--- title: Do hormone pills prevent suicidal thoughts from getting worse around menstruation? description: Yes. Giving women estradiol and progesterone during the time when their natural levels drop (around menstruation) significantly reduced suicidal thoughts, dep url: https://niyora.com/research/papers/effects-of-acute-estradiol-and-progesterone-on-perimenstrual-exacerbation-of-2022/ --- - [Niyora](https://niyora.com/) - [Research](https://niyora.com/research/) - [Library](https://niyora.com/research/library/) - Do hormone pills prevent suicidal thoughts from getting worse around menstruation? Randomised trial, 2022 # Do hormone pills prevent suicidal thoughts from getting worse around menstruation? Yes. Giving women estradiol and progesterone during the time when their natural levels drop (around menstruation) significantly reduced suicidal thoughts, depression, and feelings of rejection and burden compared to placebo. Moderate study design 28 naturally cycling psychiatric outpatients with recent suicidal thoughts (29 randomized) ## What they did 28 women with recent suicidal thoughts completed a crossover experiment. In one condition they received estradiol patches (0.1 mg/day) and progesterone pills (200 mg/day) for 14 days around menstruation. In another condition (separated by a 1-month washout) they received placebo. They rated suicidal thoughts and depression, anxiety, stress, concentration, and social feelings daily. ## What they found When women received estradiol and progesterone, suicidal thoughts, depression, hopelessness, stress, rejection sensitivity, and feelings of burden all decreased compared to placebo, especially during the perimenstrual phase. When treatment stopped and hormones were withdrawn, suicidal thoughts and rejection sensitivity returned. ## What it means for you For women whose suicidal thoughts worsen around menstruation, hormone changes during this time may be a key cause. Hormone treatment might prevent crisis during this dangerous period. Results apply only to naturally cycling women with recent suicidal thoughts, so may not generalize to everyone. 28 Women analyzed 93% Had peak suicidal thoughts in perimenstrual phase 0.1 mg Daily estradiol dose ## About the study Original title Effects of acute estradiol and progesterone on perimenstrual exacerbation of suicidal ideation and related symptoms: a crossover randomized controlled trial Authors Eisenlohr-Moul TA, Bowers SM, Prinstein MJ et al. Journal Translational psychiatry Year 2022 Study design Randomised trial What was tested Estradiol 0.1 mg/day patch plus progesterone 200 mg/day versus placebo for 14-day perimenstrual period Open access Yes Read the paper [doi.org/10.1038/s41398-022-02294-1](https://doi.org/10.1038/s41398-022-02294-1) Original abstract Female suicide attempts peak peri-menstrually-around the onset of menses-when the ovarian steroids estradiol (E2) and progesterone (P4) fall rapidly. Given preclinical evidence that withdrawal from either E2 or P4 can provoke behaviors consistent with elevated suicide risk, we hypothesized that withdrawal from one or both of these steroids contributes to perimenstrual exacerbation of suicidal ideation (SI) and related symptoms. In a randomized, controlled, double-blind crossover experiment (NCT03720847), a transdiagnostic sample of naturally cycling, medically healthy psychiatric outpatients reporting past-month SI completed two conditions during two different 14-day experimental intervals (days 7-20 where the luteinizing hormone surge = day 0), separated by a monthlong washout cycle. In the E2 and P4 (EP) condition, participants received transdermal E2 (0.1 mg/day) plus oral micronized P4 (200 mg/day as 100 mg twice daily) to buffer perimenstrual steroid withdrawal. A matched placebo (PBO) condition allowed natural perimenstrual steroid withdrawal. Participants reported daily SI and planning (primary outcomes) and indices of depression (low mood, hopelessness), threat sensitivity (anxiety, perceived stress), executive functioning (difficulty concentrating, impulsivity), and social cognitive bias (rejection sensitivity, perceived burdensomeness). In baseline cycles, no participant met prospective criteria for DSM-5 premenstrual dysphoric disorder, but 59% met all criteria except full follicular symptom remission, and 93% showed the highest SI in the perimenstrual phase. Of 29 randomized, 28 were analyzed (14 EP-PBO, 14 PBO-EP). Experimental administration of E2 and P4 (relative to PBO) reduced perimenstrual exacerbation of SI, suicide planning, depression, hopelessness, perceived stress, rejection sensitivity, and perceived burdensomeness, particularly in the perimenstrual (natural E2 and P4 withdrawal) days. Further, delayed withdrawal from experimental E2 and P4 (but not PBO) recapitulated SI, hopelessness, and rejection sensitivity. Acute perimenstrual withdrawal from ovarian steroids may play a causal role in perimenstrual worsening of depression and SI. Reproduced under CC-BY. ## Topics [Premenstrual syndrome (PMS)](https://niyora.com/research/topics/condition-pms/)[Premenstrual dysphoric disorder (PMDD)](https://niyora.com/research/topics/condition-pmdd/)[Premenstrual exacerbation (PME)](https://niyora.com/research/topics/condition-pme/)[Low mood and depression](https://niyora.com/research/topics/symptom-depression-mood/)[Mood swings and emotion regulation](https://niyora.com/research/topics/symptom-emotional-regulation/)[Suicidality](https://niyora.com/research/topics/symptom-suicidality/)[Cognition, concentration and memory](https://niyora.com/research/topics/symptom-cognition/)[Stress](https://niyora.com/research/topics/symptom-stress/)[Quality of life and daily functioning](https://niyora.com/research/topics/life-area-quality-of-life/) Research tells you what helps on average. Niyora helps on the day it hits. Calm down, see it another way, and decide what to say, with a PMS and PMDD app built by a doctor. ## Related studies Randomised trial, 2019 Does online cognitive behavioral therapy help women with PMDD? Cohort study, 2024 Does the menstrual cycle affect daily changes in suicidal thoughts? Cohort study, 2023 Does the menstrual cycle affect how often women have suicidal thoughts? Case-control study, 2023 Do emotion regulation strategies help women with PMDD manage mood and stress hormones? Cohort study, 2022 What are PMS and PMDD and how should they be diagnosed and treated? Case-control study, 2012 Do women with PMDD have working memory problems linked to concentration and irritability? Ask AI about this page Copy prompt ChatGPT ↗ Claude ↗ Perplexity ↗ Google AI Mode ↗ Grok ↗