--- title: Can PMDD cause psychosis that returns with each menstrual cycle? description: Yes. A woman experienced psychotic symptoms starting 5 days before her period and ending when her period began, and this pattern repeated every month for 5 ye url: https://niyora.com/research/papers/menstrual-psychosis-with-premenstrual-onset-a-case-presentation-2024/ --- - [Niyora](https://niyora.com/) - [Research](https://niyora.com/research/) - [Library](https://niyora.com/research/library/) - Can PMDD cause psychosis that returns with each menstrual cycle? Study, 2024 # Can PMDD cause psychosis that returns with each menstrual cycle? Yes. A woman experienced psychotic symptoms starting 5 days before her period and ending when her period began, and this pattern repeated every month for 5 years. Treatment with medications reduced the severity but did not completely stop the symptoms. Early or limited evidence A 26-year-old woman with psychosis related to the menstrual cycle ## What they did Doctors treated a 26-year-old woman who had repeated episodes of psychotic symptoms tied to her menstrual cycle. Symptoms would start 5 days before her period and end when her period started, happening every month for 5 years. She was treated with olanzapine 10 mg per day, lithium 1200 mg per day, and low-dose clonazepam. ## What they found During treatment with these medications, the severity of psychotic and mood symptoms gradually reduced over several menstrual cycles, but they did not completely go away. ## What it means for you This case shows that PMDD can include psychotic symptoms linked to the menstrual cycle, possibly related to hormone changes. However, this is one person's experience. The case also shows that even with treatment, complete relief may not happen. 26 age in years 5 years of recurring monthly episodes 10 olanzapine dose in mg per day ## About the study Original title Menstrual Psychosis with Premenstrual Onset: A case presentation Authors Turkan S, Kara E, İlhan R et al. Journal European psychiatry : the journal of the Association of European Psychiatrists Year 2024 Study design Study What was tested Olanzapine 10 mg per day, lithium 1200 mg per day, and low-dose clonazepam Open access Yes Read the paper [doi.org/10.1192/j.eurpsy.2024.1544](https://doi.org/10.1192/j.eurpsy.2024.1544) Original abstract Introduction Menstrual psychosis has an acute onset and is characterised by confusion, stupor and mutism, delusions, hallucinations, or a manic syndrome lasting for a brief duration, with full recovery. These symptoms maintain periodicity in rhythm with the menstrual cycle. The symptoms may appear in the premenstrual phase or may begin with the onset of menstrual flow (catamenial psychoses). Usually, menstrual psychosis has a polymorphism of both psychotic and affective symptoms (Brockington I. Menstrual psychosis. World Psychiatry. 2005;4(1):9-17.). In this article we present a case of menstrual psychosis with premenstrual onset. Objectives A 26 years old, nulliparous single female with one mentally ill relative on her mother’s side (her grandmother) presented with an episodic illness characterized by mood swings, irrelevant speech, irritability, suspiciousness and thought disorder related to her menstrual cycles. She had earlier suffered prolonged attacks of mania, developed a recurrent episodic illness which returned every month for five years. Her menses began at 15. She presented with the history of a few episodes of manic illness starting five days before and ending suddenly with the onset of the menses. Methods On mental status evaluation during the index episode, the patient was agitated, had labile affect, grandiose and referential delusions and erotomania. A detailed physical examination, routine biochemistry, and gonadal hormonal assay were unremarkable. Results She was started on olanzapine 10 mg/day, lithium 1200 mg/day and low-dose clonazepam. Although the severity of the psychotic and affective symptoms gradually reduced during the future menstrual cycles, they did not completely resolve. Conclusions The pathophysiology of menstrual psychosis is not exactly understood, but it has been postulated that fluctuation of the sex hormones occurring during the menstrual cycle is responsible. Previous studies have reported the association of psychosis with estrogen withdrawal (Mahé V, Dumaine A. Oestrogen withdrawal associated psychoses. Acta Psychiatr Scand. 2001;104(5):323-331.). Treatment strategies for menstrual psychosis include the use of oral contraceptive pills for the regulation of hormones during the menstrual cycle, in our case patient did not want to use oral contraceptive pills. Disclosure of Interest None Declared Reproduced under CC-BY. ## Topics [Bipolar disorder](https://niyora.com/research/topics/comorbidity-bipolar/)[Schizophrenia and psychosis](https://niyora.com/research/topics/comorbidity-psychosis/)[Menstrual cycle and mood](https://niyora.com/research/topics/condition-cycle-mood/)[Menstrual psychosis](https://niyora.com/research/topics/condition-menstrual-psychosis/)[Mood swings and emotion regulation](https://niyora.com/research/topics/symptom-emotional-regulation/)[Anxiolytics and other psychotropics](https://niyora.com/research/topics/treatment-anxiolytics/)[Oral contraceptives and drospirenone](https://niyora.com/research/topics/treatment-hormonal-contraceptives/) 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 Case report, 2017 Can mood symptoms like mania and psychosis change across the menstrual cycle in bipolar disorder? Case report, 2013 Can severe mood changes around a period be an early sign of bipolar disorder? Review, 1971 Could hormone-driven changes in brain chemicals explain premenstrual mood swings? Systematic review, 2019 Do lithium and valproate levels change during the menstrual cycle? Case-control study, 2015 Does lamotrigine reduce menstrual cycle-related mood changes in women with bipolar disorder? Case report, 2025 Can birth control medication help menstrual cycle-related psychosis? Ask AI about this page Copy prompt ChatGPT ↗ Claude ↗ Perplexity ↗ Google AI Mode ↗ Grok ↗