Women who have suffered trauma may experience more or less severe symptoms at different times in their menstrual cycles. This can pose challenges for doctors diagnosing them with post-traumatic stress disorder (or PTSD).
Study of 40 women who were naturally cycled with no trauma showed that people might experience more symptoms in the first few days and less symptoms near ovulation when estradiol levels are high.
These results could impact how PTSD is diagnosed in women with periods and other people who have it.
According to Jenna Rieder, psychologist at Thomas Jefferson University in Philadelphia, "When you evaluate women during the cycle might affect whether they meet diagnostic criteria of PTSD,"
Women who are twice as likely to develop PTSD after trauma than men could benefit from understanding how sex hormones influence moods and symptoms. However, this knowledge has been long ignored in research.
It may be helpful for women who naturally cycle to understand the effects of their menstrual cycle on their symptoms. According to Rieder, the study's leader, "When you can explain biologically what's going on, it often becomes less frightening."
PTSD (formerly known as "shell shock" or combat fatigue) is a form of anxiety disorder that can be caused by witnessing or experiencing a traumatic event, such as violence, serious accidents, natural disasters or physical or sexual assault.
One in eleven people will experience PTSD at some point in their lives. The symptoms include vivid memories, intrusive thought, flashbacks, nightmares, emotional numbness, and avoidance behaviors. These can all be triggered by cues that are reminiscent of the original trauma.
The possibility that women are more susceptible to trauma-related stress and PTSD could be due to fluctuations in their sex hormones, such as estradiol.
Estradiol, the most potent form of estrogen hormone for women who aren't pregnant or going through menopause, is the most effective. Women who have higher levels of estradiol throughout their menstrual cycle trigger ovulation.
Research also shows that low levels of estradiol in early menstrual cycles are associated with fear, stress, and increased activity in the brain's emotional centers.
It is not easy to separate the effects of estradiol and other sexhormones that fluctuate during the menstrual cycle (including progesterone) from each other. Some past studies that attempted to determine the effects of sex hormones upon PTSD symptoms were hampered by sampling issues.
Researchers looked at different phases of menstrual cycles to determine if hormone levels were significantly different. They also measured estradiol levels in saliva and two stress biomarkers in women's saliva. This was done to establish a connection between stress hormones, trauma symptoms, and stress response. The study excluded women with irregular periods.
A group of 40 women were asked to recall traumatic events they witnessed or experienced. Those with lower estradiol levels had more severe avoidance symptoms over the last month. They also had a high stress profile.
To determine the relationship between estradiol and trauma-related symptoms, a smaller group of 30 women monitored their moods and severity 5 times per day for 10 days. This was done starting 2 days after their bleeding.
Low-estradiol days are more likely to affect people's moods. The study also found that people reported more severe symptoms of PTSD on these days due to low moods, self-blame, and exaggerated negative beliefs.
"Our results suggest that women with lower levels of estradiol may be more prone towards negative affective states [moods]" Rieder and co-authors write.
These findings led Rieder and his colleagues to suggest that doctors include menstrual cycles in their treatment plans for people suffering from PTSD. This would help improve therapy outcomes. They may also be able to help people anticipate any changes in trauma-related symptoms from month to month.
"Low-estradiol parts of the cycle might represent the time window in which interviews would be most sensitive for any current PTSD symptoms, and when the reported symptoms might prove to be most severe," Rieder adds.
However, it is important to remember that these women had only low-to-moderate symptoms, and not necessarily PTSD. To verify the results, the study should be replicated with women suffering from PTSD.
The study authors concluded that menstrual cycle-driven mood and symptoms fluctuations may be more apparent in those with PTSD. However, it is possible that women with PTSD experience more consistent symptoms across their cycles, without any relief during high estradiol periods.
The journal Psychological Trauma: Theory and Research, Practice, Policy published the research.