Women with suicidal thoughts face an increased risk of ideation or planning of suicide in the days around menstruation, a study has revealed.

A research team from the University of Illinois, Chicago, examined how suicidal thoughts and related symptoms fluctuated with the menstrual cycle in a group of 119 participants. The findings were published in The American Journal of Psychiatry.

The participants were followed up daily throughout their menstrual cycle and were asked to respond to questionnaires that tracked their suicidal thoughts and other mental health symptoms.

This approach helped the researchers track the daily changes in symptoms, unlike in previous studies that estimated menstrual cycle status at a single time point after a suicide attempt.

Earlier studies have shown that suicide attempts increased in the "perimenstrual" phase, the days just before or after the onset of the menstrual cycle. The new study confirmed the pattern. The researchers noted that "suicidal ideation was more severe and suicidal planning was more likely to occur during this point in the cycle compared to other phases."

"Nearly all psychiatric symptoms covaried with fluctuations in daily suicidal ideation, and a limited set of symptoms (depression, hopelessness, rejection sensitivity, and perceived burdensomeness) predicted within-person increases in suicidal planning. Many patients demonstrated perimenstrual worsening of psychiatric symptoms, suicidal ideation, and suicidal planning," the researchers wrote.

Since the researchers could identify daily fluctuations in symptoms, the study provided a detailed understanding of how the menstrual cycle affects symptoms and suicidality in different people.

"Previously, there haven't been good predictors for why or when Person A is likely to make a suicide attempt versus when Person B is going to make an attempt. Not everyone is hormone sensitive to the cycle in the same way, and we were able to statistically show the value of including individual differences in our models," Jordan Barone, a co-author of the study, said in a news release.

"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," said Tory Eisenlohr-Moul, a senior author of the paper. "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."

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