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Premenstrual Exacerbation of Mental Health Disorders: A Systematic Review of Prospective Studies

Hughes, Liz; Nolan, Louise


Liz Hughes

Louise Nolan


Purpose: Mental health disorders can be exacerbated during periods of hormonal fluctuation (e.g., pregnancy, menopause) and the risk factors for sensitivity to these fluctuations are similar to those of mental disorders (e.g., trauma). However, the extent to which hormonal fluctuations during the menstrual cycle impact symptoms of pre-existing mental disorders remains unclear. Prospective methodology is considered the gold standard for measuring symptoms across the menstrual cycle. Thus, the aim of the review was to address this knowledge gap by summarising all available studies prospectively measuring symptoms of mental disorders across the menstrual cycle. Methods: A systematic review with narrative synthesis was conducted; meta-analysis was precluded due to methodological heterogeneity of included studies. Electronic databases MEDLINE, Embase, PyschINFO and CINAHL were systematically searched from inception. Risk of Bias for individual studies was assessed using a modified version of the Newcastle Ottawa Scale. Results: The search identified 629 studies from which 35 met inclusion criteria. There was clear evidence of symptom exacerbation during the perimenstrual phase for Psychotic Disorders, Panic Disorder, Eating Disorders, Depression and Borderline Personality Disorder. Less consistent evidence was found for Anxiety, and a different pattern of symptom exacerbation was observed in Bipolar Disorder. Sample size and methodology varied considerably amongst studies. Conclusion: Overall, there was mixed evidence for perimenstrual exacerbation across mental disorders, which could be partly explained by methodological limitations of the studies. However, hormonal fluctuations during the menstrual cycle may exacerbate psychiatric symptoms in a subgroup of individuals who are hormone sensitive.

Journal Article Type Review
Acceptance Date Jun 12, 2022
Online Publication Date Jul 22, 2022
Publication Date 2022-10
Deposit Date Jun 20, 2022
Publicly Available Date Jul 23, 2023
Journal Archives of Women's Mental Health
Print ISSN 1434-1816
Electronic ISSN 1435-1102
Publisher Springer
Peer Reviewed Peer Reviewed
Volume 25
Pages 831-852
Keywords Menstrual cycle, Premenstrual disorders, Mental health disorders, Systematic review
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Premenstrual Exacerbation Of Mental Health Disorders: A Systematic Review Of Prospective Studies (accepted version) (174 Kb)

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