Psychotic Symptoms May Worsen During Perimenstrual Phase, Meta-Analysis Suggests

Women with psychotic disorders may be more likely to be admitted into the hospital in the days immediately before or during menstruation than at other points during their menstrual cycle, according to a meta-analysis in Schizophrenia Bulletin. The findings suggest that these women may experience worsening symptoms of psychosis at times when their estrogen levels are low.

“[I]dentifying whether women whose psychotic illness is vulnerable to menstrual fluctuations are subsequently at increased risk of relapse postpartum and postmenopausal (times of declining estrogen levels) could provide impetus for novel preventative treatments,” wrote Thomas J. Reilly, M.D., of the Department of Psychosis Studies at King’s College London and colleagues.

Reilly and colleagues conducted a review and meta-analysis of studies that examined changes in psychiatric symptoms in relation to the menstrual cycle. Nineteen studies, comprising 1,193 women diagnosed with a psychotic disorder (schizophrenia, schizoaffective disorder, schizophreniform disorder, psychotic disorder not otherwise specified, bipolar disorder with psychotic symptoms, and depressive disorder with psychotic symptoms) were included in the analysis. Eleven studies examined psychiatric admission rates, five examined symptom scores, two examined self-reported exacerbation, and one examined both admission rates and symptom scores. To compare findings across studies, the authors standardized the results to a 28-day cycle, with day 1 marking the first day of menstruation and day 24 to day 5, the perimenstrual phase.

They found that psychiatric admission rates were significantly higher during the perimenstrual phase than during the non-perimenstrual phase (standardized incidence ratio = 1.48). Although four of the six studies that examined symptom scores also suggested that the participants’ symptoms worsened during the perimenstrual phase, the authors noted that the time points when symptoms were assessed varied considerably between the studies, precluding meta-analysis of the data.

“Further research is needed to characterize the effect of the menstrual cycle on the symptomatology of psychosis, whether there is a subgroup of women who individually have a strong correlation between psychotic symptoms and menstrual cycles, and whether this subgroup is amenable to intervention in the form of hormonal therapy,” the authors concluded.

For related information, see the Psychiatric News article “Raloxifene May Improve Symptoms in Older Women With Refractory Schizophrenia.”

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