The Role of Menstrual Cycle Phase in PTSD: A Scoping Review of Symptom Expression, Neuropsychology and Psychotherapy Response in Women

Women are diagnosed with post-traumatic stress disorder (PTSD) at twice the rate of men, a disparity only partly explained by trauma exposure differences. Sex-specific biological factors, particularly cyclic fluctuations in estradiol and progesterone, have been associated with PTSD symptoms/related neuropsychological processes in healthy/trauma exposed women; however, the extent and clinical translation of this literature (if any) remain unclear in PTSD populations. This review aimed to map evidence examining associations between ovarian hormones/menstrual cycle phase and PTSD symptoms and/or related neuropsychological processes (e.g., extinction learning) in women with PTSD (Aim1), and/or associations with psychotherapy outcomes in PTSD/related anxiety disorders (Aim2). A systematic search for peer-reviewed, empirical studies involving adult females was conducted across 6 databases, in accordance with PRISMA-ScR and JBI guidelines. From 2,464 results, 12 studies were included. Five studies addressed Aim 1 and seven addressed Aim 2. Hormonal operationalization was inconsistent, including continuous assays (n=5), menstrual cycle phase comparisons (n=3), and/or median split/other groupings (n=6), with estradiol most frequently measured. For Aim 1, PTSD symptom findings were inconsistent and inconclusive (n=3), whereas lower estradiol was more consistently associated with impaired fear extinction and habituation (n=2). For Aim 2, findings in anxiety-related disorders were mixed, with no study examining ovarian hormone status in psychotherapy outcomes for women with PTSD. Overall, evidence remains sparse, heterogeneous and largely cross-sectional. Findings do not yet support firm conclusions regarding ovarian hormone–PTSD symptom/neuropsychological interactions but highlight key research gaps and future directions to better understand these relationships and inform personalized PTSD treatments for women.