Premenstrual symptoms are highly prevalent in women of reproductive age. Growing evidence suggests that physical exercise can alleviate these symptoms; however, it remains unknown what is the best exercise intervention for this alleviation.

In this context, the present systematic review of systematic reviews intends to reply to two questions: (a) What do systematic review findings conclude about the effects of different exercise interventions on premenstrual symptoms? (b) Which intervention is most effective in improving premenstrual symptoms?

To be included in this study, a systematic review should have analyzed the effect of an exercise intervention in comparison to a non-exercise intervention, no intervention, or usual care on women’s (in reproductive age) Premenstrual Syndrome. Searches for systematic reviews were conducted in the following databases: Cochrane Database of Systematic Reviews (CENTRAL), EBSCOhost (EBSCO), Excerpta Medica Database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), PsycINFO, and Web of Science, with no restrictions on language or publication date. Two independent reviewers carried out the study selection process and evaluated the systematic review quality with the AMSTAR-2 tool.

After screening 286 records, 31 studies were evaluated in full text for inclusion in the systematic review. Twelve studies published between 2017 and 2024 that included between five and 436 randomized controlled trials (RCT) were eligible. The total number of women of reproductive age included in each systematic review (i.e., summing the participants included by the RCTs summarized by the systematic review) ranged from 492 to 11,590 participants. The interventions provided by the RCTs included in the systematic reviews varied considerably, encompassing yoga, aerobic exercise, diverse physical exercises, and physiotherapy. Many outcomes were evaluated by these RCTs including, pain, work absenteeism, functional status, well-being, depression, and premenstrual symptoms. Collectively, the findings of the systematic reviews support that physical exercise interventions can reduce significantly premenstrual symptoms, anxiety, depressive symptoms, and improve pain and work productivity. Most systematic reviews focused on Yoga, so, the larger part of the evidence supports this kind of exercise. Moreover, results from subgroup analyses of a systematic review suggested that aerobic exercises promote greater health benefits than other types of physical exercise. Nonetheless, some systematic reviews also identified a high risk of bias and heterogeneity in RCTs.

Overall, systematic reviews support the benefit of physical exercise interventions (e.g., Yoga, aerobic exercise, and physiotherapy), especially Yoga and aerobic exercise, to improve women’s health by reducing the impact of premenstrual symptoms and enhancing work productivity. Nevertheless, there is a need for a lower risk of bias RCTs to increase confidence in these findings.

Physical exercise interventions such as Yoga and aerobic exercise can be considered as a strategy to improve the well-being of women who suffer from premenstrual symptoms. Though more high-quality research is important, police makers' and practitioners' efforts to increase women’s engagement in physical exercise may improve their health and work productivity.