Women are twice as likely to attempt suicide than men. This difference appears at puberty, suggesting the menstrual cycle may play a key role.
Although this link has been known for a long time, it remains a disappointingly under-researched area. But a 2023 study provided new insight into this link – finding that women may be more likely to die by suicide during certain phases of their menstrual cycle.
The researchers conducted their analysis by pooling data from five studies on suicide and the menstrual cycle. They were then able to identify the menstrual cycle phase of 425 women who died by suicide, ranging in age from 11 to 50.
They found that suicide was most common in the secretory phase of the cycle (accounting for approximately 45% of deaths), followed by the proliferative phase (29% of deaths). The least common phase for death by suicide was the menstrual phase (approximately 18% of deaths).
Researchers aren’t entirely sure why suicide risk is higher during certain phases of the menstrual cycle. While it’s likely due to the complex interplay of many factors, some evidence suggests hormone fluctuations and how sensitive a person is to these changes may be related.
The menstrual cycle is divided into three phases. Each corresponds to different levels of circulating hormones, in particular estradiol and progesterone.
In the menstrual phase (when a woman typically has her period), these hormones are consistently low and stable. This is followed by the proliferative phase (also known as the follicular phase), where estradiol peaks. Finally, in the secretory phase (also known as the luteal phase), estradiol falls sharply while progesterone rises.
This recent study suggests that women have a higher risk of suicide when hormones are fluctuating. Collectively, these phases accounted for almost 80% of deaths.
One possible explanation for this link could be that some women are more sensitive to changing hormone levels throughout their cycle. One review found that while some women have no response to these hormone changes, others experience changes in their mood and mental health that ranged from mild to severe.
For some, these changes negatively affected their daily lives, sleep and relationships, all of which have a cumulative effect on mental health when experienced every month.
This link may also be explained by some mental health conditions which are known to worsen during certain phases of the menstrual cycle.
Premenstrual dysphoric disorder, for example, is a severe mood disorder that affects one in 20 women. It causes debilitating psychological symptoms in the week or two before one’s period (the secretory phase), such as overwhelming anxiety or anger.
For women diagnosed with PMDD, 72% will have suicidal thoughts, half will self-harm and one in three will attempt suicide. Tragically, some women with PMDD do not survive.
Read more: Premenstrual dysphoric disorder: the frightening psychological condition suffered by Dixie D'Amelio
The menstrual cycle has also been shown to have a negative affect on pre-existing psychiatric disorders, including bipolar disorder, depression and anxiety. This is known as premenstrual exacerbation (PME).
Some of these disorders come with increased suicide risk. PME may worsen symptoms during the secretory and proliferative phases.
The menstrual cycle has also been linked with perimenopausal depression. During perimenopause (the transitional period before menopause), the menstrual cycle begins to change, becoming less predictable until it eventually stops.
This is a high-risk phase for women’s mental health. In the UK and US, death by suicide in women is highest in those of perimenopausal age suggesting a link with hormones.
The menstrual cycle is of course not the only factor involved when it comes to suicide risk. Other social and cultural issues play an important role.
Socioeconomic factors appear to be linked to suicide risk, with 77% of global suicides occurring in low- and middle-income countries. And in some such countries, suicide accounts for approximately 70% of violent deaths among women. In Nepal, for example, suicide is the single leading cause of death in reproductive age women.
Women are also more likely than men to experience sexual violence and intimate partner violence – and to experience these types of trauma at a younger age. Childhood sexual abuse is one of the strongest predictors of suicidality in women.
This form of gender-based violence is a key reason more women than men are diagnosed with post-traumatic stress disorder (PTSD).
Women are also more likely to live in poverty, leave education early, have lower-paid jobs and a higher burden of caring responsibilities. These cumulatively impact women’s mental health and may contribute to suicide risk.
There is also the complex intersection of race and ethnicity, with research showing black women have the highest risk of trauma and mental health disorders compared to any other group. Research from the US shows black women have the highest risk of suicide among women.
While the 2023 study highlighted the link between the menstrual cycle and suicide, there are some limitations to its design.
The review only included data from five studies, the majority of which were conducted in India. As such, more research will be needed to understand whether the picture is similar in other parts of the world, and to fully understand all the factors contributing to greater suicide risk during certain phases of the menstrual cycle.
But it isn’t the first study to uncover a link between menstrual cycle and increased suicide risk, showing the clear need for greater support in order to prevent harm.
While the past few years have seen more being done to address women’s health issues, many questions still have not been fully answered. These include why women are more likely to die by suicide during certain phases of their menstrual cycle, what other social and cultural factors put women at greater risk of suicide and how can health professionals better assess those who may be most at risk.
If you’re struggling with suicidal thoughts, the following services can provide you with support:
In the UK and Ireland – call Samaritans UK at 116 123.
In the US – call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or IMAlive at 1-800-784-2433.
In Australia – call Lifeline Australia at 13 11 14.
In other countries – visit IASP or Suicide.org to find a helpline in your country.
Lynsay Matthews receives funding from the Royal Society of Edinburgh.
