Episode 168: The Biology Behind Hormones, Trauma, and Menopause

Your childhood ACE score predicts how severe your menopause experience will be — by 20 to 40%. Estrogen modulates serotonin, inflammation, and the nervous system's capacity to regulate stress. When it declines, stored trauma surfaces — this episode explains the biology. Bioidentical hormones — structurally identical to what the body makes — are part of the conversation most women are never offered.

Something is different now. The anxiety that won't settle. The depression nobody connects to anything. The exhaustion sleep does not fix. The sense that what you have been holding for decades is no longer holdable. You have been doing everything right. And still, something is breaking through. Nobody is connecting your history to your hormones. This episode does.

Menopause is a whole-body event. For women carrying stored trauma and a history of chronic stress, it is a physiological reckoning — the moment estrogen's protective effects drop, what the body has been holding for decades can no longer be suppressed. The protective effects of estrogen decline during perimenopause. Estrogen modulates serotonin. It holds the inflammatory response. It supports the nervous system's capacity to regulate stress. When that buffer goes, what was held beneath the surface comes up. Research shows women with higher ACE scores experience menopause symptoms 20 to 40% more severely. That is not coincidence. That is biology.

Dr. Betty Murray, hormone metabolism expert and functional medicine PhD, joins Dr. Aimie to name what medicine has kept separate for too long: stored trauma and hormonal health. Why did the PTSD experiences of 6,000 women correlate directly with estrogen levels? Why does targeting cortisol without addressing adrenaline miss the mechanism entirely? And why have women been told for decades that bioidentical hormones are unsafe — when a 10-million-woman study shows they reduce all-cause mortality, breast cancer risk, and dementia?

The full picture includes stored stress chemistry, the hormonal infrastructure, the metabolic context — and whether the hormones being offered are structurally identical to what the body actually makes. Working with the body means addressing these in sequence. At a dose the nervous system can receive. In the individualized way it actually requires.

Key Takeaways

• Menopause symptoms are 20 to 40% worse in women with higher ACE scores or subjective measures of stored trauma. The biology explains this relationship. Mainstream medicine is not yet communicating it to women at this life stage.

• Estrogen has receptors on every single cell in the body except two. When estrogen drops during perimenopause, every cell in the body registers it. The psychological symptoms — anxiety, depression, brain fog, irritability, emotional sensitivity — are the direct expression of the hormonal changes.

• A PTSD study of 6,000 women found that those with the lowest estrogen levels had the most severe PTSD symptom expression. Estrogen modulates the nervous system's capacity to process stress and regulate emotional response — making it directly relevant to stored trauma, not just reproduction.

• Adrenaline is the primary driver of the stress response. Cortisol rises in response to adrenaline as a protective buffer. Targeting cortisol without addressing the adrenaline signal misses the mechanism and will not produce lasting change.

• Bioidentical hormones are structurally identical to what the body makes. They are on the table for every woman, regardless of age or breast cancer family history. The Women's Health Initiative conclusions were based on synthetic progestins and conjugated equine estrogen. Those findings have been widely misrepresented for over two decades.

• The endocrine system is a symphony. Adrenals (percussion) set the stage for everything else. Testing estrogen in isolation without looking at thyroid, adrenals, insulin, and metabolic markers produces an incomplete picture — and incomplete pictures produce incomplete treatment plans.

• A 10-million-woman retrospective study found that women who remained on bioidentical hormones long-term had reduced risk of dying from breast cancer (16%), lung cancer (13%), and dementia (up to 30%). These findings have not received proportionate public attention.

• Start low and go slow. A nervous system carrying stored trauma needs time to adjust to any new biological input — including hormones. This is both good endocrinology and good trauma-informed medicine.

In This Episode You'll Learn:

[00:00] Why are hormones, buried emotions, and stored trauma connected — and why is menopause when it all surfaces?

[04:45] What is the new lens for reading hormone labs — and why does dosing one-size-fits-all fail 75% of women?

[08:00] What is actually happening biologically when a woman in perimenopause feels rage, anxiety, brain fog, and emotional sensitivity?

[8:49] How do estrogen’s receptors on every cell in the body explain the scope of menopause symptoms?

[10:51] What did a 6,000-woman PTSD study reveal about the relationship between estrogen levels and trauma symptom severity?

[14:14] What labs should be tested, when should they be tested, and why does the phase of perimenopause change what you are looking for?

[21:21] Is the depression diagnosed during menopause actually depression — or a hormone picture being handed an antidepressant?

[22:36] How do adverse childhood experiences raise the risk for first-episode major depression during menopause?

[27:35] What is the difference between bioidentical and synthetic hormones — and why does delivery mechanism matter?

[31:44] What does the 10-million-women retrospective study actually show about hormone replacement and all-cause mortality?

[36:41] What did the Women’s Health Initiative actually find — and how was a non-statistically significant finding turned into a 25% headline?

[38:42] What does Dr. Betty Murray want every woman to know before she leaves this conversation?

Notable Quotes

Dr. Aimie Apigian

Educational & Insightful

— On what the ACE research reveals about the biology underneath perimenopause symptoms: "Your childhood did not stay in the past. It is a direct prediction of how hard perimenopause will be."

— On what menopause reveals: "Buried trauma surfaces during menopause because we lose the protective nature of estrogen. The more trauma we're packing, the harder it is to adjust to changes."

— On what trauma-informed hormone therapy actually looks like in practice: "Start low and go slow. Any nervous system carrying stored trauma needs time to adjust — even to things that help."

— On the stored trauma the body has been holding long before menopause arrived: "It's always been there, underneath the surface. We've chosen to push through, until we can’t  — and oftentimes that is menopause, when we can't anymore."

Dr. Betty Murray

Educational

— On why perimenopause is a whole-body event, not a reproductive one: "Every single cell in your body except two has estrogen receptors. When estrogen drops, every single cell feels it."

— On what happens when decades of chronic stress meet the hormonal cliff-dive of perimenopause: "The gas tank is empty. We have been paddling down all the way for 20 and 30 years — and then estrogen cliff-dives and there are no reserves."

— On why supplements alone cannot replace what menopause takes away: "You cannot Five-HTP a serotonin problem away when menopause is the trigger. You cannot take GABA when progesterone is what's missing."

— On bioidentical hormones for every woman: “Bioidentical hormones are on the table for every woman. Every single woman, regardless of age.”

Insightful

— On how a non-statistically significant finding became the headline that frightened women away from hormones for two decades: "The rate of breast cancer went from four in 1,000 to five in 1,000. That increase was not statistically significant. That should never have been reported as 25% — should never have been a headline."

— On the scale of what was taken from women: “The director of the FDA said this will go down as the largest travesty in healthcare in our time — the removal of hormones from women’s arsenal.”

— On what every woman deserves: "You deserve someone who looks at you as an individual and builds a plan to work with your body, not against it."

Episode Takeaway

There is a conversation most women going into perimenopause are not being given. The anxiety is treated with an antidepressant. The brain fog is attributed to aging. The rage, the grief, the sense that something is finally breaking open — these are managed rather than explained. Nobody is connecting what the body is carrying to what the body is now experiencing.

The connection is real. It is documented. And it changes how we approach this phase. The ACE study showed us that childhood adversity predicts adult chronic illness. What Dr. Betty Murray and the research she cites adds is specific: it also predicts how severe your menopause experience will be. By 20 to 40%. That is a number that should be part of every conversation a woman has with her provider about perimenopause.

Estrogen modulates serotonin. It works through the cannabinoid system in the brain. It is anti-inflammatory. It is part of what allowed many of us to hold what we were holding for decades. When it declines, the body's capacity to suppress what has been stored declines with it. What surfaces is an old problem that finally has enough room to come up.

If this episode landed for you — if you recognised yourself in the description of a woman who has been managing, suppressing, and holding it together, and now finds that she no longer can — the Foundational Journey^® is where we begin. It is a six-week online process. It works directly with the nervous system. The biology of safety has to come first — before anything else can hold. And if you are not sure it is right for you, the quiz inside the free guide will show you where to start. Both links are in the show notes.

Resources/Guides:

• Dr. Betty Murray — Hormone metabolism expert and functional medicine clinician with over 20 years of experience in women's hormonal health, host of the Menopause Mastery podcast, and founder of The Menrva Project — an AI-powered telemedicine platform personalising menopause care across all 50 states.

• Free Guide: Steps to Identify and Heal Trauma by Dr. Aimie Apigian to help you understand what your body has been holding and how to begin working with it.

• The Biology of Trauma Book by Dr. Aimie Apigian  — Where you can read Chapter 11 on how early life experiences become the preexisting filter through which every subsequent stress — including the hormonal shifts of menopause — is experienced. 

• Foundational Journey — If this episode made you realize that stored trauma may be part of what you are experiencing in perimenopause, the Foundational Journey® is where we begin. A six-week online process working directly with the nervous system — building the biological foundation that has to come first

Related Podcast Episodes:

• Episode 69 — How Attachment Shapes Our Biology and Behavior

• Episode 135 — The Hidden Difference Between Stress and Trauma

• Episode 146 — How Attachment Affects Us for Life

About the Guest: Dr. Betty Murray is hormone metabolism expert and functional medicine clinician with over 20 years of experience in women's hormonal health, host of the Menopause Mastery podcast, and founder of The Menrva Project — an AI-powered telemedicine platform personalising menopause care across all 50 states.

Your host: Dr. Aimie Apigian is a double board-certified physician in Preventive and Addiction Medicine, author of the national bestselling book The Biology of Trauma (foreword by Gabor Maté) and the founder of the Biology of Trauma^® framework that transforms our understanding of how the body experiences and holds trauma. She holds master's degrees in biochemistry and public health. After foster-adopting a child during medical school sparked her journey, she desperately sought for answers that would only continue as she developed chronic health issues. Through her Biology of Trauma^® practitioner training, podcast, YouTube channel, and international speaking, Dr. Aimie bridges functional medicine, attachment science, and trauma therapy — with a focus on facilitating accelerated repair of trauma's impact on the mind, body, and biology.

What Your Childhood ACE Score Has to Do with Menopause — The Biology No One Is Telling Women

Most women going into perimenopause are told a version of the same story. The anxiety is a response to hormonal fluctuation. The depression may need medication. The rage and the emotional sensitivity are symptoms to manage. What they are almost never told is that the severity of everything they are experiencing is statistically linked to what their body has been holding since childhood.

This is the conversation Dr. Betty Murray, hormone metabolism expert and functional medicine PhD, brings into the open in this episode of the Biology of Trauma^® podcast. And it is a conversation that the research has been supporting for long enough that the absence of it from standard care is no longer an oversight. It is a gap.

What Happens to Estrogen During Perimenopause — and Why Every Cell Registers It

During perimenopause, estrogen declines across every estrogen-sensitive cell simultaneously — modulating serotonin, inflammation, and the nervous system's capacity to regulate stress.

Estrogen has receptors on every single cell in the human body except two. It is a master communicator. It modulates serotonin. It works through the cannabinoid system in the brain. It is anti-inflammatory. It influences sleep, emotional regulation, and the nervous system's capacity to process stress.

During perimenopause, estrogen does not decline in a straight line. It spikes and drops unpredictably for an average of eight years before it cliff-dives. Every one of those fluctuations is being registered by every estrogen-sensitive cell in the body simultaneously. The psychological symptoms that show up — anxiety, depression, brain fog, irritability, sudden emotional floods — are the direct expression of the hormonal changes.

A PTSD study of 6,000 women with prior trauma experiences documented this directly. Women with the lowest estrogen levels had the most severe PTSD symptom expression, regardless of when the original trauma occurred. Estrogen is part of the biological infrastructure that allows the nervous system to modulate stress. When it declines, that capacity declines with it.

Why Childhood Adversity Predicts How Hard Menopause Will Be

Women with higher ACE scores experience menopause symptoms 20 to 40% more severely — because stored stress chemistry and declining estrogen are directly connected.

The Adverse Childhood Experiences (ACE) study, conducted by Dr. Vincent Felitti and colleagues, established that childhood adversity is one of the strongest predictors of adult chronic illness. What the research Dr. Murray references adds is specific and significant: women with higher ACE scores or subjective measures of stored trauma experience menopause symptoms 20 to 40% more severely than women without.

A child who grows up in an unpredictable or unsafe environment develops a nervous system calibrated toward threat detection. The adrenals have been running in high gear. The stress chemistry has been elevated for decades. Estrogen, in part, has been buffering some of that — modulating serotonin, keeping inflammation in check, supporting the nervous system's capacity to regulate. When estrogen declines, that buffer goes. What has been held beneath the surface can no longer be suppressed. Menopause is the moment when the body's capacity to hold old problems reaches its limit.

The Depression Diagnosis Women Are Receiving — and What Is Actually Being Missed

A 40% increase in depression diagnoses accompanies menopause — but the mechanism is hormonal, not psychiatric, and antidepressants do not address the deficit.

A 40% increase in depression diagnoses accompanies menopause. The largest rate of suicide by age group is women between 45 and 65. When Dr. Aimie raises the research linking adverse childhood experiences to first-episode major depression during menopause, Dr. Murray's response is direct: it all comes up. And what medicine's response to that — an antidepressant prescription — is doing is treating the output without reading the input.w

Estrogen modulates serotonin. Progesterone holds the GABA receptor open — it is the hormone that produces the calming, anti-anxiety, sleep-supporting effect that declines during perimenopause. You cannot supplement serotonin with 5-HTP and expect it to address a progesterone deficit. You cannot take GABA and expect it to replace what the nervous system loses when progesterone is no longer holding the receptor. These things may help at the edges. They address something different from the hormonal deficit.

What the 10-Million-Women Study Actually Found About Hormone Replacement

Women who remained on bioidentical hormones long-term had reduced risk of all-cause mortality — breast cancer (16%), lung cancer (13%), and dementia (30%).

A retrospective study of 10 million women aged 65 and older looked at three groups: those who used no hormone replacement therapy, those who used it temporarily for symptom management, and those who remained on it long-term. The findings were clear: women who remained on bioidentical hormone therapy had a reduced risk of dying from all causes. Breast cancer risk was reduced by 16%. Lung cancer by 13%. Dementia risk was reduced by up to 30%.

What did receive disproportionate media attention — for decades — was the Women's Health Initiative's assertion that hormone replacement increased breast cancer risk by 25%. What the Women's Health Initiative actually found was that the rate of breast cancer went from four in 1,000 to five in 1,000 among women on synthetic progestins and conjugated equine estrogen. That increase was not statistically significant. It should not have been reported as 25%. The FDA has since convened a hearing acknowledging this as one of the largest travesties in healthcare in our time.

The Trauma-Informed Approach to Hormone Therapy: Start Low and Go Slow

A nervous system carrying stored trauma needs time to adjust to any new biological input — including hormones — regardless of whether the intervention is correct.

The principle Dr. Murray describes — start low and go slow — is one Dr. Aimie applies throughout the Biology of Trauma^®  framework. A nervous system carrying stored trauma needs time to adjust to any new biological input — including hormones. Too much, too fast — even when the intervention is correct — can dysregulate rather than support.

For hormone therapy, this means beginning at a low dose, checking levels, monitoring subjective response, and titrating upward carefully. It also means looking at the full picture: metabolic health, insulin resistance, thyroid function, adrenal output, and the body's capacity to metabolize and clear estrogen. A comprehensive approach takes more into account. And it is what actually works.

Where to Go From Here

Chapter 11 of The Biology of Trauma goes deep into how early life experiences become the preexisting filter through which every subsequent stress — including the hormonal changes of menopause — is experienced. Chapter 8 addresses what happens when the nervous system gets stuck in a loop between stress and overwhelm.

The free guide Steps to Identify and Heal Trauma includes a quiz that helps you understand what your body has been holding and whether the Foundational Journey^®  is the right starting point.

FAQ

Does childhood trauma make menopause worse? Yes. Women with higher ACE scores experience menopause symptoms 20 to 40% more severely — because the biology of stored stress and the biology of declining estrogen are directly connected.

Estrogen modulates serotonin, reduces inflammation, and supports the nervous system's capacity to regulate emotional response. When estrogen declines during perimenopause, these buffering effects decline with them. A nervous system calibrated by early adversity — running in chronic stress or threat-detection mode — loses part of what was holding it in check. The stored stress chemistry and suppressed emotional material now have less biological support. They surface.

What is the connection between estrogen and PTSD or anxiety? Estrogen directly modulates the nervous system's capacity to process stress and regulate emotional response — which is why lower estrogen levels are associated with more severe PTSD symptom expression, and why anxiety and emotional sensitivity increase as estrogen declines.

A study of 6,000 women with prior PTSD experiences found that those with the lowest estrogen levels had the most severe subjective PTSD symptoms. Estrogen works through the cannabinoid system in the brain, supports serotonin modulation, and has direct anti-inflammatory effects. When estrogen drops, the nervous system's capacity to regulate the stress response drops with it.

Are bioidentical hormones safe for women with a family history of breast cancer? Conventional medicine states there is no contraindication to exploring bioidentical hormones even with a family history of breast cancer — and the research that generated decades of fear was based on synthetic hormones, not bioidentical estrogen.

The Women's Health Initiative finding that led to widespread abandonment of hormone therapy was based on a combination of synthetic progestins and conjugated equine estrogen. The reported 25% increase in breast cancer risk was not statistically significant — it represented a shift from 4 in 1,000 to 5 in 1,000 women. Every subsequent study, including a 10-million-woman retrospective study, has shown bioidentical hormone therapy to be protective rather than causative.

What is the difference between bioidentical and synthetic hormones? 

Bioidentical hormones are structurally identical to what the human body produces. Synthetic hormones are similar but not identical, producing different downstream effects and metabolic byproducts.

Oral synthetic estrogens and synthetic progestins go through first-pass liver metabolism and create byproducts that carry different risk profiles. Bioidentical estrogen applied topically bypasses first-pass liver metabolism. Bioidentical oral micronized progesterone metabolizes into a GABA-supporting compound that supports sleep and reduces anxiety — an effect not produced by synthetic progestins.

Why does adrenaline matter more than cortisol in the stress response? 

Adrenaline is the primary driver of the stress response. Cortisol rises in response to adrenaline as a protective buffer — so targeting cortisol treats the buffer rather than the source.

In women with stored trauma, the driver of adrenaline is often the nervous system's own continuous threat-detection signal — a calibration set in early life and maintained through decades of chronic stress. This signal does not respond to cortisol management, dietary adjustments, or stress reduction techniques that do not address the underlying nervous system biology.

Is it too late to start hormone replacement therapy after menopause? 

No. Bioidentical hormone therapy is on the table for every woman, regardless of age or time since menopause — and the evidence shows it reduces all-cause mortality risk even in women 65 and older.

The 10-million-woman retrospective study of Medicare recipients found that women who remained on bioidentical hormone therapy had significantly reduced risk of dying from all causes compared to those who used it only temporarily or not at all. The key is starting at a low dose, titrating slowly, and monitoring response across the full endocrine picture.

Helpful Research

• Michopoulos, V., Huibregtse, M.E., Chahine, E.B., Smith, A.K., Fonkoue, I.T., Maples-Keller, J., Murphy, A., Taylor, L., Powers, A., & Stevens, J.S. (2023). Association between perimenopausal age and greater posttraumatic stress disorder and depression symptoms in trauma-exposed women. Menopause, 30(10), 1038–1044 

• Baik, S.H., Baye, F., & McDonald, C.J. (2024). Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes, and doses. Menopause, 31(5), 363–371.

• Hodis, H.N., & Mack, W.J. (2022). Menopausal hormone replacement therapy and reduction of all-cause mortality and cardiovascular disease: it's about time and timing. Cancer Journal, 28(3), 208–223. 

• Bluming, A.Z., & Tavris, C. (2018). Estrogen Matters. Little, Brown Spark. Written by a breast cancer oncologist with 50 years of clinical experience — the most comprehensive review of hormone replacement science and WHI misrepresentation available in lay language.

• Epperson, C.N., Sammel, M.D., Bale, T.L., Kim, D.R., Conlin, S., Scalice, S., Freeman, K., & Freeman, E.W. (2017). Adverse childhood experiences and risk for first-episode major depression during the menopause transition. Journal of Clinical Psychiatry, 78(3), e298–e307. 

• Rossouw, J.E., et al.; Writing Group for the Women's Health Initiative Investigators. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA, 288(3), 321–333. 

• Chlebowski, R.T., et al. (2020). Association of menopausal hormone therapy with breast cancer incidence and mortality during long-term follow-up of the Women's Health Initiative randomized clinical trials. JAMA, 324(4), 369–380. 

Foundational Research Underpinning the Biology of Trauma^® Framework

• Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., & Marks, J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. 

• Porges, S.W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. W. W. Norton & Company. Source of the neuroception concept central to Dr. Aimie's explanation of why stored trauma keeps the nervous system in continuous threat-detection — and why that signal, not cortisol, is the primary driver of the stress response.

Disclaimer: By listening to this podcast, you agree not to use this podcast as medical, psychological, or mental health advice to treat any medical or psychological condition in yourself or others. This podcast is for informational and educational purposes only and does not constitute professional advice, diagnosis, or treatment. Always consult your own physician, therapist, psychiatrist, or other qualified health provider regarding any physical or mental health issues you may be experiencing.

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