PTSD in women—does a menstrual cycle affect symptoms?

Trauma can show up and effect everyone in so many ways, some people can develop Post-Traumatic Stress Disorder (PTSD) or Complex-PSTSD after experiencing traumatic moments throughout their lives. Historically the diagnosis of PTSD has been strictly researched and treated in men particularly soldiers returning home from war. Today we know that no person is excluded from experiencing trauma and there is no one size fits all treatment when it comes to PTSD and gender, particularly hormone levels may affect how these symptoms show up.

What is PTSD?

The American Psychological Association (APA) defines PTSD as a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury. This can be assessed by a clinician using the CAPS-5.

There are certain criteria outlined in the DSM-V that one would have to meet to be diagnosed with PTSD, but generally the symptoms are as followed:

• Intrusion:
  • Intrusive thoughts
  • involuntary memories
  • distressing dreams
  • flashbacks of the traumatic event. 
• Avoidance:
  • Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that may trigger distressing memories. 
  • Avoid remembering or thinking about the traumatic event. 
• Alterations in cognition and mood:
  • Inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others 
  • distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other
  • ongoing fear, horror, anger, guilt or shame
  • much less interest in activities previously enjoyed
  • feeling detached or estranged from others
  • or being unable to experience positive emotions 
• Alterations in arousal and reactivity:
  • Arousal and reactive symptoms may include being irritable and having angry outbursts
  • behaving recklessly or in a self-destructive way
  • being overly watchful of one’s surroundings in a suspecting way
  • being easily startled
  • or having problems concentrating or sleeping.

Common psychological Pre-menstrual and menstrual symptoms women face are:

• Tension or anxiety
• Depressed mood
• Crying spells
• Mood swings and irritability or anger
• Appetite changes and food cravings
• Trouble falling asleep (insomnia)
• Social withdrawal
• Poor concentration

What does the research show?

The APA states that for women that have experienced trauma and meet the criteria may very well experience various heightened symptoms. The study shows that the level of the hormone Estradiol, which regulates the reproductive cycle in women, is the trigger for the fluctuation of these symptoms. Low estradiol levels are linked to higher levels of anxiety and increased fear responses. 

The study looked at 40 women participants from ages 18-33 who have been trauma exposed in various ways and gathered this evidence at different stages in their cycle over the course of 10 days through five daily questionnaires and saliva testing for Estradiol and cortisol levels. 

First, the researchers used the participant’s saliva to measure their estradiol levels, as well as cortisol for a stress response biomarker. Then 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.

Finally, the researchers remeasured the participants’ stress biomarkers to see whether they had changed after mentally reliving their traumatic experiences.

While the study does have its limitations it does support the notion that when a woman is being assessed for PTSD, the stage of their cycle may very much affect the severity in the presentation of their symptoms. Clinicians assessing for trauma in women should begin to take this into account as well. 

What can be done?

First always consult with your doctor and mental health care provider if you feel you may have any of the symptoms outlined above. Secondly track menstrual cycle to build awareness of fluctuation in symptoms. Finally communicate this information as best as you can to your provider to further discuss treatment planning, any medication adjustments, self-soothing, or cope ahead planning.

Important Takeaway:

The research has long left out women and marginalized people out of the narrative, but slowly new studies are helping to shape new treatment plans. For women survivors of trauma, it can be very hard to receive adequate care. The best thing one can do is research and advocate for their needs to the best of their abilities. I hope this information empowers someone to take that first step in advocating for their needs and shaping their life worth living.

American Psychological Association. (2021, October 28). PTSD symptoms vary over course of menstrual cycle [Press release]. http://www.apa.org/news/press/releases/2021/10/ptsd-menstrual-cycle

Frequently Asked Questions

Why do PTSD symptoms feel worse at certain times of the month?

Research suggests that fluctuating estradiol levels across the menstrual cycle directly influence fear responses and anxiety sensitivity. When estradiol is low — typically in the late luteal phase before a period — the brain’s threat-detection system becomes more reactive, which can intensify intrusive thoughts, hypervigilance, and emotional dysregulation. Tracking your cycle alongside symptom severity can help you and your provider identify this pattern.

Can trauma treatment be adjusted to account for hormonal fluctuations?

Yes, and this is an emerging but important area of trauma care. A trauma-informed clinician can help you time more intensive therapeutic work for higher-estradiol phases when emotional regulation tends to be more stable, and build stronger coping and stabilization strategies for the low-estradiol window. Being honest with your provider about your cycle and symptoms is the first step.

What treatments are most effective for PTSD in women?

Evidence-based treatments including EMDR, Prolonged Exposure, and trauma-focused CBT all have strong research support for women with PTSD. EMDR in particular has been shown to reduce intrusive symptoms and emotional reactivity without requiring detailed verbal retelling of traumatic events, which many survivors find less retraumatizing.

If you’re a woman experiencing PTSD symptoms — or noticing that your mental health shifts dramatically across your cycle — you deserve care that accounts for the full picture. Kind Mind Psychology’s trauma specialists work with women navigating exactly these experiences. Reach out today to find a therapist who can meet you where you are.