Suicidal behaviour and the menstrual cycle

University of Oxford, Oxford, England, United Kingdom
Psychological Medicine (Impact Factor: 5.94). 08/2006; 36(7):901-12. DOI: 10.1017/S0033291706007392
Source: PubMed


To investigate the available data regarding possible associations between phases of the menstrual cycle and suicidal behaviour.
A systematic search of major relevant databases was performed using appropriate search terms.
Forty-four relevant studies were identified in total, 13 pertaining to suicide, two pertaining to both attempted and completed suicide, 23 to suicide attempts, three to suicide attempts in those suffering from the premenstrual syndrome (PMS), three to suicidal ideation and two to repetitive self-harming behaviours. A variety of methodologies were used in these studies and there were notable differences in the conclusions reached. Studies with better methodology suggest that a positive relationship exists between aspects of the menstrual cycle and non-fatal suicidal behaviour. Such behaviour appears to be more common in those phases of the menstrual cycle when oestrogen levels are lowest (the late luteal and follicular phases), and in those suffering from PMS.
There appears to be an association between the menstrual cycle and non-fatal suicidal behaviours. Interaction between oestrogen and the serotonergic system may provide a possible mechanism.

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    • "However, the highest suicidal risk among female adolescents precede 2-3 years that of male adolescents, and by 19 years of age the risk is similar [43]. Saunders and Hawton [56] suggested that the initiation of menarche is the moment when gender differences in the ratios of affective disorders and suicide behavior move apart. "
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    ABSTRACT: It is nowadays accepted that, independently of methodological issues, women commit fewer suicides than men but make more frequent attempts. Yet, female suicidal risk varies greatly along the lifetime and is linked to the most significant moments in it. A wide analysis of the existing literature was performed to provide a narrative description on the evolution of female suicidal rates from childhood to old age, considering the milestones in their life history. A detailed analysis of gender differences in suicidal behavior is key to establish preventive measures and priorities. More specific studies are needed to adapt future interventions on female suicide.
    The Scientific World Journal 02/2013; 2013(6):485851. DOI:10.1155/2013/485851 · 1.73 Impact Factor
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    • "A meta-analysis study, evaluating 44 cases of suicide in fertile women, showed a positive relationship between the fluctuating hormone levels of the menstrual cycle and suicidal behavior. Suicide attempts seem to be associated to the menstrual phases characterized by the lowest levels of estrogen: the interaction between circulating estrogen and the serotonergic system may contribute to the risk of suicidal behavior associated to those phases (Saunders and Hawton, 2006). Many studies are focused on the specific pathways by which the neuroendocrine changes during the menstrual cycle affect mood and emotion. "
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    ABSTRACT: Abstract Accumulating evidence has highlighted a number of important, global issues regarding the influence of estrogen on emotion and cognitive functions, including learning and memory processes, both in animal models and humans. The influence of estrogen on cognition and emotion can be explained by taking into account its modulator role on several neurotransmitter systems, acetylcholine in particular, but also catecholamines, serotonin and GABA in rodents, primates and humans. Another reason may lie in the widespread presence of the two classes (α and β) of estrogen receptors in many brain regions involved in emotion and cognition, including the hippocampal formation, amygdala and cerebral cortex. The present review reports on research conducted in our laboratory and others with the objective of identifying the action of estrogens on cognition and emotion in rodents, monkeys and humans in youth. In particular, the first section, focused on the mechanisms of estrogens action in the brain, illustrates the involvement of estrogen receptors and neurotransmitters in the cognitive and emotional processes; the second section deals with the estrogen effects on cognitive and emotional mechanisms, with particular emphasis on memory and the involvement of estrogen in emotion and cognition across the estrous/menstrual cycle.
    Reviews in the neurosciences 08/2012; 23(5-6). DOI:10.1515/revneuro-2012-0051 · 3.33 Impact Factor
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    • "To determine the menstrual phase for each participant, serum luteinizing hormone (LH), follicular stimulating hormone (FSH), progesterone, and estradiol were measured within 24 h of the attempt as described in the endocrinology literature (Baca-Garcia et al., 1998, 2000, 2003a,b; Becker et al., 2005). Menstrual phase was determined with the following algorithm (Becker et al., 2005; Saunders and Hawton, 2006): those with progesterone levels >2.3 ng/ml were classified as being in the luteal phase; those with FSH levels between 5.7 and 20 mIU/ml, LH levels between 15 and 62 mIU/ml, and with low levels of progesterone (62.3 ng/ml) were classified as being in mid-cycle; those with low levels of FSH (65.7 mIU/ml), LH (615 mIU/ml), and progesterone (62.3 ng/ml) were classified as being in the follicular phase; OCP use was suspected when FSH levels were <4.9 mIU/ml, LH levels were <8 mIU/ml, and estradiol levels were <102 pg/ml. Those with FSH levels >41 mIU/ml, suggesting ovarian failure, were classified as post-menopausal; those with FSH levels >20 mIU/ml, suggesting ovarian insufficiency, were classified as menopausal if they had low levels of progesterone <0.7 ng/ml and estradiol levels <30 pg/ ml. "
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    ABSTRACT: The relationship between the menstrual cycle and risk for suicidal behaviors is not clear. The aim of this study is to determine whether perimenstrual phases in fertile women are associated with acute risk for suicide attempt and explore whether risk is elevated during low estradiol/low progesterone states. Women (N=431) recruited within 24h of a suicide attempt were assessed for psychopathology, suicidal behavior and LH, FSH, estradiol and progesterone blood levels. Among fertile women (N=281/431), suicide attempts were more likely to occur during menses (26%, 72/281 observed vs. 15%, 43/281 expected attempts; p<0.001). Compared to women whose attempts occurred during other phases, women who attempted suicide during low estradiol/low progesterone states (menstrual phase, amenorrhea and menopause) reported severe suicide intent, a measure that may be predictive of eventual suicide death. Suicide attempts among women are more likely when estrogen and progesterone levels are low and attempts made under these conditions are associated with greater severity. Low gonadal hormone levels may constitute a key factor in the neurobiological basis of suicidal behavior among women, suggesting a novel, testable hypothesis regarding the underpinnings of suicidal acts.
    Journal of Psychiatric Research 09/2009; 44(4):209-14. DOI:10.1016/j.jpsychires.2009.08.004 · 3.96 Impact Factor
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