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

Hughes, Liz; Nolan, Louise

Abstract

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.

Citation

Hughes, L., & Nolan, L. (2022). Premenstrual Exacerbation of Mental Health Disorders: A Systematic Review of Prospective Studies. Archives of Women's Mental Health, 25, 831-852. https://doi.org/10.1007/s00737-022-01246-4

• 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
• DOI: https://doi.org/10.1007/s00737-022-01246-4
• Keywords: Menstrual cycle, Premenstrual disorders, Mental health disorders, Systematic review
• Public URL: http://researchrepository.napier.ac.uk/Output/2880566