Analysis of the Natural Variation of Women's Depressive Mood across the Menstrual Cycle

Background and Purpose: Despite the widely known assumption that change in women's depressive mood is associated with the ovulatory menstrual cycle, which is an integral part of women's lives during the reproductive ages and a naturally occurring biological process involving a complex interaction among the hypothalamus-pituitary-ovary axis, the assumption has been poorly supported by empirical evidence, and the effect of the menstrual cycle on women's depressive symptoms remains controversial and unknown. One of the main reasons for the paucity of evidence is the lack of scientific research devoted to a systematic examination of this phenomenon in the general population. In addition, little is known about the social factors associated with the menstrual cycle despite its complex nature that requires a multidisciplinary approach This study is to examine if a relationship between the biological factor (hormonal changes across the menstrual cycle) and women's depressive symptoms actually exists, and if social factors are associated with the mood change.

Methods: Daily mood and symptom data and urine specimens data were derived from the Women's Wellness Study (WWS; n = 1,246), which is the first large community-based study of comprehensive women's health including menstrual cycle-related mood disorder. Black and White participants between the ages of 13 to 55 years were included in the analysis (n = 1,147; White, n = 977, 85.2%; Black, n = 170, 14.8%). After controlling for age, marital status, income, education, employment status, and oral contraceptive use, a linear mixed model analysis was used to analyze cyclic changes of depressive moods across the menstrual cycle. In addition, a multiple linear regression model was used to analyze the effect of social factors on the depressive symptom changes.

Results: Statistically significant changes were found for women's depressive symptoms (F = 11.16, p < .0001) across the menstrual cycle, and the symptom level during the premenstrual phase was significantly higher than that of the postmenstrual phase (F = 26.12, p < .0001). While the overall average severity of depressed mood through the entire cycle was associated with education (F = 14.04, p = .0002), and marital status (F = 4.31, p = .0049), no predicting variable was statistically significantly associated with change in depressive mood between the premenstrual (late luteal) and postmenstrual weeks.

Conclusion and Implication: The findings suggest that there is a statistically significant depressive mood change across the menstrual cycle in the general population even though further studies need to investigate the clinical significance of this mood change. The results imply that information on the menstrual cycle needs to be considered for research and clinical purposes in promoting women's mental health when measuring women's mental health parameters. Assessments of women's mental health without considering menstrual cycle information may result in inappropriate diagnostic decisions. With social work's commitment to bio-psycho-social approach, these multidimensional factors should be more carefully considered to promote women's mental health.