What’s PTSD got to do with menopause?

Perimenopause and menopause can be challenging for many women, thoroughly unpleasant for some, and harrowing for a few.

For a woman with post-traumatic stress disorder (PTSD), perimenopause can reopen old wounds she thought were healed long ago.

If you have battled with PTSD (post-traumatic stress disorder) or another mood disorder like anxiety or depression in the past, and are now entering perimenopause or menopause, there may be additional risks and challenges you should be aware of.*

What is PTSD?

We tend to associate PTSD with soldiers who have been in combat, and while it certainly does affect that population, PTSD can arise out of any trauma. Car accidents, assault, natural disasters – events that threaten our lives or well-being can cause PTSD, and while women are more likely to develop the disorder after a trauma, all genders are vulnerable to PTSD.

Most people will, unfortunately, suffer trauma in their lives and will have an emotional response. But according to the U.S. Department of Veterans’ Affairs National Center for PTSD, most of us will recover in a few weeks. If symptoms continue for many months, are severe and impactful, and keep you from living your life, you might have PTSD.

What are the symptoms of PTSD?

According to the National Center for PTSD, there are four symptoms, which can vary from person to person:

1. Reliving the event. This includes memories, nightmares, even flashbacks where you feel like you’re reliving the events of the trauma.
2. Avoidance. Staying away from situations or people that you worry might trigger memories. Not talking or thinking about the trauma for fear of bringing back bad memories.
3. Negative beliefs or feelings. The National Center for PTSD lists guilt, shame, disinterest in activities you used to enjoy, insecurity, mistrust, numbness, and an inability to feel happy.
4. Hyperarousal. Some also call this “hypervigilance,” and it means to be always on high alert for danger. This is a very difficult l way to live, and many people have trouble sleeping or focusing for long. Others may turn to drugs or alcohol for relief.

Why can PTSD be worse in perimenopause?

In PTSD, emotions run out of control – fight or flight responses are set to 11, as they say. Mood swings in perimenopause can feel very like the emotional chaos of PTSD. Whether or not the hormone fluctuations of perimenopause can actually trigger a recurrence is unknown, but to the woman who’s suffering, the familiar lack of emotional control can cause anxiety and hypervigilance and utterly disrupt her life.

To learn more about the intersection of PTSD and midlife hormone changes, we talked to two doctors who specialize in women’s mental and reproductive health: Dr. Carly Snyder, Director of Women’s Health for Family Health Associates and attending physician at Mount Sinai Beth Israel Medical Center and at New York-Presbyterian / Weill Cornell Medical Center, and Dr. Gauri Khurana, psychiatrist and specialist in women and mood disorders.

First, both doctors stressed that entering perimenopause is not a guarantee that PTSD symptoms will return, so even if you’ve suffered PTSD in the past, it may not come back.

PTSD and its correlations with hormone levels are imperfectly understood and, at this point, not well researched or documented, so the science on this intersection is pretty thin. But both doctors agreed on several aspects that all women – not just those with a history of PTSD – should bear in mind.

Estrogen fluctuations impact mood.

It’s not “all in your head.” It’s real: hormone shifts at menopause can make moods chaotic and unpredictable. According to Dr. Snyder, for some women, hormonal fluctuations – not reduced hormone levels – trigger mood symptoms, which is why mood can be worse in perimenopause. Hormones ride a proverbial roller coaster through the perimenopausal years, and some women feel as if their mood takes a dive as a result. Emotions often level out once the body establishes a “new normal” post-menopause.

Having your experiences belittled or dismissed can make the problem worse.

It’s a sorry truth that women’s emotional responses are not always treated with the seriousness they deserve. Worse, being ignored or condescended to may remind women of poor treatment they received when reporting the initial trauma. As Dr. Khurana told me, “So often when women report trauma like sexual assault, they aren’t believed, maybe they’re belittled or demeaned, they’re not taken seriously. So if those symptoms and severity return in menopause, and they get the same dismissiveness from doctors that they got from law enforcement, many women simply go quiet and suffer in silence.”

Mood disorders are very difficult to conquer alone.

When a mood disorder as severe as PTSD is diagnosed, recovery can be extremely difficult without professional help. “PTSD is a steam roller,” says Dr. Snyder. “Once a woman starts to experience flashbacks or nightmares, it gets harder and harder to control. Rather than waiting until you’re too far into the vortex, if you know the feelings and you know you’ve been here before, get help. Get help so you can move forward rather than looking back.”

“Women are needed.”

There are interventions and solutions that work.

Both doctors were very adamant about this: you can get better, and not just by “hanging in there” until hormone levels stabilize. For some women, an antidepressant or anti-anxiety medication may work great; for others, hormone replacement therapy (HRT) can smooth out hormonal fluctuations. Dr. Khurana suggests finding a therapist who is possibly an older woman herself and therefore more likely to understand the issues, or joining a support group. As she says, many people who have dealt with PTSD know the effectiveness of talking with others with the same problem – there’s a level of trust and understanding built in from the start.

Intervention sooner rather than later may make healing easier and bring relief faster. As Dr. Snyder says, “Help is effective. Every woman deserves to enjoy her life. There’s no point to being in unnecessary physical or emotional pain. There’s no shame in experiencing symptoms, and there’s no shame in asking for help.”

Ultimately, the best thing you can do for yourself and your family is to get the help you need. “Women are needed,” says Dr. Snyder. “We’re needed as mothers and grandmothers and partners and colleagues and friends, we’re needed for ourselves. But we can’t be there for others if we’re too far down the rabbit hole.”

If you’ve experienced PTSD symptoms in perimenopause or menopause, we’d love to hear how you dealt or are dealing with it. What interventions are working for you? How long did the problem last? If you’re willing to share your story so others can learn more, please let us know at info@gennev.com.

*The information in this article is not intended to replace expert care by a professional. If you feel you’re experiencing symptoms of PTSD or other mood disorders, please seek medical attention right away.