Menstrual Cycle in Trauma-Related Disorders: A Mini-Review

Abstract

Fluctuations of sex hormones across the menstrual cycle have been linked to exacerbation of symptoms of psychiatric disorders. Women diagnosed with trauma-related disorders such as post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD) have reported worsening of mood symptoms at various phases of their menstrual cycle. There is also considerable overlap between PTSD, BPD, and complex-PTSD (cPTSD) symptoms, suggesting similar biological underpinnings. This mini-review examines the influence of sex hormones and the menstrual cycle on PTSD, BPD, and cPTSD symptoms, and discusses the involvement of the hypothalamic-pituitary-adrenal (HPA) axis. We review literature showing that PTSD and BPD symptoms fluctuate with the menstrual cycle, though the effect of the menstrual cycle phase appears to be inconsistent, warranting future research. Based on the reported phasic vulnerability in individuals with PTSD and BPD, it is plausible to assume that women diagnosed with the newly introduced cPTSD may experience similar difficulties. However, no study to date has addressed this. This review highlights the importance of considering an individual's trauma history as it may influence symptom severity and diagnosis, and the phase of the menstrual cycle at the time of diagnosis. This review also highlights that additional work is needed to clarify the influence of estradiol and progesterone fluctuations on trauma-related symptoms, especially in cPTSD. Continued research on menstrual cycle vulnerability and trauma will lead to better informed management and treatment of PTSD, BPD, and cPTSD.

Diagnosis and Management of Perimenstrual Cycloid Motility Psychosis

“…This correlation is observed particularly in women who have experienced trauma early in life, suggesting that trauma affects the brain's sensitivity to gonadal hormone fluctuations. 31,32 For example, dysregulation of these systems may contribute to the eightfold increase in risk for premenstrual dysphoric disorder (PMDD) in women with traumatic history associated with PTSD. 33 PSYCHOSOCIAL MECHANISMS Childhood sexual trauma can lead to chronic psychological vulnerabilities through a few pro-posed mechanisms, including external locus of control, attachment difficulties, increased stress sensitivity, dissociation, and cognitive biases such as negative schemas.…”

“…Symptoms are exacerbated in the luteal phase and improve with rising levels of estradiol during the follicular phase, given its protective antidepressant and antianxiety effects. This correlation is observed particularly in women who have experienced trauma early in life, suggesting that trauma affects the brain’s sensitivity to gonadal hormone fluctuations 31,32 . For example, dysregulation of these systems may contribute to the eightfold increase in risk for premenstrual dysphoric disorder (PMDD) in women with traumatic history associated with PTSD 33 …”

To Predict, Prevent, and Manage Post-Traumatic Stress Disorder (PTSD): A Review of Pathophysiology, Treatment, and Biomarkers

“…Females are more likely to experience physical and sexual violence. Additionally, clinical evidence points to the possibility that cyclical oestrogen discharges throughout the reproductive cycle may contribute to women’s greater susceptibility to and severity of PTSD symptoms following psychological stress [ 14 , 15 ].…”