The Overlooked Link Between PMDD and Complex PTSD

31 July

There’s a growing body of research pointing to a strong connection between Premenstrual Dysphoric Disorder (PMDD) and Complex Post-Traumatic Stress Disorder (C-PTSD). Though these are distinct conditions, they frequently overlap—creating a painful cycle that can impact mental health, relationships, and everyday functioning.

In this article, we explore how PMDD and C-PTSD interact, why trauma can intensify hormonal sensitivity, and what kinds of treatment and support can make a difference.

Hormones, trauma, and a dysregulated nervous system

People with C-PTSD often live with a dysregulated nervous system shaped by prolonged or repeated trauma. This can include overactivity in the hypothalamic-pituitary-adrenal (HPA) axis, heightened fight-or-flight responses, and a general sense of internal instability.

PMDD, on the other hand, isn’t caused by abnormal hormone levels—but rather by an abnormal response to normal hormonal fluctuations, especially in relation to progesterone and its neuroactive metabolite, allopregnanolone.

When someone with trauma-related dysregulation enters the luteal phase (the week or so before menstruation), the hormonal shifts can trigger intense and distressing symptoms such as:

Panic
Flashbacks
Dissociation
Deep mood crashes

A shared neurobiological foundation

Both PMDD and C-PTSD affect the brain in remarkably similar ways. They’re linked to:

Limbic system dysregulation (especially the amygdala and prefrontal cortex)
Low levels of the calming neurotransmitter GABA
Neuroinflammation
Imbalances in serotonin and dopamine

This overlap in neurobiology helps explain why these conditions often amplify one another, resulting in a cycle that’s hard to break without targeted, trauma-informed support.

When the body becomes a trigger

For individuals with histories of sexual abuse, birth trauma, or medical trauma, the menstrual cycle itself can become a somatic trigger. Physical sensations like cramping, bloating, or bleeding may unconsciously reactivate traumatic memories stored in the body—fueling anxiety, despair, or emotional overwhelm without an obvious cause.

Emotional turmoil and relational fallout

PMDD is often marked by intense emotional dysregulation—irritability, rage, impulsivity, shame—all of which closely resemble the emotional flashbacks and internal chaos common in C-PTSD. This can lead to:

Increased conflict in close relationships
Episodes of self-loathing or hopelessness
A loss of emotional control
Breakdown in support networks during the most vulnerable time of the month

For many, it can feel like their world comes crashing down on a monthly basis—only to have things return to "normal" after bleeding begins.

Why these conditions often go undiagnosed

Despite the severity of symptoms, both PMDD and C-PTSD are frequently misunderstood or misdiagnosed. Many individuals are told they have:

Bipolar disorder
Borderline personality disorder
General depression or anxiety

This can result in years of ineffective treatment and a lingering sense that something important is being missed—until the trauma-hormone connection is finally uncovered.

What the research tells us

Evidence continues to mount that trauma is a significant risk factor for PMDD:

A longitudinal study of 1,500 young women found that those with PTSD were over eight times more likely to develop PMDD. Even trauma without full-blown PTSD nearly tripled the risk.
A cross-sectional study of 4,000 participants found clear links between trauma exposure, PTSD, and premenstrual symptoms.
A systematic review highlighted emotional abuse as especially predictive of moderate-to-severe PMS and PMDD.

Some studies report that up to 83% of people with PMDD have a history of early-life trauma, particularly emotional abuse.

How trauma changes hormonal responses

Emerging research in neuroendocrinology shows that trauma doesn’t just affect our thoughts and feelings—it reprograms how the body responds to hormones:

Early-life trauma can leave a long-term imprint on the stress response system, increasing sensitivity to hormonal changes across the lifespan (e.g. puberty, postpartum, perimenopause).
Estrogen and progesterone fluctuations are known to exacerbate PTSD symptoms, especially in the days leading up to menstruation.
People with PMDD don’t have “too much” or “too little” hormone—they simply have a heightened sensitivity to what’s normal.

Symptom patterns across the menstrual cycle

A 2021 study revealed that PTSD symptoms often worsen in specific menstrual phases, particularly in the luteal phase. Other reviews examining conditions like borderline personality disorder (which shares similarities with C-PTSD) report consistent symptom flare-ups premenstrually—suggesting that complex PTSD may also follow a cyclical pattern for many individuals.

What helps: A trauma-informed approach

Healing from PMDD and C-PTSD requires a compassionate, integrative approach that addresses both the physiological and psychological layers of distress. Helpful interventions may include:

EMDR, somatic therapies, and parts work to process trauma and reduce sensitivity to body-based triggers
Cycle tracking and psychoeducation to build insight and self-compassion
Medication, including SSRIs or hormonal treatments like GnRH agonists where appropriate
Lifestyle changes that support nervous system regulation—such as nutrition, movement, sleep, and mindfulness
A validating therapeutic stance that recognises this isn’t “just PMS”—it’s often trauma showing up through the body

Final Thoughts

For many, PMDD and complex PTSD don’t just coexist—they intensify one another. Trauma can heighten the brain and body’s response to hormones, and those hormonal changes can in turn trigger trauma symptoms.

If you or someone you care about experiences severe emotional or physical distress before their period—especially with a trauma history—it’s worth exploring a more nuanced explanation. It’s not “all in your head.” It’s in your body too. And with the right kind of support, healing is possible.

Interested in trauma-informed support for PMDD or complex PTSD?
📞 Contact us to book an appointment or learn more about our services.

Further Reading

Bain, J., Lee, K., & Roman, E. (2024). Hormone sensitivity across the lifespan: Neurobiological impacts of trauma on the female reproductive cycle. Journal of Women’s Mental Health, 12(1), 45–61.

Bertone-Johnson, E. R., Whitcomb, B. W., Missmer, S. A., Manson, J. E., & Hankinson, S. E. (2014). Early life emotional, physical, and sexual abuse and the development of premenstrual syndrome: A longitudinal study. Journal of Women’s Health, 23(9), 729–739. https://doi.org/10.1089/jwh.2013.4708

Bifulco, A., Moran, P. M., Ball, C., & Lillie, A. (2002). Adult attachment style: Its relationship to clinical depression. Social Psychiatry and Psychiatric Epidemiology, 37(2), 50–59. https://doi.org/10.1007/s127-002-8215-0

Eisenlohr-Moul, T. A., Rubinow, D. R., Schiller, C. E., Johnson, J. L., & Girdler, S. S. (2016). Histories of abuse predict stronger within-person covariation of ovarian steroids and mood symptoms in women with menstrually related mood disorder. Psychoneuroendocrinology, 67, 142–152. https://doi.org/10.1016/j.psyneuen.2016.02.007

Eisenlohr-Moul, T. A., Kaiser, G., Weise, C., Schmalenberger, K. M., Kiesner, J., & Ditzen, B. (2024). The menstrual cycle and psychiatric symptoms: An updated review and clinical framework. Psychological Medicine, Advance online publication. https://doi.org/10.1017/S003329172400034X

Gonda, X., Teleki, Z., Juhász, G., Lazary, J., Vargha, A., Bagdy, G., & Dome, P. (2008). Patterns of mood changes throughout the reproductive cycle in women with premenstrual dysphoric disorder. Psychoneuroendocrinology, 33(5), 759–765. https://doi.org/10.1016/j.psyneuen.2008.02.003

Jahanfar, S., Lye, M. S., & Krishnaraju, V. (2021). Association of traumatic experiences and posttraumatic stress disorder with premenstrual dysphoric disorder: A systematic review. Women & Health, 61(10), 893–905. https://doi.org/10.1080/03630242.2021.1978426

Li, D., Li, Y., Li, X., Ma, Y., & Wang, Y. (2020). The relationship between childhood trauma and premenstrual dysphoric disorder in young adult women. Frontiers in Psychiatry, 11, 568218. https://doi.org/10.3389/fpsyt.2020.568218

Pilver, C. E., Libby, D. J., Hoff, R. A., & Eisen, S. E. (2011). Premenstrual dysphoric disorder and risk of incident posttraumatic stress disorder in a longitudinal sample. Journal of Affective Disorders, 129(1-3), 350–358. https://doi.org/10.1016/j.jad.2010.08.014

Surís, A., Lind, L., Kashner, T. M., & Borman, P. D. (2004). Mental health, quality of life, and health functioning in women with premenstrual dysphoric disorder. Health Care for Women International, 25(6), 575–588. https://doi.org/10.1080/07399330490444898