Do Menopausal Women with PTSD Have More Risk of Dementia?

Key Points

• Post-traumatic stress disorder is more common among women due to their increased risk of sexual assault and interpersonal violence, including domestic abuse.
• A new study indicates menopausal women with PTSD are more likely than their peers to have Alzheimer's and cardiovascular disease, especially if they have severe symptoms or carry a certain genetic variation.
• Declining hormones are partially to blame, but treating PTSD and making healthy lifestyle choices could reduce the risk of long-term complications.

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The relationship between post-traumatic stress disorder (PTSD) and women is complex and well-documented. Women face distinct health challenges stemming from trauma's profound impact on the body and brain.

Now, it appears menopausal women with PTSD have a significantly higher risk of heart disease and cognitive decline, suggested a 2023 study, indicating that the effects of trauma may persist for decades.

What's the link between PTSD and heart disease?

More than half of women will experience at least one traumatic event in their lifetime, according to the National Center for PTSD.

About one in 10 will develop post-traumatic stress as a result, according to the U.S. Department of Health and Human Services Office on Women's Health.

Previous research has shown women with PTSD tend to experience worse menopause symptoms. There may be a link between childhood abuse and conditions such as polycystic ovary syndrome (PCOS), indicated a 2020 study.

Research has shown psychological stress—including trauma, depression and anxiety—can cause a "cascade of neuronal, hormonal and immunologic effects" that damage the body over time, according to the United States Department of Veterans Affairs National Center for PTSD (NCPTSD).

Studies also indicate people with trauma or post-traumatic stress, specifically, are more likely than the general population to develop and die from cardiovascular disease (CVD).

In one study of more than 1,000 women, researchers found each additional PTSD symptom raised the risk of coronary heart disease (CHD) by 17 percent, per the NCPTSD.

Women with five or more PTSD symptoms were roughly three times more likely to develop CHD than participants with no symptoms or one to four symptoms.

"In times of danger or perceived danger, the body releases a surge of hormones, such as cortisol and adrenaline," said Frank Anderson, M.D., psychiatrist and author of To Be Loved: A Story of Truth, Trauma, and Transformation, based in Concord, Massachusetts.

"In the short term, these hormones can be vital as they help to activate the body's 'fight or flight' response, enabling people to evade or combat danger," said Karen DeCocker, DNP, a Chicago-based psychiatric nurse practitioner and VP of Clinical Services at Stella.

"However, for people who've experienced trauma, levels of these hormones may remain high long after the threat has passed. This can have a toxic effect on the brain and body," DeCocker said.

"PTSD induces a chronic stress response, leading to prolonged exposure to stress hormones like cortisol and adrenaline. This can increase blood pressure, heart rate, and inflammation, contributing to the development of heart disease by damaging cardiovascular health over time," said Sogand Ghassemi, M.D., chief of medical staff and psychiatrist at PrairieCare in Brooklyn Park, Minnesota.

"For cardiovascular health, estrogen plays a role in maintaining healthy blood vessels and cholesterol levels. But as women enter perimenopause and midlife range, this protective factor is reduced due to drops in estrogen level," Ghassemi said.

Although PTSD is usually associated with male combat veterans, women—civilians and veterans—are about twice as susceptible to PTSD than men.

"This is mainly because women are more likely to experience high-impact trauma, such as sexual assault and interpersonal abuse, at an earlier age," Anderson said.

Heart disease affects about 44 percent of women in the U.S. and is the leading cause of death, according to the Centers for Disease Control and Prevention (CDC).

One 2020 Harvard study evaluated data from 51,602 participants over nine years and found women with PTSD and depression were nearly four times more likely to die prematurely of health issues such as cardiovascular disease, type 2 diabetes, accidents or suicide than their peers who didn't have depression or a history of trauma.

Researchers investigated if smoking, obesity and physical inactivity may explain the association between PTSD, depression and longevity but those factors were found to play a relatively minor part.

Other factors, such as the effect of stress hormones on the body, are probably a more significant influence.

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Recommended

• How Does PTSD Impact Women?: More women than men have PTSD because ofsexual trauma and interpersonal violence.
• What Do Women Need to Know About Heart Disease?: Some cardiovascular conditions and symptoms are specific to women.
• Coping With the Hyperarousal Symptoms of PTSD: Your fight-or-flight response is always on, you're irritable, paranoid and you can't sleep.

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How can PTSD affect brain health?

"Chronic stress from PTSD can have deleterious effects on the nervous and immune systems, both of which relate to brain health and memory," Anderson said.

Research indicates that, over time, post-traumatic stress disorder can lead to structural changes in the brain, with some regions becoming overstimulated and others underactive. Specifically, the amygdala and mid-anterior cingulate cortex (ACC), which are involved in processing fear and emotion and regulating conflict, become hyperactive, leading to the hyperarousal symptoms of PTSD.

Over time, parts of these areas may shrink due to overuse.

The hippocampus, which is involved in memory processing and consolidation, becomes underactive and tends to shrink or atrophy. The more severe a person's symptoms, the smaller these brain regions tend to be.

"These changes may accelerate cognitive decline and increase dementia risk," Ghassemi said.

Additionally, people with PTSD are three to five times more likely to develop depression, according to the National Center for PTSD.

Research has also linked depression to adverse changes in brain structure and neurochemistry, including:

• High levels of inflammation (2018 study)
• Abnormal neurotransmitter behavior (2018 study)
• Reduced gray matter volume (2018 study)

"Because estrogen plays a significant role in modulating stress responses, declining levels of the hormone at midlife could exacerbate chronic stress' negative impact on brain health," Ghassemi said.

"Its fluctuation during a woman's life, especially during menopause, might impact the severity and manifestation of PTSD symptoms."

"In the brain, estrogen helps in maintaining cognitive function and may reduce the risk of neurodegenerative diseases, but at the onset of perimenopause when estrogen levels start to decline, this protective factor is reduced," Ghassemi said.

PTSD affects your sleep, which could compound these adverse effects. Some research suggests chronic sleep deprivation may shrink the hippocampus and raise the risk of Alzheimer's and dementia and mental health conditions, such as depression and anxiety, according to a 2023 study and Cleveland Clinic.

Chronic sleeplessness also adversely impacts the heart and multiple other body systems.

Alzheimer's, a type of dementia, is the fifth leading cause of death among women in the U.S. according to the Office on Women's Health.

Multiple studies, including a 2022 analysis, indicate people who've experienced trauma in childhood, adolescence or early adulthood also tend to have more difficulty with menopause.

In the 2022 study, researchers evaluated data from 682 women over 20 years. They found those who had experienced trauma had significantly worse menopause symptoms, including sleep difficulties, depressive symptoms, vaginal dryness, hot flashes and sexual dysfunction, as well as worse overall well-being.

The reason for this is thought to be the effects of trauma on the brain.

What did the new study find about PTSD's effects on menopausal women?

Although the link between post-traumatic stress disorder and other physical and mental health challenges is well-established, there was previously little data on how PTSD affected menopausal women.

Researchers from Harvard and the University of Pittsburgh set out to change this by recruiting civilian women ages 45 to 67 from the Pittsburgh area.

They excluded prospective participants who were pregnant, those who'd had a hysterectomy or bilateral oophorectomy, and those with Parkinson's disease, brain tumors, seizure disorders, active substance abuse, a contraindication to magnetic resonance imaging (MRI), or a history of dementia, head trauma or stroke.

In the cross-sectional study, published in JAMA Network Open in 2023, the researchers gave the 274 participants PTSD questionnaires, neuropsychological exams, ultrasounds and MRIs and took body measurements.

They discovered that participants with PTSD had an increased risk of carotid atherosclerosis, and the severity of their PTSD directly correlated with their degree of risk. They also found that among people with PTSD symptoms, those carrying the apolipoprotein E (ApoE) ε4 genotype were more likely to face neurological challenges.

Specifically, participants carrying the genetic variation tended to have greater brain white matter hyperintensities (WMHs)—or lesions caused by reduced blood flow—and poorer cognition.

White matter hyperintensities tend to proliferate with age, according to the Mayo Clinic, and are common in people with a history of cognitive impairment, dementia and cerebrovascular disease.

People with WMHs are more likely to have a stroke or dementia and challenges with cognition, executive function and processing speed. They're also more likely to die sooner than those without the condition, particularly from cardiovascular disease.

The findings, researchers wrote, indicate people with post-traumatic stress disorder are more vulnerable to cardiovascular and neurocognitive disorders, especially if they carry the APoEε4 allele. The researchers recommend women with PTSD manage their condition and prevent complications.

"This study has limitations, including a relatively small sample size of primarily cisgender, non-Hispanic Black and white participants," said Mary Jacobson, M.D., chief medical officer at Hello Alpha and gynecologist in Palo Alto, California.

"Nonetheless, it shines a light on sex differences in PTSD—something that's crucial, given that women have historically been underrepresented in research—and demonstrates the profound impact the condition can have on physical and cognitive health."

Anderson agreed, noting that it's well-established that coronary artery disease, dementia and PTSD are leading causes of death in women. Exploring the link between these conditions could improve treatments for PTSD and, potentially, help reduce the rates of cardiovascular and cognitive diseases as well.

How can you lower your risk of dementia or heart disease?

"Managing symptoms of PTSD and treating this and co-occurring conditions, such as depression, is one of the best ways to take control of your heart disease risk and reduce your likelihood of developing Alzheimer's, dementia and other long-term issues," DeCocker said.

"As with most health conditions, early intervention can reduce the possibility of long-term harm."

A mental health professional can diagnose post-traumatic stress disorder, and treatment may involve therapy or counseling, medications (such as antidepressants and anti-anxiety medicines) or both, according to the Office on Women's Health and National Center for PTSD.

Some common forms of therapy include:

• Cognitive processing therapy (CPT) is a type of therapy designed specifically for treating PTSD, teaching you how to evaluate and change upsetting thoughts.
• Eye movement desensitization and reprocessing (EMDR) therapy involves gradually recalling the trauma while focusing on a specific touch, sound or visual cue to help the brain process the memory effectively.
• Prolonged exposure (PE) is a type of psychotherapy where you are encouraged to gradually and repeatedly recall a traumatic event so you can confront it and cope with the trauma.

Additionally, DeCocker and Jacobson suggested the following tips may help:

• Don't smoke, as tobacco use increases the risk of plaque buildup in the blood vessels. Smoking also leads to high blood pressure and raises the risk of heart attack, stroke and numerous other health concerns.
• Exercise your mind and body regularly.
• Keep up your social connections and engage in social activities, improving cognitive well-being and lowering the risk of dementia.
• Know the symptoms of heart disease and undergo regular heart health screening.
• Maintain a healthy diet similar to the Mediterranean, MIND diet or DASH eating plans, as research suggests they may improve cognitive and physical health.
• Manage stress using strategies including mindfulness, meditation and deep breathing. Recommended activities such as yoga or walking in nature are helpful for relaxation.
• Moderate your intake of alcohol. Drinking too much alcohol is linked to a reduced volume of the brain's white matter and a higher risk of various chronic health issues.
• Prioritize healthy sleep with a combination of lifestyle habits and environmental factors that help you get consistent, uninterrupted sleep. Make sure you address any sleep disturbances that prevent you from having a good night's sleep.

The bottom line

Trauma can affect various facets of a person's life and well-being for years afterward and may contribute to multiple chronic illnesses, including cardiovascular disease and cognitive decline.

However, post-traumatic stress is highly treatable, and managing the condition could reduce the risk of complications.

If you're experiencing symptoms of PTSD or otherwise feel your mental health is suffering, speak with a healthcare provider for guidance. You can also find online resources at the following:

• Female Veteran’s Resource: Understands that women Veterans may have unique experiences and treatment needs. VA mental health clinicians work to ensure that all women Veterans have access to high-quality gender-sensitive treatment.
• Maternal and Child Health Hotline: Strengthens public health systems to meet the needs of America’s mothers, children, and their families. Responds to the National Maternal Mental Health Hotline 1-833-TLC-MAMA (1-833-852-6262).
• National Institute of Mental Health: Celebrating 75 years, it is the lead federal agency for research on mental disorders.
• Office on Women’s Health (OWH): Coordinates women's health efforts across the U.S. Department of Health and Human Services (HHS) and addresses critical women's health issues by informing and advancing policies, educating health care professionals and consumers, and supporting innovative programs.
• SAFE Project: Committed to acknowledging and generating action-oriented approaches that are inclusive to all Americans impacted by addiction as well as the root causes of the disease.
• Well Being Trust: Resources and support for women’s mental health and well-being.