Why do I have intrusive thoughts before my period?

Believe it or not, everyone has intrusive thoughts—unwanted, seemingly random thoughts, images, or urges that pop into your head, often at the worst times. But it’s also pretty common for people to notice that their intrusive thoughts occur more often at certain times than others. 

Studies have found that some women can experience fluctuations in mental health symptoms during the premenstrual phase/or luteal phase of their menstrual cycle. This phase starts roughly around day 15 of a 28-day cycle and continues until a woman starts her period. During this phase, depression, anxiety, and panic symptoms can all increase, and some women may even be diagnosed with Premenstrual Dysphoric Disorder (PMDD), a much more severe form of PMS or Premenstrual Syndrome. 

Similarly, sometimes a woman’s menstrual cycle can cause an increase in intrusive thoughts during this time of the month. New studies have found that symptoms of obsessive-compulsive disorder (OCD)—in which intrusive thoughts play a central role—can increase during this luteal phase, due to increases in certain hormones and a decrease in others. Let’s investigate this relationship further, from possible causes to ways you can address intrusive thoughts that interfere with your life.

What are intrusive thoughts? 

Intrusive thoughts are thoughts, images, urges, or other mental events that are unwanted and unexpected, whether they arise out of nowhere or are triggered by some situation. These thoughts are ego dystonic, which means they do not align with one’s values or identity, like normal, intentional thoughts do. Here are some examples of common types of ego dystonic intrusive thoughts that one may experience:

• Causing harm to others, self, or animals
• Bad things happening to loved ones or friends
• Sexually explicit thoughts
• Taboo or morally unjust thoughts
• Contamination fears
• Health worries
• Relationship fears
• Perfectionism concerns

Everyone has intrusive thoughts, and most people are able to dismiss them as unimportant. However, for people with OCD, these thoughts sometimes seem to get “stuck,” feeling particularly meaningful or even threatening. When people have a hard time letting go of these thoughts, they may feel a strong urge to alleviate the anxiety they feel by seeking comfort or reassurance about their thoughts, or feel as if they need to act in order to prevent a bad outcome from occurring. In OCD, these behaviors, both mental and physical, are known as compulsions.

Are intrusive thoughts caused by anything? 

While there’s no single cause for intrusive thoughts, they can be influenced by several things. Intrusive thoughts can be more frequent or bothersome due to an increase in or ongoing stress and anxiety, traumatic event, or even a positive change like a new job promotion or the birth of a child. Generally speaking, as stress increases, so can intrusive thoughts. 

Specific situations or objects known as triggers can bring on intrusive thoughts or increase the intensity of intrusive thoughts, as well. It is important to recognize what one’s triggers are and start dealing with them to manage and reduce the way one responds to them. If a person has OCD, recognizing what triggers intrusive thoughts is a large part of the Exposure and Response Prevention (ERP) process. 

Does it mean anything if my intrusive thoughts come more often before my period?

If someone notices an increase in intrusive thoughts before their period, whether or not they have OCD, this may simply mean they are one of the 49% of women who notice this increase during the premenstrual phase. Intrusive thoughts in OCD will still be treated the same way, whether or not they increase during this time of the month. 

However, awareness of these fluctuations of symptoms based on a woman’s menstrual cycle can help to normalize one’s experiences. What may sometimes feel like a troubling sign of something wrong can be no cause for concern, with increased symptoms resulting from normal changes happening in the body during this phase. 

Can hormones affect intrusive thoughts? 

According to the Anxiety and Depression Association of America, studies have shown that hormonal imbalances can trigger or worsen symptoms of OCD: “OCD symptoms in women tend to worsen during premenstrual periods, pregnancy and postpartum. Premenstrual periods are when estrogen levels are highest.” 

If hormonal imbalances are contributing to mental health symptoms like intrusive thoughts, there is medical treatment available. Women who have too much estrogen may be treated with progesterone therapy. However, even women with normal overall hormone levels may still notice an increase of intrusive thoughts before their period due to fluctuation in their estrogen levels. 

Is it possible to get rid of intrusive thoughts entirely? 

Everyone has intrusive thoughts, and they will never go away entirely. However, they can decrease when a person addresses underlying causes or behaviors that make them more frequent or bothersome. 

Someone who is not diagnosed with OCD who notices an increase of intrusive thoughts before their period may need to simply look at ways they can decrease stress and prioritize self-care during this time. However, for people with OCD, exposure and response prevention (ERP) can help them manage periods of increased intrusive thoughts by interrupting the vicious cycle that makes these thoughts cause such anxiety and distress in the first place.

What can I do to make my intrusive thoughts less bothersome?

By doing ERP therapy with a trained therapist, individuals can find relief from the cycle of OCD and learn to manage the distress that comes from intrusive thoughts, or even dramatically decrease their thoughts themselves. Most individuals who do ERP with a trained therapist experience a decrease in symptoms, reduced anxiety and distress, and increased confidence in their ability to face their fears. 

In ERP, people gradually face the situations that trigger their intrusive thoughts in a controlled environment. By being exposed to these triggers, they have an opportunity to resist the urge to engage in any behaviors they use to reduce their anxiety or distress. 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. 

If you believe that you or someone you know many be struggling with OCD, I strongly encourage you to learn more about accessing evidence-based therapy with NOCD. I have seen firsthand just how big a difference treatment can make—whether your thoughts bother you around the clock, or flare up every month or so.