Premenstrual OCD worsening is real, common, and under-recognized
STUDY: Mojgani JS et al, Comprehensive Psychiatry 2026;147:152696
STUDY TYPE: Scoping review
FUNDING: Independent
Background
OCD worsens during hormonal transitions — postpartum, perimenopause, even puberty. The premenstrual phase is the most common hormonal event in a woman’s reproductive life, yet almost no rigorous data exist on what it does to OCD symptoms.
The Study
This scoping review systematically searched five databases and identified 12 eligible studies — nine examining OCD, two trichotillomania (compulsive hair pulling), and one both. Most were retrospective cross-sectional studies relying on self-report. Only one longitudinal study used a validated scale, the OCD scale (Y-BOCS), measured at three points across the cycle.
Across all studies, 20–56% of women with OCD reported premenstrual worsening. The only longitudinal study found Y-BOCS scores rose a mean of 3 points, from 14.5 in the follicular phase to 17.5 premenstrually, a clinically meaningful change. Symptoms typically started about 4 days before menstruation and lasted around 6 days.
Premenstrual worsening of OCD was more common in women whose OCD started in pregnancy or postpartum. Symptoms of premenstrual dysphoric disorder (PMDD) were linked with premenstrual worsening of OCD. About half of trichotillomania patients reported the same pattern.
Limitations: mostly retrospective, mostly self-report, and nobody controlled for hormonal contraceptives, which blunt normal hormonal swings. The changes, though real, were small.
Practice Implications
- Ask your female patients with OCD whether their symptoms cycle with their period.
- Consider increasing the SSRI dose during the luteal phase (days 15–28). This strategy is used in PMDD but not studied in OCD, so measure symptoms carefully to make sure it is worthwhile.
- We see a similar pattern, and a similar need for more research, in ADHD.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
What’s Your Take? Share in Comments
- Are you seeing patients with OCD whose symptoms worsen around menses?
