Background: Premenstrual syndrome (PMS) involves physical and psychological symptoms that can disrupt young women’s daily functioning, particularly among university students facing academic and social pressures. Aromatherapy has gained interest as a complementary approach for PMS management, yet evidence from controlled trials remains limited. This study examined the effectiveness of Rosa damascena aromatherapy on PMS and related

psychological symptoms among Palestinian female university students.

Methods: A double-blind randomized controlled trial was conducted in two phases. Phase 1 used a cross-sectional survey to identify PMS prevalence and recruit participants with moderate-to-severe symptoms. In Phase 2, participants were randomly assigned to inhale either Rosa damascena essential oil or an odorless placebo three times weekly for three months. Outcomes were assessed using validated self-reported tools, including the DASS-21,

with adherence monitored throughout.

Results: Of 300 students screened, 107 met the criteria, and 69 enrolled. They were randomized into the intervention (n = 35) or control group (n = 34). Baseline PMS and psychological scores were similar. Over time, PMS symptoms decreased significantly in both groups (intervention: −40%; control: −20%; p = 0.001). Depression (p = 0.006), anxiety (p =0.002), and stress (p = 0.001) scores also declined. However, no significant between-group