PITCH: A systematic review of physical exercise as a treatment for symptoms of premenstrual syndrome

Problem

Premenstrual syndrome (PMS) affects up to 30% of all menstruating women. The remainder almost exclusively experience at least one related symptom per menstrual cycle. Symptoms of PMS are largely broken into physical, behavioural and psychological, and can be exacerbated by many health states including smoking, obesity and traumatic early life events. PMS is also related to poor mental and gynaecological health and may also be implicated in the development of high blood pressure in later life. This represents a large burden of disease seen in general practice.

Pharmacological treatments are only available to those with diagnosed PMS, and are often poorly adhered to. Women indicate that they would prefer alternative therapeutic advice, and this includes exercise. Exercise is currently a first line recommended therapy for PMS, but the evidence underpinning its use is minimal.

Approach

Multiple databases (MEDLINE, EMBASE, CENTRAL, CINAHL, AMED, SportDISCUS, PsycINFO, clinicaltrials.gov and WHO ICTR) will be searched systematically alongside grey literature. Identified papers will be assessed for inclusion according to the following criteria: randomised controlled trial or controlled trial, exercise as at least one intervention for 8 or more weeks. Studies will be excluded if physical exercise is not clearly defined or measured, or if included women all have irregular menstrual cycles or all suffer with diagnosed psychiatric disorders. No restrictions will be placed upon studies according to publication date or language.

Two reviewers will independently screen titles and abstracts for inclusion. In cases of disagreement a third reviewer opinion will be sought. All data extracted from included studies will be recorded on a predesigned form, piloted on the first four studies and refined for ease of use. All selected papers will be included in a narrative review, and if heterogeneity between both intervention and outcome measure is deemed sufficiently low (as measured by I2 less than 50% and reviewer judgement) then a meta-analysis will also be performed using a random effects model. Risk of bias will be assessed for all studies using the Cochrane Risk of Bias tool. Publication bias will be assessed via the production of a funnel plot.

Findings

This review is currently underway. A search strategy and data extraction form have been developed and a screening team is in place. Searches will be undertaken in March 2018, with the presumption that data extraction and analysis will be complete by June 2018. A PROSPERO proforma has been published here: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=88418.

Consequences

If found to be supportive of exercise as a treatment for PMS, this review will lend greater support to the current guidelines in use and aid general practitioners in advising their female patients about exercise.