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Ovarian Hormones as a Source of Fluctuating Biological Vulnerability in Borderline Personality Disorder


Purpose of Review

To examine the potential role of ovarian hormones in biological vulnerability to borderline personality disorder (BPD). The review focuses primarily on research examining the menstrual cycle as a source of short-term lability of BPD symptom expression, while discussing the currently understudied possibility of ovarian hormone influence in the developmental course of BPD.


Several patterns of menstrual cycle effects on BPD symptoms and relevant features in non-clinical samples have been observed in empirical studies. Most symptoms demonstrated patterns consistent with perimenstrual exacerbation; however, timing varied between high and low arousal symptoms, potentially reflecting differing mechanisms. Symptoms are typically lowest around ovulation, with an exception for proactive aggression and some forms of impulsive behaviors.


Preliminary evidence suggests ovarian hormones may exert strong effects on BPD symptom expression, and further research is warranted examining mechanisms and developing interventions. Recommendations for researchers and clinicians working with BPD are provided.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington: American Psychiatric Pub; 2013.

  2. 2.

    •• Schiller CE, Johnson SL, Abate AC, Schmidt PJ, Rubinow DR. Reproductive steroid regulation of mood and behavior. Compr Physiol. 2016;6(3):1135–60. https://doi.org/10.1002/cphy.c150014. Comprehensive review of the pathophysiology of reproductive mood disorders.

  3. 3.

    Gehlert S, Song IH, Chang C-H, Hartlage SA. The prevalence of premenstrual dysphoric disorder in a randomly selected group of urban and rural women. Psychol Med. 2009;39(1):129–36. https://doi.org/10.1017/S003329170800322X.

  4. 4.

    Schmidt PJ, Nieman LK, Danaceau MA, Adams LF, Rubinow DR. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med. 1998;338(4):209–16. https://doi.org/10.1056/NEJM199801223380401.

  5. 5.

    Bloch M. Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatr. 2000;157(6):924–30.

  6. 6.

    Schmidt PJ, Ben Dor R, Martinez PE, Guerrieri GM, Harsh VL, Thompson K, et al. Effects of estradiol withdrawal on mood in women with past Perimenopausal depression: a randomized clinical trial. JAMA psychiatry. 2015;72(7):714–26. https://doi.org/10.1001/jamapsychiatry.2015.0111.

  7. 7.

    Gordon JL, Rubinow DR, Eisenlohr-Moul TA, Xia K, Schmidt PJ, Girdler SS. Efficacy of transdermal estradiol and micronized progesterone in the prevention of depressive symptoms in the menopause transition: a randomized clinical trial. JAMA psychiatry. 2018;75(2):149–57. https://doi.org/10.1001/jamapsychiatry.2017.3998.

  8. 8.

    Gordon JL, Rubinow DR, Eisenlohr-Moul TA. Estradiol variability, stressful life events, and the emergence of depressive symptomatology during the menopausal transition. Menopause. 2015.

  9. 9.

    • Kiesner J. The menstrual cycle-response and developmental affective-risk model: a multilevel and integrative model of influence. Psychol Rev. 2017;124(2):215–44. https://doi.org/10.1037/rev0000058. Theory regarding the role of the menstrual cycle in the development of psychopathology during the pubertal transition.

  10. 10.

    Stepp SD, Keenan K, Hipwell AE, Krueger RF. The impact of childhood temperament on the development of borderline personality disorder symptoms over the course of adolescence. Borderline Personality Disorder and Emotion Dysregulation. 2014;1(1):1–10. https://doi.org/10.1186/2051-6673-1-18.

  11. 11.

    Ball JS, Links PS. Borderline personality disorder and childhood trauma: evidence for a causal relationship. Curr Psychiatry Rep 2009;11(1):63–8. https://doi.org/10.1007/s11920-009-0010-4.

  12. 12.

    Crowell SE, Beauchaine TP, Linehan MM. A biosocial developmental model of borderline personality: elaborating and extending linehan’s theory. Psychol Bull. 2009;135(3):495–510. https://doi.org/10.1037/a0015616.

  13. 13.

    Gollenberg AL, Hediger ML, Mumford SL, Whitcomb BW, Hovey KM, Wactawski-Wende J, et al. Perceived stress and severity of perimenstrual symptoms: the BioCycle study. J Women's Health. 2010;19(5):959–67. https://doi.org/10.1089/jwh.2009.1717.

  14. 14.

    Namavar Jahromi B, Pakmehr S, Hagh-Shenas H. Work stress, premenstrual syndrome and dysphoric disorder: are there any associations? Iran Red Crescent Med J. 2011;13(3):199–202.

  15. 15.

    Eisenlohr-Moul TA, Rubinow DR, Schiller CE, Johnson JL, Leserman J, Girdler SS. Histories of abuse predict stronger within-person covariation of ovarian steroids and mood symptoms in women with menstrually related mood disorder. Psychoneuroendocrinology. 2016;67:142–52. https://doi.org/10.1016/j.psyneuen.2016.01.026.

  16. 16.

    Nillni YI, Pineles SL, Patton SC, Rouse MH, Sawyer AT, Rasmusson AM. Menstrual cycle effects on psychological symptoms in women with PTSD. J Trauma Stress. 2015;28(1):1–7. https://doi.org/10.1002/jts.21984.

  17. 17.

    Schulte Holthausen B, Habel U. Sex differences in personality disorders. Curr Psychiatry Rep. 2018;20(12):107. https://doi.org/10.1007/s11920-018-0975-y.

  18. 18.

    Skodol AE, Bender DS. Why are women diagnosed borderline more than men? Psychiatry Q. 2003;74(4):349–60.

  19. 19.

    Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the wave 2 National Epidemiologic Survey on alcohol and related conditions. J Clin Psychiat. 2008;69(4):533–45.

  20. 20.

    Silberschmidt AL, Lee SS, Zanarini MC, Schulz SC. Gender differences in borderline personality disorder: results from a multinational, clinical trial sample. J Personal Disord. 2015;29(6):828–38. https://doi.org/10.1521/pedi_2014_28_175.

  21. 21.

    Benson KT, Donnellan MB, Morey LC. Gender-related differential item functioning in DSM-IV/DSM-5-III (alternative model) diagnostic criteria for borderline personality disorder. Personal Disord Theory Res Treat. 2017;8(1):87–93. https://doi.org/10.1037/per0000166.

  22. 22.

    Hoertel N, Peyre H, Wall MM, Limosin F, Blanco C. Examining sex differences in DSM-IV borderline personality disorder symptom expression using item response theory (IRT). J Psychiatr Res. 2014;59:213–9. https://doi.org/10.1016/j.jpsychires.2014.08.019.

  23. 23.

    Sher L, Rutter SB, New AS, Siever LJ, Hazlett EA. Gender differences and similarities in aggression, suicidal behaviour, and psychiatric comorbidity in borderline personality disorder. Acta Psychiatr Scand. 2019;139(2):145–53. https://doi.org/10.1111/acps.12981.

  24. 24.

    Schmidt PJ, Berlin KL, Danaceau MA, Neeren A, Haq NA, Roca CA, et al. The effects of pharmacologically induced hypogonadism on mood in HealthyMen. Arch Gen Psychiatry. 2004;61(10):997–1004. https://doi.org/10.1001/archpsyc.61.10.997.

  25. 25.

    Pearlstein T, Yonkers KA, Fayyad R, Gillespie JA. Pretreatment pattern of symptom expression in premenstrual dysphoric disorder. J Affect Disord. 2005;85(3):275–82. https://doi.org/10.1016/j.jad.2004.10.004.

  26. 26.

    Staebler K, Helbing E, Rosenbach C, Renneberg B. Rejection sensitivity and borderline personality disorder. Clin Psychol Psychother. 2010;18(4):275–83. https://doi.org/10.1002/cpp.705.

  27. 27.

    Fernandez E, Johnson SL. Anger in psychological disorders: prevalence, presentation, etiology and prognostic implications. Clin Psychol Rev. 2016;46:124–35. https://doi.org/10.1016/j.cpr.2016.04.012.

  28. 28.

    • Hartlage S, Brandenburg D, Kravitz H. Premenstrual exacerbation of depressive disorders in a community-based sample in the United States. Psychosom Med. 2004;66(5):698–706. https://doi.org/10.1097/01.psy.0000138131.92408.b9. Prospective study showing that 60% of women with a chronic depressive disorder experience clinically significant premenstrual exacerbation of symptoms.

  29. 29.

    Dias RS, Lafer B, Russo C, Del Debbio A, Nierenberg AA, Sachs GS, et al. Longitudinal follow-up of bipolar disorder in women with premenstrual exacerbation: findings from STEP-BD. Am J Psychiatr. 2011;168(4):386–94. https://doi.org/10.1176/appi.ajp.2010.09121816.

  30. 30.

    Peters JR, Upton BT, Baer RA. Brief report: relationships between facets of impulsivity and borderline personality features. J Personal Disord. 2013;27(4):547–52.

  31. 31.

    Links P, Heslegrave R, van Reekum R. Impulsivity: core aspect of borderline personality disorder. J Personal Disord. 1999;13(1):1–9.

  32. 32.

    • Dawson DN, Eisenlohr-Moul TA, Paulson JL, Peters JR, Rubinow DR, Girdler SS. Emotion-related impulsivity and rumination predict the perimenstrual severity and trajectory of symptoms in women with a menstrually related mood disorder. J Clin Psychol. 2018;74(4):579–93. https://doi.org/10.1002/jclp.22522. Longitudinal study showing trait level emotion-related impulsivity and rumination predict more severe PME in those with clinically significant PMDD symptoms.

  33. 33.

    •• DeSoto MC, Geary DC, Hoard MK, Sheldon MS, Cooper L. Estrogen fluctuations, oral contraceptives and borderline personality. Psychoneuroendocrinology. 2003;28(6):751–66. https://doi.org/10.1016/S0306-4530(02)00068-9. Study finding that women with BPD features experience increases in symptoms when starting oral contraceptives.

  34. 34.

    •• Eisenlohr-Moul TA, DeWall CN, Girdler SS, Segerstrom SC. Ovarian hormones and borderline personality disorder features: preliminary evidence for interactive effects of estradiol and progesterone. Biol Psychol. 2015;109:37–52. https://doi.org/10.1016/j.biopsycho.2015.03.016. Longitudinal study showing daily links between E2, P4, and BPD features in an enriched college sample.

  35. 35.

    Steiner M, Pearlstein T, Cohen LS, Endicott J, Kornstein SG, Roberts C, et al. Expert guidelines for the treatment of severe PMS, PMDD, and comorbidities: the role of SSRIs. J Women's Health. 2006;15(1):57–69.

  36. 36.

    Ziv B, Russ MJ, Moline M, Hurt S. Menstrual cycle influences on mood and behavior in women with borderline personality disorder. J Personal Disord. 1995;9:68–75. https://doi.org/10.1521/pedi.1995.9.1.68.

  37. 37.

    •• Eisenlohr-Moul TA, Schmalenberger KM, Owens SA, Peters JR, Dawson DN, Girdler SS. Perimenstrual exacerbation of symptoms in borderline personality disorder: evidence from multilevel models and the Carolina premenstrual assessment scoring system. Psychol Med. 2018;6:1–11. https://doi.org/10.1017/S0033291718001253. Longitudinal study showing significant perimenstrual exacerbation of symptoms in an unmedicated sample of women with BPD.

  38. 38.

    Schmalenberger KM, Eisenlohr-Moul TA, Surana P, Rubinow DR, Girdler SS. Predictors of premenstrual impairment among women undergoing prospective assessment for premenstrual dysphoric disorder: a cycle-level analysis. Psychol Med. 2017;47(9):1585–96. https://doi.org/10.1017/S0033291716003524.

  39. 39.

    Bixo M, Ekberg K, Poromaa IS, Hirschberg AL, Jonasson AF, Andréen L, et al. Treatment of premenstrual dysphoric disorder with the GABAA receptor modulating steroid antagonist Sepranolone (UC1010)—a randomized controlled trial. Psychoneuroendocrinology. 2017;80:46–55. https://doi.org/10.1016/j.psyneuen.2017.02.031.

  40. 40.

    Martinez PE, Rubinow DR, Nieman LK, Koziol DE, Morrow AL, Schiller CE, et al. 5α-reductase inhibition prevents the luteal phase increase in plasma allopregnanolone levels and mitigates symptoms in women with premenstrual dysphoric disorder. Neuropsychopharmacology. 2016;41(4):1093–102. https://doi.org/10.1038/npp.2015.246.

  41. 41.

    • Eisenlohr-Moul T, Schmalenberger K, Weise C, Kiesner J, Kaiser G, Ditzen B, Kleinstauber M. Are there temporal subtypes of premenstrual dysphoric disorder?: using group-based trajectory modeling to identify individual differences in symptom change. Psychol Med. n.d.. Study finding early and late-onset subtypes of PMDD with implications for pathophysiological overlap with BPD.

  42. 42.

    Catherine DeSoto M. Borderline personality disorder, gender, and serotonin: does estrogen play a role? In: Psychoneuroendocrinology Research Trends 1st ed. Hauppage: Nova Science Publishers; 2007. p. 149–60.

  43. 43.

    Saunders K, Hawton K. Suicidal behaviour and the menstrual cycle. Psychol Med. 2006;36(7):901–12.

  44. 44.

    Baca-Garcia E, Diaz-Sastre C, Ceverino A, Perez-Rodriguez MM, Navarro-Jimenez R, Lopez-Castroman J, et al. Suicide attempts among women during low estradiol/low progesterone states. J Psychiatr Res. 2010;44(4):209–14. https://doi.org/10.1016/j.jpsychires.2009.08.004.

  45. 45.

    Baca-García E, Diaz-Sastre C, Ceverino A, Saiz-Ruiz J, Diaz FJ, de Leon J. Association between the menses and suicide attempts: a replication study. Psychosom Med. 2015;65(2):237–44.

  46. 46.

    Baca-Garcia E, Diaz-Sastre C, Ceverino A, Saiz-Ruiz J, Diaz FJ, de Leon J. Association between the menses and suicide attempts: a replication study. Psychosom Med. 2003;65(2):237–44.

  47. 47.

    •• Eisenlohr-Moul T, Prinstein M, Rubinow D, Young S, Walsh E, Bowers S, et al. S104. Ovarian steroid withdrawal underlies perimenstrual worsening of suicidality: evidence from a crossover steroid stabilization trial. Biol Psychiatry. 2018;83(9, Supplement):S387. https://doi.org/10.1016/j.biopsych.2018.02.995. Preliminary study showing prevention of perimenstrual exacerbation of suicidality in a transdiagnostic sample using hormone stabilization.

  48. 48.

    Baer RA, Peters JR, Eisenlohr-Moul TA, Geiger PJ, Sauer SE. Emotion-related cognitive processes in borderline personality disorder: a review of the empirical literature. Clin Psychol Rev. 2012;32(5):359–69. https://doi.org/10.1016/j.cpr.2012.03.002.

  49. 49.

    Peters JR, Geiger PJ, Smart LM, Baer RA. Shame and borderline personality features: the potential mediating role of anger and anger rumination. Personal Disord Theory Res Treat. 2014;5(1):1–9. https://doi.org/10.1037/per0000022.

  50. 50.

    Peters JR, Eisenlohr-Moul TA, Upton BT, Talavera NA, Folsom JJ, Baer RA. Characteristics of repetitive thought associated with borderline personality features: a multimodal investigation of ruminative content and style. J Psychopathol Behav Assess. 2017;39(3):456–66.

  51. 51.

    • Owens SA, Eisenlohr-Moul T . Suicide risk and the menstrual cycle: a review of candidate RDoC mechanisms, 1–11 2018. doi:https://doi.org/10.1007/s11920-018-0962-3. Review exploring potential Research Domain Criterion-consistent mechanisms underlying PME of suicidal behavior.

  52. 52.

    Poulin F, Boivin M. Reactive and proactive aggression: evidence of a two-factor model. Psychol Assess. 2000;12(2):115–22. https://doi.org/10.1037//1040-3590.12.2.115.

  53. 53.

    •• Peters JR, Owens SA, Schmalenberger KM, Eisenlohr-Moul TA. Differential effects of the menstrual cycle on reactive and proactive aggression in borderline personality disorder. bioRxiv. 2018. https://doi.org/10.1101/452607. Longitudinal study showing ovulatory increases in proactive aggression and PME of reactive aggression in an unmedicated sample with BPD.

  54. 54.

    Roney JR, Simmons ZL. Within-cycle fluctuations in progesterone negatively predict changes in both in-pair and extra-pair desire among partnered women. Horm Behav. 2016;81(C):45–52.

  55. 55.

    Roney JR, Simmons ZL. Hormonal predictors of sexual motivation in natural menstrual cycles. Horm Behav. 2013;63(4):636–45.

  56. 56.

    Klump KL, Keel PK, Culbert KM, Edler C. Ovarian hormones and binge eating: exploring associations in community samples. Psychol Med. 2008;38(12):1749–57. https://doi.org/10.1017/S0033291708002997.

  57. 57.

    Klump KL, Keel PK, Racine SE, Burt SA, Neale M, Sisk CL, et al. The interactive effects of estrogen and progesterone on changes in emotional eating across the menstrual cycle. J Abnorm Psychol. 2013;122(1):131–7.

  58. 58.

    Edler C, Lipson SF, Keel PK. Ovarian hormones and binge eating in bulimia nervosa. Psychol Med. 2007;37(1):131–41. https://doi.org/10.1017/S0033291706008956.

  59. 59.

    Martel MM, Eisenlohr-Moul T, Roberts B. Interactive effects of ovarian steroid hormones on alcohol use and binge drinking across the menstrual cycle. J Abnorm Psychol. 2017;126(8):1104–13. https://doi.org/10.1037/abn0000304.

  60. 60.

    Joyce KM, Hudson A, O’Connor RM, Goldstein AL, Ellery M, McGrath DS, … Stewart SH. Retrospective and prospective assessments of gambling-related behaviors across the female menstrual cycle. J Behav Addict 2019 1–11. doi:https://doi.org/10.1556/2006.7.2018.133.

  61. 61.

    Blake KR, Bastian B, O’Dean SM, Denson TF. High estradiol and low progesterone are associated with high assertiveness in women. Psychoneuroendocrinology. 2017;75:91–9. https://doi.org/10.1016/j.psyneuen.2016.10.008.

  62. 62.

    Becker JB. Direct effect of 17β-estradiol on striatum: sex differences in dopamine release. Synapse. 1990;5:157–64.

  63. 63.

    Becker JB Gender differences in dopaminergic function in striatum and nucleus accumbens. Pharmacology, Biochemistry and Behavior. 1999

  64. 64.

    Korol DL, Malin EL, Borden KA, Busby RA, Couper-Leo J. Shifts in preferred learning strategy across the estrous cycle in female rats. Horm Behav. 2004;45(5):330–8.

  65. 65.

    Windels F, Kiyatkin EA. Modulatory action of acetylcholine on striatal neurons: microiontophoretic study in awake, unrestrained rats. Eur J Neurosci. 2003;17(3):613–22.

  66. 66.

    Dreher J-C, Schmidt PJ, Kohn P, Furman D, Rubinow D, Berman KF. Menstrual cycle phase modulates reward-related neural function in women. Proc Natl Acad Sci. 2007;104(7):2465–70.

  67. 67.

    Dreher JC. Neuroimaging evidences of gonadal steroid hormone influences on reward processing and social decision-making in humans. In Brain Mapping (pp. 1011–1018) 2015 Elsevier.

  68. 68.

    Roberts B, Eisenlohr-Moul T, Martel MM. Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology. 2018;88:105–14. https://doi.org/10.1016/j.psyneuen.2017.11.015.

  69. 69.

    •• Eisenlohr-Moul TA, Girdler SS, Schmalenberger KM, Dawson DN, Surana P, Johnson JL, et al. Toward the reliable diagnosis of DSM-5 premenstrual dysphoric disorder: the Carolina premenstrual assessment scoring system (C-PASS). Am J Psychiatry. 2017;174(1):51–9. https://doi.org/10.1176/appi.ajp.2016.15121510. A standardized method for utilizing daily ratings to assess clinically significant effects of the menstrual cycle of symptoms for research and/or clinical purposes (includes tracking sheets and excel and SAS macros).

  70. 70.

    Endicott J, Nee J, Harrison W. Daily record of severity of problems (DRSP): reliability and validity. Arch Womens Ment Health. 2006;9(1):41–9.

  71. 71.

    • Schmalenberger KM, Eisenlohr-Moul T. Operationalizing menstrual cycle phase: standardized approaches for hypothesis testing. BiorXiv. 2019. Methodological guide for researchers on multiple methods of assessing the menstrual cycle.

  72. 72.

    Eisenlohr-Moul T. Premenstrual disorders: a primer and research agenda for psychologists. Clin Psychol. n.d.; 5.

  73. 73.

    Casper RF, Yonkers KA. Treatment of premenstrual syndrome and premenstrual dysphoric disorder. UpToDate, Inc. 2019 Retrieved from. https://www.uptodate.com/contents/treatment-of-premenstrual-syndrome-and-premenstrual-dysphoric-disorder

  74. 74.

    Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst Rev. 2012;2:CD006586. https://doi.org/10.1002/14651858.CD006586.pub4.

  75. 75.

    Peters W, Freeman MP, Kim S, Cohen LS, Joffe H. Treatment of premenstrual breakthrough of depression with adjunctive oral contraceptive pills compared with placebo. J Clin Psychopharmacol. 2017;37(5):609–14. https://doi.org/10.1097/JCP.0000000000000761.

  76. 76.

    Schmidt PJ, Martinez PE, Nieman LK, Koziol DE, Thompson KD, Schenkel L, et al. Premenstrual dysphoric disorder symptoms following ovarian suppression: triggered by change in ovarian steroid levels but not continuous stable levels. Am J Psychiatry. 2017;174(10):980–9. https://doi.org/10.1176/appi.ajp.2017.16101113.

  77. 77.

    Wyatt KM, Dimmock PW, Ismail KMK, Jones PW, O’Brien PMS. The effectiveness of GnRHa with and without “add-back” therapy in treating premenstrual syndrome: a meta analysis. BJOG 2004;111(6):585–93. https://doi.org/10.1111/j.1471-0528.2004.00135.x.

  78. 78.

    Cronje WH. Hysterectomy and bilateral oophorectomy for severe premenstrual syndrome. Hum Reprod. 2004;19(9):2152–5.

  79. 79.

    Kleinstäuber M, Witthöft M, Hiller W. Cognitive-behavioral and pharmacological interventions for premenstrual syndrome or premenstrual dysphoric disorder: a meta-analysis. J Clin Psychol Med Settings. 2012;19(3):308–19. https://doi.org/10.1007/s10880-012-9299-y.

  80. 80.

    Linehan MM. DBT® skills training manual, Second Edition. Guilford Publications 2014.

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This work was supported by grants from the National Institute of Mental Health (K23MH112889, R00MH109667) and the Brain & Behavior Research Foundation.

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Correspondence to Jessica R. Peters.

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Peters, J.R., Eisenlohr-Moul, T.A. Ovarian Hormones as a Source of Fluctuating Biological Vulnerability in Borderline Personality Disorder. Curr Psychiatry Rep 21, 109 (2019). https://doi.org/10.1007/s11920-019-1096-y

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  • Menstrual cycle
  • Estradiol
  • Progesterone
  • Borderline personality disorder
  • Premenstrual exacerbation
  • Premenstrual dysphoric disorder