The role of rumination in shaping emotional symptom trajectories across the menstrual cycle

Abstract

Premenstrual dysphoric disorder (PMDD) was added to the DSM-5 following evidence that it represents an abnormal brain reaction to normal hormone changes across the menstrual cycle. However, few studies have examined the cognitive and behavioral constructs that may contribute to these adverse psychoendocrine responses. Several small prior studies have found that rumination, a maladaptive form of repetitive thought, may intensify cyclical hormone sensitivity. 232 naturally cycling females (mean age = 30.93; 59% Caucasian) completed the Rumination Response Scale at baseline, then provided 2-3 months of ratings using the Daily Record of Severity of Problems (i.e., emotional, behavioral, physical symptoms). Using a prospective daily survey design and multilevel growth modeling, we tested the hypotheses that higher baseline trait rumination would predict (1) higher baseline symptoms, (2) a more rapid increase in premenstrual symptoms during the luteal phase (i.e., during elevations/fluctuations of E2 and P4), and (3) a slower recovery to baseline after menses onset (i.e., following E2 and P4 withdrawal). Contrary to predictions, higher rumination did not predict baseline level, premenstrual increase, or postmenstrual decrease of any symptom. In post hoc analyses, this failure to predict severity or trajectory persisted in a subsample selected for any cyclical symptom change. This study, which utilized a large sample size and gold-standard daily rating methods, does not support the hypothesis that rumination is a key moderator of premenstrual hormone-sensitive symptoms, suggesting the need to identify other moderators.