CHICAGO — An alarming new study reveals a significant connection between the menstrual cycle and increased suicidal thoughts and planning among women with a history of mental health issues. Researchers say this study is the first of its kind to track how suicidal thoughts vary on a day-to-day basis across the menstrual cycle.
“As clinicians, we feel responsible for keeping our patients safe from a suicide attempt, but we often don’t have much information about when we need to be most concerned about their safety,” says study senior author Tory Eisenlohr-Moul, an associate professor of psychiatry at University of Illiniois-Chicago (UIC), in a university release. “This study establishes that the menstrual cycle can affect many people who have suicidal thoughts, which makes it one of the only predictable recurring risk factors that has been identified for detecting when a suicide attempt might occur.”
The study followed 119 patients over at least one menstrual cycle. Participants completed daily surveys tracking suicidal thoughts and other mental health symptoms. This approach allowed for a detailed observation of changes throughout the menstrual cycle, a methodology not employed in previous research which only estimated menstrual cycle status at a single time point after a suicide attempt.
The study replicated earlier findings that suggest suicide attempts increase around the onset of menstruation — known as the “perimenstrual” phase. During this phase, suicidal ideation was found to be more intense, and suicidal planning more likely, compared to other times in the cycle. Researchers also revealed individual differences in how the menstrual cycle affects symptoms and suicidality.
“Previously, there haven’t been good predictors for why or when Person A is likely to make a suicide attempt versus when Person B is going to make an attempt,” notes Jordan Barone, an MD/PhD student at UIC. “Not everyone is hormone sensitive to the cycle in the same way, and we were able to statistically show the value of including individual differences in our models.”
Most study participants reported heightened psychiatric symptoms like depression, anxiety, and hopelessness during the premenstrual and early menstrual phases. However, emotional changes and specific symptoms associated with suicidal thoughts varied among individuals.
“People differed in which emotional symptoms were most correlated with suicidality for them,” explains Eisenlohr-Moul. “Just because the cycle makes somebody irritable or have mood swings or feel anxious, it doesn’t necessarily mean that that’s going to have the same effect on creating suicidality for each person.”
Eisenlohr-Moul’s group, the CLEAR lab, which also researches premenstrual dysphoric disorder (PMDD), noted that these findings might relate to some people’s increased sensitivity to reproductive hormones like estrogen and progesterone. Stabilizing these hormones has been shown to lessen symptoms in PMDD, suggesting a similar mechanism might influence suicidal thoughts in those without PMDD.
Researchers propose that patients track their mental health symptoms throughout their cycle, similar to the study’s methodology. This data could help clinicians tailor personalized care recommendations.
“We’re excited to use the best methods out there to try to create individual prediction models for each person, so that we’re not putting people into a box,” concludes Eisenlohr-Moul. “We want to really figure out: does the cycle matter for this person, and then exactly how does it matter and how we can best intervene based on that information.”
The study is published in The American Journal of Psychiatry.
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