Relationships Between Sleep Quality, Perceived Stress, and Premenstrual Syndrome Among Medical and Nursing Students: A Cross-Sectional Study in Palestine

Background: Premenstrual syndrome (PMS) significantly impacts daily functioning among women of reproductive age. Medical and nursing students face exceptional stressors that may exacerbate PMS, yet the interrelationships between sleep quality, perceived stress, and PMS remain understudied in Middle Eastern contexts. This study aimed to investigate the relationships between sleep quality, perceived stress, and self-reported PMS symptoms among Palestinian female medical and nursing students, to assess their prevalence and severity, and to examine variations across sociodemographic and lifestyle factors. Methods: This cross-sectional correlational study recruited 708 female medical and nursing students from three Palestinian universities. Validated Arabic instruments assessed sleep quality (PSQI), perceived stress (PSS-10), and PMS symptoms (A-PMSS). Analyses included Spearman’s correlations, non-parametric tests (Mann–Whitney U Test, Kruskal–Wallis Test), and multivariable linear regression. Results: Nearly all participants (98%) reported some degree of self-reported PMS symptoms at any severity level, with 76% experiencing moderate-to-severe symptoms. Poor sleep quality (PSQI > 5) affected 62.1%, while 94.5% reported moderate-to-high perceived stress. Significant positive correlations were identified between PSQI and PMS (rho = 0.295, p < 0.001) and between PSS-10 and PMS (rho = 0.483, p < 0.001). Multivariable regression revealed that perceived stress and sleep quality were significant independent predictors of PMS severity after adjusting for covariates, with the overall model explaining 27.5% of variance in PMS scores. Conclusions: This study reveals a substantial burden of PMS, poor sleep quality, and stress among Palestinian female medical and nursing students. Perceived stress and sleep quality were independently associated with PMS severity. These findings highlight need for integrated wellness programs in healthcare education for Palestinian students.