Menstrual Cycle Dynamics and Their Impact on Psychotherapy: Insights From a Mixed-Methods Study

Despite substantial research on the physiological and psychological effects of the menstrual cycle (MC) on somatic and mental health, its impact on psychotherapy remains largely overlooked. Importantly, MC follows a recurring pattern of inflammatory activity. Emotional states, mood, cognitive functioning and sleep patterns fluctuate across the MC, affecting overall functioning and well-being. Additionally, hormonal shifts across the cycle are linked to the exacerbation of psychiatric symptoms, particularly in premenopausal women who exhibit heightened sensitivity to normal changes in sex steroid levels. However, MC-related hormonal fluctuations and inflammatory processes are rarely considered in psychotherapeutic settings. This exploratory mixed-methods study examined how MC-related fluctuations influence clients' psychotherapy experiences. In an online survey setting, a total of N = 425 female clients completed the Client Satisfaction Questionnaire-8 (CSQ-8) and the WHO Well-Being Index (WHO-5), alongside qualitative questions on symptom and therapy experiences. Most participants received cognitive-behavioural (35.5%), psychodynamic (14.4%), systemic (9.4%) or humanistic (6.8%) therapy, while 33.9% were unsure of their therapy orientation, mostly in outpatient settings. Quantitative findings revealed reduced therapy satisfaction during premenstrual and perimenstrual phases compared with other phases. Qualitative data highlighted symptom exacerbation during these phases, negatively affecting emotional states, therapeutic participation, cognitive functioning and perceptions of therapy's necessity and effectiveness. Participants reported that the open discussion of the MC in therapy improved treatment outcomes. They advocated for individualized consideration of MC-related factors in therapy planning. These findings underscore the need for more personalized clinical approaches that integrate MC-related dynamics into psychotherapy to optimize treatment outcomes.