Intrusive thoughts, those pesky, uninvited negative ideas crowding up our minds. We all struggle with them from time to time. But have you ever wondered why they might seem worse during different times of the month? Some women notice an increase in intrusive thoughts during the fase lútea of the cycle, coinciding with other premenstrual syndrome (PMS) symptoms [1]. Obsessive compulsive disorder (OCD) is very different from occasional intrusive thoughts and a very serious, diagnosable illness. However, women who experience OCD are also influenced by the changes in their cycle. Here is how.
What is OCD?
For the approximately 2% of the population diagnosed with OCD, recurring, intensely disturbing thoughts can be a daily event. OCD is characterized by persistent, unwanted, distressing thoughts (obsessions) that are out of sync with one’s character or moral code. While everyone periodically has intrusive thoughts, most people are able to automatically dismiss them as unimportant or not real. For OCD sufferers, the intrusive thoughts get “stuck,” and they feel unable to let go of them.
Compulsions are repetitive physical or mental responses sufferers engage in to alleviate the mental pain and anxiety caused by the thought of one’s obsessions potentially coming true. While compulsions inicialmente reduce anxiety, in the long run they empeorar it to such an extent that significant mental and/or physical energy is expended every single day trying to escape the obsession-compulsion cycle.
OCD symptoms may worsen during big hormonal shifts
Major changes in reproductive life, such as menarche (a girl’s first period), pregnancy, posparto, and menopause, are known to impact OCD symptoms [2]. About 3-5% of new mothers may experience postpartum OCD, según to the Anxiety and Depression Association of America (ADAA). Due to hormonal fluctuations throughout the ciclo menstrual, women with OCD may also experience increased intrusive thoughts (and stronger tendencies to respond compulsively, or more difficulty resisting compulsive responses) at certain times of the month.
What’s the relationship between OCD and the menstrual cycle, specifically?
We’ve previously escrito about the effects female reproductive hormones can have on mental health, in particular, anxiety and depression. Rises in estrógeno, such as the one that occurs during the follicular phase of the menstrual cycle, have been shown to decrease negative mental health symptoms [1]. Meanwhile, an increase in mental health symptoms may accompany the drop in progesterone and estrogen levels at the end of the luteal phase before menstruation [1].
Remember how I wrote earlier that everyone has intrusive thoughts, though most people are able to let them go? According to a 2019 study published in Psiconeuroendocrinología, 49% of healthy young women experienced an increase in checking behaviors (“inspection of one’s own behaviors to reduce anxiety about potential adverse outcomes”) during the mid-luteal phase [1].
A Estudio de 2013 suggests that in women with OCD, a subset (49.3% of study participants) experience a worsening of sexual/religious obsessions, anxiety, depression, and suicidality, during the premenstrual phase [3]. Recall that the premenstrual phase, the few days before your period starts, is a time of major hormonal withdrawal as ambos estrogen and progesterone levels decrease.
Can OCD symptoms be alleviated?
If you experience OCD and find the few days before your “time of the month” to be particularly difficult, you’re likely wondering, is there treatment available for OCD symptoms? The answer, thankfully, is a resounding yes.
Exposure and response prevention therapy (ERP)
Según NOCD, Exposure and Response Prevention (ERP) therapy is the gold-standard (and usually affordable!) treatment for individuals with OCD.
This therapy involves gradual exposure to one’s OCD triggers to help them develop fear habituation (desensitization) sin performing compulsive mental or physical behaviors. NOCD helpfully explains, “Over time, this allows them to tolerate anxiety without relying on compulsions or avoidance to feel better, and their intrusive thoughts cause less distress in the long run.”
Acceptance and commitment therapy
OCD sufferers may also benefit from Acceptance and Commitment Therapy (ACT) in tandem with ERP. ACT teaches people with OCD to distinguish the difference between thoughts or feelings (you cannot control) versus actions (you can control). ACT helps individuals see their thoughts as just thoughts, not as dangers. A 2018 study found that ERP + ACT and ERP alone “were both highly effective treatments for OCD” [4]. The full text of the study, including a review of research on the role of medications and traditional cognitive behavioral therapy (CBT) in treating OCD, is aquí.
Progesterone supplementation
En artículo on the ADAA website observes, “Studies have shown that women with OCD are likely to have abnormal hormone levels and that these hormones play a role in triggering or worsening the condition.” The article continues, “There are also treatments that can help with hormone levels to alleviate OCD symptoms. Women who have elevated levels of estrogen may consider progesterone therapy to balance high estrogen levels.” The idea of progesterone support is far from a surprise for those familiar with restorative reproductive medicine supplementation protocols for women suffering from síndrome premenstrual (PMS), trastorno disfórico premenstrual (PMDD), or postpartum depression (PPD).
The article further stipulates, “Growth hormone and pregnenolone (a steroid hormone involved in the sex hormones) can also play a role” in treating OCD patients with hormonal imbalances. Pregnenolone is a precursor to cortisol, testosterone, estrogen, and progesterone. A pregnenolone metabolite, allopregnanolone, is the active ingredient in the only FDA-approved medications (an IV option and an oral option exist) to treat postpartum depression.
Women with OCD and PMS should learn to chart their menstrual cycles
For some women with OCD, intrusive thoughts will worsen during a certain part of the menstrual cycle. Because of the role progesterone supplementation may play in alleviating premenstrual symptoms, and the role hormonal support can play in resolving hormonal disorders generally, fertility awareness charting is especially important for women with OCD and PMS. While fertility awareness charting is beneficial for any woman, it can help these women in particular gain an understanding of why they’re feeling the way they feel, so that they can respond more mindfully and engage more purposefully in ERP and possibly ACT.
Furthermore, fertility awareness can help reproductive medicine-trained professionals identify hormonal disorders, resolve imbalances, and hopefully in doing so, also improve the effectiveness of their patient’s other therapies.
THANK YOU SO MUCH for posting this article! I am truly so so grateful, and I will be sharing it with all my lady friends who have OCD, as well as with a clinician or two! There is so much untapped potential in exploring the link between hormone levels and the severity of OCD symptoms. I pray that the TRUE nature of OCD–and how terribly DEBILITATING it is–will spread throughout the world, inspiring compassion and saving lives. And I also pray that Fertility/Cycle Awareness Methods will become an additional “gold-standard” model of care, alongside ERP and ACT.
Please post more articles discussing this! Thank you!