Menstrual cycle-related fluctuations of tics in Tourette syndrome.

In a survey of 47 women of all ages with Tourette syndrome, 26% had a premenstrual increase in tics (P less than .001) when various hormonal states were examined. An increase in tics at menarche predicted the premenstrual tic exacerbation (P less than .001). In contrast, other hormonally influenced conditions, such as premenstrual syndrome, oral contraceptive use, pregnancy, and menopause were not associated with a change in tic frequency. The finding of an increase in tic frequency during the estrogenic phase of the menstrual cycle provides additional insight into an important control mechanism for tic expression and suggests possible therapeutic options.