'Gynecology has a lot of knowledge about the menstrual cycle and psychiatry knows a lot about depression, but the interaction between the two disciplines has barely been studied. A standard method to assess presence of PME (Premenstrual Exacerbation) is currently lacking,' says Margot Morssinkhof, a neuroscientist and researcher at the Amsterdam Public Health (APH) research institute at Amsterdam UMC. This lack of knowledge is remarkable, because many women say they notice that their hormonal fluctuations can have an adverse effect on their mental health. 

For some women, the mood symptoms are so severe, that their daily activities in the week before their periods start, are impossible to carry out. For others, the symptoms are milder but still affect daily life. 'In women with pre-existing depression, there has been very little research on how the menstrual cycle affects their symptoms. This is striking, because we know that depression and hormonal fluctuations are linked,' Morssinkhof said. 

Mood symptoms and menstrual cycle 

Morssinkhof's research focuses on the week prior to menstruation during which depressive symptoms become more severe: 'American estimates suggest that this occurs in 50 to 60 percent of women with a natural cycle, but we do not yet know how often it occurs in the Netherlands,' she says. The study will ask a group of women with a regular menstrual cycle and depression to keep a daily digital diary for two months. In it, they will record their mood symptoms and menstrual cycle.  

The insights from this study could mean a lot to women with depression. 'If we know, for example, that a woman structurally sleeps worse or becomes more irritable in the week before her period, we are able to better inform her and her loved ones,' explains Morssinkhof. This can help give context to emotions, protect social relationships and better tailor care measures, such as therapy, to individual needs. 

In addition, this research also has societal implications. According to Morssinkhof, women's suffering, whether due to menstruation, pregnancy or menopause, is often normalized and not taken seriously. 'Breaking this stigma starts with better scientific evidence and concrete tools and recommendations for healthcare providers'. 

The study's approach 

During the study, women will track their moods and other relevant data daily via questionnaires they complete on their phone. A research assistant will regularly guide participants and answer any questions they may have. 
After two months, participants receive a personalized summary of their pattern of symptoms, with visual representations such as graphs. This helps them gain insight into how their symptoms are related to their menstrual cycle: 'This instant feedback mechanism is not only valuable for the participant, but it could also be useful for their healthcare providers, as it provides insight into an aspect that is often overlooked,' Morssinkhof explains. 

The potential payoff: from science to better care 

'A standard method to assess presence of PME (Premenstrual Exacerbation) is currently lacking. We want to establish a clearly delineated definition that can be used in psychiatric practice,' says Morssinkhof. In addition, the research may offer insights which could lead to new studies on treatment strategies for PME, which could include adapting medication dosages to the cycle or starting hormonal contraceptives or medication. 

The AUF Startstipendium played an important role in initiating this research. 'It felt almost touching to receive this grant,' says Morssinkhof. 'It shows that this topic is taken seriously, despite the stigma that often attaches to topics such as depression and menstruation.' The stipendium will mainly be used the appointment of a research assistant who will be instrumental in collecting the measurements. 'The personal contact with participants is essential. It is important to be approachable and supportive, because we really do this research together with the participants,’ Morssinkhof explains. 

With this research, Morssinkhof hopes to fill an important gap in science. 'It's a first step, but one that will hopefully make a big difference to women's mental health,' she concludes.