PTSD AND PMS...IS THERE A CONNECTION?

A woman who comes to me mentioned that every month she has intense emotions and irritability during the 5-7 days before the onset of her period representing symptoms of a premenstrual sydrome [PMS].  This person also has post traumatic stress disorder [PTSD] and I wondered if there is a connection between her PMS symptoms and PTSD. I was aware that stress and anxiety can influence hormones. I started to research the possible influence of estrogen and progesterone on PTSD symptoms. There have been a number of studies that have suggested that PTSD symptoms intensify when estrogen and possibly progesterone levels are lower and conversely PTSD symptoms are lower when these levels are higher. During the prementrual period estrogen levels rapidly decrease and it is possible that this triggers an increase in PTSD symptoms. The monthly cycle for women starts with menses when estrogen and progesterone are lowest followed by the follicular phase with an increase in estradiol that triggers the release of follical stimulating horomone [FSH] that stimulates follicle [egg] development. Then leutinizing hormone [LH] increases triggering the release of the egg [ovulation] with a rapid drop in estradiol. This is. followed by the luteal phase when estradiol increases again in preparation for fertilization of the egg. Without fertilization, estradiol and progesterone levels drop late in the luteal phase triggering prementrual symptoms followed by the onset of menses. Estrogen levels increase in the later follicular phase and then drop around ovulation with leutinizing hormone peaking and then increases again halfway through the luteal phase before dropping rapidly leading to onset of menses. The progesterone increases in the late follicular phase and then peaks and levels off during the middle of the luteal phase with rapid drop off just before menses. Leutinizing hormone and follicular stimulating hormone both peak in late follicular phase and then rapidly drop off after ovulation. 

What is the point of elaborating on the fluctuations of hormones during the mentrual cycle? Well, PTSD symptoms are reported to increase with decreasing estrogen and progesterone levels and this is correlated with later luteal phase of the cycle including the several days leading up to menses. So if PMS is accentuated by PTSD symptoms then these PMS symptoms will be increased especially during the luteal phase until just before menses. This is when my patients experience their PMS symptoms. 

So, if the PTSD symptoms increase as they are triggered by the hormone level changes and if these symptoms are lower with increased estrogen levels then they should be lower during pregnancy and other times when estrogen levels are high. Focusing on the hormone levels  would support the liklihood of PMS occuring during a signficant part of the luteal phase up until near the onset of menses. This seems to be true for the woman who came to me for treatment. 

I wonder if it is possible to reduce PMS by lowering PTSD symptoms. This would make sense if for some women PMS represents a coping mechanism dealing with traumatic memories. 

What do you think?