Cyclical change in metacognition across the menstrual cycle

Abstract

This study investigates changes in metacognition across the menstrual cycle among naturally-cycling women. Metacognition, the ability to reflect on and regulate one’s own cognitive abilities, is crucial in understanding subjective cognitive impairments often reported in the absence of objective cognitive performance changes. Despite its relevance, research on metacognition during the menstrual cycle remains limited. This study aims to address this research gap by examining metacognitive change and its covariation with physical and affective symptoms. Participants (n=121) completed the Daily Online Metacognitive Evaluation (DOME), a novel questionnaire developed specifically for this study, which included measures of physical and affective symptoms. Over the course of two full menstrual cycles, a total of 7,172 questionnaires were collected. Multi-level modelling, utilizing cosine regression functions, and structural equation modelling techniques were employed to analyze within-person individual differences and the relationship between cognitive, physical, and affective changes. The results evidence a menstrual effect on metacognition and demonstrate that individual variations in cyclical change are consistently significant and hold greater importance than average levels of change. Looking at co-variations: cognitive, physical, affective, and headache symptom type changes were correlated but distinct. This study presents the first systematic documentation of metacognitive changes in the context of the menstrual cycle, shedding light on underlying causal mechanisms and informing menstrual symptom classifications. Notably, the evidence of symptom covariation supports the reclassification of metacognitive symptoms as primary symptoms alongside physical and affective symptoms, rather than as behavioural accessory symptoms as currently listed in the DSM-5. Beyond clinical implications, these findings hold significance in shaping social policies, such as those pertaining to menstrual leave.