Even though there is an abundance of literature on PTSD, we lack a thorough understanding of the biological causes that explain why it is more than twice as prevalent in women than men. Women are also more likely to experience chronic PTSD for more than a year. Despite this, women have often been excluded from studies; variable hormonal cycles have been cited as a factor, but in recent years, new findings have shed light on how estrogen and hormonal cycles can influence PTSD.(1)
In an article published in 2016, low estrogen levels were associated with symptoms of anxiety and depression. This can occur during all phases: premenstrual, post-partum, perimenopausal, and postmenopausal periods. Specifically, women with low levels of estradiol had heightened fear responses and more intrusive thoughts days after being shown violent film clips. The phasic nature of the hormonal cycle may actually make women more vulnerable to PTSD. The hypothalamus and amygdala each have many estrogen receptors, and the hypothalamus is part of the hypothalamic-pituitary-adrenal (HPA) axis, which is also associated with the vasomotor symptoms of perimenopause, i.e., hot flashes, night sweats, heart palpitations, and sleep disturbances.
The HPA axis itself is thought to be a potential underpinning for PTSD. Trauma occurring in early childhood may inhibit the development of the oxytocin system, which works with the HPA axis to regulate stress responses.(2) Lower levels of cerebrospinal fluid oxytocin concentrations were noted in women who experienced abuse as children. This means that with less oxytocin, the stress hormone cortisol isn’t regulated, and the fear persists. This is associated with the fight and flight responses. Both oxytocin and cortisol seem to be dysregulated as a result of trauma. This may also be a factor in the chronic health conditions that are associated with PTSD.
While the precise mechanism correlating estrogen and the symptoms of PTSD isn’t yet known, studies suggest that estrogen may help alleviate them. In a study comparing sexual assault victims, those who took an emergency contraceptive containing estrogen reported significantly lower symptoms of PTSD six months after the incident.(1) Hormone replacement therapy is a common option for those experiencing perimenopause, and estrogen may be a beneficial option for people who live with complex PTSD as well, and hopefully, future studies will reveal more about this connection.
Further research has shown that adverse childhood experiences (ACEs) may put women at higher risk of depression during perimenopause. This too may be related to how trauma impacts the body early in life and the resulting dysregulation of the oxytocin system. A 2017 study about ACEs as a factor for depression during perimenopause reported that of nearly 300 participants, 60.5% experienced at least one adverse childhood event. In this group, 20.7% were diagnosed with major depressive disorder during perimenopause and 22.4% were diagnosed with it before perimenopause started.(3)
PTSD can have an impact on the menopausal transition. Because we already may have sleep disorders because of PTSD, the severity can increase. The severity of menopausal symptoms hasn’t been studied in-depth, but the evidence we have does suggest a correlation. In a study of 1,148 women, 1 in 5 had experienced intimate partner violence and/or sexual assault, and 1 in 4 had PTSD.(4) Difficulty sleeping was the most frequent problem, followed by hot flashes and night sweats.
In my personal experience, complex PTSD has done some of its worst to me during perimenopause. It was the reason I finally sought help and ultimately got my diagnosis. I thought I had done a good job out trying to outrun it for decades. I had fooled myself well, but over the past year, as perimenopause entered a particularly difficult phase, my mental health grew increasingly worse. I’m still in the process of figuring out the best way to manage it all, but this knowledge has helped me considerably. I’m better at predicting when my inner critic may be louder and more vicious. My days spent lost in a fog make more sense. When I’m especially adrift, it often corresponds to something happening in my hormonal cycle. I find it comforting to pore over research to gain a better understanding of complex PTSD. A nerd by nature, reporting back on what the science says is how I best communicate what’s happening when speaking with friends and family. Understanding the link between the menopausal transition and PTSD was a starting point for my recovery, and I’m grateful to have found my way to this path of healing.
Sources:
- Estrogen and extinction of fear memories: implications for post-traumatic stress disorder treatment. Glover, Ebony, Jovanovic, Tanja. Biol Psychiatry, August 2015: 78(3): 178–185: doi: 10.1016).
- Exploring the mutual regulation between oxytocin and cortisol as a marker of resilience. Li, Yang, Hassett, Afton. Arch Psychiatric Nursing, April 2019: 33(2): 164–173: doi: 10.1016).
- Adverse childhood experiences and risk for first-episode major depression during the menopause transition. Epperson, C. Neill, Sammel, Mary. Journal of Clinical Psychiatry, March 2017, 78(3):298–307.
- Associations of intimate partner violence, sexual assault, and posttraumatic stress disorder with menopause symptoms among midlife and older women. Gibson, Carolyn, Huang, Alison. JAMA Internal Medicine, 2019; 179(1):80-87.
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Lee Frost has worked for nonprofits and marketing agencies focusing on healthcare for the past ten years. She’s a patient advocate and recently launched a blog about menopause and CPTSD called the Sinsemillier. She grew up in the Boston area and has a BA from UMass Boston and a master’s from Harvard Extension School. Lee lives north of Boston with her husband, where they both love to nerd out on sci-fi and fantasy.
Wow! Thank you penning this! I appreciate your sharing such valuable information !
I wish we could talk more about this! I relate to this, so thoroughly, and my perimenopause is making it difficult to impossible to manage my symptoms.
It was very helpful to read this. Thank you
Hi Lee – I was wondering, if you are willing to share, what are some ways you’ve found useful for coping with your peri/meno symptoms?
Hi Michelle,
Happy to share! Personally, I’m not eligible for hormone replacement therapy, so I’ve relied on a number of lifestyle changes like giving up coffee and alcohol—that helped decrease the anxiety and insomnia significantly. I still drink a cup of tea every morning though and have been fine. I also became a medical cannabis patient and primarily use tinctures and edibles in small doses (10 mg or less) to manage a range of symptoms—it’s been incredibly helpful for hot flashes, aches and pains, and I take larger doses (25 mg+) to help me sleep through the night (I have a lot of problems with nightmares, so that’s why I take a bigger dose.). It’s taken me a few years to get a good routine down—making sure I eat as healthy as I can, get a decent amount of sleep (and I’m a night owl by nature, so this one’s tough!). I keep a calendar with notes about symptoms, what I did, the result, and over time learned the patterns and solutions that have been most helpful. Somatic therapy and yoga has helped with flexibility, strength, and easing tension. Of course there are lapses, but I do my best! 🙂
Great to hear you’ve figured out how to heal yourself. Thanks for sharing!
I’ve just immediately hit on this from a search for exactly this issue, I’m confused by my situation is it my Cptsd or peri-menopause draining me with insomnia …I had a gut feeling they were exacerbating each other. Thanks for sharing
Fantastic connection. I got Covid in February 2020, which blocked my estrogen, I was literally taking on the emotions & situations of characters of movies I would watch. And I found out my husband has been gaslighting me but I also watched a show on that so now I don’t know how bad he really? No lie this connection is crazy….thank you, and I suffer from ptsd for years since. Is this long Covid for women?…..men?
This is the most valuable information I have found to date. My estrogen was blocked by the 1st Covid sending me into a spiral of nervous system fire. No HRT would change it, just kept backing up in my liver. Yes, I had childhood trauma & my husband turned out to be gaslighting me. No one seems to understand why my nervous system is more acute than the average woman with all of these circumstances. Thank you for confirming that I’ve always suspected. I’ve only gotten profound relief with certain homeopathic remedies made specifically for menopause. You can do all the breathing all the meditating all the trauma work you want and I have, but I tell you it’s unfair women everywhere suffer from this and their husbands don’t wanna deal or are a problem as well. Then women are left with the inability to think clearly, or get out of flight/fight/freeze and having to fight for their lives in court.
Hi Lynn,
I’m so glad you found this helpful, as difficult as the topic is. I have a number of new articles in the works, including one on how COVID affects the vagus nerve, which is dysregulated by CPTSD. And perimenopause is certainly a factor in that as well! I’m hoping to have that one done soon, but I dig deep on the research articles to ensure it’s properly vetted and accurate. Somatic therapy has also been a huge help in healing. Thank you for reading the article; I’m grateful that you found support in it. Wishing you comfort and peace on your healing journey.
Lee
Hi! Thank you so much for sharing this – so validating. I have a couple things going on: depression, Cptsd and more. Like you I can’t ignore it any more. Finding a legit trauma therapist has been challenging with my insurance in nyc. Should u have any suggestions pls lmk. Could you pls lmk too – what somatic therapy was helpful to you? Thanks again 🙂
I’m so glad you found it helpful! Finding a good trauma-informed therapist is hard–there were only a couple in-network through my insurance, and it was impossible to get an appointment. I really needed help recently and after attending a free session here through the CPTSD Foundation with a trauma-informed coach (Rachel Grant), I signed up for her email list and attended a couple more free sessions. She has a great vibe and the advice she offered really resonated with me, so I signed up for a free 1:1 session with her a few weeks ago and signed up for her 7-month program. I only just started this week, but I’m getting a lot out of it–she offers a ton of resources and is wonderful to talk with. She really gets it. It’s not therapy, but it’s more action oriented, and the structure of the program helps keep me motivated. I’d definitely recommend at least checking out some of her free resources. In terms of somatic work, I’d recommend Irene Lyon’s YouTube channel. In addition to the tons of free resources she has there, she has an amazing somatic program called SmartBody SmartMind–it’s around $2K, but you become a lifetime member and can join their live virtual program that takes place twice a year and they keep everything on their site for you to access anytime (you can also download their audio and video exercises, which is awesome). It’s by far my favorite program for complex trauma. As an alternative, Workout Witch has a recorded video program with gentle bodywork for about $200. I use those videos almost every day. I hope you can find a healing pathway that works for you! I was diagnosed with CPTSD exactly 3 years ago–as far as I’ve come, there’s still more to learn–especially when it comes to being kind to myself and giving myself time to process and recover. It can be tough to sort through all the resources to make sure they’re legit, but I keep coming back to things I found through this site and I know they’re vetted. Best of luck to you. 🙂