Menstrual cycle effects on psychological symptoms in women with PTSD
Abstract
The menstrual cycle has been implicated as a sex-specific biological process influencing psychological symptoms across a variety of disorders. Limited research exists regarding the role of the menstrual cycle in psychological symptoms among women with posttraumatic stress disorder (PTSD). The current study examined the severity of a broad range of psychological symptoms in both the early follicular (Days 2-6) and midluteal (6-10 days postlutenizing hormone surge) phases of the menstrual cycle in a sample of trauma-exposed women with and without PTSD (N = 49). In the sample overall, total psychological symptoms (d = 0.63), as well as depression (d = 0.81) and phobic anxiety (d = 0.81) symptoms, specifically, were increased in the early follicular compared to midluteal phase. The impact of menstrual cycle phase on phobic anxiety was modified by a significant PTSD × Menstrual Phase interaction (d = 0.63). Women with PTSD reported more severe phobic anxiety during the early follicular versus midluteal phase, whereas phobic anxiety did not differ across the menstrual cycle in women without PTSD. Thus, the menstrual cycle appears to impact fear-related symptoms in women with PTSD. The clinical implications of the findings and future research directions are discussed.
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Hillcoat, A., Prakash, J., Martin, L., Zhang, Y., Rosa, G., Tiemeier, H. W., Torres, N. S., Mustieles, V., Adams, C. D., & Messerlian, C. (2023) · Human Reproduction · doi:10.1093/humrep/dead087 · Cited by 12 · see citing works
Emotional distress and tobacco demand during the menstrual cycle in female smokers
Farris, S. G., Abrantes, A. M., & Zvolensky, M. J. (2018) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2018.1494208 · Cited by 12 · see citing works
“This set of findings is consistent with the non-smoking literature on the role of decreasing/low levels of progesterone and estradiol and their link to dysregulated emotional states (Nillni et al., 2015, 2012).”
BackgroundResultCombat exposure is associated with cortical thickness in Veterans with a history of chronic pain
Corbo, V., Salat, D. H., Powell, M. A., Milberg, W., & McGlinchey, R. E. (2016) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2016.02.003 · Cited by 11 · see citing works
Trauma Characteristics Moderate the Relation Between Estradiol and Trauma‐Related Symptoms
Rieder, J. K., Kleshchova, O., & Weierich, M. R. (2021) · Journal of Traumatic Stress · doi:10.1002/jts.22725 · Cited by 11 · see citing works
Peltier, M. R., Verplaetse, T. L., Altemus, M. M., Zakiniaeiz, Y., Ralevski, E., Mineur, Y. S., Gueorguieva, R. V., Picciotto, M. R., Cosgrove, K., Petrakis, I. L., et al. (2024) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2023.101119 · Cited by 10 · see citing works
Nillni, Y. I., Hall, K. A. A., Langdon, K. J., & Pineles, S. L. (2019) · Anxiety Stress & Coping · doi:10.1080/10615806.2019.1660322 · Cited by 10 · see citing works
“Plasma was available to confirm menstrual cycle phases via estradiol and progesterone assays (procedures described fully in Nillni et al., 2015).”
BackgroundMethodSex and gender differences in trauma victims presenting for treatment
Christiansen, D. M. (2017) · Principles of Gender-Specific Medicine · doi:10.1016/b978-0-12-803506-1.00043-7 · Cited by 9 · see citing works
Ralevski, E., Newcomb, J., Pisani, E., DeNegre, D., Peltier, M. R., Jane, J. S., Yoon, G., & Petrakis, I. L. (2023) · Journal of Dual Diagnosis · doi:10.1080/15504263.2023.2294989 · Cited by 9 · see citing works
“It has been documented that during times of the menstrual cycle (i.e., midluteal phase), where progesterone is elevated, there is a reduction in psychological symptoms (anxiety and depression) among women with PTSD (Nillni et al., 2015).”
BackgroundThe Social Side of Pain: What Does it Mean to Feel Another’s Pain?
Giummarra, M. J., Tracy, L. M., Young, K. A., & Fitzgibbon, B. M. (2016) · Springer eBooks · doi:10.1007/978-3-319-49022-9_21 · Cited by 7 · see citing works
Roy, N., Imran, S. M., Siddiky, A., Sultana, S., Mahmud, S., Rashid, R., ALmerab, M. M., & Mamun, M. A. (2025) · PLoS ONE · doi:10.1371/journal.pone.0321097 · Cited by 9 · see citing works
Asch, R., Pothula, S., Toyonaga, T., Fowles, K., Groman, S. M., García-Milian, R., Dileone, R., Taylor, J. R., & Esterlis, I. (2022) · Neuropsychopharmacology · doi:10.1038/s41386-022-01441-y · Cited by 6 · see citing works
Chang, S.-H., Chang, Y.-M., Chen, H.-Y., Shaw, F.-Z., & Shyu, B.-C. (2023) · Neurobiology of Stress · doi:10.1016/j.ynstr.2023.100569 · Cited by 5 · see citing works
Chudoba, R., & Dabrowska, J. (2025) · Biological Psychiatry · doi:10.1016/j.biopsych.2025.07.017 · Cited by 6 · see citing works
Pereira, J. P. C., Jacques, L. S., Santos, T. M. D. C., Pereira, F. A. C., Castelo, P. M., & Borges, B. D. B. (2024) · Archives of Women s Mental Health · doi:10.1007/s00737-024-01499-1 · Cited by 5 · see citing works
Asch, R., Fowles, K., Pietrzak, R. H., Taylor, J. R., & Esterlis, I. (2023) · Chronic Stress · doi:10.1177/24705470231215001 · Cited by 5 · see citing works
“There is mounting evidence implicating a modulatory role of sex hormone signaling in response to stress, 38 PTSD and mood symptoms, 39 ‐ 41 pain processing, 42 and interactions between estrogen and mGlu5 receptor signaling.”
BackgroundAlmeida-Souza, T. H., Campos, A. C. P., Rabelo, T. K., Emtyazi, D., McCann, E., Brandão‐Lima, P. N., Diwan, M., Lipsman, N., & Hamani, C. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.02.041 · Cited by 4 · see citing works
Schmitz, J. C. S., Prenoveau, J. M., Papadakis, A. A., Johnson, A. J., Lating, J. M., Mendelson, T., & Dariotis, J. K. (2020) · Psychiatric Quarterly · doi:10.1007/s11126-020-09774-x · Cited by 4 · see citing works
Trauma and gender in primary care
Christiansen, D. M. (2023) · Principles of Gender-Specific Medicine · doi:10.1016/b978-0-323-88534-8.00043-2 · Cited by 3 · see citing works
Epigenetic prediction of 17β-estradiol and relationship to trauma-related outcomes in women
Hack, L. M., Nishitani, S., Knight, A. K., Kilaru, V., Maddox, S. A., Seligowski, A. V., Jovanović, T., Ressler, K. J., Smith, A. K., & Michopoulos, V. (2021) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2021.100045 · Cited by 3 · see citing works
“Furthermore, trauma-exposed women experience greater severity of phobic anxiety during a phase of their menstrual cycle characterized by lower E2 (early follicular) as compared to higher E2 (mid luteal) concentrations and this difference is driven by women with PTSD [14].”
BackgroundResultMethodological approach for an integrated female-specific study of anxiety and smoking comorbidity
Farris, S. G., Smith, J. E., Steinberg, D. R., Altman, B. R., Lambert-Messerlian, G. M., DUNSIGER, S. I., Williams, D. M., Saladin, M. E., & Abrantes, A. M. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1267753 · Cited by 3 · see citing works
Sex Differences in the Neurobiology of Fear and Anxiety
Oliver, K. I., DelRosario, D., & Stevens, J. S. (2024) · Current topics in behavioral neurosciences · doi:10.1007/7854_2024_536 · Cited by 4 · see citing works
The Junior Eysenck Personality Inventory ratings of traumatized youth with and without PTSD
Saigh, P. A., Hackler, D., Yasik, A. E., McGuire, L. A., Bellantuono, A., Dekis, C., Durham, K., Halamandaris, P. V., & Oberfield, R. A. (2016) · Personality and Individual Differences · doi:10.1016/j.paid.2016.05.013 · Cited by 3 · see citing works
Methods to reduce false reporting of substance abstinence in clinical research
Japuntich, S. J., Hall, K. A. A., Joos, C. M., Rasmusson, A. M., & Pineles, S. L. (2018) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1603 · Cited by 3 · see citing works
“The current study used a pre‐post design (i.e., Phases 1 and 2) to examine the effectiveness of methods to reduce false reports of substance abstinence during eligibility assessment for a larger study (Nillni et al., 2015; Pineles, Blumenthal, et al., 2016; Pineles, Nillni, et al., 2016).”
MethodPosttraumatische Belastungsstörungen
Michael, T., Sopp, R., & Maercker, A. R. A. (2018) · Springer eBooks · doi:10.1007/978-3-662-54909-4_6 · Cited by 3 · see citing works
Freger, S. M., Cavalier, S., Cornea, M., Aharoni, S., Shetty, R. R., & Leonardi, M. (2026) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.70167 · Cited by 2 · see citing works
Bichon, J. A., Ellis, R. A., Merker, J. B., Webber, T. K., & Seligowski, A. V. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2436245 · Cited by 2 · see citing works
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Travma Sonrası Stres Bozukluğunun Önlenmesine Yönelik Korku Belleği Üzerine Yapılan Müdahaleler
İlhan, Ç. F., & Kışlal, S. (2023) · Ayna Klinik Psikoloji Dergisi · doi:10.31682/ayna.1348783 · Cited by 1 · see citing works
Polytrauma with Sexual Dysfunction in a Female Soldier Following IED Blast Exposure
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Musheyev, Y., Levada, M., Ftiha, F., Garrick, I., Ahasan, H., & Jiang, M. (2022) · Cureus · doi:10.7759/cureus.22812 · Cited by 1 · see citing works
“Introduction The menstrual cycle has been implicated as a sex-specific biological process influencing psychological symptoms across a variety of disorders [1].”
BackgroundThe Role of Technology in Expressions of Grief
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Compassion for Everyday Living
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“PME has been documented across a wide range of psychiatric disorders, including anxiety [11,12], depressive [11,13], bipolar [11,13], psychotic [11,14], personality [15], eating [16,17], substance use [11,18], and attention-deficit/hyperactivity disorder (ADHD) [19], with prevalence estimates…”
Strengthening School Resilience: Basis for Disaster Preparedness and Recovery Framework
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- Authors
- Nillni, Y. I., Pineles, S. L., Patton, S. C., Rouse, M. H., Sawyer, A. T., & Rasmusson, A. M.
- Affiliations
- Boston University (US)
- VA Boston Healthcare System (US)
- Corresponding author
- Nillni, Yael I.
- Venue
- Journal of Traumatic Stress
- Publisher
- Wiley
- Published
- 2015-01-22
- Volume
- 28
- Issue
- 1
- Pages
- 1-7
- ISSN
- 0894-9867 (ISSN-L)
- 1573-6598
- OpenAlex
- W1551181424
- Cited by
- 100
- References
- 26
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 10 · 2023: 14 · 2022: 11 · 2021: 6 · 2020: 10 · 2019: 11 · 2018: 10 · 2017: 9 · 2016: 7 · 2015: 3
- FWCI
- 12.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Traumatic Stress (publishedVersion)
- PubMed (publishedVersion)
- Funders
- VA Career Development Award
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- menstrual cycle, post-traumatic stress disorder, psychological symptoms, depression, phobic anxiety, follicular phase, luteal phase, sex differences
- MeSH terms
- Adult, Anxiety, Depression, Fear, Female, Follicular Phase, Humans, Luteal Phase, Phobic Disorders, Psychiatric Status Rating Scales, Stress Disorders, Post-Traumatic, Case-Control Studies, Young Adult
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