MEDICALLY REVIEWED

Understanding PMDD: How Menstruation Can Trigger Suicidal Ideation

Silently impacting many worldwide, Premenstrual Dysphoric Disorder (PMDD) carries with it a significant, dark link to suicidal ideation. 

This comprehensive exploration shines a spotlight on PMDD’s significant correlation with suicidal ideation, demonstrating the critical need for enhanced understanding and robust support systems. 

Delve into the medical and emotional dimensions of PMDD, as this discussion underscores the urgency of addressing this health concern. 

The Science Behind PMDD and Suicidality

Understanding the intricate relationships between hormonal fluctuations, neurotransmitter activity, and emotional and cognitive functioning is paramount for grasping the depth of PMDD’s influence on mental health and suicidality. 

Unraveling these connections offers a clearer insight into the potential interventions and support necessary for mitigating these serious mental health concerns associated with PMDD.

1. Role of Sex Hormones

Estrogen and Progesterone: These two primary female hormones fluctuate throughout the menstrual cycle. Estrogen generally has a mood-enhancing effect, while sudden drops in its level, as seen in the late luteal phase of the menstrual cycle, can lead to mood destabilisation, a hallmark of PMDD. 

Progesterone, on the other hand, can have a calming effect, but its decline can also contribute to mood swings and irritability.

Impact on Serotonin: Estrogen plays a role in increasing serotonin levels and the number of serotonin receptors in the brain. A decrease in estrogen levels can lead to a reduction in serotonin, a neurotransmitter crucial for mood regulation, potentially contributing to depressive symptoms and suicidal ideation.

Hormonal Sensitivity: Certain individuals may have a heightened sensitivity to these hormonal fluctuations, leading to more severe mood disruptions, emotional dysregulation, and an increased risk of PMDD and associated suicidality.

2. Neurotransmitter Activity

Serotonin: Serotonin, a neurotransmitter, plays a pivotal role in mood regulation, emotional stability, and impulse control. A decrease in serotonin levels or activity is closely associated with depressive symptoms and suicidality.

Individuals with PMDD often exhibit altered serotonin activity, potentially making them more vulnerable to mood disturbances and suicidal thoughts.

Gamma-Aminobutyric Acid (GABA): GABA, an inhibitory neurotransmitter, is implicated in PMDD. An imbalance in GABAergic activity can contribute to anxiety, irritability, and mood instability, factors that can exacerbate suicidal ideation and behavior.

3. Emotional and Cognitive Functioning

Emotional Dysregulation: Women with PMDD frequently experience significant emotional dysregulation, characterised by heightened emotional sensitivity, mood swings, and difficulty managing stress and negative emotions.

This emotional turmoil can exacerbate feelings of despair, hopelessness, and thoughts of self-harm or suicide.

Impaired Interpersonal Functioning: Impaired interpersonal relationships and feelings of isolation can compound the emotional distress experienced by individuals with PMDD, further heightening suicide risk.

Therapeutic Implications for PMDD and Associated Suicidality

There are various therapeutic options for managing PMDD symptoms and associated suicidality, emphasising the importance of a multi-faceted approach to care.

1. Pharmacotherapy

Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs, by increasing serotonin levels in the brain, play a crucial role in mood regulation. Enhanced neurotransmission through the blocking of serotonin reuptake can stabilize emotional states.

Proven effective in mitigating physical and emotional PMDD symptoms, SSRIs indirectly diminish the risk of suicidal thoughts and behaviours associated with the disorder.

2. Hormonal Therapies

Hormonal therapies focus on stabilising or modulating hormonal fluctuations throughout the menstrual cycle, with some treatments suppressing ovulation to establish a stable hormonal environment.

By reducing hormonal volatility, hormonal therapies can relieve PMDD symptoms, enhancing emotional stability and lowering suicidality risk.

3. Psychotherapy

Cognitive-Behavioural Therapy (CBT): CBT assists individuals in identifying and altering negative thought patterns and behaviours, offering emotional regulation and stress-coping strategies.

CBT can help manage PMDD symptoms, lower emotional distress, and subsequently reduce suicidal ideation and behaviour.

Accessible in individual or group settings, digital platforms are increasingly offering CBT, enhancing its availability.

4. Complementary Therapies

Acupuncture, yoga, and herbal supplements may offer further symptom management support in PMDD.

Getting Help When Needed

Emphasising the importance of a comprehensive approach to managing PMDD and reducing associated suicidality is paramount. Continuous monitoring for signs of escalating distress or suicidality is crucial.

Support and Crisis Intervention

Women experiencing severe emotional distress or suicidal thoughts should urgently seek help from mental health professionals, crisis hotlines, or local emergency departments.

Helpline numbers

Singapore: 1800-221-4444​1​ (SOS)

Malaysia: (03) 7956 8144, (03) 7956 8145​2​

Thailand: 1300 (One Stop Crisis Centre)​

Philippines: 0919 777 7377 (PNP Women and Children’s Protection Center)​

Indonesia: +62 811 943 6633 (Yayasan Pulih)​

References

  1. Prasad, D., Wollenhaupt-Aguiar, B., Kidd, K. N., De Azevedo Cardoso, T., & Frey, B. N. (2021, December 1). Suicidal Risk in Women with Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Systematic Review and Meta-Analysis. Journal of Womens Health; Mary Ann Liebert, Inc. https://doi.org/10.1089/jwh.2021.0185

  2. Prasad, D., Wollenhaupt-Aguiar, B., Kidd, K. N., De Azevedo Cardoso, T., & Frey, B. N. (2021, December 1). Suicidal Risk in Women with Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Systematic Review and Meta-Analysis. Journal of Womens Health; Mary Ann Liebert, Inc. https://doi.org/10.1089/jwh.2021.0185

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  5. Yonkers, K. A., O’Brien, P. S., & Eriksson, E. (2008, April 1). Premenstrual syndrome. The Lancet; Elsevier BV. https://doi.org/10.1016/s0140-6736(08)60527-9

  6. Segebladh, B., Bannbers, E., Moby, L., Nyberg, S., Bixo, M., Bäckström, T., & Sundström‐Poromaa, I. (2013, January 18). Allopregnanolone serum concentrations and diurnal cortisol secretion in women with premenstrual dysphoric disorder. Archives of Women’s Mental Health; Springer Science+Business Media. https://doi.org/10.1007/s00737-013-0327-1

  7. Bethea, C. L., Pecins‐Thompson, M., Schutzer, W. E., Gundlah, C., & Lü, Z. (1998, October 1). Ovarian steroids and serotonin neural function. Molecular Neurobiology; Springer Science+Business Media. https://doi.org/10.1007/bf02914268

  8. Maguire, J. (2019, March 8). Neuroactive Steroids and GABAergic Involvement in the Neuroendocrine Dysfunction Associated With Major Depressive Disorder and Postpartum Depression. Frontiers in Cellular Neuroscience; Frontiers Media. https://doi.org/10.3389/fncel.2019.00083

  9. Finfgeld, D. L. (2009, January 16). Selective Serotonin Reuptake Inhibitors and Treatment of Premenstrual Dysphoric Disorder. Perspectives in Psychiatric Care; Wiley-Blackwell. https://doi.org/10.1111/j.1744-6163.2002.tb00657.x

  10. Mindfulness meditation research: issues of participant screening, safety procedures, and researcher training. (n.d.). PubMed. https://pubmed.ncbi.nlm.nih.gov/20671334/

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