NEWS

PTSD Symptoms Can Vary Throughout the Menstrual Cycle

A close up of a phone app that says "cycle" like a menstrual tracker.

TARIK KIZILKAYA/Getty

Key Takeaways

  • Research has shown that there is a relationship between the fluctuating hormone levels of the menstrual cycle and a person's mood.
  • New research suggests that people with symptoms of post-traumatic stress disorder (PTSD) may notice variations in their symptoms depending on where they are in their menstrual cycle.
  • Understanding how the menstrual cycle affects mood and mental health is beneficial for all patients who get periods.

If you menstruate, you may have noticed that your cycle can affect your mood. At certain times during the cycle, you may have heightened depressive or anxious feelings, or feel more easily irritable, tired, and moody.

According to a new study published in Psychological Trauma: Theory, Research, Practice, and Policy, people with post-traumatic stress disorder (PTSD) symptoms may notice variations in their symptoms at different parts of their menstrual cycle.

PTSD Symptoms

The symptoms of post-traumatic stress disorder (PTSD) occur after a person is exposed to or goes through a traumatic event.

People with PSTD may have trouble sleeping or have nightmares; have difficulty concentrating, experience aggression, feel overwhelmed with guilt, be easily startled, and have self-destructive behaviors.

Measuring Hormones and Trauma Response

The study's findings provide more evidence that hormones can affect trauma response and PTSD symptoms. Learning more about the relationship between the menstrual cycle and PTSD could help bridge the knowledge gaps in the diagnosis and treatment of PTSD.

“I think much of the time when I explain my research to people like at conferences, people are not usually shocked," Jenna Rieder, PhD, an assistant professor of psychology at Thomas Jefferson University in Philadelphia and the study's lead author, told Verywell. "They're often just kind of like, ‘Oh, we didn't know this already?’"

The Role of Estradiol

Estradiol is the main estrogen in the body from the time that a person gets their first period to when they go through menopause.

Estradiol is responsible for maturing and maintaining the reproductive system of people with a uterus and ovaries. The hormone triggers ovulation and thickens the uterine lining to allow an egg to implant.

Previous research has looked at women, specifically, to assess the link between estradiol and the risk for mood disorders. For example, studies have shown that when estradiol steeply declines during menopause and in the postpartum period, a person's risk for affective disorders goes up.

Other studies have shown that people with low estradiol may have more intrusive memories after being exposed to triggering content.

Researchers have also found that the menstrual cycle may affect the symptoms of other mental health conditions like bipolar disorder and obsessive-compulsive disorder (OCD).

Who Was Included In the Study?

Rieder’s team looked at data on 40 women between the ages 18 to 35 who had self-reported traumatic experiences (such as sexual violence or severe injury) and subsequent symptoms of PTSD. The women in the study were not diagnosed with PTSD.

The participants were deemed “high functioning” by the researchers, which indicated that their symptoms were not severe enough to disrupt their daily lives.

All of the participants had naturally induced menstrual cycles, had not used hormonal contraceptives in the past 6 months, were not pregnant or lactating, did not smoke, and did not take steroid medications.

First, the researchers used the participant’s saliva to measure their estradiol levels, as well as two stress biomarkers: cortisol (the hormone which regulates slow and steady stress response) and salivary alpha-amylase (the enzyme that’s associated with a more quick, fervent stress response).

Next, the researchers asked the participants to tell the story of the trauma that they had experienced and discuss any post-traumatic symptoms that they had experienced after.

Lastly, the researchers remeasured the participants' stress biomarkers to see whether they had changed after having mentally relived their traumatic experiences.

What Did the Results Show?

After telling talking about their trauma, the participants who were at the beginning of their cycles had lower cortisol and higher salivary alpha-amylase levels than the participants who were in the higher estradiol level part of their menstrual cycle.

The researchers also found that lower estradiol levels were associated with greater self-reported symptoms; when the participants told examiners how they were feeling, their results were more likely to be worse than the participants who had high estradiol levels.

“Our main results are basically that for women who were trauma-exposed with varying levels of symptoms," Rieder said. "The symptoms just seem to be worse during the lower estradiol portion of the cycle."

Reider also said that lower estradiol is "predictive of women reporting more symptoms when they were reflecting on their experiences over the past month." 

Follow-Up Data

After discussing their trauma, the participants filled out five daily questionnaires for 10 days, answering questions about how they were feeling. They also checked in about their PTSD symptoms every night.

According to Reider, the researchers "wanted to see what experiences were like in the course of their everyday lives. So outside of a lab environment that's controlled and in the context of the experiences that they normally had. So we sampled them at a total of 50 different time points."

The data that they gathered from the surveys corroborated the researcher’s initial hypothesis and other findings. On average, not only did the participants report more severe PTSD symptoms on the low-estradiol days, but they also had greater variability in their daily moods.

Reider said that these findings suggest that "real-time fluctuations in estradiol levels could impact people's daily experiences," and also "that estradiol levels impact how people are reflecting on their experiences."

Limitations

The study did have some important limitations. The sample of participants was small and only inclusive of women who had PTSD symptoms but were not diagnosed with PTSD.

Jenna Rieder, PhD

Just because a person doesn't meet clinical criteria for PTSD doesn't mean that it has no impact on their lives.

— Jenna Rieder, PhD

Studies that include people diagnosed with PTSD who are not coping as well as the participants in the recent study could provide more insight into how the condition affects someone’s life. It would also be important to look at whether the changes in symptoms related to hormones would be noted in people with more severe PTSD symptoms.

Future Research

Regarding the limitations, the researchers say that they wanted to take a more holistic approach because trauma is trauma, even if a person is not clinically diagnosed with PTSD.

“We think the benefit of this is, for one thing, it can take the focus away from a purely diagnostic model and more towards this dimensional understanding that trauma impacts a lot of people and people can be affected by bearing expenses," Rieder said. “So, just because a person doesn't meet clinical criteria for PTSD doesn't mean that it has no impact on their lives.”

According to Reider, the team "wanted to capture that variability and experiences that people have."

Research has shown that women are twice as likely to develop PTSD after going through a trauma than men, and women often experience more severe symptoms.

However, women have been underrepresented in PTSD research. In many of the early studies, most of the people who were experiencing PTSD were veterans, and most veterans at the time were men.

Still, future research may take a broader view. “I think some immediate next steps would be figuring out the extent to which this generalizes more broadly,” Rieder said. "In this case, we recruited women who had regular menstrual cycles and other factors, but for lots of people who are trauma-exposed, all of those factors might not be met.”

Improving PTSD Care

Findings like those from Reider's study could contribute to improvements in PTSD diagnosis and treatment, and any research that tackles the disparities in medicine could help address barriers like access and insurance that make it harder for women to get the care that they need.

“If a clinician were aware of these potential problems and could anticipate that with their clients who menstruate, you know, I think that could do a lot to help make treatment stronger,” Rieder said. “This is something that they could impart to their clients so that people have this expectation.”

For example, if someone feels more overwhelmed by PTSD symptoms during specific parts of their cycle and their usual treatments are not helping, their doctor or therapist might recommend an adjustment to their medication or treatment plan during that time.

For some people, simply knowing that their symptoms might temporarily get worse at a certain point in the month and understanding what could be driving the exacerbation could be reassuring and that knowledge could empower them to be more proactive about coping and self-care.

What This Means For You

If you experience symptoms related to a traumatic experience or have been diagnosed with post-traumatic stress disorder (PTSD) and you have a menstrual cycle, you might notice a change in your symptoms at certain points in your cycle. If you are having trouble coping with these variations, it's important to talk to your doctor and mental health care provider about treatment.

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9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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