TW: This article mentions suicide and suicidal ideation.

The doom and gloom right before or during your period isn’t a fragment of your imagination.

According to new findings from the University of Illinois-Chicago (UIC), there is an increased risk of suicidal ideation or planning on the days surrounding your period for people with a history of suicidality.

The study titled, “Predicting Acute Changes in Suicidal Ideation and Planning: A Longitudinal Study of Symptom Mediators and the Role of the Menstrual Cycle in Female Psychiatric Outpatients With Suicidality” followed 119 patients, who filled out surveys about their suicidal thoughts and other mental health symptoms, such as hopelessness, anxiety, and agitation, for at least one menstrual cycle. This allowed researchers to observe changes in their mental health and how the timing of these shifts correlated with the phases of their period.

The results found that suicidal ideation and planning was most likely to occur during the days right before or after bleeding started. Feelings of depression, hopelessness, burdensomeness, and lack of interest were most strongly associated with increased suicidality.

“As clinicians, we feel responsible for keeping our patients safe from a suicide attempt, but we often don’t have much information about when we need to be most concerned about their safety,” said Tory Eisenlohr-Moul, UIC associate professor of psychiatry and senior author of the study. “This study establishes that the menstrual cycle can affect many people who have suicidal thoughts, which makes it one of the only predictable recurring risk factors that has been identified for detecting when a suicide attempt might occur.”

The intersectional reality of suicide

Suicide is the 11th leading cause of death in the U.S., but does not impact all genders equally, creating a so-called gender paradox. According to VeryWell Mind, women are more likely to experience suicidal thoughts, though men are more likely to die by suicide.

Last year, a study at Boston University looked into suicide in women and found that Black women aged 18 to 65 have the highest risk of suicide. When their income was taken into account, Black women in the highest income ranking had a 20% higher chance of suicide or self-inflicted injury than white women in the lowest economic ranking, according to the study.

Suicide rates in the U.S. declined in 2019 and 2020 overall, though examining the numbers through an intersectional lens gave more insight to the complexities which groups are most impacted. From 1999 to 2020, the suicide rates for Black women increased from 2 deaths per 100,000 in 1999 to 3.4 per 100,000 in 2020, according to research from Columbia University. For Black girls and young adults the suicide rate rose from 1.9 to 4.9 per 100,000 deaths.

“While the reasons why remain under investigation, it could be that cyberbullying and online racial attacks toward Black female youth may be on the rise, in particular, and therefore interventions targeting certain stressors are particularly critical for young Black women,” wrote Katherine Keyes, senior author and professor of Epidemiology at Columbia, who says that her research is in trend with others that show that suicide is increasing in youth of color.

Suicide is the leading cause of death for youth and young adults between the ages of 15 and 24.

The study of menstruation

No two periods look the same. From cycle length to preferred period product many aspects of menstruation are unique to the individual’s experience, including the emotions felt during that time. Most patients included in the UIC study reported symptoms like depression and hopelessness during early days, or days leading up to their period, but others experienced them in other stages of their cycle – and these emotions did not necessarily imply thoughts of suicide for everyone.

“People differed in which emotional symptoms were most correlated with suicidality for them,” Eisenlohr-Moul said. “Just because the cycle makes somebody irritable or have mood swings or feel anxious, it doesn’t necessarily mean that that’s going to have the same effect on creating suicidality for each person.”

Past studies on the link between periods and suicide have been smaller and did not track day to day fluctuations symptoms and feelings. According to UIC Today, this is the first evidence from a research study that shows how daily observation of a larger sample of patients can provide greater understanding to how the menstrual cycle can influence risk of suicide.

“Previously, there haven’t been good predictors for why or when Person A is likely to make a suicide attempt versus when Person B is going to make an attempt,” said co-lead author of the study Jordan Barone. “Not everyone is hormone sensitive to the cycle in the same way, and we were able to statistically show the value of including individual differences in our models.”

Menstruation in general is understudied. The term Premenstrual Syndrome (PMS), was coined by UK doctors Raymond Greene and Katharina Dalton in 1953 who identified fatigue, breast pain, bloating, anxiety, and depression as symptoms associated with the menstrual cycle. Today, this group of physical and emotional symptoms experienced in the week or two leading up to one’s period is estimated to affect 48% of reproductive age women, according to a study by the Louisiana State University Health Science Center, though there is no diagnostic test to confirm PMS.

David Rubinow, professor of psychiatry and medicine at University of North Carolina at Chapel Hill, published a “Suicide and the Menstrual Cycle” editorial in The American Journal of Psychiatry this month, which references UIC’s research. He says that doctors should ask more questions about menstrual-related symptoms to better access their patients’ needs.

“To state the obvious, our patients have lives and experiences outside of our offices: their lives are not static but rather dynamically fluctuate across different states, and information that might help us to better understand our patients may be found in the states and the transitions between them.”