Menstruation and suicide: should coroners record period status?

Warning: This article discusses suicide, self-harm, and other mental health problems. If you need help, contact Lifeline on 0800 543 354 or text 4357 (HELP).

Women attempt suicide at greater rates than men. Yet almost nothing is known about why - including whether menstruation plays a role.

Investigations that follow a woman’s suspected suicide should consider recording whether she was menstruating at the time of death, a group of New Zealand researchers say.

The connections between menstrual cycles and suicide attempts is - like many parts of women’s health - understudied and poorly understood.

But overseas pathologists have noted potential connections. And researchers say it should now be investigated here.

“I was really taken aback by the scarcity of research in this area,” said Angie Hoskin, a PhD student at the University of Otago who specialises in psychology and suicide.

Suicide rates are higher among men in New Zealand, but women have higher rates of non-fatal suicide attempts.

In a letter published in the New Zealand Medical Journal today, Hoskin and her doctoral supervisors said little was known about women’s suicidal behaviours, especially with regard to menstruation’s impact on mental health.

This was partly a result of the stigma surrounding the issue, which led to delayed diagnosis and poor treatment.

Menstrual cycles have significant impacts on social, physical and mental wellbeing - and for some those impacts could be “catastrophic”, the NZMJ letter said. Premenstrual disorders in particular were associated with higher risks of suicide.

Hoskin said that in the last 30 years, just one country - India - had carried out robust research into the connection between period cycles and suicide attempts.

“What those studies from India do indicate is that there is a possible link between the menstrual phase and maybe the secretory phase of the cycle and death by suicide. However, without further research, we just don’t know.”

In New Zealand, suspected suicides are routinely referred to a coroner and the coronial process includes a post-mortem by a pathologist and sometimes an autopsy.

Hoskin and her colleagues interviewed pathologists in New Zealand and overseas and found inconsistent approaches to collecting menstrual cycle data during autopsies.

Some did it routinely, others felt it was irrelevant to the cause of death, and some never considered it. Significantly, several of those who did record a woman’s period status said they had noted a trend of menstruation in suicide cases.

The researchers then surveyed pathologists about all autopsies, not just suicides. Responses from 100 pathologists in 60 countries showed that any intersection between menstruation and suicide was poorly understood.

Hoskin said the absence of rigorous studies on the issue warranted further exploration.

There would be some challenges in getting New Zealand pathologists to record menstruation data, including time, cost resources and ethical issues.

“It would be challenging, yes, but possible because some people do it. It is really exploratory at this stage to understand what it would mean to include this kind of information.”

That data collection could potentially inform evidence-based healthcare and potential suicide prevention strategies, the NZMJ letter said.

Isaac Davison is an Auckland-based reporter who covers health issues. He joined the Herald in 2008 and has previously covered the environment, politics, and social issues.