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Menstruation may worsen symptoms in borderline personality disorder

Study findings revealed that females with borderline personality disorder may be at high risk for perimenstrual symptom exacerbation.

“Little prospective evidence is available to evaluate the hypothesis that females with [borderline personality disorder] are at high risk of [perimenstrual exacerbation],” Tory A. Eisenlohr-Moul, PhD, clinical psychologist from the University of North Carolina at Chapel Hill, and colleagues wrote. “Given that the ovarian steroid hormones estradiol and progesterone regulate nearly every brain system implicated in emotional disorders, the rapid changes in ovarian steroid hormones that occur across the monthly female menstrual cycle could represent one source of fluctuating biological vulnerability to [borderline personality disorder] symptoms.”

Researchers examined whether the menstrual cycle contributes to symptom instability among 15 women aged 18 to 45 years with borderline personality disorder who were not taking psychiatric medication or birth control. Participants reported daily symptoms for 35 days, then the investigators assessed cyclical worsening of symptoms using phase contrasts in multilevel models as well as the Carolina Premenstrual Assessment Scoring System. To confirm ovulation and cycle phase, they used urine luteinizing hormone and salivary progesterone tests.

The investigators found that most symptoms attributable to borderline personality disorder significantly worsened among participants in the week before and during menstruation. Specifically, the symptoms showed midluteal worsening and peaked during the perimenstrual period, followed by resolution of symptoms in the follicular or ovulatory phase, the authors wrote in Psychological Medicine. Most participants experienced a worsening of symptoms by at least 30% during the perimenstrual phase, meeting criteria for clinically significant symptom exacerbation per the Carolina Premenstrual Assessment Scoring System.

Post-hoc analysis examining person-centered progesterone showed negative correlations with most symptoms, according to the authors. Researchers observed baseline levels of depressive symptoms in the ovulatory and midluteal phases, whereas exacerbations were observed during both the perimenstrual and follicular phases, demonstrating an unforeseen delayed pattern.

"Our study provides the first evidence that females with borderline personality disorder are at risk for worsened symptoms during the perimenstrual window of their menstrual cycle — the week before and during menses,” Eisenlohr-Moul said in a press release. “This is particularly important since people with borderline personality disorder are at a high risk of suicide, so anything that can help patients and clinicians reliably predict changes in their symptoms is very useful.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.