Does PMDD make intrusive thoughts worse?

Most women can attest to the dreaded hormone surge that happens in the week leading up to their period. Mood swings, fatigue, irritability, pain, headaches, feeling sad or depressed, anxiety—these symptoms add up to a personal hell for many women during this time of the month. But there’s another premenstrual symptom that doesn’t get as much air time, even though a lot of people struggle with it: intrusive thoughts. 

Sure, everyone has the occasional thought that they wish they didn’t have. But if the time before your period fills you with intrusive thoughts, it’s common to wonder if this is normal. Rest assured: as a therapist, it’s become the norm for me to take into account where my member is in their cycle when we are discussing their symptoms, including intrusive thoughts. That’s because there’s a scientific connection between this time of the month and the thoughts that cross your mind. Learning more about it is the first step to finding some relief. 

What are intrusive thoughts?

Before we get into the connection between your menstrual cycle and intrusive thoughts, let’s define what intrusive thoughts actually are. Intrusive thoughts (as well as intrusive images and urges) are mental experiences that are unpleasant or distressing, happen against your will, and do not align with your true feelings or values. They tend to be about outcomes people don’t want to occur, or things they don’t want to be true of themselves. 

Intrusive thoughts seem to pop into your mind out of nowhere, often with no apparent trigger or cause. While there is an element of randomness about intrusive thoughts, there are some reasons and explanations for why you have them in general, as well as why our intrusive thoughts may be more prevalent at certain times of the month.

PMS, PMDD, and Intrusive Thoughts

It’s not all in your head: studies have found that some women can experience fluctuations in mental health symptoms during the premenstrual/luteal phase of their menstrual cycle. This phase starts roughly around day 15 of a 28-day cycle and continues until the beginning of the period. During this phase, depression, anxiety, and panic symptoms can all increase, and some people who menstruate are diagnosed with Premenstrual Dysphoric Disorder (PMDD), a much more severe form of PMS or Premenstrual Syndrome. 

According to the Diagnostic and Statistical Manual of Mental Disorders, PMDD symptoms include all or a combination of the following symptoms: 

• Mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection
• Irritability/Anger
• Depressed mood, feelings of hopelessness or self-deprecating thoughts
• Marked anxiety, tension, or feeling “keyed up” and on edge
• Decreased interest in things that are usual activities
• Difficulty concentrating
• Lethargy or fatigue
• Marked change in appetite
• Sleeping too much or too little
• Feeling overwhelmed or out of control
• Physical symptoms including breast tenderness or swelling, joint or muscle pain, bloating, and weight gain

Although PMS may also involve some of the symptoms of PMDD, the overall impact on a person’s well being is much more intense with PMDD. Not only will some or all of these symptoms be present, but you may have significant distress about these symptoms. You might think to yourself, “I’m just not functioning right now,” missing days of work or social engagements, and your relationships may also be affected. 

As for intrusive thoughts? 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.

Can PMS and PMDD make intrusive thoughts worse?

Yes, it can. As a therapist who specializes in OCD, it is quite common for me to hear about symptoms increasing during the week before a therapy member’s period. In fact, some people will be in what we call a “maintenance phase” from their OCD, but they still know to expect an increase in their intrusive thoughts one week out of the month. 

Of course, it’s important to point out that it’s not only people who struggle with OCD who have intrusive thoughts before their period. People experiencing PMS or PMDD—with or without an OCD diagnosis—can have intrusive thoughts, and they may become more distressing around these times.

How to stop intrusive thoughts related to PMDD

If PMDD is affecting you and leading to intrusive thoughts, there are many ways to deal with this disorder. Sometimes, coordination of care between an OB-GYN and therapist can be helpful in treating PMDD with medical therapeutic techniques. Symptoms of PMDD may be treated with antidepressant medications including SSRIs. In addition to medication, your doctor or therapist may recommend changes in your diet and exercise routine. Caffeine, sugar, and alcohol might be discouraged due to their inflammatory effects. Regular exercise can be beneficial in treatment as well as taking different supplements like B6, calcium, and magnesium. 

Sometimes medications will be prescribed to treat hormone imbalances. For instance, women who have too much estrogen may be treated with progesterone therapy. Birth control pills may also be used to shorten periods or make them more manageable. 

Other ways to cope with intrusive thoughts before your period 

1. Don’t try to figure out what they mean

While it can be helpful to understand the nature of intrusive thoughts, agonizing over why you had a particular thought or whether it says something bad about you will only make things worse.

2. Don’t try to push them away

Trying not to think about any thought makes it more likely that you’ll think about it. This is often called the “pink elephant” effect—try not to think of a pink elephant right now, and you’ll understand why. Instead of resisting intrusive thoughts, simply allow them to exist when they do.

3. Don’t let intrusive thoughts be an obstacle

Your intrusive thoughts might make you think you need to avoid certain situations. This will only cause intrusive thoughts to grow more powerful. Instead of avoiding them, confront your intrusive thoughts head-on and learn that they don’t mean what you think they do. 

4. See a mental health professional for ERP

If you find you can’t manage your intrusive thoughts on your own, it’s worth seeing a mental health professional. When it comes to tackling intrusive thoughts in OCD, exposure and response prevention (ERP) therapy is the gold standard. 

In ERP, people are exposed to whatever triggers their intrusive thoughts without engaging in their typical safety-seeking behaviors, like avoidance, reassurance seeking, distraction, substance use, or compulsions. Over time, you learn to sit with discomfort, your intrusive thoughts become less frequent and distressing, and the urge to complete compulsions subsides.

If you are already working with an ERP therapist and you notice your intrusive thoughts get worse before your period, you might make a plan to have an extra session during this time. Or simply know that you may be doing some extra practice facing those intrusive thoughts during that week. Making a plan to deal with the increase of intrusive thoughts due to hormonal fluctuation could be very helpful. 

You can start overcoming intrusive thoughts today

ERP done in live, face-to-face teletherapy (over a video call) is just as effective as traditional in-person ERP therapy. If you think you may be suffering from OCD that gets worse before your period, I encourage you to learn more about NOCD’s accessible approach to treatment—I know from personal experience that you don’t always have to feel this way, whether every day or at certain times in the month. You can learn to overcome the impact that intrusive thoughts are having in your life.