Why Anxiety and OCD Often Spike Before Your Period — And What You Can Do About It

Many of the women I talk with in my practice describe something similar each month. As their period approaches, their anxiety or OCD symptoms feel different — thoughts get stickier, emotions feel more intense, and even small stressors are harder to handle than usual. For women who already live with anxiety or OCD, this isn’t just the usual premenstrual discomfort; it’s a noticeable spike in anxiety that reliably shows up right before their period.

If you’ve experienced this, it can be unsettling. You might find yourself wondering why your symptoms suddenly feel so intense or why you’re reacting so differently to things that typically feel manageable. But this pattern is extremely common, and there are real biological and psychological reasons behind it.

This blog will walk you through why this spike happens, how to identify your own pattern, and what tools can help you move through this part of your cycle with more understanding and support.

What’s Happening in the Body During the Premenstrual Phase

During the second half of your menstrual cycle (the luteal phase), your body goes through a series of hormonal changes as it prepares for your next period. Estrogen and progesterone rise and fall, and for some women, those shifts have a noticeable impact on:

• mood
  
  

• emotional sensitivity
  
  

• sleep
  
  

• energy levels
  
  

• anxiety
  
  

• intrusive thoughts
  

These hormonal fluctuations also influence neurotransmitters, including serotonin — a key player in mood and anxiety regulation. If you already experience anxiety or OCD, your system may be more sensitive to these changes, which can temporarily intensify symptoms.

PMS vs. When Symptoms Feel More Intense

Most women are familiar with PMS (Premenstrual Syndrome) — a cluster of physical and emotional symptoms that happen in the days before a period and typically improve soon after bleeding begins.

Some women, however, experience symptoms that feel more significant. A smaller percentage experience PMDD (Premenstrual Dysphoric Disorder) — which is a more intense form of premenstrual mood disruption that can include marked irritability, mood swings, sadness, anxiety, or feeling overwhelmed, often with noticeable impact on daily functioning.

You don’t need to diagnose yourself, and this blog isn’t meant to help anyone do that. But having a general understanding of the spectrum can make it easier to recognize when symptoms feel beyond what’s typical for you — and when it might help to talk with a medical provider.

Why Anxiety and OCD Tend to Feel Worse During This Week

At our practice, we hear a very similar story from many women. A few days before their period:

• intrusive thoughts feel more frequent or intense
  
  

• anxiety spikes more quickly
  
  

• urges to check or mentally review feel stronger
  
  

• emotions feel closer to the surface
  
  

• stress tolerance is lower
  
  

• physical sensations (like tension or restlessness) feel amplified
  
  

Then, within a day or so of bleeding starting, they describe feeling more like themselves again.

Noticing this pattern can be incredibly helpful. Instead of assuming the worst or that your progress suddenly disappeared, you can recognize, “My mind and body are more sensitive right now…and this phase will pass.”

How to Support Yourself During This Part of Your Cycle

Once you understand why this spike happens, the next step is figuring out how to work with your body and mind during this phase. Here are a few ways to make this week feel more manageable.

Step One: Track Your Cycle and Your Symptoms

To help you make sense of the premenstrual spike, it helps to actually see the pattern. It helps to track your cycle and symptoms for at least two full menstrual cycles. 

It doesn’t have to be complicated — you’re simply paying attention to when your period starts, and then noting the days where anxiety, intrusive thoughts, or emotional sensitivity feel stronger. It’s also important to track other things like sleep changes or irritability, just to get a fuller picture.

There are several apps that make this really easy, such as Clue or Flo. But if you prefer pen and paper, you can use this printable cycle tracker if that feels more your style.

What matters most is giving yourself a way to notice the pattern. 

Tracking helps you see what’s actually happening instead of guessing, and it makes it easier to understand why certain days feel harder. 

It also allows you to anticipate the part of the month when you may need a little more support — and it gives you helpful information to bring to your doctor or therapist if you choose.

Step Two: Build a Plan for Your High-Sensitivity Week

Once you notice the pattern, you can build a supportive plan for that stretch of the month that feels reasonable. 

1. Adjust Demands Gently

You might find it helpful to:

• simplify non-essential tasks
  
  

• protect your sleep
  
  

• plan ahead for easy meals
  
  

This doesn’t mean you need to “lower the bar” for yourself but just give extra grace for a week when you may be struggling more than usual. 

2. Use Cognitive Tools Intentionally

During this phase, your brain may interpret things in a more catastrophic way. A few helpful strategies:

• Name what’s happening: “This is the part of my cycle where my symptoms usually flare.”
  
  

• Create some distance from thoughts: “I’m noticing my mind jumping to worst-case scenarios.”
  
  

• Remind yourself of the temporary nature of the spike: “This feels strong right now, and it will pass.”
  
  

You’re not trying to eliminate negative thoughts. You’re simply acknowledging them and making space for them to be there.

3. Emotion Regulation Tools

This is where small, simple practices make a big impact:

• Mindfulness: For a few minutes per day, practice mindfulness. If you do not regularly engage in mindfulness, it can be useful to use an app (like Headspace or Calm) to guide you through the process.
  
  

• Grounding practices: Feel your feet on the floor, name 3 objects in the room that you can see, take a steady breath.
  
  

• Self-validation: “My system is more sensitive right now — that makes sense.”
  
  

• Distress tolerance skills: such as intense exercise to release built up emotions or use sour or spicy candy to notice other intense sensations.

4. Movement and Routine

Movement helps regulate your mood and this is an especially important week to make it a priority — even in small ways:

• a short walk
  
  

• light yoga
  
  

• gentle cardio
  
  

5. If You’re Doing ERP

If you’re currently doing exposure-based work for anxiety or OCD, you might notice that exposures feel harder during this week. It can be helpful to:

• adjust to lighter exposures
  
  

• keep the structure without overwhelming your system
  
  

• talk with your therapist about pacing
  
  

Don’t just stop exposures all together. Consistency matters more than intensity.

Step Three: When to Talk With a Medical Provider

If your symptoms feel severe, disruptive, or consistently difficult during this phase of your cycle, it may be worth talking with a medical provider. You don’t have to navigate the medical side of this alone.

Here are a few options you can ask about:

1. SSRIs

SSRIs are commonly used as first-line treatment for more severe PMS or PMDD symptoms. Even if you’re already on an SSRI, some providers consider:

• adjusting the dose during the luteal phase, or
  
  

• using a “luteal-only” dosing schedule
  
  

This is always something to discuss directly with your doctor, psychiatrist, or OB/GYN.

2. Calcium Supplementation

Some research shows that calcium supplements may help reduce PMS-related mood symptoms. This is another conversation to have with your provider.

3. Hormonal Options

For some women, hormonal birth control can help stabilize fluctuations across the month. Your medical provider can help you determine whether this might be appropriate.

This Spike Doesn’t Mean Something Is Wrong With You

Premenstrual anxiety or OCD spikes can feel discouraging — but they are also predictable, explainable, and manageable with the right support.

Noticing your pattern helps you respond with clarity instead of panic. With awareness, tools, and medical support when appropriate, this week of the month becomes something you can prepare for rather than something that blindsides you.

Ready for Support?

If you’re noticing a pattern of heightened anxiety or OCD before your period, you don’t have to sort through it on your own. 

Our therapists at State of Mind Therapy in Bloomington can help you understand what’s happening in your cycle and figure out the next steps that make sense for you.

👉 Schedule your free 15-minute phone consultation to get started.