Histopathological study to correlate fatal deliberate self-harm and phases of the menstrual cycle

The study of suicide and self-harm behaviour is a complex and multidimensional area of research and requires a great and in-depth examination of various aspects contributing to it.Many factors have been established, that indicate the population or subgroup of women may have an increased risk of suicide. It has been established that acting out behavior patterns as well as exacerbations of psychiatric disorders have increased propensity to occur at certain periods of the menstrual cycle. It again implies that the menstrual cycle could be an important area of research in suicidology. During the study period from January 2010 to September 2011, a total of 44 uterus were obtained during the post-mortem examination of suicides occurring in females in the reproductive age group at the department of Forensic Medicine, KMC, Manipal, and subjected to histopathological examination. Histopathological examination of the uterus showed that more than half of the victims (52%) were in the proliferative stage of the menstrual cycle when they were alleged to have committed suicide. Twelve of the victims (27%) were in the secretory phase while 9 victims (21%) were in the menses phase. These results were then subjected to Chi-Square test using SPSS software which showed an association between the proliferative phase of the menstrual cycle and an increased incidence of fatal deliberate self-harm(Chi-Square = 7.409, P = 0.025.) Based on this study we recommend that the proliferative phase and in general the first half of the menstrual cycle to be considered as the critical phase in women with suicidal behavior. In addition we believe that our study validates that an attempt be made to study stress as a factor modifying the physiology of the menstrual cycle and efforts be made to better differentiate the phases of the menstrual cycle histologically. We believe that there is an unquestionable need to conduct further studies to correlate gonadal hormones, stress hormones, phase of the menstrual cycle and self-harm behavior to reduce morbidity and mortality.