Women's symptoms of post-traumatic stress disorder (PTSD) may vary with their menstrual cycle, which could have implications for diagnosis and treatment, researchers say.
Their study included 40 women between 18 and 33 years of age who had PTSD after experiencing or witnessing a traumatic event, such as sexual violence or a serious injury.
"For women who are naturally cycling, it may be useful to understand how the menstrual cycle affects their symptoms," said lead author Jenna Rieder, an assistant professor of psychology at Thomas Jefferson University in Philadelphia. "When you can explain what's happening biologically, it often becomes less threatening."
She and her colleagues asked participants about their PTSD symptoms in the past month and checked their level of estradiol, a form of estrogen that regulates the female reproductive cycle.
They found that participants had more PTSD symptoms during the first few days of their cycle when estradiol is low, and fewer symptoms close to ovulation, when estradiol is high.
The findings were published online Oct. 28 in the journal Psychological Trauma: Theory, Research, Practice, and Policy.
Researchers also measured two biomarkers of stress in participants' saliva -- the hormone cortisol and the enzyme salivary alpha-amylase, before and after women described their trauma. Salivary alpha-amylase is related to the body's "fight-or-flight" stress response, and cortisol is related to the body's slower, more sustained response to stress.
"In a healthy system, we want a moderate, coordinated response of both of these biomarkers," Rieder said in a journal news release. In women in the low-estradiol portions of their menstrual cycles, however, cortisol levels were low and salivary alpha-amylase was high -- a pattern previous studies have tied to poor stress responses.
Rieder said the results could help guide diagnosis and treatment of PTSD in women.
"When in the cycle you assess women might actually affect whether they meet diagnostic criteria for PTSD, especially for people who are right on the border," she explained. "And that can have real practical implications, say for someone who is a veteran and entitled to benefits or for health insurance purposes."
Rieder noted that women have long been underrepresented in PTSD research.
"PTSD for a long time was mostly studied in men, in part because it was mainly studied in veterans, who were mostly men," she said.
Along with guiding diagnosis and treatment, knowing that the menstrual cycle affects PTSD symptoms could reassure women, according to Rieder.
"I think this is something that clinicians would want to know, so they can impart this knowledge as part of psychoeducation," she said.
The U.S. Office on Women's Health has more on PTSD.
SOURCE: Psychological Trauma: Theory, Research, Practice, and Policy, news release, Oct. 28, 2021