title: Menstrual cycle characteristics in women with persistent schizophrenia.
abstract: OBJECTIVE
  Oestradiol has been implicated in the pathogenesis of schizophrenia. Women with schizophrenia often suffer with menstrual dysfunction, usually associated with low oestradiol levels, but whether menstrual dysfunction has an effect on their psychiatric symptoms is not well researched. The aim of this study is to document the menstrual characteristics of women with chronic schizophrenia with focus upon menstrual regularity, menstrual cycle length and menstrual symptoms. To determine which patient characteristics are associated with irregular menses and whether irregular menses are associated with the severity of psychotic symptoms, menstrual symptoms or depressive symptoms.
  
  
  METHODS
  Cross-sectional analyses using baseline data of women enrolled in a clinical trial. Inclusion criteria include Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective or schizophreniform disorder; aged between 18 and 51 years; residual symptoms of psychosis despite treatment with a stable dose of antipsychotic medication for at least 4 weeks. Menstrual cycle characteristics including regularity, cycle length and menstrual associated symptoms were documented. Symptoms of schizophrenia were measured using Positive and Negative Syndrome Scale, cognition was measured using Repeatable Battery for the Assessment of Neuropsychological Status and depression was assessed using the Montgomery-Asberg Depression Rating Scale. Blood samples were collected at baseline for hormone assays.
  
  
  RESULTS
  Of the 139 women, 77 (55.4%) had regular menses, 57 (41%) had irregular menses and 5 (3.6%) women had missing data on their menstrual cycle. Use of atypical antipsychotics associated with hyperprolactinaemia was positively associated with irregular menses (odds ratio = 4.4, 95% confidence interval = [1.8, 10.9], p = 0.001), while age more than 30 years was negatively associated (odds ratio = 0.3, 95% confidence interval = [0.1, 0.6], p = 0.004). Women with irregular cycles had significantly lower oestradiol levels than women with regular cycles (213.2 ± 25.0 vs 299.0 ± 27.3, p = 0.03), but there was no difference in Positive and Negative Syndrome Scale, Montgomery-Asberg Depression Rating Scale or Repeatable Battery for the Assessment of Neuropsychological Status between those with regular and irregular cycles. The most common menstrual associated symptoms were decrease in mood with the menstrual cycle (64.8%), bloating (64.8%), cramps (59.7%), back pain (37.6%) and worsening of psychosis symptoms (32.4%).
  
  
  CONCLUSIONS
  Regular menses are associated with higher oestradiol levels and higher rates of cyclical mood symptoms but are not associated with Positive and Negative Syndrome Scale scores. Understanding the effect the menstrual cycle can have on psychiatric illness, such as premenstrual exacerbations, is important for the holistic care of women with schizophrenia.
authors.affiliation: School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Pia C
authors.initials: PC
authors.lastname: Gleeson
authors.affiliation: Alfred Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia.
authors.forename: Roisin
authors.initials: R
authors.lastname: Worsley
authors.affiliation: Alfred Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia.
authors.forename: Emorfia
authors.initials: E
authors.lastname: Gavrilidis
authors.affiliation: Alfred Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia.
authors.forename: Shainal
authors.initials: S
authors.lastname: Nathoo
authors.affiliation: Alfred Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ng
authors.affiliation: Alfred Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia.
authors.forename: Stuart
authors.initials: S
authors.lastname: Lee
authors.affiliation: Alfred Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia jayashri.kulkarni@monash.edu.
authors.forename: Jayashri
authors.initials: J
authors.lastname: Kulkarni
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000097:blood / Q000150:complications; D004958:Estradiol / Q000097:blood; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000097:blood / Q000523:psychology; D008599:Menstruation Disturbances / Q000097:blood / Q000150:complications* / Q000503:physiopathology* / Q000523:psychology; D008875:Middle Aged; D012559:Schizophrenia / Q000097:blood / Q000150:complications* / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D004958:Estradiol
keywords: menstrual cycle; oestradiol; psychosis; schizophrenia