Handy, A. B., Greenfield, S. F., Yonkers, K. A., & Payne, L. A. (2022). Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review. Harvard Review of Psychiatry, 30(2), 100-117. https://doi.org/10.1097/HRP.0000000000000329
Handy AB, Greenfield SF, Yonkers KA, Payne LA. Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review. Harv Rev Psychiatry. 2022;30(2):100-117. doi:10.1097/HRP.0000000000000329
Handy, Ariel B., et al. "Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review." Harvard Review of Psychiatry, vol. 30, no. 2, 2022, pp. 100-117.
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Suicide Attempts Rise During Menstruation, Review Finds
A 2022 review of studies on women who still get periods found that psychiatric symptoms got worse most often right before and during a period. The strongest evidence was for suicide attempts: across 11 well-designed studies, rates were highest during menstruation.
Key Findings
In the one well-designed study of women with schizophrenia, 32.4% showed cyclical worsening of psychotic symptoms across the menstrual cycle.
Autopsy studies found completed suicides during the menstrual phase ranged from 25% to 54%, versus only 4.5% to 6.75% of deaths from other causes occurring in that same phase.
Suicide attempt rates during the menstrual phase alone ranged from 26% to 42% across studies, and one study found luteal-phase attempt rates as high as 67%.
Suicide and suicide attempts were the most thoroughly studied symptom, with 11 well-designed studies yielding consistent results: rates were highest during menstruation.
Three of the 16 symptom types, including generalized anxiety disorder and cocaine use, had no well-designed studies. Three others, including psychosis and bipolar disorder, had only one each.
Interpretation
This review examined PubMed studies on women who still get periods, covering 16 types of psychiatric symptoms. Each study's quality was rated by whether it used a body sign of cycle phase, had at least 30 women, and confirmed diagnoses when needed. Only suicide and suicide attempts had enough strong studies, 11 of them, to show a clear pattern: rates were highest during menstruation. Depression (7 studies) and anxiety and stress (14 studies) stayed mixed. Three symptom types had no strong studies. The authors note that most studies relied on memory of cycle timing. The findings support larger studies that track cycle phase directly.
RRM Context
Their quality bar for rating studies required a body sign of cycle phase, such as basal body temperature or hormone levels. Fertility awareness-based methods already track that way: a woman marks signs such as waking temperature and cervical mucus every day. She then has a record of where she was in her cycle when a symptom showed up, the kind of data this review found many studies lack.
Our editorial summary of this paper, not the article's abstract.
Abstract
Learning Objectives
After participating in this activity, learners should be better able to:• Discuss and outline the general and overlapping effects of the menstrual cycle on women's mental health.
Abstract
A growing body of research demonstrates menstrual cycle-dependent fluctuations in psychiatric symptoms; these fluctuations can therefore be considered as prevalent phenomena. Possible mechanisms underlying these fluctuations posit behavioral, psychological, and neuroendocrine influences. Recent reviews document cyclic exacerbation of symptoms and explore these mechanisms in the context of specific and often single disorders. The question remains, however, as to whether there are general and overlapping effects of the menstrual cycle on women's mental health. To address this gap, we synthesized the literature examining the exacerbation of a variety of psychiatric symptoms across the menstrual cycle in adult women. Results show that the premenstrual and menstrual phases are most consistently implicated in transdiagnostic symptom exacerbation. Specifically, strong evidence indicates increases in psychosis, mania, depression, suicide/suicide attempts, and alcohol use during these phases. Anxiety, stress, and binge eating appear to be elevated more generally throughout the luteal phase. The subjective effects of smoking and cocaine use are reduced during the luteal phase, but fewer data are available for other substances. Less consistent patterns are demonstrated for panic disorder, symptoms of posttraumatic stress disorder, and borderline personality disorder, and it is difficult to draw conclusions for symptoms of generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and trichotillomania because of the limited data. Future research should focus on developing standardized approaches to identifying menstrual cycle phases and adapting pharmacological and behavioral interventions for managing fluctuations in psychiatric symptoms across the menstrual cycle.
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