Menstruation and mental health

Menstruation can have a notable impact on mental health, with some individuals experiencing mood disturbances and psychopathological symptoms during their menstrual cycle. Menstruation involves hormonal fluctuations and physiological changes in the body, which can affect a person's mood and psychological state. Many individuals report experiencing mood swings, irritability, anxiety, and even depression in the days leading up to their menstrual period. This cluster of symptoms is often referred to as premenstrual syndrome (PMS). For some individuals, the psychopathological symptoms associated with menstruation can be severe and debilitating, leading to a condition known as premenstrual dysphoric disorder (PMDD). PMDD is characterized by intense mood disturbances, cognitive, and somatic symptoms, which occur in a cyclical pattern linked to the menstrual cycle. In addition to PMDD, menstruation can exacerbate existing mental health conditions. The complex relationship between menstruation and mental well-being has garnered increased attention in both scientific research and public discourse.

Premenstrual disturbances

The period before menstruation, known as the premenstrual phase, is often linked to emotional distress. Conditions related to the menstrual cycle encompass premenstrual tension syndrome, premenstrual dysphoric disorder, and the exacerbation of another medical condition during the premenstrual phase.[1]

Menstruation is linked to a range of psychopathological symptoms, such as lower self-esteem, increased anxiety, dysphoria, and feelings of being persecuted.[2] Changes in behavior, like decreased social interaction during menstruation, can lead to feelings of loneliness and potentially contribute to the development of depression.[3] Several reviews have reported that psychopathological symptoms and mental disorders, such as psychoses, suicidal tendencies,[4] post-traumatic stress disorder,[5] and addictive behaviors,[6] tend to worsen during menstruation.[7][8] Variations in ovarian hormone levels are also linked to the presence of symptoms related to eating disorders.[9][10][11] Some comprehensive studies have indicated that women might be at a higher risk of suicide during menstruation.[4] The symptoms occurring during menstruation can have a significant impact on mental health and lead to severe consequences.[4][12]

Premenstrual tension syndrome
Main article: Premenstrual syndrome

Premenstrual tension syndrome is a condition marked by particular metabolic, environmental, or behavioral factors that arise during the luteal phase of the menstrual cycle. It results in recurring somatic, behavioral, or affective symptoms that disrupt a person's daily life.[13] While the quality of studies and their findings in this area can vary, it's common for women to report symptoms like mood swings, depression, tension, irritability, and anger occurring before their period.[4]

Premenstrual dysphoric disorder
Main article: Premenstrual dysphoric disorder

Premenstrual dysphoric disorder is an affective disorder characterized by emotional, cognitive, and somatic symptoms that consistently occur in the days leading up to menstruation and improve shortly after it begins. These somatic symptoms encompass joint pain, overeating, and lethargy, while cognitive symptoms involve forgetfulness and difficulty concentrating. Mood-related symptoms consist of irritability and depression.[14] Studies evaluating the use of combined oral contraceptive pills containing both progesterone and estrogen have demonstrated their effectiveness in alleviating the symptoms of premenstrual dysphoric disorder.[15]

Comorbidity

Psychotic symptoms tend to worsen when estrogen levels drop during the premenstrual period, leading to increased psychiatric admissions for women with schizophrenia just before and during their menstrual cycles.[16] Another contributing factor to the higher incidence of schizophrenia onset in midlife women may be the reduced estrogen levels associated with menopause.[16] In women with bipolar disorder, especially bipolar II disorder, premenstrual syndrome and premenstrual dysphoric disorder are common.[16] For those women who experience these premenstrual conditions, bipolar affective symptoms and mood swings may be more severe.[16]

Menstrual psychosis

Menstrual psychosis was documented in the mid-19th century and has been extensively discussed in numerous articles. However, it is not widely recognized or diagnosed by modern psychiatrists. The earliest clear clinical descriptions of this condition emerged in French literature around 1850, with most well-documented cases appearing in German literature between 1880 and 1930.[17] As per British psychiatrist Ian Brockington, diagnosing menstrual psychosis requires specific criteria to be met, including symptoms recurring in sync with the menstrual cycle, acute onset against a background of normality, a brief duration followed by complete recovery, and the presence of psychotic features such as delusions, hallucinations, confusion, mutism, stupor, or manic syndrome.[18][17][19]

See also

References
  1. Yonkers, Kimberly Ann; Simoni, Michael K. (2018). "Premenstrual disorders". American Journal of Obstetrics and Gynecology. Elsevier BV. 218 (1): 68–74. doi:10.1016/j.ajog.2017.05.045. ISSN 0002-9378.
  2. Brock, Rosalind; Rowse, Georgina; Slade, Pauline (2015-08-11). "Relationships between paranoid thinking, self-esteem and the menstrual cycle". Archives of Women's Mental Health. Springer Science and Business Media LLC. 19 (2): 271–279. doi:10.1007/s00737-015-0558-4. ISSN 1434-1816.
  3. van Iersel, Kirsten C.; Kiesner, Jeff; Pastore, Massimiliano; Scholte, Ron H.J. (2016-03-24). "The impact of menstrual cycle‐related physical symptoms on daily activities and psychological wellness among adolescent girls". Journal of Adolescence. Wiley. 49 (1): 81–90. doi:10.1016/j.adolescence.2016.03.007. ISSN 0140-1971.
  4. Jang, Daisung; Elfenbein, Hillary Anger (2018-05-14). "Menstrual Cycle Effects on Mental Health Outcomes: A Meta-Analysis". Archives of Suicide Research. Informa UK Limited. 23 (2): 312–332. doi:10.1080/13811118.2018.1430638. ISSN 1381-1118.
  5. Nillni, Yael I.; Rasmusson, Ann M.; Paul, Emilie L.; Pineles, Suzanne L. (2021-01-06). "The Impact of the Menstrual Cycle and Underlying Hormones in Anxiety and PTSD: What Do We Know and Where Do We Go From Here?". Current Psychiatry Reports. Springer Science and Business Media LLC. 23 (2). doi:10.1007/s11920-020-01221-9. ISSN 1523-3812.
  6. Joyce, Kayla M.; Good, Kimberley P.; Tibbo, Philip; Brown, Jocelyn; Stewart, Sherry H. (2021-01-06). "Addictive behaviors across the menstrual cycle: a systematic review". Archives of Women's Mental Health. Springer Science and Business Media LLC. 24 (4): 529–542. doi:10.1007/s00737-020-01094-0. ISSN 1434-1816.
  7. Handy, Ariel B.; Greenfield, Shelly F.; Yonkers, Kimberly A.; Payne, Laura A. (2022). "Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review". Harvard Review of Psychiatry. Ovid Technologies (Wolters Kluwer Health). 30 (2): 100–117. doi:10.1097/hrp.0000000000000329. ISSN 1465-7309.
  8. Barron, Mary Lee; Flick, Louise H.; Cook, Cynthia A.; Homan, Sharon M.; Campbell, Claudia (2008). "Associations Between Psychiatric Disorders and Menstrual Cycle Characteristics". Archives of Psychiatric Nursing. Elsevier BV. 22 (5): 254–265. doi:10.1016/j.apnu.2007.11.001. ISSN 0883-9417.
  9. Edler, Crystal; Lipson, Susan F.; Keel, Pamela K. (2006-10-12). "Ovarian hormones and binge eating in bulimia nervosa". Psychological Medicine. Cambridge University Press (CUP). 37 (1): 131–141. doi:10.1017/s0033291706008956. ISSN 0033-2917.
  10. Klump, Kelly l.; Gobrogge, Kyle l.; Perkins, Patrick s.; Thorne, David; Sisk, Cheryl l.; Breedlove, S. Marc (2005-12-12). "Preliminary evidence that gonadal hormones organize and activate disordered eating". Psychological Medicine. Cambridge University Press (CUP). 36 (4): 539–546. doi:10.1017/s0033291705006653. ISSN 0033-2917.
  11. Klump, Kelly L.; Keel, Pamela K.; Racine, Sarah E.; Burt, S. Alexandra; Neale, Michael; Sisk, Cheryl L.; Boker, Steven; Hu, Jean Yueqin (2013). "The interactive effects of estrogen and progesterone on changes in emotional eating across the menstrual cycle". Journal of Abnormal Psychology. American Psychological Association (APA). 122 (1): 131–137. doi:10.1037/a0029524. ISSN 1939-1846.
  12. Saunders, Kate E. A.; Hawton, Keith (2006-03-30). "Suicidal behaviour and the menstrual cycle". Psychological Medicine. Cambridge University Press (CUP). 36 (07): 901. doi:10.1017/s0033291706007392. ISSN 0033-2917.
  13. "ICD-11 for Mortality and Morbidity Statistics. GA34.40 Premenstrual tension syndrome". ICD-11. Retrieved 2023-09-05.
  14. "ICD-11 for Mortality and Morbidity Statistics. GA34.41 Premenstrual dysphoric disorder". ICD-11. Retrieved 2023-09-05.
  15. Lopez, Laureen M; Kaptein, Adrian A; Helmerhorst, Frans M (2012-02-15). "Oral contraceptives containing drospirenone for premenstrual syndrome". Cochrane Database of Systematic Reviews. Wiley. doi:10.1002/14651858.cd006586.pub4. ISSN 1465-1858.
  16. Diagnostic and statistical manual of mental disorders: DSM-5-TR. Washington, DC: American Psychiatric Association Publishing. 2022. pp. 119, 148, 160. ISBN 978-0-89042-575-6.
  17. Brockington, Ian F. (2011-03-19). "Menstrual Psychosis: A Bipolar Disorder with a Link to the Hypothalamus". Current Psychiatry Reports. Springer Science and Business Media LLC. 13 (3): 193–197. doi:10.1007/s11920-011-0191-5. ISSN 1523-3812.
  18. Ahern, E.; Cohen, D.; Prior, C.; Raji, E. (2019-09-10). "Menstrual psychosis". Irish Journal of Psychological Medicine. Cambridge University Press (CUP). 39 (1): 103–105. doi:10.1017/ipm.2019.36. ISSN 0790-9667. PMID 31500681.
  19. Brockington, Ian F. (February 2005). "Menstrual psychosis". World Psychiatry. 4 (1): 9–17. ISSN 1723-8617. PMC 1414712. PMID 16633495.
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