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Menstrual Cycles Can Spur Daily Suicide Risk

Suicidal ideation was more severe and suicidal planning was more likely to occur in the days surrounding menstruation, according to a new study. Most patients in the study at the University of Illinois Chicago (UIC) reported significant elevation of psychiatric symptoms such as depression, anxiety, and hopelessness in the premenstrual and early menstrual phases, while others reported emotional changes at different times of their cycle.

“The study establishes that the menstrual cycle can affect many people who have suicidal thoughts, which makes it one of the few predictable recurring risk factors that have been identified for detecting when a suicide attempt might occur,” said Tory Eisenlohr-Moul, associate professor of psychiatry at UIC.

The study, published in the American Journal of Psychiatry, followed 119 patients who completed a daily survey to track suicidal thoughts and other mental health symptoms over at least one menstrual cycle.

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The researchers collected detailed data on changes in patients’ mental health over the course of their cycle. Individuals also varied in the specific psychiatric symptoms that appeared alongside suicidal thoughts.

“People differed in which emotional symptoms were most correlated with suicidality for them,” Eisenlohr-Moul said. “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.”

The team also studied premenstrual dysphoric disorder (PMDD), a condition associated with an increased risk of suicidal thoughts and behaviours. Observational studies and clinical trials have found that PMDD may result from some people’s heightened sensitivity to the reproductive hormones oestrogen and progesterone — and stabilising those hormones may lessen symptoms.

Similar dynamics of hormone sensitivity may be at play in the influence of the menstrual cycle upon suicidal thoughts in people without PMDD, the authors said.

However, more research is needed to determine how these factors affect each other in individual patients and how that information could best be used clinically to prevent suicide attempts.

“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,” Eisenlohr-Moul said. “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.”