Personalised approach to risk: learning event 2

Menstrual health, premenstrual dysphoric disorder, self-harm, and suicide prevention

17th December 2024

On this page:

• Recording of the session
• Links and resources
  • Speaker resources
  • National Institute for Health and Care Excellence (NICE) resources
  • Health Services Safety Investigations Body
  • Research

Recording of the session

Premenstrual disorders, perimenopause, mental health and suicide

Dr Lynsay Matthews provides an overview of research on premenstrual disorders, perimenopause, mental health and suicide.

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Links and resources

Speaker resources

• Premenstrual Dysphoric Disorder (PMDD) Research
  The website for PMDD Research, led by Dr Lynsay Matthews and Julie Riddell, provides evidence on PMDD and information on current projects undertaken by PMDD Research.
• International Association for Premenstrual Disorders (IAPMD)
  The IAMPD website provides support, information and resources for people with PMDD and premenstrual exacerbation.
• Suicide risk is higher in certain phases of the menstrual cycle – here’s what we know about this
  This article by Dr Lynsay Matthews discusses fluctuations in suicide risk during the menstrual cycle and the factors that may be associated with these fluctuations.
• Menstrual health in psychiatric inpatient settings report
  This report discusses experiences of menstruation in psychiatric inpatient settings. The research was commissioned by the National Survivor User Network and was motivated and informed by Hat Porter’s lived experiences of menstruation on mental health wards.
• ‘It’s a horrible place to have a period’: a survivor-led investigation of experiences of menstrual health in psychiatric inpatient settings in England (International Journal of Mental Health Nursing, 2024)
  This paper discusses patient experiences of menstrual health on psychiatric inpatient wards with both patients and staff.

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National Institute for Health and Care Excellence (NICE) resources

• Premenstrual syndrome
  This NICE clinical knowledge summary provides information on the diagnosis of premenstrual syndrome, management and background information on causes, prevalence, risk factors and prognosis.
• Management of premenstrual syndrome
  This NICE scenario provides advice on how to manage premenstrual syndrome and premenstrual dysphoric disorder.
• Heavy menstrual bleeding: assessment and management
  This NICE guideline provides information on assessing and managing heavy menstrual bleeding (menorrhagia).

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Health Services Safety Investigations Body

• Care delivery within community mental health teams
  This patient safety investigation aims to support improvements in the work of community mental health teams. Four areas were examined, including considering menopause as a risk factor for mental health conditions.

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Research

• Cyclical exacerbation of suicidal ideation in female outpatients: prospective evidence from daily ratings in a transdiagnostic sample (Journal of Psychopathology and Clinical Science, 2023)
  This study examines the relationship between the menstrual cycle and suicidal ideation, and related symptoms known to show a cyclical change in some patients (for example, depression, hopelessness, guilt).
• Incidence and comparison of suicide in various phases of the menstrual cycle: a systematic review and meta-analysis (Acta Informatica Medica, 2023)
  This systematic review reports on five articles examining the incidence of suicide during different phases of the menstrual phase. This review indicates that the menstrual phase is associated with a lower risk of suicide when compared to the other two phases of the menstrual cycle.
• Premenstrual exacerbations of mood disorders: findings and knowledge gaps (Current Psychiatry Reports, 2021)
  This review examines premenstrual exacerbations of mood disorders, associated diagnostic issues, epidemiology, underlying mechanisms and treatment. The review concludes that there is a lack of research on premenstrual exacerbations of mood disorders, especially on underlying mechanisms and treatments.
• Suicidal behaviour and the menstrual cycle (Psychological Medicine, 2006)
  This systematic review examines 44 studies on suicidal behaviour and phases of the menstrual cycle. There appears to be an association between the menstrual cycle and non-fatal suicidal behaviours.
• Psychiatric symptoms across the menstrual cycle in adult women: a comprehensive review (Harvard Review of Psychiatry, 2022)
  This review synthesises the literature examining psychiatric symptoms across the menstrual cycle in adult women. There is evidence of increases in psychosis, mania, depression, suicide/suicide attempts and alcohol use during the pre-menstrual and menstrual phases. Anxiety, stress and binge eating appear to increase throughout the luteal phase.
• Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder (BMC Psychiatry, 2022)
  This study indicates there is a high prevalence of self-injurious thoughts and behaviours in patients with a diagnosis of PMDD.
• Psychiatric illness across the menstrual cycle (Frontiers in Psychiatry, 2024)
  This Research Topic in Frontiers in Psychiatric includes nine articles related to mental health and the menstrual cycle.
• A call to integrate menstrual cycle influences into just-in-time adaptive interventions for suicide prevention (Frontiers in Psychiatry, 2024)
  This paper advocates for the integration of the menstrual cycle as a time-varying factor into models and interventions for suicide prevention.
• Unveiling the burden of premenstrual dysphoric disorder: a narrative review to call for gender perspective and intersectional approaches (Frontiers in Psychiatry, 2024)
  This review discusses the burden of PMDD and emphasises the need for increased awareness, education and research on this disorder.
• Women with premenstrual dysphoric disorder experiences of suicidal thoughts and behaviours: a mixed methods study (Frontiers in Psychiatry, 2024)
  This mixed-method study explores the prevalence and experiences of self-harm, suicidal thoughts and attempts in women with PMDD.
• The behavioral and physiological correlates of affective mood switching in premenstrual dysphoric disorder (Frontiers in Psychiatry, 2024)
  This review synthesises the literature on behavioural and physiological correlates of PMDD, and suggests that PMDD may be suitable for remote monitoring (using heart rate variability, sleep and physical activity).
• The link between childhood traumatic events and the continuum of premenstrual disorders (Frontiers in Psychiatry, 2024)
  This study examines the association between childhood trauma and premenstrual disorders and premenstrual exacerbation.
• Understanding premenstrual exacerbation: navigating the intersection of the menstrual cycle and psychiatric illnesses (Frontiers in Psychiatry, 2024)
  The review examines premenstrual exacerbation and its impact on mood, anxiety, psychotic, obsessive-compulsive, personality and trauma-related disorders, and advocates for novel treatment approaches.
• Premenstrual syndrome: new insights into etiology and review of treatment methods (Frontiers in Psychiatry, 2024)
  This paper overviews the evidence on the etiology of premenstrual syndrome and therapeutic interventions.

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This work was completed as part of the Culture of Care Programme. The work was supported by the National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC) (Grant Reference Number NIHR204295). Leah Quinlivan is fully funded by the NIHR GM PSRC, Pauline Rivart was part funded by the NIHR GM PSRC, and Professor Nav Kapur is part funded by the NIHR GM PSRC.  The views expressed on this webpage are those of the authors and not necessarily those of NICE, NIHR, NHS, or the UK Department of Health and Social Care.