Women's Health

History of Abuse, PTSD Worsen Menopausal Symptoms

by U.S. Medicine

March 25, 2019

SAN FRANCISCO—Emotional abuse from a partner or spouse can increase the risk of heightened menopause symptoms, as can post-traumatic stress disorder, according to a VA-led study.

Little is known about the prevalence of traumatic exposures among midlife and older women and the association of these traumatic exposures with health issues, noted the report in JAMA Internal Medicine.

San Francisco VA Healthcare System-led researchers examined the associations of intimate partner violence, sexual assault and posttraumatic stress with menopause symptoms among midlife and older women. To do that, they performed a cross-sectional analysis of data from a multiethnic cohort of 2,016 women 40 to 80 years of age in the Kaiser Permanente Northern California healthcare system from Nov. 15, 2008, to March 30, 2012, with analysis from June 8, 2016, to Sept. 6, 2017.

The study team used questionnaires to document lifetime physical or emotional IPV, sexual assault and current symptoms of PTSD in the participants with an average age of 60.5. The main outcomes were considered to be troubling menopause symptoms such as difficulty sleeping, vasomotor symptoms and vaginal symptoms.

Results indicated that lifetime emotional IPV was reported by 423 women (21.0%), lifetime physical IPV was reported by 316 women (15.7%), sexual assault was reported by 382 women (18.9%), and 450 of 2,000 women (22.5%) had current clinically significant symptoms of PTSD.

Researchers determined that symptoms of PTSD were associated with difficulty sleeping (odds ratio [OR], 3.02; 95% CI, 2.22-4.09), vasomotor symptoms (hot flashes: OR, 1.69; 95% CI, 1.34-2.12; night sweats: OR, 1.72; 95% CI, 1.37-2.15), and vaginal symptoms (vaginal dryness: OR, 1.73; 95% CI, 1.37-2.18; vaginal irritation: OR, 2.20; 95% CI, 1.66-2.93; pain with intercourse: OR, 2.16; 95% CI, 1.57-2.98).

Emotional IPV, meanwhile, was associated with difficulty sleeping (OR, 1.36; 95% CI, 1.09-1.71), night sweats (OR, 1.50; 95% CI, 1.19-1.89) and pain with intercourse (OR, 1.60; 95% CI, 1.14-2.25).

Physical IPV was associated with night sweats (OR, 1.33; 95% CI, 1.03-1.72), and sexual assault was associated with vaginal symptoms (vaginal dryness: OR, 1.41; 95% CI, 1.10-1.82; vaginal irritation: OR, 1.42; 95% CI, 1.04-1.95; pain with intercourse: OR, 1.44; 95% CI, 1.00-2.06), according to the report.

“Lifetime history of IPV or sexual assault and current clinically significant symptoms of posttraumatic stress disorder are common and are associated with menopause symptoms,” study authors concluded. “These findings highlight the need for greater recognition of these exposures by clinicians caring for midlife and older women.”

“Traditionally, menopause symptoms have been largely attributed to biological and hormonal changes, as well as negative mood symptoms, health-risk behaviors, cardio-metabolic risk factors and chronic health conditions that occur at a higher rate during and after menopause,” said first author Carolyn Gibson, PhD, a clinical research psychologist based at the San Francisco VA Health Care System.

“Stress related to emotional abuse and other traumatic exposures may influence the hormonal and physiological changes of menopause and aging, affecting biological susceptibility as well as the subjective experience of these symptoms,” Gibson added in a University of California, San Francisco press release.

Gibson CJ, Huang AJ, McCaw B, Subak LL, Thom DH, Van Den Eeden SK.

  • Associations of Intimate Partner Violence, Sexual Assault, and Posttraumatic Stress Disorder With Menopause Symptoms Among Midlife and Older Women. JAMA Intern Med. 2018 Nov 19. doi: 10.1001/jamainternmed.2018.5233. [Epub ahead of print] PubMed PMID: 30453319.

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