Estradiol, Stress Reactivity, and Daily Affective Experiences in Trauma-Exposed Women

Clinical Impact Statement We show that lower estradiol is associated with greater number and severity of self-reported PTSD symptoms in naturally cycling women with a history of trauma exposure. In addition, trauma-exposed women in low- versus high-estradiol menstrual cycle phases show greater sympathetic and lower hypothalamic-pituitary-adrenal axis reactivity to a trauma reminder, more severe daily PTSD symptoms, and more variable daily affect. These results have potential implications for clinical assessment, as menstrual cycle phase at the time of assessment could influence PTSD diagnosis. Additionally, clinicians working with women with PTSD might anticipate greater affective lability and increased symptoms during low-estradiol menstrual cycle phases. Objective: Women experience higher risk for PTSD following trauma compared with men. Fluctuations in ovarian hormones might contribute to this greater vulnerability, given that estradiol is associated with affect and stress reactivity. Our objective was to test the relations between menstrual cycle-related changes in estradiol, affect, stress reactivity, and trauma-related symptoms. Method: We assessed trauma-related symptoms in ethnically diverse naturally cycling women with a history of trauma during a clinical interview. Participants also completed a 10-day ecological momentary assessment (EMA) that included lower- and higher-estradiol phases. We tested associations between estradiol and PTSD symptoms and stress reactivity to a trauma reminder using Spearman correlation and Wilcoxon rank-sum tests. We tested the effect of menstrual cycle day on daily affect using multilevel modeling. Results: Estradiol was negatively associated with symptom severity (r(s) = -.36), and participants in low- versus high-estradiol cycle phases at interview had higher sympathetic (r = .35) and lower hypothalamic-pituitary-adrenal axis (r = .41) reactivity. Across the EMA period, participants showed a decrease in daily PTSD symptoms (b = -.39), negative (b = -.11) and positive (b = -.24) affect, and variability in daily valence (b = -.07) and arousal (b = -.08), from the low- to high-estradiol phase. Conclusions: Consistent with prior evidence of more aversive affective experiences in low-estradiol states, lower estradiol was associated with higher trauma-related symptoms. In addition, trauma-exposed women showed a discordant pattern of stress reactivity to a trauma reminder, higher daily symptoms, and greater affective lability in a low-estradiol phase. Given that our sample consisted of high-functioning trauma-exposed women, these results should be replicated in women with PTSD.