Sex Hormones Fluctuation and Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is a severe psychiatric condition with an estimated global prevalence of 2-3%. In women the age of onset is bimodal with the first peak between the age of 13 and 16 years and the second peak between 22 and 32 years. These peaks coincide with puberty and child-bearing years, respectively. Besides these two periods, it has been proposed that premenstrum, pregnancy and post-partum are also associated with an increased risk of onset or exacerbation of OCD. In this paper, we review the available information addressing the relationship between sex hormones and OCD. The following topics are addressed to the relationship between the onset or worsening of OCD and fluctuation of hormonal levels, increased women's propensity to develop OCD, and future diagnosis and treatment approaches. The studies included in this review show that the gonadal hormones, estrogen and progesterone, represent an increased risk for OCD during the puerperium, assuming that they may change serotoninergic function. In spite of not knowing the exact mechanism of action, remarkably the periods of gonadal hormones fluctuation coincide with worsening and onset of OCD. The high incidence of the disease in significant life events (28-64%) constitutes a serious issue. An aggregative theory is needed to explain and integrate all these findings.