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OCD and the Reproductive Cycle

Summary and Comment |
February 10, 2014

OCD and the Reproductive Cycle

  1. Deborah Cowley, MD

Worsening of obsessive-compulsive symptoms, either during a first pregnancy or in the postpartum period is associated with heightened risk for worsening in or after a second pregnancy.

  1. Deborah Cowley, MD

In small studies, investigators have inconsistently reported the onset or exacerbation of obsessive-compulsive disorder (OCD) during female reproductive events. Now, researchers have conducted a large, international, survey study to examine rates of OCD in women at menarche, premenstrually, during or after pregnancy, and at menopause and to look at risk for repeat exacerbations in a second pregnancy after worsening in the first.

The participants were 540 adult women with OCD but without lifetime psychotic disorders or cognitive impairment, who were recruited in the U.S. (n=351 women; mean age, 45) and the Netherlands (n=189; mean age, 44). More than 25% reported OCD onset related to a reproductive event, primarily menarche. Worsening of preexisting OCD was reported by 38% of women premenstrually, 33% during pregnancy, 47% in the postpartum period, and 33% at menopause. Compared with women without such exacerbations, those whose symptoms worsened during their first pregnancy were at least 7 times more likely to experience worsening in their second pregnancy; women with postpartum symptom exacerbation after the first pregnancy were at least 5 times more likely to worsen in postpartum after the second pregnancy.

Comment

A study weakness is the reliance on participants' retrospective self-reports. However, in this large sample, onset or exacerbation of OCD symptoms was strongly associated with female reproductive events. To advise women appropriately about treatment during pregnancy and postpartum, clinicians should monitor women with OCD for worsening with these events, ask them about worsening in previous pregnancies or postpartum periods, and be aware of the heightened risk with subsequent pregnancies.

  • Disclosures for Deborah Cowley, MD at time of publication Grant / research support Health Resources and Services Administration Leadership positions in professional societies American Association of Directors of Psychiatric Residency Training (Co-Chair, Pre-Meeting Task Force)

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