Premenstrual Worsening of Symptoms in Women with Psychotic Disorders

By | June 11, 2019

Clinically we see that many women with major depressive disorder and bipolar disorder experience worsening of their symptoms prior to the onset of menses. We have less data on the impact of menstrual cycle on psychotic disorders.  

In a recent study, researchers analyzed a total of 19 published studies  examining the impact of the menstrual cycle on symptoms in women with psychotic disorders.  Evidence of illness exacerbation included psychiatric hospital admissions, changes in scores on psychiatric symptom scales, and self-reported symptom severity.

Women with psychotic disorders were about 1.5-fold more likely to be psychiatrically hospitalized during the premenstrual phase of their cycle. Similarly they were more likely to report premenstrual worsening of symptoms (on rating scales and by self-report).

While some women may experience premenstrual worsening of symptoms, there is little research to guide treatment.  Would these women benefit from an increase in antipsychotic medications either premenstrually or throughout the entire cycle?  Would they benefit from the addition of an SSRI, which is the treatment of choice for PMDD?

There has also been some interesting data indicating that hormonal modulation may have beneficial effects in women with psychotic disorders.  

Ruta Nonacs, MD PhD

Reilly TJ, Sagnay de la Bastida VC, Joyce DW, Cullen AE, McGuire P.  Exacerbation of psychosis during the perimenstrual phase of the menstrual cycle: systematic review and meta-analysis.  Schizophr Bull, May 2019.  

MGH Center for Women's Mental Health