Editor’s Note: This story includes a discussion of suicide.
Women with a history of suicide risk have an increased likelihood of suicidal ideation or planning to end their lives in the days surrounding menstruation, a new peer-reviewed study by the University of Illinois Chicago found.
It’s considered the first longitudinal study looking into how suicidal thoughts and related symptoms can fluctuate during a woman’s menstrual cycle, finding some female patients are at their highest risk during this period of time.
“I would say our biggest key finding was that most symptoms do fluctuate across the menstrual cycle for people, but to varying degrees and at varying places,” UIC MD/PhD student and co-lead author Jordan Barone said in an interview with Global News.
Tory Eisenlohr-Moul, who is also a senior author of the paper, said that the study establishes the menstrual cycle can affect many people who have suicidal thoughts. But she also notes that it’s only one of the predictable recurring risk factors identified for determining when a suicide attempt may occur.
“As clinicians, we feel responsible for keeping our patients safe from a suicide attempt, but we often don’t have much more information about when we need to be most concerned about their safety,” said Eisenlohr-Moul, who is a UIC associate professor of psychiatry.
The study, published in the American Journal of Psychiatry Thursday, asked 119 patients to complete a daily survey to track suicidal thoughts and other mental health symptoms over at least one menstrual cycle.
According to a news release from UIC, this format allowed detailed data to be collected on changes in their mental health over the course of the cycle. It added previous research only worked to estimate timing of a person’s menstrual cycle status with a single time-point after a suicidal attempt.
Those studies observed suicide attempts increased in the days before or after the onset of the “menses”, often considered the “perimenstrual” phase. The UIC study replicated this pattern, and found suicidal thoughts were more severe and suicide planning more likely to occur during this part of the cycle.
Barone said these thoughts could include a wish to go to sleep and not wake up, thinking of suicidal methods, and wishing for death on that day. They then rated these thoughts on a scale from “not at all” to “extremely” in terms of they had them.
Barone said the researchers were not shocked by the results, noting that past studies as well as their own research had shown “single time-point links” during different phases of the menstrual cycle.
“We were really, I would say, validated. And finding that day-to-day changes when you track people across multiple menstrual cycles do line up with the cross-sectional findings. So it’s more powerful,” she said.
The study found “significant” elevation of psychiatric symptoms, including depression, anxiety and hopelessness in the premenstrual and early menstrual phases among most patients. Though it notes others reported emotional changes at different times in their cycle. The specific symptoms that appeared alongside suicidal thoughts also varied among individuals.
It also found these three specific symptoms were responsible for people having changes in suicidal ideation. It’s not anxiety, anger and mood swings which contribute, Barone said.
Some individuals, Barone notes, may be “hormonally sensitive” to the menstrual cycle though there is nothing medically wrong with their cycles.
“There’s no hormone imbalances or abnormality, but they have a brain or neurochemical neurohormonal sensitivity to the normal fluctuating hormones of the menstrual cycle,” she said. “So we don’t know what those mechanisms are yet, but there’s a lot of really great research into identifying how to figure out who is most sensitive and to which hormones.
Studies and clinical trials conducted by Eisenlohr-Moul’s group found that premenstrual dysphoric disorder (PMDD) — a condition associated with an increased risk of suicidal thoughts and behaviours – could be the result from some people’s heightened sensitivity to the reproductive hormones estrogen and progesterone.
The hope for the impact of the study, Barone said, is clinicians considering the menstrual cycle as a possible source of the day-to-day changes in suicide risk for patients who have these symptoms.
“There’s so few things that we can do to predict when someone is at risk of suicide,” she said. “So have your patients chart their symptoms daily. There’s a good chance that they don’t have menstrual cycle-related fluctuations in their symptoms, but if they do, that gives us a predictable time-varying factor that can help us maybe pinpoint when they might be more at risk, and kind of remind them maybe you need a little bit more care at this time.”
Asked how this could help, Barone said the menstrual cycle can be a source of “changing vulnerabilities” to suicide risk and this study could help predict when someone may be more at risk for worsening symptoms.
“It’s important to realize it’s not one-size-fits-all, which is why we really stress the importance of patients doing daily reading so that their clinicians can understand when in their cycle they might be more vulnerable if they are,” she said.
— with files from Global News’ Katherine Ward
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help.
For immediate mental health support, call 988. For a directory of support services in your area, visit the Canadian Association for Suicide Prevention at suicideprevention.ca.
Learn more about preventing suicide with these warning signs and tips on how to help.
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