Why Your Picking or Pulling Gets Worse Before Your Period
BFRBs · Hormones & your cycle
Why Your Picking or Pulling Gets Worse Before Your Period
If you've noticed that the week before your period turns your skin picking or hair pulling up to eleven, you're not imagining it, and you're not uniquely undisciplined that week. There's research behind the pattern, and better yet, there's a way to plan for it.
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Key takeaways
- Research on hair pulling found stronger urges, more pulling, and less control in the premenstrual days, easing once the period starts.1
- BFRBs are regulation behaviors, so a week when emotions run hotter and stress tolerance runs lower hands the loop more fuel.2
- If the flare travels with severe mood crashes, PMDD may be part of the picture, and it deserves its own attention.
- The fix isn't more willpower in your worst week; it's tracking the pattern and planning for it on purpose.
Most of my clients discover this pattern by accident: they start tracking their episodes for therapy, glance at their cycle app, and there it is, a spike in the same handful of days, month after month. It's one of the most validating discoveries in BFRB work, because it converts "I randomly fail sometimes" into "my body runs on a schedule I can plan around." Here's what's actually going on.
The premenstrual spike is real
In a study of 59 people with trichotillomania, participants reported that the premenstrual phase brought more intense urges, more actual pulling, and a reduced ability to control it, and that symptoms eased during menstruation and shortly after.1 Clinically, skin pickers describe the same shape: the late luteal days are when the mirror becomes a trap and every bump feels louder. The research base here is smaller and older than it should be, which is typical for BFRBs, so the honest framing is that the pattern is documented and widely reported, while the mechanism is still being worked out.
Urges often spike in the late luteal (premenstrual) days, then ease once the period starts.1
A simplified ~28-day cycle. Yours may run differently, which is exactly why tracking your own pattern matters.
Why hormones turn up the volume
Nobody has found a "picking hormone." What the late luteal phase reliably does for many people is shift the conditions the BFRB lives in. Estrogen and progesterone fall, and with them, for many, go mood stability, stress tolerance, and sleep quality. Since BFRBs function as regulation behaviors, tools your nervous system reaches for when tension, restlessness, or "not right" feelings exceed what you can comfortably hold,2 a week that raises the emotional load while lowering your capacity is a week that feeds the loop from both ends. Add the physical layer, since premenstrual skin changes and breakouts give picking more targets exactly when resistance is lowest, and the spike stops being mysterious.
When it might be PMDD too
For some people, the premenstrual week doesn't just intensify the BFRB; it brings a full mood crash, despair, rage, anxiety, or hopelessness that arrives on schedule and lifts within days of the period starting. That pattern has a name, premenstrual dysphoric disorder, and it's a condition I treat in its own right. The two can travel together: PMDD makes the luteal phase emotionally brutal, and the BFRB works overtime trying to regulate it. If you recognize yourself in that description, my post on how to know if you have PMDD is a good next read, the two-minute PMDD reflection quiz is a gentle starting point, and the PMDD therapy page covers how that work looks. And to be clear about lanes: questions about hormonal treatment, birth control, or medication belong with a doctor or prescriber, and with your permission I'm glad to coordinate with yours.
Suspecting your cycle and your picking are tangled together? You can book a free 15-minute consultation and we'll look at the pattern together.
How to work with the pattern instead of against it
Once the pattern is visible, it becomes something you can plan for, and planning beats promising every time.
- Track both together for two or three months. Episodes and cycle days, side by side, in whatever format your brain will actually use. You're looking for your personal spike window, which may not match the textbook.
- Front-load the hard week. Barriers, tools, and environmental changes go up before the spike, not during it: this is stimulus control with a calendar attached.
- Lower the demands where you can. If the late luteal week reliably costs you more, budget for it: fewer optional obligations, more recovery time, easier meals.
- Schedule the self-compassion in advance. Decide now what you'll say to yourself after a bad night in the spike window, because shame is fuel for the loop, and it burns hottest premenstrually.
- Add a cycle layer in therapy. In ComB-based work, your map of triggers gets a time dimension: the premenstrual days get their own strategies, matched to how your urges actually change.3
The short version
Premenstrual worsening of picking and pulling is a documented, common pattern, not a monthly character failure. Hormonal shifts raise the emotional load your BFRB is trying to regulate, right when your capacity is lowest. Track it, plan for it, and if severe mood symptoms ride along, take the PMDD question seriously too. The week is predictable, and predictable things can be prepared for.
What working with me looks like
This intersection is unusually close to home for my practice: I treat both BFRBs and PMDD, online for adults in Texas, Maine, New Hampshire, and Montana, so the cycle layer isn't an afterthought bolted onto BFRB work; it's something we map deliberately. Sessions are secure, HIPAA-compliant video from anywhere private in your state, and if you're curious how the process runs, I've written about what to expect from BFRB therapy. A free 15-minute consultation is a low-pressure place to start.
Helpful next steps
- New to BFRBs? Start with what BFRBs are and why they're not just bad habits.
- Wondering about the mood side? Read how to know if you have PMDD or take the 2-minute reflection quiz.
- Ready to map your pattern? Book a free 15-minute consultation or call/text (512) 790-0019.
Your worst week deserves a plan, not a lecture
A free 15-minute consultation is just a conversation, no commitment, no judgment, about your pattern and what would actually help.
Book a free 15-min consultationFrequently asked questions
Why does my skin picking or hair pulling get worse before my period?
You're not imagining it. Research on hair pulling found that people reported stronger urges, more actual pulling, and less ability to control it in the premenstrual days, with symptoms easing during and shortly after menstruation. The exact mechanism isn't settled, but the hormonal shifts of the late luteal phase raise emotional reactivity and lower stress tolerance for many people, and since BFRBs are regulation behaviors, a harder-to-regulate week means more fuel for the loop.
Could my premenstrual picking or pulling mean I have PMDD?
Not by itself. Premenstrual worsening of a BFRB can happen with ordinary cycle shifts. PMDD is its own condition, marked by severe mood symptoms, such as despair, rage, or anxiety, that arrive in the luteal phase and lift with your period. If your picking spike travels with that kind of mood crash, it's worth exploring both, since they can share the same premenstrual window and each deserves its own support.
What can I do about cycle-related BFRB flares?
Start by tracking your cycle and your episodes side by side for two or three months, so the pattern becomes visible instead of feeling like random failure. Then plan for the hard week on purpose: extra barriers and tools, lighter demands, more support, and self-compassion scheduled in advance. In therapy, a cycle layer gets added to your ComB map so premenstrual days have their own strategies. Questions about hormonal treatment belong with a doctor or prescriber.
About Sagebrush Counseling
Online therapy for adults · BFRBs, PMDD, OCD, anxiety & neurodivergence
Sagebrush Counseling is a telehealth practice specializing in BFRBs, OCD, anxiety, and neurodivergence in adults, with particular attention to how hormonal and neurodivergent experiences intersect with picking and pulling. BFRB work uses the research-backed ComB model, and the approach throughout is affirming, practical, and direct, delivered entirely online.
Sessions are available for adults in Texas, Maine, New Hampshire, and Montana; join from anywhere in your state. Call or text (512) 790-0019, email contact@sagebrushcounseling.com, or book a free consultation.
References
- Keuthen NJ, O'Sullivan RL, Hayday CF, et al. The relationship of menstrual cycle and pregnancy to compulsive hairpulling. Psychotherapy and Psychosomatics, 1997. Premenstrual exacerbation of urge intensity, pulling frequency, and reduced control, alleviated during and shortly after menstruation. pubmed.ncbi.nlm.nih.gov
- Body Focused Repetitive Behavior Disorders: Behavioral Models and Neurobiological Mechanisms. Review of emotion-regulation and reinforcement models of BFRBs. pmc.ncbi.nlm.nih.gov
- Carlson EJ, Malloy EJ, Brauer L, Golomb RG, Grant JE, Mansueto CS, Haaga DAF. Comprehensive Behavioral (ComB) Treatment of Trichotillomania: A Randomized Clinical Trial. Behavior Therapy, 2021. sciencedirect.com
- International Association for Premenstrual Disorders (IAPMD). About PMDD: symptoms, tracking, and support. iapmd.org
This article is for educational purposes and is not a substitute for individualized professional care. It does not diagnose any condition and is not medical advice; decisions about medication or hormonal treatment belong with a qualified prescriber. If you are in crisis or having thoughts of self-harm, call or text the 988 Suicide & Crisis Lifeline any time, and call 911 if you are in immediate danger.
More in this series: What are BFRBs? · Why you can't "just stop" · What to expect from BFRB therapy · BFRB therapy · PMDD therapy
