Cited by 153Menstrual Health and DisordersMaternal Mental Health During Pregnancy and PostpartumBipolar Disorder and Treatment

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Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review

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Handy, Ariel B., Greenfield, Shelly F., Yonkers, Kimberly A., Payne, Laura A.·2022·Harvard Review of Psychiatry

DOI 10.1097/hrp.0000000000000329PMC PMC8906247

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Abstract

LEARNING OBJECTIVE: After participating in this activity, learners should be better able to:• Discuss and outline the general and overlapping effects of the menstrual cycle on women's mental health. ABSTRACT: A growing body of research demonstrates menstrual cycle-dependent fluctuations in psychiatric symptoms; these fluctuations can therefore be considered as prevalent phenomena. Possible mechanisms underlying these fluctuations posit behavioral, psychological, and neuroendocrine influences. Recent reviews document cyclic exacerbation of symptoms and explore these mechanisms in the context of specific and often single disorders. The question remains, however, as to whether there are general and overlapping effects of the menstrual cycle on women's mental health. To address this gap, we synthesized the literature examining the exacerbation of a variety of psychiatric symptoms across the menstrual cycle in adult women. Results show that the premenstrual and menstrual phases are most consistently implicated in transdiagnostic symptom exacerbation. Specifically, strong evidence indicates increases in psychosis, mania, depression, suicide/suicide attempts, and alcohol use during these phases. Anxiety, stress, and binge eating appear to be elevated more generally throughout the luteal phase. The subjective effects of smoking and cocaine use are reduced during the luteal phase, but fewer data are available for other substances. Less consistent patterns are demonstrated for panic disorder, symptoms of posttraumatic stress disorder, and borderline personality disorder, and it is difficult to draw conclusions for symptoms of generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and trichotillomania because of the limited data. Future research should focus on developing standardized approaches to identifying menstrual cycle phases and adapting pharmacological and behavioral interventions for managing fluctuations in psychiatric symptoms across the menstrual cycle.

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Figure 1 Estrogen and progesterone levels across a typical 28-day menstrual cycle (adapted from Glover et al. (2013).2CC BY-NC-ND · PubMed Central

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See all 153

Authors: Handy, A. B., Greenfield, S. F., Yonkers, K. A., & Payne, L. A.
Affiliations: Harvard University (US)
Corresponding author: Payne, Laura A.
ORCID: Handy, Ariel B.
Greenfield, Shelly F.
Yonkers, Kimberly A.
Payne, Laura A.
Venue: Harvard Review of Psychiatry
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2022-03
Volume: 30
Issue: 2
Pages: 100-117
ISSN: 1067-3229 (ISSN-L)
1465-7309
DOI: 10.1097/hrp.0000000000000329
PMC: PMC8906247
OpenAlex: W4220970268
Cited by: 153
References: 230
Citations by year: 2026: 44 · 2025: 46 · 2024: 30 · 2023: 27 · 2022: 6
FWCI: 5.42
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/4.0/ (unspecified)
Locations: Harvard Review of Psychiatry (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords: menstrual cycle, psychiatric symptoms, premenstrual phase, luteal phase, women's mental health, transdiagnostic symptoms, psychosis, mania, depression, suicide, alcohol consumption, anxiety, binge eating, substance use, post-traumatic stress disorder, borderline personality disorder, neuroendocrine mechanisms
MeSH terms: Adult, Anxiety, Anxiety Disorders, Female, Humans, Menstrual Cycle, Smoking, Stress Disorders, Post-Traumatic

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Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review

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