Fluctuations in progesterone (P4) and estradiol (E2) across the menstrual cycle can exert direct effects on biological systems implicated in neuropsychiatric disorders and represent a key biological source of variability in affective, cognitive, and behavioral disorders. Although these cyclical symptoms may be most readily identified when they occur exclusively in relation to the menstrual cycle, as in DSM-5 premenstrual dysphoric disorder, symptom changes of similar magnitude occur in a larger proportion of people with ongoing psychiatric disorders. Studies investigating cyclical regulation of brain and behavior often produce inconsistent results, which may be attributed to a lack of focus on specific hormonal events and individual differences in related sensitivities. We propose a transdiagnostic Dimensional Affective Sensitivity to Hormones across the Menstrual Cycle (DASH-MC) framework, postulating that atypical neural responses to several key hormonal events provoke specific temporal patterns of affective and behavioral change across the menstrual cycle. We review prospective and experimental evidence providing initial support for these dimensions, which include (1) luteal-onset negative affect caused by a sensitivity to E2 or P4 surges (mediated by neuroactive metabolites such as allopregnanolone), typified by irritability and hyperarousal; (2) perimenstrual-onset negative affect caused by a sensitivity to low or falling E2, typified by low mood and cognitive dysfunction; and (3) preovulatory-onset positive affect dysregulation caused by a sensitivity to E2 surges, typified by harmful substance use and other risky reward-seeking. This multidimensional, transdiagnostic framework for hormone sensitivity can inform more precise research on ovarian steroid regulation of psychopathology, including further mechanistic research, diagnostic refinement, and precision psychiatry treatment development. Additionally, given the high rates of hormone sensitivity across affective disorders, the DASH-MC may guide broader insights into the complex neurobiological vulnerabilities driving female-biased affective risk, as well as potential triggers and mechanisms of affective state change in psychiatric disorders.

孕酮 （P4） 和雌二醇 （E2） 在整个月经周期中的波动会对与神经精神疾病有关的生物系统产生直接影响，并且是情感、认知和行为障碍变异的关键生物学来源。尽管这些周期性症状仅在与月经周期相关时可能最容易识别，如 DSM-5 经前焦虑障碍，但类似程度的症状变化发生在更大比例的持续性精神疾病患者中。调查大脑和行为的周期性调节的研究经常产生不一致的结果，这可能是由于缺乏对特定荷尔蒙事件的关注以及相关敏感性的个体差异。我们提出了一个跨诊断的跨月经周期对激素的维度情感敏感性 （DASH-MC） 框架，假设对几个关键激素事件的非典型神经反应会在整个月经周期中引发情感和行为变化的特定时间模式。我们回顾了为这些维度提供初步支持的前瞻性和实验证据，其中包括 （1） 由对 E2 或 P4 激增（由神经活性代谢物介导，如异孕酮）敏感引起的黄体发作负面影响，典型表现为易怒和过度觉醒;（2） 由对低或下降的 E2 敏感引起的围经期发作的负面影响，以情绪低落和认知功能障碍为典型;（3） 由对 E2 激增的敏感性引起的排卵前起病阳性影响失调，典型表现为有害物质使用和其他冒险的寻求回报。 这种激素敏感性的多维、跨诊断框架可以为精神病理学卵巢类固醇调节的更精确研究提供信息，包括进一步的机制研究、诊断改进和精准精神病学治疗开发。此外，鉴于情感障碍的激素敏感性很高，DASH-MC 可以指导更广泛地了解驱动女性偏倚情感风险的复杂神经生物学脆弱性，以及精神疾病中情感状态变化的潜在触发因素和机制。