Suicidal Symptoms May Worsen for Some Women Before, During Menses

Women who experience suicidal thoughts and behaviors may experience worsening symptoms in the days before and during menses, though the symptom changes vary significantly among individuals, according to a study published today in The American Journal of Psychiatry.

“Females (assigned female at birth) are three times more likely than individuals assigned male at birth to report suicidal ideation, suicidal planning, or a suicide attempt,” wrote Jaclyn Ross, Ph.D., of the University of Illinois at Chicago and colleagues. “Accumulating evidence shows that ovarian hormone fluctuations modulate imminent suicide risk for many females, resulting in increased likelihood of suicide attempts and deaths during the premenstrual and menstrual weeks.”

Ross and colleagues analyzed data provided by women aged 18 to 45 with 21- to 35-day menstrual cycles who were receiving outpatient mental health care and had experienced past-month suicidal ideation. For inclusion in the study, the women could not be pregnant or planning to become pregnant, nor could they be taking hormonal medications.

All participants completed daily electronic surveys through which they reported when menses began and psychiatric symptoms each menstrual cycle. The surveys asked the study participants to report suicidal thoughts and planning, as well as feelings of anxiety, depression, hopelessness, agitation, and more. The participants also provided urine samples, which allowed the authors to identify when ovulation occurred each cycle.

A total of 119 participants provided data covering two menstrual cycles. Findings included the following:

• Many participants experienced worsening psychiatric symptoms, suicidal ideation, and suicidal planning during the perimenstrual period (the days immediately before and after the onset of menses).
• Suicidal planning was more likely to occur during the perimenstrual period compared with other phases of the menstrual cycle.
• Depressive symptoms (depression, hopelessness, perceived burdensomeness, and anhedonia) were the most robust predictors of suicidal ideation and behaviors worsening during the perimenstrual period.
• Symptom changes in response to the menstrual cycle varied significantly across the study participants. The authors wrote that this finding underscores the importance of understanding individual differences in hormone sensitivity.

“These findings highlight the need for more intensive, longitudinal research on the mechanisms underlying and the prevention of suicidality across the cycle,” the authors wrote. “[I]ntervention efforts may benefit from strategies that specifically target depressive symptoms as they fluctuate across the cycle, given their powerful role in the cycle-suicidality relationship.”

For related information, see the Psychiatric News article “Depression After Hormonal Contraception Initiation Linked to PPD.”

(Image: Getty Images/iStock/hsyncoban)

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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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