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Menstrual cycle linked with increased suicide risk

In a first-of-its-kind study, scientists have uncovered that suicidal ideation, planning, and attempts are most common in the days just before and after bleeding begins.

Though the average woman menstruates for 2,535 days of her life (that’s seven years total of pads, tampons, ruined underwear, cramps, and red rivets of womb lining), period stigma prevails.

This is most evident in our education systems where, from the moment we’re first visited by Aunt Flow, we’re taught to understand the science behind the menstrual cycle, but not the challenging reality of experiencing one – to label reproductive organs in our biology notebooks, but to avoid discussing any details with our peers and to feel embarrassed at the sight of our own blood.

As a result, it’s not uncommon that we often feel conditioned to accept that debilitating pain and the inability to regulate our emotions is normal, nay something we should pay no attention to.

In fact, ask anyone with a regular period, and I’m sure they’d readily list off the occasions on which they felt compelled to keep going, regardless of the physical discomfort and significant mental strain that’s brought on by their time of the month.

The tide is turning, however.

During the last decade, we’ve seen researchers start testing the absorption of period products using actual human blood instead of water or saline solution (yes, it did take this long), countries introduce laws granting menstruating employees paid leave, and social media emerge as a safe space for educating on the symptoms and hormone changes that coincide with uterine shedding.

Yet despite these strides towards confronting the physical implications of periods, what’s still rarely addressed is how much some women suffer mentally throughout the entirety of their cycle.

‘This is a vastly under-researched area and even within my own professional training, there was very little emphasis on the impact of menstruation on our psychological wellbeing,’ says clinical psychologist Dr Charlotte Russell.

‘This is interesting given that in practice many clients report significant mood changes linked to their menstrual cycle.’

To put this issue into perspective, premenstrual dysphoric disorder (PMDD), which can cause severe irritability, depression, or anxiety two weeks before bleeding – wasn’t even categorised until the early 2000s.

And, adding insult to injury, it’s only just been uncovered that the risk of suicidal ideation, planning, and attempts increases in the days surrounding menstruation.

In a first-of-its-kind study, published in the American Journal of Psychiatry, scientists at the University of Illinois Chicago (UIC) found that women with a history of suicidal thoughts or behaviours may undergo a surge in those feelings based on where she is in her cycle.

To reach this conclusion, they followed 119 patients with a mental health diagnosis (including PMDD, substance abuse, or an eating disorder) who completed a daily survey tracking their mood.

‘As clinicians, we feel responsible for keeping our patients safe from a suicide attempt, but we often don’t have much information about when we need to be most concerned about their safety,’ says senior author, Professor Tory Eisenlohr-Moul.

‘This study establishes that the menstrual cycle can affect many people who have suicidal thoughts, which makes it one of the only predictable recurring risk factors that has been identified for detecting when a suicide attempt might occur.’

As she explains, there are individual differences in when people are sensitive to mood fluctuations based on cyclical hormones.

This doesn’t mean that their hormones are too high at a certain point or too low, rather that some people have brains that are particularly sensitive to acute alterations in progesterone or oestrogen.

With this in mind, offering guidance for clinicians about when to focus interventions with suicidal patients is key.

‘We need to be tracking these things daily, understanding, what are the symptoms that tend to drive your thoughts of suicide the most?,’ says Eisenlohr-Moul.

‘We want to really figure out: does the cycle matter for this person, and then exactly how does it matter and how we can best intervene based on that information.’

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