Menstrual Cycle Variations and Suicide Risk Explored in UIC Research

A groundbreaking study by researchers at the University of Illinois Chicago has shed light on the intricate relationship between the menstrual cycle and suicidal ideation in female patients with a history of suicidality. This longitudinal study, the first of its kind, has not only identified specific high-risk periods but also offers valuable insights for clinicians to tailor interventions effectively. 

The research, published in the American Journal of Psychiatry, delves into the fluctuations of suicidal thoughts and related symptoms across the menstrual cycle. Led by Associate Professor of Psychiatry Tory Eisenlohr-Moul, the study involved 119 female patients who completed a daily survey tracking suicidal thoughts and mental health symptoms over at least one menstrual cycle. 

Clinicians often face the challenge of limited information regarding when to be most vigilant about a patient’s safety, especially concerning suicide attempts. This study, however, establishes the menstrual cycle as a recurring and predictable risk factor for individuals experiencing suicidal thoughts. The identification of these patterns provides a crucial foundation for developing targeted interventions. 

The research confirms previous observations that suicide attempts tend to increase in the perimenstrual phase, occurring just before or after the onset of menses. The perimenstrual phase emerged as a critical period, with heightened severity of suicidal ideation and an increased likelihood of suicidal planning. This novel study, benefiting from daily tracking, surpasses earlier research efforts by offering detailed data on how mental health changes throughout the menstrual cycle. 

The study recognizes that not all individuals respond to hormonal fluctuations in the same way. By incorporating individual differences into their models, the researchers observed that hormone sensitivity varies, influencing the manifestation of symptoms and suicidality. The majority of patients reported increased psychiatric symptoms such as depression, anxiety, and hopelessness in the premenstrual and early menstrual phases. The diversity in emotional symptoms and their correlation with suicidality underscores the need for personalized approaches. 

The findings highlight the importance of considering individual differences in hormone sensitivity when assessing suicide risk. Clinicians can now explore personalized prediction models for each patient, moving away from generalized approaches and ensuring tailored interventions. Patients may be encouraged to track their mental health symptoms throughout their menstrual cycle, facilitating more accurate assessments and personalized recommendations. 

The study draws parallels with research on premenstrual dysphoric disorder (PMDD), a condition associated with an increased risk of suicidal thoughts and behaviors. Eisenlohr-Moul’s laboratory, the CLEAR lab, has previously conducted observational studies and clinical trials indicating that stabilizing reproductive hormones, estrogen and progesterone, may alleviate PMDD symptoms. Similar hormone sensitivity dynamics may play a role in influencing suicidal thoughts during the menstrual cycle, suggesting potential avenues for intervention. 

While the study provides crucial insights, further research is necessary to unravel the intricate interplay between hormonal factors and suicidal ideation in individual patients. Understanding how these factors intersect and impact each other can inform more targeted and effective clinical interventions. The research team expresses enthusiasm for exploring the best methods available to create personalized prediction models for each patient, moving towards a more nuanced and patient-centered approach. 

The University of Illinois Chicago’s pioneering study on the relationship between the menstrual cycle and suicidal ideation marks a significant step forward in understanding and addressing suicide risk in female patients with a history of suicidality. By identifying specific high-risk periods and acknowledging individual differences in hormone sensitivity, clinicians can now strive for more personalized and effective interventions, ultimately enhancing patient safety and well-being. 

Journal Reference  

Jaclyn M. Ross et al, Predicting Acute Changes in Suicidal Ideation and Planning: A Longitudinal Study of Symptom Mediators and the Role of the Menstrual Cycle in Female Psychiatric Outpatients With Suicidality, American Journal of Psychiatry (2023). DOI: 10.1176/appi.ajp.20230303.