According to the Centers for Disease Control and Prevention, suicide rates were the highest ever recorded in 2022, highlighting the urgency to study risk factors for suicide.

Premenstrual exacerbation (PME) of psychiatric symptoms (worsening of mental health conditions just prior to a woman’s period), is not a new term or idea. Yet PME of psychiatric symptoms such as depression, mania, and psychosis, to name a few, has been understudied compared to other illnesses related to the menstrual cycle. The work that has been done surrounding this idea has mostly asked women to report past experience of worsening psychiatric symptoms around their menstrual cycle. This is problematic in research because it can be difficult to remember specifics of symptom changes.

Studies have also not confirmed the phases of the menstrual cycle in research participants, so it is unclear if worsening symptoms occur in the week or two before the menstrual cycle (luteal phase). Nonetheless, these studies have reported that approximately 60% of women with major depressive disorder or bipolar disorder report menstrual cycle-related mood changes, and that in women with schizophrenia, premenstrual exacerbation of psychotic symptoms, like hallucinations, have been reported.

Given that PME of psychiatric symptoms occurs in the luteal phase, examining whether suicidal thoughts worsen during this critical time period and whether women are at higher risk of suicide at different points in the menstrual cycle is a natural next step. An eloquent study published recently in The American Journal of Psychiatry, “What Predicts Acute Changes in Suicidal Ideation and planning? A Longitudinal Study of Symptom Mediators and the Role of the Menstrual Cycle in Female Psychiatric Outpatients with Suicidality,” does just that. The study not only followed women through their menstrual cycle, but it also specifically identified different stages of the menstrual cycle.

“Overall, this study is an example of the type of information we need to better clarify suicide risk, and it highlights that a detailed reproductive history should be part of a suicide risk assessment.”

Most importantly, this new study demonstrated worsening of suicidal thoughts just prior to the menstrual cycle. The researchers also asked about suicidal thoughts as well as suicidal planning daily during the study. They demonstrated that specific depressive symptoms such as hopelessness, rejection sensitivity, and perceived burdensomeness, were predictive of suicidal planning.

Overall, this study is an example of the type of information we need to better clarify suicide risk, and it highlights that a detailed reproductive history should be part of a suicide risk assessment. Prospective monitoring of psychiatric symptoms in patients with menstrual cycles can be a useful tool for managing psychiatric illness across the menstrual cycle.

By
Anne Louise Stewart, M.D.
and
Jennifer L. Payne, M.D.

Resources

• See more on PMS and PMDD from the Office of Women’s Health (HHS).
• If you or a loved one is in distress and needs support now, contact the National Suicide and Crisis Lifeline - call or text 988, or chat 988lifeline.org