OCD symptoms may intensify during menopause, review shows

Menopause onset may affect obsessive-compulsive disorder (OCD) symptom severity, according to a research review recently published in Menopause. A team of researchers, including lead author Carmela Melina Albanese, MSc, Ph.D., a postdoctoral research fellow at the University of British Columbia, reviewed seven original research studies and one abstract, which, in all, included more than 1,600 women.

Specifically, Albanese and her team found that among the 373 women reporting OCD symptom onset, 5% noticed their OCD symptoms began at the onset of menopause. Of the 265 women reporting symptom change, 27% reported that their OCD symptoms worsened with menopause, while 11% noticed an improvement in their OCD symptoms.

Obsessive-compulsive disorder is a mental health disorder characterized by repetitive, excessive thoughts or actions, which are done to reduce stress — also referred to as “compulsions.” Common compulsion themes include contamination, fear of causing harm and a preoccupation with order and symmetry. This disorder also affects more women than men, with women experiencing a lifetime prevalence of approximately 1.6 times higher than men. Although it’s unclear exactly why, some studies have shown rates are affected by exposure to ovarian hormone fluctuation across the lifespan. In one specific study, rats injected with estradiol, the estrogen hormone used to treat menopause symptoms, showed a decrease in obsessive behaviors, suggesting a potential hormonal mechanism that could be relevant in humans.

The review followed established methodological guidelines for scoping reviews and searched several major academic databases, including MEDLINE, Embase, CINAHL and PsycINFO, for studies published through April 2025. Additional sources of grey literature, such as conference abstracts, theses and dissertations, were also included. Studies were eligible if they examined the relationship between perimenopause or postmenopause and OCD onset, symptom severity or personal experiences with obsessive-compulsive symptoms. Most studies defined menopause as a minimum of 12 consecutive months without menstruation, although some failed to offer a precise definition. Participants self-reported their menopausal status in all studies.

After screening the available literature, the researchers identified eight relevant studies, including seven full research articles and one conference abstract. These studies included participants from several countries, including the United States, the Netherlands, Turkey, Mexico, India, South Africa and Spain.

Overall, the review suggests that menopause may influence obsessive-compulsive symptoms in a subset of women, potentially through hormonal changes that affect brain systems involved in mood, cognition and behavior.

“OCD appears to be influenced by reproductive life events such as menarche, pregnancy, and the postpartum period; however, literature examining OCD in relation to perimenopause is scarce,” Albanese and her team write in the study. “Furthermore, existing research has been in small samples and relied on retrospective recall reports, which are subject to information bias.”

However, the authors emphasize that the evidence base remains small and fragmented.

They also highlight the importance of exploring potential interventions for women whose OCD symptoms are affected by menopause, which could improve quality of life and mental health outcomes in this population.

“Future research is warranted, especially using prospective study designs, objective measures of stages of reproductive aging, and valid measures of OCD symptoms to further characterize the relationship between perimenopause and OCD,” Albanese and her team write.