Can hormonal therapy treat psychotic symptoms tied to the menstrual cycle?

Menstrual psychosis, a condition characterized by acute onset, brief duration with full recovery, and psychotic or manic symptoms aligned with the menstrual cycle, has been described in the literature. However, it is not recognized as an independent diagnostic entity in either the International Classification of Diseases, 11th Revision (ICD-11) or the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), and treatment options and comorbidities associated with this condition remain poorly understood. We report the case of a 26-year-old woman who repeatedly developed acute psychotic symptoms, including catatonia, which was in synchrony with her menstrual cycle, with the first two episodes triggered by minimal alcohol intake. Retrospective assessment revealed the presence of premenstrual dysphoric disorder (PMDD) as a comorbidity. Although antipsychotic treatment initially improved her symptoms, relapses occurred until low-dose estrogen-progestin (LEP) therapy was introduced, resulting in sustained remission. This case highlights the potential efficacy of hormonal intervention, the overlap between menstrual psychosis and PMDD, and the possible role of alcohol as a trigger. It emphasizes the need for a rigorous approach to diagnosis and the development of evidence-based treatment strategies.

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