Menstrual problems in women with primary affective illness

Reports in the literature on the relationship between manifestations or exacerbations of symptoms of affective psychiatric illness and menstruation are often conflicting and confusing. For example, McClure et al.,¹ in a study investigating premenstrual symptoms of women calling a suicide prevention center, suggest that hypomanic premenstrual symptoms may be an indicator of a tendency to an affective illness. However, Coppen² reports that women suffering from affective disturbance have a normal prevalence of menstrual disorders and that two-thirds of these patients report that affective symptoms are unchanged or improved at menstruation. In contrast, Mandell and Mandell³ found that an increased number of women called the Los Angeles Suicide Prevention Center in the late luteal and menstrual phase of their cycle, and MacKinnon and MacKinnon⁴ report that women who died from accident or suicide did so very much more frequently in the premenstrual phase than at other times. Correlations have also been reported between premenstrual or menstrual phases of cycle and admission to a hospital for acute psychiatric illness.⁵. In view of the seemingly conflicting reports in the literature, the present study was undertaken to determine the extent of premenstrual and menstrual somatic and affective disturbances in a carefully selected, well-defined group of women with primary affective illness. The possible relationship between hormonal changes and affective menstrual symptoms is discussed.