Premenstrual Disorders: A Primer and Research Agenda for Psychologists

Abstract

Females are two times more likely to develop an affective disorder and three times more likely to make a suicide attempt. The etiology of these sex differences is complex, and cannot be reduced to biology alone. However, the growing field of reproductive mood disorders highlights how lifetime exposure to fluctuations in neuroactive sex hormones (including across the menstrual cycle) do contribute to greater female risk, specifically among those females who are neurobiologically sensitive to normal hormone changes (e.g., those with premenstrual disorders). Psychologists--and particularly clinical psychologists-- are trained to be expert in skills relevant to the study and treatment of premenstrual disorders, including assessment, differential diagnosis, and mechanisms of complex behaviors, and often develop other relevant expertise in the neurobiology of affective disorders and advanced longitudinal methods. The purpose of this article is to clarify how psychologists’ strengths can be readily applied to advance scientific knowledge and improve patient care in premenstrual disorders. In order to increase psychologist involvement in this emerging field, this article includes a primer on premenstrual disorders such as premenstrual dysphoric disorder (PMDD) and premenstrual exacerbation (PME) of underlying disorders. It then provides recommendations for research psychologists interested in engaging this field, and outlines critical research areas for future work. Finally, brief recommendations for psychologists in clinical practice are provided.

Menstrual health: a definition for policy, practice, and research

“…A range of disorders of the menstrual cycle have significant implications for physical, mental, and social well-being. 39 In addition, other difficulties associated with the menstrual cycle impact quality of life including pain, physical discomfort, impacts on mental health, 40 , 41 and abnormal uterine bleeding. 42 These may occur in the absence of disorders of the menstrual cycle.…”

Understanding When and Why Some Adolescent Girls Attempt Suicide: An Emerging Framework Integrating Menstrual Cycle Fluctuations in Risk

“…In addition, several studies using behavioral tasks have documented perimenstrual reductions in inhibitory control and associated cortical activity for some hormone‐sensitive women (for a review, see Owens & Eisenlohr‐Moul, 2018). Studies with younger participants have found similar perimenstrual elevations in self‐reported impulsive behavior among those with high trait‐level impulsivity (Roberts et al, 2018) or high borderline personality disorder traits (reviewed in Eisenlohr‐Moul, 2019), but no studies of adolescents have examined within‐person changes in inhibitory control across the cycle using behavioral measures. In addition, deficits of inhibitory control have been identified as a potential risk factor in the transition from suicidal thoughts to suicidal behavior, particularly among adolescents (e.g., Glenn & Nock, 2014).…”

“…The perimenstrual phase is associated with increases in negative affect, including depressed mood, anxiety, mood lability, and anger/irritability among women with PMDD. It is also associated with worsened mood among women with depressive disorders (reviewed in Eisenlohr‐Moul, 2019) and hormone‐sensitive adolescents (Buddhabunyakan et al, 2017; Czajkowska et al, 2015). Naturally, within‐person increases in negative affect are associated strongly with increases in adolescent girls’ suicidal thoughts and behaviors (e.g., Nock, Prinstein, & Sterba, 2010).…”

“…Third, while this framework suggests new lines of inquiry for suicide prevention and intervention, novel studies of treatment targets in adolescents are essential because current treatment recommendations for adults with PMDD and PME of other disorders are untested for hormone‐sensitive adolescents. Although the first line of treatment for PMDD are selective serotonin reuptake inhibitors (SSRIs; Eisenlohr‐Moul, 2019), SSRIs may increase suicide risk among adolescents (Rapkin & Mikacich, 2013). In addition, while suppressing hormone cycling using oral contraceptives may be recommended for adults with PMDD, this approach is ineffective in alleviating PME of other disorders (Eisenlohr‐Moul, 2019) and is prospectively associated with increased risk for suicidal thoughts and behaviors among adolescents generally (e.g., Skovlund, Mørch, Kessing, Lange, & Lidegaard, 2018).…”

“…Although the first line of treatment for PMDD are selective serotonin reuptake inhibitors (SSRIs; Eisenlohr‐Moul, 2019), SSRIs may increase suicide risk among adolescents (Rapkin & Mikacich, 2013). In addition, while suppressing hormone cycling using oral contraceptives may be recommended for adults with PMDD, this approach is ineffective in alleviating PME of other disorders (Eisenlohr‐Moul, 2019) and is prospectively associated with increased risk for suicidal thoughts and behaviors among adolescents generally (e.g., Skovlund, Mørch, Kessing, Lange, & Lidegaard, 2018). In summary, we need large clinical trials to determine the effectiveness of traditional treatment options among adolescents with PMDD and PME, perhaps especially with respect to outcomes related to suicidal thoughts and behaviors (Eisenlohr‐Moul, 2019).…”