Green Saria Adele, Graham Bronwyn M
School of Psychology, The University of New South Wales Sydney, Sydney, New South Wales, 2052, Australia.
Arch Womens Ment Health. 2022 Feb;25(1):71-85. doi: 10.1007/s00737-021-01187-4. Epub 2021 Oct 19.
Anxiety disorders are more prevalent and severe in women than men. Extant research suggests that the menstrual cycle modulates the severity and expression of anxiety symptoms across a range of disorders. The aims of this systematic review were to synthesise the existing literature investigating menstrual phase-related fluctuations in symptoms of anxiety disorders, and related conditions PTSD and OCD, in menstruating women, and to evaluate the methodologies used. PsycINFO and PubMed were searched through to April 2021 for studies that measured and compared symptoms of a diagnosed anxiety disorder, PTSD, or OCD, between at least two menstrual phases. Fourteen studies meeting inclusion criteria were identified. The review revealed evidence for exacerbation of a broad range of symptoms in panic disorder, PTSD, social anxiety disorder, and generalised anxiety disorder, around the weeks prior to and post menses onset, coincident with elevated but declining ovarian hormones, and low hormone levels, respectively. Effects were heterogenous between individuals and different symptom types. Key methodological weaknesses included sub-optimal and inconsistent means of defining and identifying menstrual phases, low sample representativeness, and small sample sizes. Menstrual fluctuations in anxiety symptoms appear to be a feature of anxiety disorders, PTSD, and OCD, but likely only occur in a subset of women. Future research in this field could better manage and account for such heterogeneity by using group-based trajectory modelling in larger sample sizes and using pre-screening to recruit women with known histories of menstrual fluctuation in anxiety symptoms.
焦虑症在女性中比男性更普遍且更严重。现有研究表明，月经周期会调节一系列疾病中焦虑症状的严重程度和表现。本系统综述的目的是综合现有文献，研究月经女性焦虑症症状以及相关疾病创伤后应激障碍（PTSD）和强迫症（OCD）中与月经周期相关的波动情况，并评估所使用的方法。通过检索PsycINFO和PubMed数据库至2021年4月，查找在至少两个月经周期之间测量和比较已诊断焦虑症、创伤后应激障碍或强迫症症状的研究。确定了14项符合纳入标准的研究。该综述揭示，在恐慌症、创伤后应激障碍、社交焦虑症和广泛性焦虑症中，在月经开始前几周和月经开始后几周左右，分别与卵巢激素升高但下降以及激素水平较低同时出现的广泛症状会加重。个体之间和不同症状类型之间的影响存在异质性。关键的方法学弱点包括定义和识别月经周期的方法不够理想且不一致、样本代表性低以及样本量小。焦虑症状的月经波动似乎是焦虑症、创伤后应激障碍和强迫症的一个特征，但可能仅发生在一部分女性中。该领域未来的研究可以通过在更大样本量中使用基于群体的轨迹模型，并通过预先筛选招募有焦虑症状月经波动已知病史的女性，来更好地管理和解释这种异质性。
