When the body keeps the score - every month
It’s been reported that around 80% with PMDD have experienced early life trauma. And before you wonder if that’s because trauma is common for women generally - other research finds those with PMDD are 2 to 3 times more likely to have trauma history, compared to women without PMDD.
Women are also twice as likely as men to develop post-traumatic stress disorder (PTSD), even after controlling for trauma type, income, and social support.
So something deeper is going on. It turns out trauma can reshape how the brain responds to hormones - and there's a two-way relationship between trauma and hormonal sensitivity that almost nobody is talking about.
This article covers two related but distinct areas - first, how PTSD interacts with the menstrual cycle, and second, PMDD and trauma specifically. One important clarification: not everyone with PMDD has a trauma history. PMDD is multifactorial - hormonal sensitivity can develop through other pathways entirely unrelated to trauma. This piece focuses specifically how trauma and PMDD overlap only If the link may be relevant for someone, not on PMDD as a whole.
What does trauma actually do to your stress system? (1)
Your body’s stress response system, or the hypothalamic-pituitary-adrenal (HPA) axis, regulates how you react to threat through the release of cortisol.
In a healthy system, this cascade activates in the face of danger, then dampens down. Trauma disrupts that balance. It can leave the HPA axis either constantly on high alert or, in some cases, blunted and unable to initiate an appropriate response at all.
Trauma can physically alter the brain: the amygdala (threat-detection centre), becomes overactive. The prefrontal cortex (rational thinking, emotional regulation) becomes underactive. The result is a nervous system primed to perceive danger even when none is present.
Removing the regulation: estrogen’s role (2, 3)
PTSD, trauma and estrogen
Women experience stress-related disorders at roughly twice the rate of men. One significant contributor is estrogen. Estrogen receptors are found throughout the brain, and in particularly high concentrations in the very regions that trauma reshapes. Estrogen also plays a central role in encoding emotional memories and regulating emotional arousal.
But the relationship isn't straightforward. Preclinical data suggests it follows a bell-shaped curve: at normal concentrations, estrogen acts as a stabilising force. At high or low levels, it can tip the system into dysregulation.
The study that changed everything
A study investigated this looking into women who had been exposed to trauma, those who had not and those with PTSD and here’s what they found:
•In those with little trauma history, estrogen calmed the amygdala and reduced threat reactivity
•In those who were trauma exposed, estrogen increased amygdala reactivation, sending threat signals into overdrive
•In those with PTSD diagnosis, estrogen had no effect at all.
At this point, a discovery was made: trauma seems to rewire estrogen receptors in fear circuits, flipping them from protective to destabilising.
This has direct implications for the menstrual cycle. Estrogen fluctuates twice every month: after ovulation, and again just before menstruation. For most people, these are unremarkable fluctuations. But for those whose fear circuits have been reshaped by trauma, they open windows of neurobiological vulnerability. The brain becomes primed to read the world as threatening - not because of what's happening now, but because of what the nervous system learned then.
The hormone fluctuations in the luteal phase may be actively lowering the threshold at which trauma responses are triggered, making it more likely for PTSD to develop in women. Studies also show that women with PTSD report a significant worsening of symptoms premenstrually (4).
And what about the overlap with PMDD? Interestingly, a study in 4,000 women found that women with PTSD have 8x higher odds of also having PMDD - a disorder characterised by severe emotional and behavioural symptoms including depression, anxiety and intrusive thoughts clustered to the luteal phase (5). This leads us onto PMDD itself...
The Link Between PMDD and Trauma (6, 7, 8, 9, 10, 11, 12, 13, 14)
One study in a group of women with PMDD reported that 83% had a history of early life trauma. A meta-analysis of 16 studies showed that women with PMDD were twice as likely to have a history of trauma exposure compared to women who don’t have PMDD.
How can early trauma impact PMDD development?
When the nervous system is exposed to threat or adversity in childhood, inflammation is upregulated as a defence mechanism. That inflammation is not just in the body, it’s also in the brain. Experiencing this heightened state while the brain is still developing (a “critical window") can alter molecular pathways in our brain that can then continue to affect us later in life.
The following neurobiology can be affect:
1. Neurotransmitter systems
2. Brain circuitry
3. Dysregulation of the HPA axis (stress response system)
In PMDD, that may manifest as a hyper-sensitive response in the brain to normal hormonal fluctuations. The fluctuations in progesterone during the luteal phase triggers symptoms for most PMDD sufferers, but for those with a trauma history, fluctuations in estrogen may compound this further, reactivating trauma-linked fear responses both around ovulation and during the luteal phase Two separate mechanisms of vulnerability, converging each month.
*Not everyone with PMDD has a trauma history - PMDD is multifactorial, and hormonal sensitivity can develop through other pathways. This article focused on the trauma-PMDD overlap specifically.*
What if this is you? (15)
Many researchers and clinicians discuss that trauma-informed care should be central to PMDD treatment. A newly proposed DBT (dialectical behaviour therapy)-informed model does exactly that. Unlike standard CBT, which focuses on changing thoughts and behaviours, DBT emphasises acceptance, emotional regulation, and building distress tolerance - skills that are particularly well-suited to the intensity and unpredictability of PMDD symptoms like rage, anxiety, and emotional overwhelm. The model also prioritises validation from the very first session, recognising that many women with PMDD have spent years being dismissed or misdiagnosed. If this resonates with you, it may be worth looking for a therapist with experience in both DBT and trauma-informed care, and sharing this emerging framework with them.
References:
1. Bany-Mohammed, M., Asim, S., Elalami, M., & Agrawal, D. K. (2025). Trauma, Stress, and Mental Health Outcomes. Journal of psychiatry and psychiatric disorders, 9(5), 276–288. https://doi.org/10.26502/jppd.2572-519X0260
2. Lawrence S, Scofield RH. Post traumatic stress disorder associated hypothalamic-pituitary-adrenal axis dysregulation and physical illness. Brain, Behavior, & Immunity - Health [Internet]. 2024 Nov;41:100849. Available from: https://www.sciencedirect.com/science/article/pii/S2666354624001273
3. Stevens JS, Davis M, Hinojosa CA, Hinrichs R, Roeckner AR, Oliver KI, et al. Hormonal mechanisms of women’s risk in the face of traumatic stress. Proceedings of the National Academy of Sciences. 2025.
4. Green, S.A., Graham, B.M. Symptom fluctuation over the menstrual cycle in anxiety disorders, PTSD, and OCD: a systematic review. Arch Womens Ment Health 25, 71–85 (2022). https://doi.org/10.1007/s00737-021-01187-4
5. Pilver CE, Levy BR, Libby DJ, Desai RA. Posttraumatic stress disorder and trauma characteristics are correlates of premenstrual dysphoric disorder. Arch Womens Ment Health. 2011 Oct;14(5):383-93. doi: 10.1007/s00737-011-0232-4. Epub 2011 Jul 23. PMID: 21786081; PMCID: PMC3404806.
6. Grewal JK, Mu E, Li Q, Thomas EHX, Kulkarni J, Chen L. The prevalence of traumatic exposure in women with premenstrual dysphoric disorder (PMDD): a systematic review. Arch Womens Ment Health. 2025 Aug;28(4):723-740. doi: 10.1007/s00737-024-01536-z. Epub 2024 Nov 15. PMID: 39546002.
7. Kulkarni et al.. The prevalence of early life trauma in premenstrual dysphoric disorder (PMDD). Psychiatry Res. 2022
8. Grewal et al. The prevalence of traumatic exposure in women with premenstrual dysphoric disorder (PMDD): a systematic review. Arch Womens Ment Health. 2025
9. Yang et al. Association between adverse childhood experiences and premenstrual disorders: a cross-sectional analysis of 11,973 women. BMC Med. 2022.
10. Standeven et al. The link between childhood traumatic events and the continuum of premenstrual disorders. Front Psychiatry. 2024.
11. Bannister. There is increasing evidence to suggest that brain inflammation could play a key role in the aetiology of psychiatric illness. Could inflammation be a cause of the premenstrual syndromes PMS and PMDD?. Post Reprod Health. 2019
12. Younes et al. Premenstrual dysphoric disorder and childhood maltreatment, adulthood stressful life events and depression among Lebanese university students: a structural equation modeling approach. BMC Psychiatry. 2021.
13. Ongoing trial: Stress, Inflammation and Neuroimaging in Major Depressive Disorder as Compared to Premenstrual Dysphoric Disorder (NCT06130371)
14. Slavich & Irwin. From stress to inflammation and major depressive disorder: a social signal transduction theory of depression. Psychol Bull. 2014
15. Oliveri A, Muir S, Mu E, Kulkarni J. Advancing psychological interventions for premenstrual dysphoric disorder: A dialectical behaviour therapy–informed treatment model. Australian & New Zealand Journal of Psychiatry. 2025;59(8):670-673. doi:10.1177/00048674251348370