• Posted December 15, 2023

Suicide Risk May Fluctuate With the Menstrual Cycle

Most women know that their menstrual cycle can affect their mood. Now, new research suggests suicidal thoughts may peak at certain points during the monthly cycle.

The finding could have an upside, helping people pinpoint when they might be most vulnerable to suicide, so they can better prevent it.

“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,” said study senior author Tory Eisenlohr-Moul, an associate professor of psychiatry at the University of Illinois in Chicago (UIC).

“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," Eisenlohr-Moul added in a university news release.

In the study, her team asked 119 women to complete daily surveys of any suicidal thoughts they might have, or any other mental health issues they experience, over the course of at least one menstrual cycle.

The study found that suicidal thoughts, planning and attempts were more common in the "perimenstrual" phase -- the days just before and after onset of menses (bleeding).

But patterns weren't universal. Feelings of "depression, anxiety and hopelessness" were most common during the premenstrual and early menstrual phases.

But other women reported these types of emotional changes during other times in their cycle.

“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,” said study co-lead author Jordan Barone, an MD/PhD student at UIC. “Not everyone is hormone-sensitive to the cycle in the same way.”

The actual psychiatric symptoms women might experience alongside suicidal thoughts also varied.

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

The study was published Dec. 14 in The American Journal of Psychiatry.

So, what can women and their doctors do with these findings?

Because levels of hormones such as estrogen or progesterone fluctuate in a woman's body during her menstrual cycle, targeting those hormones might help prevent premenstrual dysphoric disorder (PMDD), a condition that's long been linked to suicidal thoughts and behaviors, the Chicago team theorized.

Knowing when in a monthly cycle a woman is most at risk for thoughts of self-harm could also be a useful tool that helps her and her doctor reduce risks for suicide.

“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.”

More information

There's more on the menstrual cycle and emotional health at the American Psychological Association.

SOURCE: University of Illinois, Chicago, news release, Dec. 14, 2023