Top 100 Cited Papers on Premenstrual Syndrome/Premenstrual Dysphoric Disorder: A Bibliometric Study

Background: Premenstrual syndrome/premenstrual dysphoric disorder is a serious condition affecting women worldwide, causing clinically significant distress or interference. Therefore, solving these diseases has become the utmost concern worldwide, culminating in numerous studies. In this study, we performed bibliometric analysis on the 100 most cited papers with the aim of identifying research hot spots and trends in this field.

Methods: We screened the Science Citation Index Expanded (SCIE) of Web of Science (WOS) to identify the top 100 cited studies on PMS/PMDD. Next, we analyzed relevant literature from various journals, countries/regions, institutions, authors, and keywords. Finally, we used VOSviewer and Citespace software to generate knowledge maps and identify hot spots and trends.

Results: The top 100 highly cited studies were published in 55 journals, between 1999 and 2017, across 24 countries/regions around the world. Most articles were published in Obstetrics and Gynecology, whereas Psych neuroendocrinology had the largest average number of citations per paper. The United States had the highest number of publications, followed by England, Canada, and Sweden. The top three institutions that published the highly cited literature were the University of Pennsylvania, Yale University, and National Institute of Mental Health (NIMH). Obstetrics, Gynecology, Psychiatry, and Reproductive Biology were the main research directions, whereas the top 10 Co-occurrence of Keywords included double-blind, fluoxetine, efficacy, prevalence, epidemiology, phase sertraline treatment, depression, progesterone, placebo, and placebo-controlled trial. Results from cluster analysis indicated that more comprehensive epidemiology and steroid pathogenesis have gradually become the hot spots and trends.

Conclusion: These findings demonstrated that bibliometric analysis can intuitively and rapidly reveal the frontiers and hot spots of research in PMS/PMDD. Notably, epidemiology, steroid pathogenesis, GABAA receptor delta subunits, and double-blind placebo-controlled trials are potential areas of focus for future research.

Introduction

Premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS), refers to a condition in which women of childbearing age exhibit periodic symptoms of discomfort, emotion, and physical disorders in the luteal phase, which deeply affect the patients' ability to study, and work as well as quality of life (1–5). Clinically, PMS/PMDD not only brings a substantial burden on both physical and mental aspects of life (6, 7) but also predisposes affected individuals to depression and bipolar disorders (8–10). Recent studies have demonstrated that some PMDD patients are suicidal, as evidenced by the fact that nearly 40% of PMDD women reported suicidal ideation (11, 12).

Published articles on PMS/PMDD date back to 1950 (13). In the past 60 years, researchers have made significant progress on PMS/PMDD, a phenomenon that is still ongoing (14). However, It is difficult to grasp the development overview and trend of PMS/PMDD research field, and scientific analysis of bibliometrics is urgently needed.

Knowledge on the top 100 cited papers may generate an understanding into the current focus of researchers. Bibliometric analysis, an effective method for analyzing literature, enhances researchers' understanding of a particular research area (15). In this study, we adopted bibliometric analysis to identify the top 100 cited papers on PMS/PMDD, and determined the trends in research on this topic from a perspective different from the previous research (14), which will promote the development of this research field and promote the basic research to gain new discoveries.

Materials and Methods

Data Sources and Search Strategies

Data were obtained from the Science Citation Index Expanded (SCI-E) database in the Web of Science Core Collection (WOSCC) (1). The literature search was framed as follows: [TI = (Premenstrual Syndrome) OR TI = (Premenstrual Dysphoric Disorder) OR TI = (late luteal phase dysphoric disorder) referring to related retrieval strategy (16). The range of article publication dates range was set from inception of the database to April 8th, 2022. No limitations were applied with regards to either the year of publication or language.

Inclusion and Exclusion Criteria

Papers were displayed in descending order, based on the number of citations. Where necessary, two independent researchers identified the 100 most-cited papers after reading the titles, abstracts, and full texts. Conference papers and studies in which PMS/PMDD was not the central topic were excluded. Any disagreement, between the researchers, was resolved through discussion and consensus with a third researcher.

Data Collection and Analysis

The top 100 articles were selected, then imported into Endnote X9, where several study characteristics, including title, keywords, document type, citation number, publication date, country, institutions, journals, and the 2020 impact factor of journals, were extracted. Next, we combined the online platform https://bibliometric.com, with VOSviewer 1.6.17, and Citespace R 5.8 to determine potential research hot spots and trends in this field by visualizing the aforementioned characteristics in the top 100 articles.

Results

Citation Characteristics of the Included Articles

A total of 1,135 documents were initially retrieved from WoSCC. The list was arranged in descending order of citations, and the top 100 cited papers selected as listed in Table 1. The total number of citations for these 100 papers was 9,675 (median = 96.75) and frequency distribution of citations by year could been seen in Figure 1. The top 100 papers had 3821 references, with an h-index of 68. The most frequently cited articles included “The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD)” (17) by Halbreich, U (431 citations), followed by “Prevalence, incidence, and stability of premenstrual dysphoric disorder in the community” (355 citations) (18), “Cortical gamma-aminobutyric acid levels across the menstrual cycle in healthy women and those with premenstrual dysphoric disorder—A proton magnetic resonance spectroscopy study” (257 citations) (19), “Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder” (226 citations) (20) and “Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome: a systematic review” (218 citations) (21). The abovementioned articles have been cited more than 200 times.

TABLE 1

Table 1. The 100 most cited papers in PMS/PMDD until 2022.

FIGURE 1

Figure 1. Frequency distribution of citations by year.

Year and Types of Publication

The distribution of publications by year is illustrated using a histogram in Figure 2. The top 100 cited papers on PMS/PMDD were published between 1999 and 2017, although articles published between 2018 and 2022 were not included in the list. Additionally, 13 papers published in 2007 had the most significant impact on research in this field. Among the selected papers, 67 and 33 were original research articles and reviews, respectively. Furthermore, the 23 papers published in 2003 had the most significant impact on research in this field (Figure 2).

FIGURE 2

Figure 2. Distribution of articles by year of publication.

Distribution Per Journal

We generated a citation network of journals, based on the average published year, to depict interaction among the top 100 cited articles published in 55 journals (Figure 3). Notably, Obstetrics and Gynecology published the largest number of papers (7 papers), followed by the American journal of psychiatry (6 papers). On the other hand, Psych neuroendocrinology had the largest average number of citations per paper (1 paper, 917 citations).

FIGURE 3

Figure 3. Network-based visualization of journals that published the 100 most cited articles according to average publication year. The size of the circles represents the number of articles in the 100 most cited list, whereas the width of the curved line denotes link strength. The distance between 2 journals indicates the approximate relatedness of the nodes.

Contributing Authors

A total of 360 authors contributed to the top 100 cited papers, although some of the 386 items in the network were not connected. The largest set of connected items comprised 83 items. Notably, Freeman EW was at the core of this network, although Halbreich U and Yonkers KA emerged as new authors in recent years. Freeman EW had the highest number of papers (11, with 956 citations), followed by Halbreich U and Yonkers KA who had 645 and 894 citations, respectively (Figure 4).

FIGURE 4

Figure 4. Networks showing interconnectivity among co-authors across the 100 most cited articles according to the average published year. Size of the circles indicate the number of articles in the 100 most cited list, while the width of the curved line represents the link strength. The distance between two authors indicates approximate relatedness among the nodes.

Contributing Countries/Regions and Institutions

The selected top 100 cited papers were published across 24 countries or regions (Figure 5). Among them, the United States had the highest contribution (68 articles), followed by England (13 papers). Among the 24 countries, the United States formed the largest national cooperation network, covering 17 countries. In terms of research institutions, the 100 most cited papers were published by 153 institutions, with the largest set of connected items comprising 107 institutions. Specifically, the University of Pennsylvania contributed the most papers (15 papers), followed by Yale University and NiMH which accounted for 13 and 10 papers, respectively (Figure 6).

FIGURE 5

Figure 5. Networks showing the collaboration among countries/regions in the top 100 cited papers. Circle size represents the number of papers in the top 100 cited articles.

FIGURE 6

Figure 6. Network visualization of the institutions that contributed to the top 100 cited articles. The size of the circle represents the number of papers in the top 100 list.

Research Direction

The top 100 cited papers on PMS/PMDD were stratified into various study directions based on WOS categories as shown in Table 2. Among them, “Obstetrics Gynecology” (98 papers) was the topmost research direction, followed by “Psychiatry” (63 papers), and “Reproductive Biology” (61 papers), among others (Table 2).

TABLE 2

Table 2. Top 10 research directions identified in the 100 most cited papers on PMS/PMDD.

Co-occurrence of Keywords

A total of 477 keywords were identified across the top 100 cited papers. We excluded 10 keywords, such as women, menstrual cycle, premenstrual dysphoric disorder, and premenstrual syndrome, among others. Further analysis revealed cooccurring keywords, with the following forming the top 10; double-blind, fluoxetine, efficacy, prevalence, epidemiology, phase sertraline treatment, depression, progesterone, placebo, and placebo-controlled trial (Table 3). These keywords were further classified into 11 clusters as follows: cluster 1 (epidemiology), cluster 2 (placebo-controlled trial), cluster 3 (steroid), cluster 4 (late luteal phase), cluster 5(premenstrual syndrome), cluster 6 (emotional perception), cluster 7 (dysmenorrhea), cluster 8 (therapeutic use), cluster 9 (brain-derived neurotrophic factor), cluster 10 (delta) and cluster 11 (Japanese women) (Figure 7, Table 4).

TABLE 3

Table 3. Top 10 Co-occurring Keywords in the Top 100 cited papers on PMS/PMDD.

FIGURE 7

Figure 7. Network showing interaction among cooccurring keywords in the top 100 cited papers.

TABLE 4

Table 4. Clusters of keywords cooccurring in the top 100 cited papers on PMS/PMDD.

Discussion

Women's menstrual cycle-related disorders, such as premenstrual syndrome and dysmenorrhea, predispose many women to various diseases which subsequently adversely affect their health (22).

General Information From the Top 100 Most-Cited Papers on Top 100 Most-Cited Papers

The top 100 cited papers were selected from papers titled “Premenstrual Syndrome,” “Premenstrual Dysphoric Disorder,” or “late luteal phase dysphoric disorder” referring to its citations, which represent the concerns of researchers. Analysis of the selected top 100 cited articles resulted in a total of 9,676 citations, with an average of 96.76 citations per article. Among them, the earliest paper entitled “Randomized controlled trial of the management of premenstrual syndrome and premenstrual mastalgia using luteal phase-only danazol,” was published in 1999 (23), whereas the most recent one was “Premenstrual Dysphoric Disorder Symptoms Following Ovarian Suppression: Triggered by Change in Ovarian Steroid Levels but Not Continuous Stable Levels” published in 2017 (24). Moreover, “The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD)” (17) by Halbreich was the most cited article.

Influential Authors and Cooperative Network

Analysis of the 100 most cited papers revealed contribution by 386 authors. Among them, Freeman EW, Halbreich U, and Yonkers KA were the highest contributors to the most influential articles, suggesting that their researches are a potential hotspot in this field. Particularly, Freeman EW's s newest paper, entitled “Are there differential symptom profiles that improve in response to different pharmacological treatments of premenstrual syndrome/premenstrual dysphoric disorder?” revealed possible well-defined subgroups of PMDD. It is evident that overall treatment response rates may improve if treatments are targeted at subtypes (25). On the other hand, Yonkers KA's paper, entitled “Premenstrual Dysphoric Disorder: Evidence for a New Category for DSM-5,” discussed DSM-5 for premenstrual dysphoric disorder (26), whereas Halbreich U's article “Clinical diagnostic criteria for premenstrual syndrome and guidelines for their quantification for research studies,” revealed updated diagnostic criteria for PMS/PMDD and guidelines for clinical and research applications (27). A total of 83 items showed an interaction, of which Freeman EW was at the core of this network, although new scholars, such as Halbreich U and Yonkers KA have emerged in recent years. These authors are distributed across 24 countries or regions and 153 institutions. Among them, the University of Pennsylvania and the United States contributed the highest number of publications. This indicated that American institutions and authors play a leading role in research on PMDD, this may guide future research activities.

Future Perspectives

Epidemiology for Prevalence and Risk Factors

Epidemiological research is the primary and critical approach for exploring development and progression of PMS/PMDD. Notably, 11 out of the 100 most cited articles described prevalence of PMS/PMDD between 2000 and 2014 (17, 18, 28–35), while 29 focused on epidemiology. Collectively, these articles provide reliable data sources to better our understanding of PMS/PMDD, including incidence rate. In recent years, numerous studies have evaluated childhood body size and premenstrual disorders in young adulthood (36), comorbid bipolar disorder (37), prevalence, and associated factors among different groups (38). For instance, studies showed that the prevalence of PMS among Academics at a University in Midwest Brazil was 46.9% (38), and 21.1% for university students (39), which are higher than ever before. Moreover, risk factors for PMS/PMDD include childhood abuse and neglect (40), childhood maltreatment (41), and perinatal depression (42), among others.

Steroid Pathogenesis

At present, the pathogenesis of PMDD remains unclear. However, steroid pathogenesis such as progesterone and allopregnanolone in PMS/PMDD has always been research hotspots. New findings have suggested that progesterone exerts a different effect on the metabolic profiles of women with PMDD compared to controls (43). In addition, a change in estradiol/progesterone levels from low to high, and not the steady-state level, was associated with onset of PMDD symptoms (24). Gradually, researchers have found that allopregnanolone is the provoking factor behind the negative mood symptoms in PMDD, a disease whose pathophysiology is significantly correlated with impaired GABAA-R response to dynamic ALLO fluctuations across the menstrual cycle, manifesting in affective symptoms (44–46). It is possible that GABAA-R response to allopregnanolone, alpha4 and delta subunits of GABAA-R may be playing an essential role in mood swings (47). Recent studies have also associated copy number variations in GABRB2 with PMDD (48, 49). Future studies are expected to elucidate GABAA-R's susceptibility to ALLO.

Placebo-Controlled Trials for Treatment of PMS/PMDD

Treatment is a crucial step in management of PMS/PMDD. The clusters of co-occurrent keywords suggest that prospecting for effective treatment therapies for PMS/PMDD, such as use of fluoxetine (50), and vitex agnus castus (51), is a promising research hotspot. However, placebo-controlled trials are needed to generate more reliable data.

Limitations

This study had several limitations. After consulting numerous literature, we used the Web of Science to identify relevant datasets. Although this is the most commonly used database for literature searches, some early publications may be missing. For an accurate econometric analysis, we referred to previous studies (16) and adopted a Title keyword rather than Topic keyword retrieval approach. Although our search results were accurate, they may not be extensive enough.

Conclusion

To the best of our knowledge, this is the first bibliometric analysis of the most frequently cited papers on PMS/PMDD. Our results indicate that most essential studies on PMS/PMDD have been published in the Journal of Obstetrics and Gynecology. American authors and institutions have played a leading role in research on PMDD, thus represent a future research direction. Moreover, epidemiology for prevalence and risk factors, steroid pathogenesis, such as progesterone, allopregnanolone, and placebo-controlled trial for the treatment represent future trends in this field of research.

Author Contributions

MG designed the study and wrote and revised the draft manuscript. MG, HZ, CW, and XM performed literature search, retrieval, and data collection. MG and HZ carried out data visualization and graphical interpretation. QZ, DG, and JW provided critical assistance or funding. All authors contributed to and approved the final draft of the manuscript before submission.

Funding

This study was supported by funds from the Key Project of Natural Science Foundation of Shandong Province (No. ZR2020ZD17), National Natural Science Foundation of China (Nos. 81001484 and 81473558), Natural Science Foundation of Shandong Province (No. ZR202102270167), Shandong medical and health science and technology development plan project (No. 202105010467) and 20 articles for colleges and universities funded project in Jinan (No. 2020GXRC002).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

The authors would like to acknowledge the support of the Team of Research and Innovation Focusing on Emotional Diseases and Syndromes in Shandong University of Traditional Chinese Medicine, Team of Young Scientific Research and Innovation Focusing on Pharmacology Mechanism of Emotional Diseases and Syndromes in Ganzangxiang.

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