Many factors can contribute to the development of PTSD, or post-traumatic stress disorder. Some include combat, serious accidents or health issues, sexual abuse, and, as it turns out, being a woman. In fact, that last factor alone doubles an individual’s chance of having this debilitating anxiety disorder.
Yet, despite PTSD’s ubiquity among women, clinical research and models have historically excluded women from their findings. Of course, when one considers the medical field’s long, tarnished history of ignoring or misunderstanding women’s health, this isn’t exactly surprising. But it doesn’t make it any less disconcerting.
The relationship between PTSD and female hormones affects every aspect of a woman’s health (and nearly every age). It explains why she would be more likely to develop an anxiety disorder than her male counterpart. And it could also shine a light on some of menopause’s more troubling symptoms.
PTSD’s Effect On Hormones
While PTSD largely seems relegated to the brain and our emotions, it also has a domino effect on our hormones. When the brain perceives danger, it signals a stress response by releasing hormones like cortisol and norepinephrine. Then, the oxytocin system works with our HPA axis (hypothalamic-pituitary-adrenal axis) to regulate the stress response.
However, trauma—particularly childhood trauma—may inhibit the development or functionality of the oxytocin system. With less oxytocin in the body, stress hormones aren’t regulated and the feeling of fear and anxiety persists. Trauma also directly affects sex hormones, like estradiol, progesterone, and estrogen.
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The Link Between Estrogen And Trauma
According to a 2022 article published in Frontiers, “[female sex hormone] levels at the time of trauma exposure have been suggested to contribute to the development of PTSD symptoms.”
Estrogen receptors are densely expressed in the amygdala, hypothalamus, and hippocampus, which suggests estrogen’s influence on emotion and cognition (just like PTSD, which affects the same areas of the brain). Studies have found a stronger fear response in the brain when estrogen levels are low and lesser fear responses when they’re high.
These neuroimaging studies found greater activation of neural networks involved in stress responses during the early phases of the menstrual cycle (when estrogen is low). During mid-cycle, when estrogen levels are high, these networks are less activated and, in turn, less stressed.
A similar result was found in a 2012 study that compared sexual assault victims who did and did not take estrogen-based emergency contraceptives immediately after the assault. Those who took the estrogen had significantly lower PTSD symptoms six months after the incident.
What This Means For Sexually Mature Women
Women’s estrogen levels naturally fluctuate throughout the menstrual cycle each month. We’re more likely to report symptoms of depression and anxiety during pre-menstrual and menstruating stages when estrogen levels are relatively low. (But did a scientific study really need to tell you that PMS makes you feel like crap?)
The average woman has over 450 menstrual cycles in her lifetime. This means that during each of these periods, a woman is more likely to develop a dysfunctional stress response to a traumatic event. It also suggests that underlying PTSD symptoms can either flare up or subside, depending on how low or high estrogen levels are.
So, no—it isn’t your PMS ‘making you crazy.’ It’s your brain’s natural response to deregulated stress hormones and subsequent stress management. But unfortunately, this phenomenon isn’t for menstruating women only. The link between estrogen and PTSD affects our peri- and post-menopausal experiences, too.
What This Means For Menopause Specifically
Estrogen levels reach an all-time low during peri- and post-menopause, making older women the most at risk of developing depression, anxiety, PTSD, and other mental disorders. But it can also shed light on why some people experience worse menopausal symptoms than others.
As mentioned before, PTSD disaffects the functionality of the HPA axis. The HPA axis works with the vasomotor system, which is responsible for some of menopause’s more notorious symptoms (i.e., hot flashes, night sweats, heart palpitations, and sleep disturbances). When this axis is unregulated, symptoms can get worse.
A 2019 California-based study supports this correlation. The study interviewed 2016 women aged 40-80, around 20% of whom had experienced trauma (either ongoing or specific) in their lives. Those with trauma experience reported higher incidents of sleep disturbances, hot flashes, and unpleasant vaginal symptoms in menopause.
The Clinical Implications Of This Connection
The symptoms of PTSD have been recognized since the late 19th century, and the disorder was codified by the American Psychiatric Association in 1980. Yet, the connection between significant hormonal fluctuations (like menopause) and the severity of PTSD wasn’t discussed until the mid-aughts. Even today, the literature remains scant.
Navigating the medical world as a woman can feel incredibly lonely. A notable lack of female-based clinical studies has created a void of inaccurate, apathetic medical care. More often than not, a woman’s best solution to dealing with hormonal health issues is to “deal with it.”
And while women are tough as hell and likely could deal with it, that doesn’t mean we should. The link between estrogen and PTSD offers significant clinical implications, like using hormone therapy as a potential treatment. But first, more research must be done examining PTSD in women specifically.
In the meantime, there is a silver lining to be found here. The sexist trends of the medical world are on their way out, and a rejuvenated women’s wellness boom is taking its place. The first step in easing hormonal dysfunction’s grip on our lives is identifying the problem. Now that we’ve done that, we can move on to fixing it.
