The influence of menstrual cycle-related processes on clients’ psychotherapy experience: results from an exploratory mixed-methods study

Despite substantial research on the physiological and psychological effects of the menstrual cycle (MC) on somatic and mental health, its impact on psychotherapy remains largely overlooked. The menstrual cycle follows a recurring pattern of inflammatory activity. Emotional states, mood, cognitive functioning, and sleep patterns fluctuate across the MC, affecting overall functioning and well-being. Additionally, hormonal shifts across the cycle have been linked to the exacerbation of psychiatric symptoms, particularly in premenopausal women who exhibit heightened sensitivity to normal changes in sex steroid levels. However, MC-related hormonal fluctuations and inflammatory processes are rarely, if at all, considered in psychotherapeutic settings. This exploratory study provides initial insight into the impact of MC-related fluctuations on clients’ psychotherapy experiences. Employing a mixed methods approach, this investigation surveyed N=425 female therapy clients for their evaluation of the importance of MC in the context of psychotherapy. Quantitative findings revealed reduced satisfaction with therapy sessions during premenstrual and perimenstrual phases compared to other phases. Qualitative data highlighted symptom exacerbation during these phases, negatively affecting emotional states, therapeutic participation, cognitive functioning, and perceptions of therapy’s necessity and effectiveness. Participants reported that the open discussion of the MC in therapy improved treatment outcomes. They advocated for individualized consideration of MC-related factors in therapy planning. These findings underscore the need for more personalized clinical approaches that integrate MC-related dynamics into psychotherapy to optimize treatment outcomes. This study highlights the MC as a critical example of how biological and clinical perspectives can enhance psychotherapeutic practices and calls for further research in this underexplored area.