Characterizing the menstrual cycle in adolescents – challenges and guidelines for psychological research

Abstract

The pubertal transition is characterized by a rapidly changing hormone milieu, which is heavily influenced by the first menstrual cycle – menarche. The first year following menarche is associated with menstrual cycles that are infrequent, anovulatory, with a greater likelihood of luteal insufficiency and lower hormone levels than adult cycles. Peripuberty also marks the beginning of a female-dominated risk of suicidality and depression, suggesting an important role of the menstrual cycle and hormone fluctuations. However, there are limited methods and no guidelines for studying the menstrual cycle in this age group. Thus, this study investigated methods of characterizing the menstrual cycle in peripubertal females and compared depressive symptoms based on cycle characteristics. 40 peripubertal females (ages 11-14) provided daily ratings of depressive symptoms and urinary metabolites of estrogen and progesterone (estrone-3-glucuronide (E1G), pregnanediol glucuronide (PdG)), and LH for one menstrual cycle. Eleven literature-derived methods for determining LH-peak or PdG rise were compared, focusing on the feasibility of the method for psychological research. Menstrual cycle and phase lengths, hormone concentrations and ovulatory status based on the presence of an LH peak and PdG rise are described. Further, daily mood ratings and their fluctuation related to hormone changes are examined based on menstrual cycle characteristics. Recommendations for studying peripubertal menstrual cycles and associated hormone-related mood changes are offered to assist future investigations. Understanding the involvement of hormone fluctuations and the menstrual cycle in psychopathology during the pubertal transition is critical for developing novel prevention and treatment strategies.