Contemplative-based interventions for premenstrual syndrome: a systematic review of psychobiological outcomes.

INTRODUCTION: Premenstrual syndrome (PMS) is a cyclically recurring psychobiological condition affecting up to 47.8% of women of reproductive age, with considerable impact on daily functioning, quality of life and a documented economic burden linked to work absenteeism. Despite its prevalence, PMS remains substantially undertreated, and pharmacological approaches are often associated with undesirable side effects. METHODS: This systematic review was conducted following PRISMA 2020 guidelines and evaluated the efficacy of contemplative practices (CPs), specifically mindfulness-based programs, yoga, and qigong, across psychobiological outcome domains in women with PMS. A comprehensive search of PubMed, Scopus, and Web of Science (2015-2026) identified 18 studies comprising 15 independent trials (n = 1,080). RESULTS: Across studies, CPs were associated with improvements in mood, stress, and anxiety, reductions in somatic complaints, and enhanced sleep quality. Movement-based CPs (yoga and qigong) produced broader physiological effects including reductions in blood pressure, preliminary evidence of hormonal modulation, and cardiopulmonary improvements, while non-movement mindfulness-based interventions more selectively targeted psychological and emotional domains. Methodological quality was moderate (PEDro median = 7), and most trials were rated as having some concerns on RoB 2.0. DISCUSSION: These findings are interpreted within a dual-axis modulation framework, in which CPs may simultaneously attenuate HPA-driven suppression of reproductive function and support HPO axis activity via autonomic and anti-inflammatory pathways. Future research should prioritize luteal phase-confirmed designs, objective biomarkers including heart rate variability and hormonal profiles, and adequately powered trials to elucidate mechanisms and optimal dosing. SYSTEMATIC REVIEW REGISTRATION: https://osf.io/hdpyf/overview.