Objective Based on the Global Burden of Disease (GBD) 2021 database, to analyze the dynamic trends and regional differences in the burden of disease of premenstrual syndrome (PMS) among women of childbearing age globally from 1990 to 2021, and to provide an evidence-based basis for optimizing the allocation of reproductive health resources. Methods Data on the prevalence, incidence and disability-adjusted life years (DALYs) of PMS in 204 countries and regions in the GBD 2021 database were extracted and combined with sociodemographic indices (SDI) to assess the temporal trends and spatial distribution characteristics of the burden of disease using the annual average percentage change (AAPC). Results The global prevalence, incidence and DALYs of PMS in women of reproductive age in 2021 were 45 666.32/100 000, 11 935.05/100 000 and 381.11/100 000, respectively. From 1990 to 2021, the prevalence (AAPC=0.05%) and DALYs (AAPC=0.05%) showed a slight upward trend and a slight decrease in prevalence (AAPC=−0.06%). Prevalence and DALYs increased at a higher rate in low SDI regions (AAPC=0.13% to 0.26%), and the fastest rate of increase was seen in high-income North America in high-SDI regions (AAPC=0.50% to 0.52%). Conclusion The PMS disease burden is unevenly distributed globally and is influenced by a variety of factors, including the level of social development. In the future, it is necessary to combine multidisciplinary intervention strategies and incorporate prospective data to improve prediction models to support the development of global female reproductive health policies.