Although premenstrual symptoms had already been described by Hippocrates 2500 years ago, and Robert T. Frank provided the first modern description of premenstrual syndrome (PMS) as early as 1931, some questions about the premenstrual changes experienced by most women remain unanswered. The etiology of PMS continues to be a matter of debate and there is a lack of appropriate therapeutic options, particularly for the more severe form of PMS, premenstrual dysphoric disorder (PMDD). Both the disease burden and the public health impact of PMS/PMDD are considerable. Why some women are more susceptible to the hormonal changes during the menstrual cycle than others, remains controversial, and it is a fact that perceptions of premenstrual changes vary according to social and/or ethnic background. While the first data on the prevalence of PMS and PMDD came mainly from the USA, population-based studies from several countries worldwide followed from the 2000s onwards.

In the October issue of AWMH, Liisa Hantsoo and co-authors presented data on the prevalence of premenstrual symptoms from a broader, i.e., global, approach (Hantsoo et al. 2022). They collected data from 238,114 app users from 140 countries via the mobile app "Flo", which is available in 22 languages and targets cycle monitoring. The authors showed that across all countries and age groups, most women suffered from premenstrual symptoms and that the range of symptoms varied by age, except for mood swings and anxiety, which occurred equally across the reproductive lifespan. More than a quarter of respondents reported that menstrual symptoms interfered with daily activities during each menstrual cycle. The high prevalence is important information for clinicians, as some may be unaware of the common nature especially of mood complaints, leaving premenstrual mood symptoms under-recognized and under-treated. Given the impairment caused by premenstrual symptoms in general, the assessment and appropriate management of premenstrual symptoms is an important clinical and public health issue.

Even though the chosen global approach can be considered as being absolutely contemporary, its limitations must be taken into account. The authors mention that due to international privacy regulations for mobile apps, the study had to be based on aggregated, pooled data and therefore no individual-level data was available. There is also the likelihood of reporting bias, i.e., only those women who use the app and are interested in or aware of their PMS symptoms are likely to have taken the time to complete the questions.

Apart from providing new evidence with potential clinical impact, this study also raises important questions about the challenges of using social media in research. We need to be aware that social media is now the most effective channel for reaching people of reproductive age — not only for surveys but also for the purpose of education, as well as preventive and possibly therapeutic strategies. It is a goal of this journal to contribute to and promote discussion on how social media can be integrated into research in the most appropriate and gainful way.