Menstruation and mental health

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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.

Contents

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

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

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

Related Research Articles

<span class="mw-page-title-main">Menstruation</span> Shedding of the uterine lining

Menstruation is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of hormones. Menstruation is triggered by falling progesterone levels and is a sign that pregnancy has not occurred.

<span class="mw-page-title-main">Mood disorder</span> Mental disorder affecting the mood of an individual, over a long period of time

A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).

<span class="mw-page-title-main">Menstrual cycle</span> Natural changes in the human female reproductive system

The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that makes pregnancy possible. The ovarian cycle controls the production and release of eggs and the cyclic release of estrogen and progesterone. The uterine cycle governs the preparation and maintenance of the lining of the uterus (womb) to receive an embryo. These cycles are concurrent and coordinated, normally last between 21 and 35 days, with a median length of 28 days, and continue for about 30–45 years.

<span class="mw-page-title-main">Borderline personality disorder</span> Personality disorder of emotional instability

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a long-term pattern of intense and unstable interpersonal relationships, distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behaviors, often due to their difficulty with returning their emotional level to a healthy or normal baseline. They may also struggle with dissociation, a feeling of emptiness, and a fear of abandonment.

Premenstrual syndrome (PMS) is a disruptive set of emotional and physical symptoms that regularly occur in the one to two weeks before the start of each menstrual period. Symptoms resolve around the time menstrual bleeding begins. Different women experience different symptoms. Premenstrual syndrome commonly produces one or more physical, emotional, or behavioral symptoms, that resolve with menses. The range of symptoms is wide, and most commonly are breast tenderness, bloating, headache, mood swings, depression, anxiety, anger, and irritability. To be diagnosed as PMS, rather than a normal discomfort of the menstrual cycle, these symptoms must interfere with daily living, during two menstrual cycles of prospective recording. These symptoms are nonspecific and are seen in women without PMS. Often PMS-related symptoms are present for about six days. An individual's pattern of symptoms may change over time. PMS does not produce symptoms during pregnancy or following menopause.

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis requires symptoms of both schizophrenia and a mood disorder: either bipolar disorder or depression. The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses.

<span class="mw-page-title-main">Mood swing</span> Extreme or rapid change in mood

A mood swing is an extreme or sudden change of mood. Such changes can play a positive part in promoting problem solving and in producing flexible forward planning, or be disruptive. When mood swings are severe, they may be categorized as part of a mental illness, such as bipolar disorder, where erratic and disruptive mood swings are a defining feature.

Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized by emotional, cognitive, and physical symptoms. PMDD causes significant distress or impairment in menstruating women during the luteal phase of the menstrual cycle. The symptoms occur in the luteal phase, improve within a few days after the onset of menses, and are minimal or absent in the week after menses. PMDD has a profound impact on a person's quality of life and dramatically increases the risk of suicidal ideation and even suicide attempts. Many women of reproductive age experience discomfort or mild mood changes prior to menstruation. However, 5–8% experience severe premenstrual syndrome causing significant distress or functional impairment. Within this population of reproductive age, some will meet the criteria for PMDD.

Dysphoria is a profound state of unease or dissatisfaction. It is the semantic opposite of euphoria. In a psychiatric context, dysphoria may accompany depression, anxiety, or agitation.

Premenstrual water retention is the buildup of additional water or fluid in the body. This phenomenon can be seen in various forms like increasing weight gain and swollen belly, legs, or ankles. Water retention is a symptom felt by some people of all backgrounds before their menstruation onset and was listed as one of the most common premenstrual symptoms in addition to cramping and back pain. There is a study that mentions the age effect being potentially linked to the intensity of symptoms, where the maximum symptom intensity was seen around age 35. This symptom, among others, have been connected to premenstrual syndrome (PMS), which is experienced by people days before their menstrual cycle begins. However, water retention itself can cause symptoms similar to those of PMS like body aches, headaches, and nausea. The actual duration of how long symptoms can last varies in length, from a few days to two weeks.

In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture. There are no objective biochemical or structural alterations of body organs or functions, and the disease is not recognized in other cultures. The term culture-bound syndrome was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders which also includes a list of the most common culture-bound conditions. Counterpart within the framework of ICD-10 are the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research.

<span class="mw-page-title-main">Menstrual disorder</span> Medical condition affecting menstrual cycle

A menstrual disorder is characterized as any abnormal condition with regards to a woman's menstrual cycle. There are many different types of menstrual disorders that vary with signs and symptoms, including pain during menstruation, heavy bleeding, or absence of menstruation. Normal variations can occur in menstrual patterns but generally menstrual disorders can also include periods that come sooner than 21 days apart, more than 3 months apart, or last more than 10 days in duration. Variations of the menstrual cycle are mainly caused by the immaturity of the hypothalamic-pituitary-ovarian (HPO) axis, and early detection and management is required in order to minimize the possibility of complications regarding future reproductive ability.

Psychoneuroendocrinology is the clinical study of hormone fluctuations and their relationship to human behavior. It may be viewed from the perspective of psychiatry, where in certain mood disorders, there are associated neuroendocrine or hormonal changes affecting the brain. It may also be viewed from the perspective of endocrinology, where certain endocrine disorders can be associated with negative health outcomes and psychiatric illness. Brain dysfunctions associated with the hypothalamus-pituitary-adrenal axis HPA axis can affect the endocrine system, which in turn can result in physiological and psychological symptoms. This complex blend of psychiatry, psychology, neurology, biochemistry, and endocrinology is needed to comprehensively understand and treat symptoms related to the brain, endocrine system (hormones), and psychological health..

Brief psychotic disorder ⁠— according to the classifications of mental disorders DSM-IV-TR and DSM-5 ⁠— is a psychotic condition involving the sudden onset of at least one psychotic symptom lasting 1 day to 1 month, often accompanied by emotional turmoil. Remission of all symptoms is complete with patients returning to the previous level of functioning. It may follow a period of extreme stress including the loss of a loved one. Most patients with this condition under DSM-5 would be classified as having acute and transient psychotic disorders under ICD-10. Prior to DSM-IV, this condition was called "brief reactive psychosis." This condition may or may not be recurrent, and it should not be caused by another condition.

<span class="mw-page-title-main">Postpartum psychosis</span> Rare psychiatric emergency beginning suddenly in the first two weeks after childbirth

Postpartum psychosis(PPP), also known as puerperal psychosis or peripartum psychosis, involves the abrupt onset of psychotic symptoms shortly following childbirth, typically within two weeks of delivery but less than 4 weeks postpartum. PPP is a condition currently represented under "Brief Psychotic Disorder" in the Diagnostic and Statistical Manual of Mental Disorders, Volume V (DSM-V). Symptoms may include delusions, hallucinations, disorganized speech (e.g, incoherent speech), and/or abnormal motor behavior (e.g., catatonia). Other symptoms frequently associated with PPP include confusion, disorganized thought, severe difficulty sleeping, variations of mood disorders (including depression, agitation, mania, or a combination of the above), as well as cognitive features such as consciousness that comes and goes (waxing and waning) or disorientation.

Estrogen dominance (ED) is a theory about a metabolic state where the level of estrogen outweighs the level of progesterone in the body. This is said to be caused by a decrease in progesterone without a subsequent decrease in estrogen.

Menstrual leave is a type of leave where a person may have the option to take paid or unpaid leave from their employment if they are menstruating and are unable to go to work because of this. Throughout its history, menstrual leave has been associated with controversy and discrimination against men, with very few countries enacting policies; it is associated with low uptake in those countries that have enacted policies. It is seen by some as a criticism of women's work efficiency or as sexism against men. Supporters of menstrual leave policies compare its function to that of maternity leave and view it as a promoter of gender equality.

Menstrual suppression refers to the practice of using hormonal management to stop or reduce menstrual bleeding. In contrast to surgical options for this purpose, such as hysterectomy or endometrial ablation, hormonal methods to manipulate menstruation are reversible.

Menstrual migraine is term used to describe both true menstrual migraines and menstrually related migraines. About 7%–14% of women have migraines only at the time of menstruation, these are called true menstrual migraines. Most female migraneurs experience migraine attacks throughout the menstruation cycle with an increased number perimenstrually, these are referred to as menstrually related or menstrually triggered migraine.

Sleep problems in women can manifest at various stages of their life cycle. Both subjective and objective data indicate that women are at an increased risk of experiencing different types of sleeping problems during different life stages. Factors such as hormonal changes, aging, psycho-social aspects, physical and psychological conditions, and the presence of sleeping disorders can disrupt women's sleep. Research supports the presence of disturbed sleep during the menstrual cycle, pregnancy, postpartum period, and menopausal transition. The relationship between sleep and women's psychological well-being suggests that the underlying causes of sleep disturbances are often multi-factorial throughout a woman's lifespan.

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. PMID   28571724. S2CID   21125434.
  2. ↑ Brock, Rosalind; Rowse, Georgina; Slade, Pauline (2015-08-11). "Relationships between paranoid thinking, self-esteem and the menstrual cycle" (PDF). 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. PMID   26260035. S2CID   9161510.
  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. PMID   27017504.
  4. 1 2 3 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. PMID   29461935.
  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): 8. doi:10.1007/s11920-020-01221-9. ISSN   1523-3812. PMC   8819663 . PMID   33404887.
  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. PMID   33404701. S2CID   230783638.
  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. PMC   8906247 . PMID   35267252.
  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. PMC   2588420 . PMID   18809118.
  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. PMID   17038206. S2CID   36609028.
  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. PMID   16336745. S2CID   15401026.
  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. PMC   3570621 . PMID   22889242.
  12. ↑ Saunders, Kate E. A.; Hawton, Keith (2006-03-30). "Suicidal behaviour and the menstrual cycle". Psychological Medicine. Cambridge University Press (CUP). 36 (7): 901–912. doi:10.1017/s0033291706007392. ISSN   0033-2917. PMID   16573848. S2CID   32453613.
  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 (2): CD006586. doi:10.1002/14651858.cd006586.pub4. ISSN   1465-1858. PMID   22336820.
  16. 1 2 3 4 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. 1 2 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. PMID   21424263. S2CID   23188834.
  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. S2CID   202406398.
  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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