Abstract
Anxiety disorders are more prevalent and severe in women than men. Extant research suggests that the menstrual cycle modulates the severity and expression of anxiety symptoms across a range of disorders. The aims of this systematic review were to synthesise the existing literature investigating menstrual phase-related fluctuations in symptoms of anxiety disorders, and related conditions PTSD and OCD, in menstruating women, and to evaluate the methodologies used. PsycINFO and PubMed were searched through to April 2021 for studies that measured and compared symptoms of a diagnosed anxiety disorder, PTSD, or OCD, between at least two menstrual phases. Fourteen studies meeting inclusion criteria were identified. The review revealed evidence for exacerbation of a broad range of symptoms in panic disorder, PTSD, social anxiety disorder, OCD, and generalised anxiety disorder, around the weeks prior to and post menses onset, coincident with elevated but declining ovarian hormones, and low hormone levels, respectively. Effects were heterogenous between individuals and different symptom types. Key methodological weaknesses included sub-optimal and inconsistent means of defining and identifying menstrual phases, low sample representativeness, and small sample sizes. Menstrual fluctuations in anxiety symptoms appear to be a feature of anxiety disorders, PTSD, and OCD, but likely only occur in a subset of women. Future research in this field could better manage and account for such heterogeneity by using group-based trajectory modelling in larger sample sizes and using pre-screening to recruit women with known histories of menstrual fluctuation in anxiety symptoms.
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06 May 2022
A Correction to this paper has been published: https://doi.org/10.1007/s00737-022-01237-5
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This manuscript is based on SG’s thesis, submitted in partial fulfilment of the requirements of a Masters of Psychology (Clinical) at the University of New South Wales Australia. SG and BMG collaboratively designed the study. SG and BMG each independently conducted the literature searches, extracted the data, and conducted the quality assessment. SG synthesised the data, with supervision from BMG. BG and SG interpreted the results and co-wrote manuscript. All authors have approved the final manuscript.
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The original online version of this article was revised due to changes in Figure 1, Table 2, and text pertaining to the Vulink et al (2006) study.
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Green, S.A., Graham, B.M. Symptom fluctuation over the menstrual cycle in anxiety disorders, PTSD, and OCD: a systematic review. Arch Womens Ment Health 25, 71–85 (2022). https://doi.org/10.1007/s00737-021-01187-4
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DOI: https://doi.org/10.1007/s00737-021-01187-4