.89 for the scale. As the PSST is a validated screening rather than a definitive diagnostic instrument, participants meeting the PSST criteria were classified as having ‘probable PMDD’.

Dyadic Adjustment Scale (DAS)

Spanier (1976) developed the Dyadic Adjustment Scale to assess married or cohabiting couples’ relationship quality.²⁶ The Turkish Dyadic Adjustment Scale (DAS) validity and reliability study was done by Fışıloğlu and Demir (2000).²⁷ It assesses dyadic satisfaction, cohesion, consensus and affectional expression. The total score measures dyadic satisfaction and cohesiveness. More marital harmony means a higher score (min: 0, max: 151). Fışıloğlu and Demir (2000) reported a Cronbach’s alpha reliability coefficient of 0.92 for the scale.²⁷ In this study, the Cronbach’s alpha coefficient was found to be 0.91.

Premenstrual coping measure (PCM)

Read et al created it to assess how well women between the ages of 18 and 49 coped with premenstrual symptoms.²⁸ The premenstrual coping measure is not evaluated based on the total score. The scale consists of five subdimensions. Examples of items representing each PMCM subscale include statements such as: “I avoid situations that have the potential to provoke me” (avoiding harm), “I accept my changeable moods” (awareness and acceptance of premenstrual change), “I decrease my social activities” (adjusting energy), “I spend time doing things that help me relax” (self-care) and “II tell others about how I am feeling” (communicating). As the score from the scale subscales increases, coping with premenstrual symptoms increases.²⁸ Abay and Kaplan (2020) conducted a Turkish validity and reliability study of the scale, reporting Cronbach’s alpha reliability coefficients ranging from 0.78 to 0.89 for its subdimensions.²⁹ For this study, the subscale Cronbach’s alpha values of the scale vary between 0.71 and 0.92.

Multidimensional Scale of Perceived Social Support (MSPSS)

It comprises three subscales, each representing a source of support and containing four items. These are family, friends and a romantic partner. In the updated scale analysis, the subscale score was derived by aggregating the scores of the four items within each subscale, while the overall scale score was calculated by summing all subscale scores.³⁰ A high score indicates that individuals perceive a significant amount of social support. The original study reported Cronbach’s alpha reliability coefficients of 0.85–0.92 for the scale.³⁰ The Cronbach alpha value for this study was 0.89.

Data analysis

The data were analysed using the Statistical Package for Social Sciences (SPSS) 25.0 statistical package programme. Number (n), percentage (%), mean and SD (x̅±SD) were used for descriptive statistics. For the normality test, the Kolmogorov-Smirnov test, skewness and kurtosis coefficients were examined. The use of one-way analysis of variance (ANOVA) to compare continuous variables among the PMS severity groups. The method used to assess the homogeneity of variances, such as Levene’s test. The specific post-hoc test used for pairwise group comparisons. Data were analysed with Pearson correlation coefficient. The significance level of the findings was evaluated at the 95% CI and the p<0.05 significance level.

Patient and public involvement

Patients and members of the public were not involved in the design, conduct, reporting or dissemination plans of this research.

Results

The women participating in the study had mean age of 26.03±7.63 years (range from 18 to 49 years). Of the participants, 67.6% (n=267) were university graduates, 65.3% (n=258) were unemployed and 30.1% (n=119) had unemployed spouses. 58.5% (n=231) indicated that their income and expenses were balanced, whereas 79.7% (n=315) resided in a nuclear family structure. The mean duration of their romantic partnerships was 5.12±6.53 years, spanning from 1 to 32 years.

Among the study participants, 58.5% of the women had mild premenstrual syndrome, 9.6% had moderate to severe PMS and 31.9% screened positive for probable PMDD according to the PSST. Women’s DAS and Multidimensional Scale of Perceived Social Support (MSPSS) level mean scores were 113.05±20.52 and 63.51±15.13, respectively (table 1). Women’s coping with premenstrual symptom scale avoiding harm, awareness and acceptance of premenstrual change, adjusting energy, self-care and communicating subscale mean scores were 21.01±6.30, 23.67±5.80, 7.51±2.35, 14.01±3.99 and 11.79±4.36, respectively (table 1).

Table 1. Distribution of women by results of the PSST, the PMCM subscale scores, the DAS subscale scores and MSPSS subscale scores (n=395).

	N	%
PSST results
Mild PMS	231	58.5
Moderate/severe PMS	38	9.6
Probable PMDD	126	31.9
	x̅ ± SD (min–max)
PMCM subscales
Avoiding harm	21.01±6.30 (7–35)
Awareness and acceptance of premenstrual change	23.67±5.80 (10–36)
Adjusting energy	7.51±2.35 (3–12)
Self-care	14.01±3.99 (4–20)
Communicating	11.79±4.36 (4–22)
DAS subscale scores
Dyadic satisfaction	35.65±8.21 (9–50)
Dyadic cohesion	16.09±5.83 (0–24)
Dyadic consensus	51.74±10.37 (0–65)
Affectional expression	9.57±2.30 (0–12)
Total	113.05±20.52 (34–151)
MSPSS	63.51±15.13 (17–84)

%, percentage; DAS, Dyadic Adjustment Scale; MSPSS, Multidimensional Scale of Perceived Social Support; n, number; PMCM, the premenstrual coping measure; PMDD, the premenstrual dysphoric disorder; PMS, the premenstrual syndrome; PSST, the premenstrual symptoms screening tool; x̅, mean.

The relationship between women’s dyadic adjustment, perceived social support levels and the premenstrual symptom levels they experience is presented in table 2. It was found that the mean scores of the total DAS and the Dyadic Consensus subscale were significantly different between the groups. Post hoc analysis revealed that the significant difference in DAS total scores was between the probable PMDD and mild PMS groups. The probable PMDD group also had lower DAS total and dyadic consensus scores than the mild PMS group (table 2).

Table 2. The relationship between women’s dyadic adjustment and perceived levels of social support and their experience of premenstrual symptoms, PMS, probable PMDD.

		Mild PMS	Moderate/severe PMS	Probable PMDD	F	P value
		x̅ ± SD	x̅ ± SD	x̅ ± SD
DAS	Dyadic satisfaction	36.27±8.20	35.79±7.08	34.46±8.48	1.999	0.137
	Dyadic cohesion	16.30±5.74	16.76±5.69	15.49±6.02	1.070	0.344
	Dyadic consensus	52.96±9.86	53.18±7.38	49.09±11.55	6.237	0.002*
	Affectional expression	9.74±2.23	9.68±1.93	9.21±2.49	2.297	0.102
	Total	115.28±20.77	115.42±14.85	108.25±20.84	5.171	0.006*
MSPSS	Total	64.75±14.48	62.87±14.50	61.42±16.32	2.019	0.134

^*p<0.05.

DAS, Dyadic Adjustment Scale; F, one-way ANOVA; MSPSS, Multidimensional Scale of Perceived Social Support; PMDD, the premenstrual dysphoric disorder; PMS, the premenstrual syndrome; x̅, mean.

The findings revealed a significant positive relationship between dyadic satisfaction, perceived social support (MSPSS) and the ‘avoiding harm’ subscale of the PMCM. In contrast, no significant associations were found between the ‘awareness and acceptance of premenstrual changes’ subscale and dyadic adjustment or perceived social support scores. The ‘adjusting energy’ subscale showed a significant negative correlation with dyadic satisfaction, dyadic consensus, affectional expression and dyadic adjustment total score. Conversely, the ‘self-care’ subscale was positively associated with women’s dyadic satisfaction, dyadic cohesion, dyadic adjustment total score and perceived social support. Finally, a significant positive correlation was identified between the ‘communicating’ subscale and the total MSPSS score (table 3).

Table 3. The relationship between dyadic adjustment, perceived social support and the PMCM subscale scores (n=395).

Scale and subscale scores		PMCM subscales
		Avoiding harm	Awareness and acceptance of premenstrual change	Adjusting energy	Self-care	Communicating
DAS	Dyadic satisfaction	r=0.11, p=0.020*	r=−0.06, p=0.216	r=−0.14, p=0.004*	r=0.14, p=0.005*	r=0.06, p=0.194
	Dyadic cohesion	r=0.07, p=0.137	r=0.01, p=0.708	r=−0.08, p=0.086	r=0.13, p=0.009*	r=0.01, p=0.841
	Dyadic consensus	r=−0.03, p=0.503	r=−0.08, p=0.110	r=−0.18, p<0.001*	r=0.04, p=0.410	r=0.01, p=0.782
	Affectional expression	r=−0.02, p=0.687	r=−0.09, p=0.052	r=−0.11, p=0.020*	r=0.08, p=0.090	r=−0.01, p=0.787
	Total	r=0.04, p=0.333	r=−0.07, p=0.157	r=−0.19, p<0.001*	r=0.12, p=0.014*	r=0.03, p=0.492
MSPSS	Total	r=0.15, p=0.002*	r=−0.07, p=0.124	r=−0.07, p=0.137	r=0.18, p<0.001*	r=0.30, p<0.001*

^* p<0.05.

DAS, Dyadic Adjustment Scale; MSPSS, Multidimensional Scale of Perceived Social Support; PMCM, the premenstrual coping measure; r, Pearson corelation; x̅, mean.

Discussion

Women with probable PMDD demonstrated poorer dyadic adjustment than women with mild PMS, particularly in the domains of dyadic satisfaction and consensus, suggesting that greater premenstrual symptom severity may adversely affect relationship functioning and partner communication. In addition, coping strategies were differentially associated with dyadic adjustment and perceived social support. Specifically, adaptive coping strategies, including self-care and communication-oriented coping, were associated with more favourable relational and social outcomes, whereas maladaptive coping strategies, such as energy withdrawal, were associated with poorer dyadic adjustment. Although these associations were statistically significant, their low magnitudes indicate that they should be interpreted with caution. Taken together, these findings advance our understanding of the associations between coping strategies, dyadic adjustment and perceived social support across varying levels of premenstrual symptom severity.

In our study, nearly one third of the women screened positive for probable PMDD according to the PSST. Notably, the proportion of women who screened positive for probable PMDD was substantially higher than the proportion classified as having moderate to severe PMS. Ercan Doğu et al reported that PMDD was more prevalent than moderate/severe PMS, which is consistent with our findings.²³ However, the rate of moderate/severe PMS was found to be higher than the rate of PMDD in another study by Çoban et al.³¹ It is crucial to emphasise that the PSST is solely a screening instrument. Therefore, the current findings reflect the proportion of probable cases in the study sample rather than establishing a definitive clinical prevalence. Despite the use of similar screening tools across these studies, such variations in the rates of probable cases are frequently observed in the literature. These variations may be attributed to differences in sociodemographic characteristics, individuals’ subjective assessments and cognitive appraisal of premenstrual distress, and coping thresholds across environmental settings. Furthermore, methodological differences, such as cross-sectional study designs and online self-reported data collection, may also contribute to variability in reported prevalence estimates through potential selection and reporting bias.

In the present study, lower dyadic adjustment was observed among women with probable PMDD compared with the other groups. This finding aligns with previous research indicating that severe premenstrual symptoms are negatively associated with components of marital adjustment and marital satisfaction.^{13 14} The lower dyadic adjustment observed among women with probable PMDD may reflect the increased psychosocial burden, communication difficulties and relational conflicts commonly experienced during the luteal phase.^{8 32} Given the cross-sectional design, causal inferences cannot be made, and the bidirectional nature of this relationship cannot be ruled out. While severe PMDD symptoms may impair dyadic functioning, it is equally plausible that pre-existing poor relationship quality and insufficient spousal support exacerbate the perceived severity of premenstrual symptoms and hinder effective coping.¹⁵ Therefore, although the observed association supports a link between greater symptom severity and poorer relationship quality among women of reproductive age, this relationship is likely to be complex and multifactorial. Future longitudinal studies are needed to clarify the underlying causal pathways.

Women with probable PMDD exhibited lower overall dyadic adjustment and dyadic consensus than the other groups. On the other hand, the participants’ perceived social support levels (MSPSS) did not statistically differ according to symptom severity. This discrepancy may suggest that, although severe premenstrual symptoms disrupt the internal dynamics of an intimate relationship, they do not necessarily alter women’s overall perceptions of their broader social support network, including support from family and friends. Within the romantic relationship, however, the partner plays a central role. Previous studies have shown that improving partners’ awareness of PMS is associated with greater marital satisfaction¹⁴ and a reduced symptom burden.³³ In addition, the lower levels of dyadic consensus observed among women with probable PMDD may reflect greater difficulty in reaching mutual agreement within the relationship in the presence of more severe premenstrual symptoms. Emotional dysregulation may contribute to this pattern, as women experiencing severe premenstrual symptoms frequently report heightened anger and poorer anger regulation.³⁴ Such emotional difficulties may interfere with constructive communication and conflict resolution, thereby reducing dyadic consensus. Collectively, these findings suggest that probable PMDD is more closely associated with impairments in intimate relationship functioning, particularly dyadic consensus, than with women’s overall perceptions of social support.

In this study, greater use of the ‘avoiding harm’ and ‘self-care’ coping strategies was positively associated with several aspects of dyadic satisfaction, although it is important to note that these correlations were relatively weak. Self-care practices, such as focusing on personal needs, resting, taking a bath, reading a book and receiving massage, are recognised as important coping strategies for women with PMS.²⁸ While previous research has reported an association between severe premenstrual symptoms, including depressed mood and autonomic changes, and poorer marital adjustment,¹³ the present findings suggest that adaptive coping strategies may buffer some of these adverse effects on relationship functioning. These findings also highlight the crucial value of involving spouses or partners in clinical interventions aimed at supporting women. Increasing partners’ awareness of premenstrual symptoms and encouraging mutual coping strategies may contribute to a more supportive relationship environment during the premenstrual phase. However, the methodological limitations of this study must be acknowledged. The cross-sectional design precludes definitive conclusions regarding the causal direction of these relationships, and the reliance on self-report measures introduces potential response bias.

Another finding of this study was that higher scores on the ‘adjusting energy’ coping strategy were negatively and weakly correlated with dyadic satisfaction, dyadic consensus, affectional expression and the total dyadic adjustment score. The ‘adjusting energy’ subdimension of coping with PMS is defined as reducing social and physical activity and focusing less on the needs of others.²⁸ In the study conducted by Başağaç and Ege (2021), it was determined that women experienced social withdrawal and impaired social functioning due to PMS.¹³ When a woman employs this strategy to manage her symptoms, her temporary withdrawal and reduced focus on her partner’s needs may inadvertently lead to a decrease in affectional expression and mutual consensus. These findings may reflect the possibility that while social withdrawal serves as a self-protective coping mechanism for the woman, it may disrupt the interpersonal and communicative dynamics of the relationship, which in turn is reflected in lower overall dyadic adjustment.

In the current study, multidimensional perceived social support was positively correlated with the ‘communicating,’ ‘avoiding harm’ and ‘self-care’ coping subscales. Although statistically significant, these weak correlations indicate that coping behaviours explain only a limited proportion of the variability in perceived social support. Effective communication is widely recognised as a key component of supportive relationships; however, it may become more difficult during the symptomatic phase. For example, a phenomenological study involving women with probable PMDD and their partners reported that women experienced heightened sensitivity to criticism and difficulty expressing themselves during the luteal phase, often resulting in misunderstandings and interpersonal conflict.³² These communication difficulties may help explain why individual coping efforts are not always accompanied by higher levels of perceived social support. Accordingly, the findings highlight the potential value of partner-inclusive interventions in supporting women with PMS. Previous studies have shown that couple-based cognitive behavioural therapy improves coping behaviours and perceptions of support among women with PMDD.⁸ Similarly, educating spouses or romantic partners about premenstrual symptoms has been associated with greater partner support and better symptom management.^{14 33} Taken together, these findings suggest that interventions focusing on communication skills and partner education may strengthen supportive interactions and improve partners’ understanding of women’s premenstrual experiences.

Strengths and limitations

This study has several strengths. To our knowledge, this is one of the few studies examining dyadic adjustment, coping strategies and perceived social support simultaneously across different levels of premenstrual symptom severity. The use of validated instruments and the inclusion of women representing a broad spectrum of symptom severity also strengthen the robustness of the findings. In addition to the study strengths, there are several methodological limitations, and the results should be interpreted within the context of these limitations. First, participants were classified according to the PSST, which is a validated screening instrument rather than a diagnostic tool for PMDD. Therefore, women classified as having probable PMDD should not be considered to have a clinically confirmed diagnosis. Second, the cross-sectional design precludes conclusions regarding the direction or causality of the observed relationships. Third, data were collected using online self-report questionnaires, which may have introduced selection and response bias. Consequently, symptom severity, coping behaviours and perceived social support may have been overestimated or underestimated, potentially influencing the magnitude of the observed associations. Finally, participants were recruited from a specific geographical setting. Therefore, the findings may not be directly generalisable to women from different cultural or healthcare settings.

Conclusions and recommendations

The present findings suggest that greater premenstrual symptom severity may be associated with poorer dyadic adjustment, whereas associations with perceived social support appear to be more limited. In addition, specific coping strategies demonstrated differential associations with dyadic adjustment and perceived social support, highlighting the potential relevance of coping behaviours in the psychosocial experiences of women with premenstrual symptoms. These results may provide useful considerations for women’s health professionals when planning supportive care for women experiencing premenstrual symptoms. Cultural characteristics should also be considered when interpreting these findings and when developing supportive approaches for women with PMS. Future research using prospective diagnostic methods for PMDD, longitudinal designs and culturally diverse populations is warranted to confirm and extend these findings, further clarify the observed relationships and evaluate interventions involving both women and their partners.

Data availability statement

Data are available upon reasonable request.