<p>Purpose</p><p>Premenstrual syndrome (PMS) is characterized by mental and physical symptoms during the luteal phase of the menstrual cycle. In Japan, 70–90% of women experience some symptoms related to PMS. This review aimed to assess the effects of aromatherapy on PMS symptoms and autonomic nerve system among women with PMS.</p><p>Methods</p><p>A search was performed through six databases (Ichushi-Web, CiNii, MEDLINE, CINAHL, Cochrane Library, and PsycINFO) using keywords such as “aromatherapy” and “premenstrual syndrome” for identifying relevant articles that were published in Japanese and English until March 2021. The study design consisted of only randomized controlled trials. These articles were screened based on the inclusion and exclusion criteria. We used inverse variance methods to integrate the results of articles included in the review.</p><p>Results</p><p>Five articles were included in this review. Essential oils used in these articles were lavender, clary sage, rosa damascene, citrus aurantium, and geranium. Two articles assessed the immediate effects of aromatherapy while three articles assessed its longitudinal effects. Aromatherapy significantly reduced the mental symptoms related to PMS, such as irritability, anxiety, and depression in four out of four articles, and significantly reduced the physical symptoms such as edema, fatigue, and hypersomnia in three out of three articles. Two articles examined the effects of aromatherapy on the autonomous nervous system and found that it increased the high frequency power, an indicator of the parasympathetic nervous system activity. Meta-analyses showed that aromatherapy significantly reduced mental and physical symptoms of PMS, and significantly increased the high frequency power. However, heterogeneity was found in these analyses.</p><p>Conclusion</p><p>The findings of this review suggest that aromatherapy reduces the mental and physical symptoms and positively affects the autonomic nervous system among the PMS patients. Further studies are required to identify the most effective essential oils and implementation methods for reducing PMS symptoms.</p>