Menstruation profoundly affects the body and mind in myriad ways.
Yet, menstruation and its extensive impact on one’s overall health has been under researched for decades, resulting in limited understanding and awareness of exactly how menstruation can affect health.
Approximately 61.5 million people aged 15-44 experience menstruation in the U.S. annually.
This lack of awareness can compromise the day-to-day living for a significant portion of the population.
Much more support for menstruation research is needed in the U.S., to make significant strides in achieving health equity standards, and finding effective treatments for underrecognized issues in women’s mental health. At UIC, that support comes in the form of educator, researcher and nationally recognized advocate for women's health, Dr. Tory Eisenlohr-Moul.
Dr. Eisenlohr-Moul studies the effects of the menstrual cycle on emotions, thought patterns and behaviors. She has dedicated her research career to refuting myths and misconceptions surrounding the menstrual cycle, raising awareness of how the menstrual cycle impacts mental health, and advancing clinical understanding of current menstrual health treatments.
Tory Eisenlohr-Moul and her team of researchers study many under researched and underfunded menstrual related issues. Her award-winning lab aims to CLarify the Endocrinology of Acute Risk (CLEAR Lab) for emotional distress, interpersonal problems, substance abuse, and suicide attempts across the menstrual cycle in at-risk females. CLEAR Lab seeks to reduce suffering in those with ovarian hormone-related emotional, cognitive, and behavioral symptoms, particularly across the menstrual cycle, through impactful scientific research, specialized scientific training, and global efforts to improve clinical care.
In this issue of the UICDR newsletter we highlight the work of Dr. Tory Eisenlohr-Moul and CLEAR Lab, from innovative research around menstruation and suicide, treating and raising awareness Premenstrual dysphoric disorder (PMDD), and serving as a vital resource for addressing the social determinants of menstruation-related problems. Through her work, Dr. Eisenlohr-Moul has become a recognized leading voice, advocate and researcher on the menstrual cycle’s impact on female cognitive abilities.
Menstrual cycles affect day-to-day suicide risk
Conducting groundbreaking research has always been at the forefront of CLEAR Lab. Recently, the lab conducted a first-in-its-kind study of how suicidal thoughts fluctuate across the menstrual cycle.
Suicide is the second leading cause of death among Americans ages 10 to 34, with alarming recent increases in suicide rates among those assigned female at birth. A large body of evidence points to menstrual cycle influences on self-injurious thoughts and behaviors, suggesting that neurobiological hormone sensitivities may drive suicide risks in females.
In a trailblazing study co-led by Dr. Eisenlohr-Moul, postdoctoral researcher and clinical psychologist Jaclyn Ross, and M.D. and Ph.D. student Jordan Barone, CLEAR lab examined how the menstrual cycle can relate to risk and timing of risk for suicidal thoughts.
The study, published in The American Journal of Psychiatry, found that suicidal thoughts and related symptoms fluctuate across the menstrual cycle, identifying when some female patients are at the highest risk, and offering new guidance for clinicians about when to focus interventions with suicidal patients.
The study followed 119 patients who completed a daily survey to track suicidal thoughts and other mental health symptoms over at least one menstrual cycle. The design allowed the researchers to collect detailed data on changes in patients’ mental health over the course of their cycle, allowing for a much finer grained analysis of suicide risk timing than has been accomplished in previous research.
Past studies observed a pattern where suicide attempts increased in the days just before or after the onset of menses — the “perimenstrual” phase. Dr. Eisenlohr-Moul’s study replicated this pattern, finding that suicidal ideation was more severe, and suicidal planning was more likely to occur, during this point in the cycle compared to other phases.
The daily data also allowed the researchers to delve deeper into individual differences in how the cycle affects symptoms and suicidality.
Most patients in the study reported significant elevation of psychiatric symptoms such as depression, anxiety and hopelessness in the premenstrual and early menstrual phases, while others reported emotional changes at different times of their cycle. Individuals also varied in the specific psychiatric symptoms that appeared alongside suicidal thoughts.
“We’re excited to use the best methods out there to try to create individual prediction models for each person, so that we’re not putting people into a box,” Eisenlohr-Moul said. “We want to really figure out: does the cycle matter for this person, and then exactly how does it matter and how we can best intervene based on that information.”
An overlooked condition that can trigger extreme behavior in in menstruating people
Premenstrual dysphoric disorder (PMDD) is an understudied menstrual mood disorder, and thus often misunderstood by the general public.
“Providers and communities often dismiss patients’ concerns, in part because women’s complaints are less likely to be taken seriously than men’s but also because of persistent and even sexist stigma and misconceptions around menstruation in general,” explains Dr. Eisenlohr-Moul.
“Raising awareness about PMDD is crucial for several reasons, first, it is important to clarify that most menstruating people do not experience significant menstrual cycle affective changes (MCAC). Only a minority, about 15%, are affected by significant MCAC, which can be diagnosed and treated.
Currently, there is still a widespread misconception that all menstruating individuals suffer from significant emotional PMS. This is not true, and such beliefs hinder proper understanding and treatment of these conditions. Additionally, many doctors mistakenly treat these disorders as a single entity, whereas research strongly suggests there are likely multiple distinct ways to be sensitive to the cycle.”
”To illustrate, consider the historical understanding of breast cancer. Initially, there was a misconception that all women were at high risk of being affected, and it was treated as a single disease. Over time, we learned that breast cancer has many different mechanisms and types. Similarly, PMDD and related disorders only occur in some people, and the causes and types are diverse, but societal and medical understanding has not yet caught up.”
“This widespread misinformation, coupled with societal taboos around menstruation and hormones, prevents open discussion and proper education about these disorders. As a result, jokes about PMS persist, and many doctors remain uninformed about how to treat people with real cyclical suffering. Raising awareness can help correct these misunderstandings and promote better diagnosis and treatment.”
Social change and the power to make a difference
The importance of CLEAR Lab’s work is underscored by health inequities such as “Period Poverty,” which affects the lives of millions of women in the US and worldwide. Period Poverty refers to the insufficient access to menstrual products, education and medical/mental health support surrounding menstruation for a large portion of the population.
Socioeconomic barriers contribute to depriving many of menstruating safely and respectfully, reducing quality of life, causing psychological stress and depression that women and girls experience because of menstruation-related taboos and stigma.
The work of Dr. Tory Eisenlohr-Moul and CLEAR Lab continues to focus on delivering solutions to societal menstrual health dilemmas, to help ensure the fundamental human right to menstrual mental health, dignity, and justice, and destigmatizing seeking mental health.
“While many people recognize the importance of mental health, there has been a longstanding reluctance to challenge stigmatized beliefs about mental health within some religious and philosophical communities. To fully adopt a healthcare-oriented perspective on mental health, it is essential to actively question and reevaluate our community norms and assumptions about human behavior,” says Dr. Eisenlohr-Moul.
“Traditionally, many communities in the US attribute behavior primarily to personal choice, willpower, and divine intervention. This contrasts with the medical and healthcare models, which highlight the profound influence of environmental and biological factors on our decisions and behaviors. Accepting that our behavior is partly driven by external factors and biology, and not solely by our own choice, requires acknowledging that we have less control over our lives than previously believed. This can be a really difficult realization that might require a total rewrite of one's personal understanding of themselves and others. It's no wonder people resist it by developing mental health stigma.”
“Embracing this perspective involves a significant cultural shift, and it may take several generations of effort to achieve widespread acceptance of medical models of mental and menstrual health. Nonetheless, destigmatizing evidence-based healthcare is crucial for building a healthier, more understanding society for people of all genders.”