Menstruation and mental health

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.

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.

Menstruation is linked to a range of psychopathological symptoms, such as lower self-esteem, increased anxiety, dysphoria, and feelings of being persecuted. Changes in behavior, like decreased social interaction during menstruation, can lead to feelings of loneliness and potentially contribute to the development of depression. Several reviews have reported that psychopathological symptoms and mental disorders, such as psychoses, suicidal tendencies, post-traumatic stress disorder, and addictive behaviors, tend to worsen during menstruation. Variations in ovarian hormone levels are also linked to the presence of symptoms related to eating disorders. Some comprehensive studies have indicated that women might be at a higher risk of suicide during menstruation. The symptoms occurring during menstruation can have a significant impact on mental health and lead to severe consequences.

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. 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.

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. 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.

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. Another contributing factor to the higher incidence of schizophrenia onset in midlife women may be the reduced estrogen levels associated with menopause. In women with bipolar disorder, especially bipolar II disorder, premenstrual syndrome and premenstrual dysphoric disorder are common. For those women who experience these premenstrual conditions, bipolar affective symptoms and mood swings may be more severe.

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. 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.