While training as a therapist, Tory Eisenlohr-Moul noticed some patients experienced chronic suicidal thoughts that varied from week to week. When one patient mentioned her menstrual cycle affecting her symptoms, Eisenlohr-Moul focused on the potential impact of menstruation.
Eisenlohr-Moul had patients monitor their mood symptoms in relation to their menstrual cycle and found that for many patients, this was a significant factor in the fluctuation of suicidal thoughts and depression.
Eisenlohr-Moul led a study to examine how suicidal thoughts change throughout the menstrual cycle, resulting in a longitudinal study. The study was published in the American Journal of Psychiatry. A study in December followed 119 female patients who tracked their suicidal thoughts and mental health symptoms daily over at least one menstrual cycle. It was found that female patients with a history of suicidality have an increased risk of suicidal thoughts or planning surrounding menstruation.
The researchers defined suicidal ideation as wishing to go to sleep and never wake up, or feeling that one might be better off dead. Suicidal planning involves thinking about how and when to kill oneself and which methods to use.
Data from female patients in Chicago and North Carolina was used in the study, with participants required to have a regular menstrual cycle and not be on certain forms of birth control. They also could not have been recently pregnant.
Patients were asked about thoughts related to death, killing themselves, or wishing to be dead. Those who reported such symptoms within the past month were asked to track them.
Previous research had shown that suicide attempts increased just before or during menses. The UIC study, however, was unique in its ability to measure day-to-day patterns of suicidal thoughts, finding that suicidal ideation was more severe and planning was more likely to occur in the week before and during menses compared to other times.
The study found that suicidal ideation and planning peak premenstrually for most people, while the lowest levels are experienced during the early luteal phase. Symptoms like depression, hopelessness, and loss of interest in usual activities were found to drive increases in suicidal ideation during the peri-menstrual phase. It was depression that primarily contributed to suicidal planning.
Shalene Gupta dealt with thoughts of wanting to end her life. The journalist from Boston had intense emotions when she was in her mid-20s. In 2020, she was diagnosed with premenstrual dysphoric disorder (PMDD), a severe type of premenstrual syndrome with physical and behavioral symptoms that usually go away when menstruation starts.
Shalene Gupta used to think she was a bad person with poor emotional control because she would have terrible fights with her boyfriend once a month. She is usually calm and conflict-averse but would have intense fights, including screaming, walking around at midnight, and threatening to break up, a few days before her period. She eventually broke up with her boyfriend after six years. When she started dating her now husband, the pattern of fights continued, prompting her to research menstrual rage, PMS, and anger. Eventually, she sought help for the disorder after talking to her doctor. Gupta wrote a book about her experience with menstruation and PMDD.
The couple broke up after being together for six years. When Gupta started dating her now husband, the pattern of fights continued. This led her to research about menstrual rage, PMS, and anger. After speaking with her doctor, Gupta, who is now 36, sought help for the disorder. She also wrote a book about her experience with menstruation and PMDD.The book, called “The Cycle: Confronting the Pain of Periods and PMDD,” written by Gupta, discusses the history of PMDD and its journey. Gupta cites the work of Eisenlohr-Moul in her book.Gupta wrote a book called “The Cycle: Confronting the Pain of Periods and PMDD,” where she references Eisenlohr-Moul’s work. The book details the history of PMDD, which has been known as a condition since the 1960s. However, the condition faced a feminist debate in the 1980s, and concerns about discrediting women kept it from being included in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
A PMDD diagnosis involves a combination of symptoms such as increased mood swings, anger, depression, anxiety, decreased interest in activities, difficulty concentrating, lethargy, change in appetite, sleeping patterns, feeling overwhelmed, and physical symptoms like breast tenderness, joint or muscle pain, bloating, or weight gain. For it to be considered PMDD, the symptoms must be severe enough to interfere with work, education, or relationships. The symptoms must also occur a week before menstruation and then go away a week after menstruation.
Gupta received help through antidepressants. Treatment can also involve the use of birth control. Gupta mentioned that 5% to 10% of the population has classic PMDD, which can be inherited from parents with a 30% to 80% chance of being passed to offspring.
Eisenlohr-Moul stated that the medical community should not use a one-size-fits-all definition of premenstrual syndrome or PMDD according to the data from the UIC study. She believes that a broader understanding of how people can be sensitive to the menstrual cycle is needed to provide more specific treatments.
Ross, who operates a private practice clinic for premenstrual disorders, agreed. She pointed out the wide range of effects on patients across their menstrual cycles to emphasize the necessity for customizing treatment approaches in cases of suicidality and menstruation, especially in psychotherapy. Eisenlohr-Moul highlighted the importance of changing the way PMS and PMDD are discussed in society, emphasizing that it is a disorder that people can have, not a default characteristic of menstruating women.
“In the past, we thought that some people experience premenstrual mood symptoms while others don't,” Eisenlohr-Moul explained. “In the general population, only 1% have noticeable changes. However, when recruiting females with suicidal thoughts, most show some degree of change, but it varies. It's not a clear yes or no situation. It's a spectrum: How much are you affected by these hormonal brain changes?”
The American College of Obstetricians and Gynecologists has recently issued fresh clinical treatment recommendations for doctors treating premenstrual disorders. Eisenlohr-Moul mentioned that despite these disorders being caused by abnormal brain sensitivity to normal hormone fluctuations, treatment can be given by gynecologists, psychiatrists, or primary care providers. Psychologists and other mental health professionals can assist patients in managing and reducing stress, which can exacerbate the condition.
Researchers recommend that women monitor their symptoms throughout their menstrual cycle. This can help doctors offer personalized care recommendations. Patients can find symptom trackers and menstrual resources at the International Association for Premenstrual Disorders. Gupta also sees the value in tracking menstrual symptoms and emphasizes that mental symptoms related to menstruation constitute a disorder.
“If you're experiencing regular breakdowns, it's important to determine the timing,” she said. “This is something doctors should inquire about.” She tracked her symptoms and mentioned that it took about two months of monitoring before receiving an official diagnosis.
“We're conducting numerous biomarker studies,” Eisenlohr-Moul stated. “Jordan’s dissertation is exploring a marker that we believe may be particularly important for progesterone sensitivity, one of the hormones that people can be sensitive to. Others are focusing on sensitivity to estrogen and its impact on different systems. We're seeking specific pathways to understand the biology of menstruation so we can develop treatments. Biological targets… behavioral targets… simply because symptoms are hormone-related doesn't mean that a behavioral intervention couldn't help correct the situation and enable people to function and even reverse some of those biological changes. We're tackling this issue from all angles.”
Gupta is optimistic about the ongoing research on menstruation and mental health. She noted that menstruation is often unfairly stigmatized and viewed through a sexist lens to undermine individuals.
“I read a 600-page biography of Elon Musk by Walter Isaacson. (Musk) has publicly discussed his undiagnosed bipolar disorder. He is the CEO of six companies, and no one questions his ability due to his condition,” she said. “In that case, if someone has PMDD, and they are receiving treatment and managing it, it shouldn't limit their opportunities in society.”
