Related Experiment Video
Updated: May 22, 2026
Rodent Estrous Cycle Monitoring Utilizing Vaginal Lavage: No Such Thing As a Normal Cycle
Published on: August 30, 2021
Gold-standard evidence and best practice guidance for menstrual cycle-informed clinical care: An overview for
Ellen R Lambert1, Louise N Nolan2, Katja M Schmalenberger3
1Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College London (KCL), London, UK.
Objectives:
To synthesize current evidence and provide clinically actionable recommendations for integrating menstrual cycle-related processes-particularly hormone sensitivity, Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME)-into psychological assessment, formulation and treatment.
Design:
Narrative, clinically oriented review.
Methods:
We integrated findings from experimental, longitudinal and clinical studies on menstrual cycle physiology, hormone sensitivity, PMDD and PME, with a focus on evidence relevant to psychological practice. Emphasis was placed on gold-standard methodologies (e.g., prospective symptom assessment, biologically anchored cycle phase determination) and on translational relevance for clinical decision-making.
Results:
A substantial minority of naturally cycling individuals show sensitivity to normative hormonal fluctuations, resulting in clinically significant distress or impairment. PMDD affects approximately 3-8% of menstruating individuals and is characterissed by severe, luteal-phase-specific symptoms and elevated suicidality risk. PME appears even more prevalent, affecting up to 50-60% of individuals with mood disorders. Despite this, menstrual cycle-related symptom patterns are rarely assessed or incorporated into routine care. The literature supports several key clinical strategies: (1) prospective daily symptom tracking across at least two menstrual cycles; (2) cycle-informed case formulations integrating timing and symptom expression; and (3) adaptation of evidence-based interventions to predictable cyclical patterns. Clinician-ready tools and case-based approaches facilitate implementation.
Conclusions:
The menstrual cycle represents a clinically meaningful yet underrecognized source of within-person variability in mental health. Integrating cycle-informed approaches into psychological care can enhance diagnostic precision, improve personalized formulations and optimize treatment outcomes for individuals affected by PMDD and PME.
Related Concept Videos
01:19The Menstrual Cycle
The menstrual phase occurs from days 1 to 5 and involves the shedding of the stratum functionalis, as a uterine...
01:22Hormonal Regulation of the Menstrual Cycle
At puberty, GnRH begins a pulsatile release pattern, which triggers the anterior pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The frequency and amplitude of GnRH pulses vary across the menstrual cycle, with faster pulses favoring LH release and slower pulses favoring FSH release.
01:27Ovarian Cycle
01:30Hormonal Control of the Ovarian Cycle
Before puberty, the hypothalamus releases GnRH in a low frequency, low amplitude pulsatile manner. This along with the immature hypothalamic-pituitary-gonadal axis activity, results in low estrogen levels and the absence of a fully functional ovarian cycle. At puberty, GnRH secretion increases in both frequency and...
01:18Menses Phase
When fertilization does not occur, the corpus luteum deteriorates, causing a significant drop in the levels of estrogen and progesterone in the body. This hormonal decrease triggers the release of prostaglandins, which cause the uterine...
01:19Secretory Phase
Following ovulation, the corpus luteum, a temporary endocrine structure, produces progesterone and estrogens. These hormones stimulate the growth and coiling of endometrial...