Menstrual Psychosis
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Menstruation and mental health are closely connected, as
hormonal A hormone (from the Greek participle , "setting in motion") is a class of signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physiology and behavior. Hormones a ...
fluctuations throughout the
menstrual cycle The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that makes pregnancy possible. The ovarian cycle controls the production and release of eg ...
influence mood,
cognition Cognition is the "mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...
, and
emotional well-being Emotional well-being (EWB) is a field of study that focuses on the emotional aspects of human experience and is recognized as a crucial component of overall health and quality of life. It is often used interchangeably with, but is distinct from ment ...
. Many individuals experience mood swings,
irritability Irritability is the excitatory ability that living organisms have to respond to changes in their environment. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimul ...
,
anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
, and depression in the days leading up to menstruation, a cluster of symptoms commonly referred to as
premenstrual syndrome Premenstrual syndrome (PMS) is a disruptive set of emotional and physical symptoms that regularly occur in the one to two weeks before the start of each menstrual period. Symptoms resolve around the time menstrual bleeding begins. Symptoms v ...
(PMS). In more severe cases, individuals may develop
premenstrual dysphoric disorder Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized by emotional, cognitive, and physical symptoms. PMDD causes significant distress or impairment in menstruating women during the luteal phase of the menstrual cycle. The symp ...
(PMDD), a condition characterized by intense mood disturbances, cognitive impairments, and somatic symptoms that follow a cyclical pattern. Additionally, menstruation can exacerbate preexisting mental health conditions. The interplay between hormonal changes, neurochemical activity, and psychological health has been a growing focus of scientific research and public discourse.


Premenstrual disturbances

The period before menstruation, known as the premenstrual phase, is often linked to emotional distress. Conditions related to the menstrual cycle encompass premenstrual tension syndrome,
premenstrual dysphoric disorder Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized by emotional, cognitive, and physical symptoms. PMDD causes significant distress or impairment in menstruating women during the luteal phase of the menstrual cycle. The symp ...
, and the exacerbation of another medical condition during the premenstrual phase. Menstruation is linked to a range of psychopathological symptoms, such as lower
self-esteem Self-esteem is confidence in one's own worth, abilities, or morals. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Macki ...
, increased
anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...
,
dysphoria Dysphoria (; ) is a profound state of unease or dissatisfaction. It is the semantic opposite of euphoria. In a psychiatric context, dysphoria may accompany depression, anxiety, or agitation. In psychiatry Intense states of distress and uneas ...
, and feelings of being persecuted. Changes in behavior, like decreased social interaction during menstruation, can lead to feelings of loneliness and potentially contribute to the development of depression. Several reviews have reported that psychopathological symptoms and mental disorders, such as psychoses,
suicidal tendencies Suicidal Tendencies is an American crossover thrash band formed in 1980 in Venice, California, by vocalist Mike Muir. The band has undergone various lineup changes, with Muir as the only remaining original member. Their current lineup includes ...
,
post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental disorder that develops from experiencing a Psychological trauma, traumatic event, such as sexual assault, domestic violence, child abuse, warfare and its associated traumas, natural disaster ...
, and addictive behaviors, tend to worsen during menstruation. Variations in ovarian hormone levels are also linked to the presence of symptoms related to
eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's health, physical or mental health, mental health. These behaviors may include eating too much food or too little food. Types of eatin ...
s. Some comprehensive studies have indicated that women might be at a higher risk of
suicide Suicide is the act of intentionally causing one's own death. Risk factors for suicide include mental disorders, physical disorders, and substance abuse. Some suicides are impulsive acts driven by stress (such as from financial or ac ...
during menstruation. The symptoms occurring during menstruation can have a significant impact on mental health and lead to severe consequences.


Premenstrual tension syndrome

Premenstrual tension syndrome is a condition marked by particular metabolic, environmental, or behavioral factors that arise during the
luteal phase The menstrual cycle is on average 28 days in length. It begins with Menstruation, menses (day 1–7) during the follicular phase (day 1–14), followed by ovulation (day 14) and ending with the luteal phase (day 14–28). While historically, medi ...
of the menstrual cycle. It results in recurring somatic, behavioral, or affective symptoms that disrupt a person's daily life. While the quality of studies and their findings in this area can vary, it's common for women to report symptoms like mood swings, depression, tension,
irritability Irritability is the excitatory ability that living organisms have to respond to changes in their environment. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimul ...
, and
anger Anger, also known as wrath ( ; ) or rage (emotion), rage, is an intense emotional state involving a strong, uncomfortable and non-cooperative response to a perceived provocation, hurt, or threat. A person experiencing anger will often experie ...
occurring before their period.


Premenstrual dysphoric disorder

Premenstrual dysphoric disorder Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized by emotional, cognitive, and physical symptoms. PMDD causes significant distress or impairment in menstruating women during the luteal phase of the menstrual cycle. The symp ...
is an affective disorder characterized by emotional, cognitive, and somatic symptoms that consistently occur in the days leading up to menstruation and improve shortly after it begins. These somatic symptoms encompass
joint pain Arthralgia () literally means 'joint pain'. Specifically, arthralgia is a symptom of injury, infection, illness (in particular arthritis), or an allergic reaction to medication Medication (also called medicament, medicine, pharmaceutic ...
, overeating, and
lethargy Lethargy is a state of tiredness, sleepiness, weariness, fatigue, sluggishness, or lack of energy. It can be accompanied by depression, decreased motivation, or apathy. Lethargy can be a normal response to inadequate sleep, overexertion, overw ...
, while cognitive symptoms involve forgetfulness and difficulty concentrating. Mood-related symptoms consist of
irritability Irritability is the excitatory ability that living organisms have to respond to changes in their environment. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimul ...
and depression. Studies evaluating the use of combined oral contraceptive pills containing both
progesterone Progesterone (; P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the ma ...
and
estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...
have demonstrated their effectiveness in alleviating the symptoms of premenstrual dysphoric disorder.


Comorbidity

Premenstrual disorders are usually comorbid with many psychiatric conditions, suich as anxiety and personality disorders. Psychotic symptoms tend to worsen when
estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...
levels drop during the premenstrual period, leading to increased psychiatric admissions for women with
schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
just before and during their menstrual cycles. Estrogen may have a neuroprotective role by influencing neurotransmitters such as
serotonin Serotonin (), also known as 5-hydroxytryptamine (5-HT), is a monoamine neurotransmitter with a wide range of functions in both the central nervous system (CNS) and also peripheral tissues. It is involved in mood, cognition, reward, learning, ...
,
dopamine Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic chemical of the catecholamine and phenethylamine families. It is an amine synthesized ...
, and
norepinephrine Norepinephrine (NE), also called noradrenaline (NA) or noradrenalin, is an organic compound, organic chemical in the catecholamine family that functions in the brain and human body, body as a hormone, neurotransmitter and neuromodulator. The ...
. These are all associated with mood regulation, which is how psychotic symptoms could worsen. Another contributing factor to the higher incidence of schizophrenia onset in midlife women may be the reduced estrogen levels associated with
menopause Menopause, also known as the climacteric, is the time when Menstruation, menstrual periods permanently stop, marking the end of the Human reproduction, reproductive stage for the female human. It typically occurs between the ages of 45 and 5 ...
. In women with
bipolar disorder Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...
, especially bipolar II disorder, premenstrual syndrome and premenstrual dysphoric disorder are common. For those women who experience these premenstrual conditions, bipolar affective symptoms and mood swings may be more severe.


Menstrual psychosis

Menstrual
psychosis In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or inco ...
was documented in the mid-19th century and has been extensively discussed in numerous articles. However, it is not widely recognized or diagnosed by modern psychiatrists. The earliest clear clinical descriptions of this condition emerged in French literature around 1850, with most well-documented cases appearing in German literature between 1880 and 1930. As per British psychiatrist Ian Brockington, diagnosing menstrual psychosis requires specific criteria to be met, including symptoms recurring in sync with the menstrual cycle, acute onset against a background of normality, a brief duration followed by complete recovery, and the presence of psychotic features such as
delusion A delusion is a fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other m ...
s,
hallucination A hallucination is a perception in the absence of an external stimulus that has the compelling sense of reality. They are distinguishable from several related phenomena, such as dreaming ( REM sleep), which does not involve wakefulness; pse ...
s,
confusion In psychology, confusion is the quality or emotional state of being bewildered or unclear. The term "acute mental confusion"
,
mutism In human development, muteness or mutism is defined as an absence of speech, with or without an ability to hear the speech of others. Mutism is typically understood as a person's inability to speak, and commonly observed by their family members, c ...
,
stupor Stupor is the lack of critical mental function and a level of consciousness, in which an affected person is almost entirely unresponsive and responds only to intense stimuli such as pain. The word derives from the Latin '' stupor'' ("numbness, in ...
, or manic syndrome. Menstrual psychosis is not formally classified, however, new studies and clinical reports continue to explore how hormonal fluctuations in estrogen and
progesterone Progesterone (; P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the ma ...
could trigger symptoms. Management for menstrual psychosis typically focuses on hormonal therapy, antipsychotic medications, and mood stabilizers, although standardized treatment guidelines have not been established.


Daily life impact

Menstruation Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and Mucous membrane, mucosal tissue from the endometrium, inner lining of the uterus through the vagina. The menstrual cycle is characterized ...
affects many individuals' daily lives beyond certain mental disorders. A survey conducted with over 42,000 women found that common menstruation symptoms, such as stress and
fatigue Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself. Fatigue (in the medical sense) is sometimes associated wit ...
, caused women to be impacted significantly in their daily lives. These symptoms meant that individuals had to prepare for their lives in advance because of the possible challenges that could be experienced by them. In high-pressure environments such as the workplace or school, menstruation can cause extra stress and affect productivity and engagement. Menstruation can present daily challenges that affect how someone may do their usual routine. Furthermore, menstruation causes additional stress because of the access that someone may have to menstrual products and healthcare. Socioeconomic factors have a major role in the access to these products and whether someone has the proper means to deal with their menstruation-related symptoms and menstrual disorders. People may experience heavier menstrual flow or migraines and may lack the access to treatment if they are from a lower
socioeconomic status Socioeconomic status (SES) is a measurement used by economics, economists and sociology, sociologsts. The measurement combines a person's work experience and their or their family's access to economic resources and social position in relation t ...
, which is shown in period poverty. These disparities show how menstruation-related mental health challenges can be affected by social and economic status.


See also

* Miscarriage and mental disorders * Psychiatric disorders of childbirth


References

{{Menstrual cycle Menstrual cycle Mental disorders Women's mental health