Summary: A UC San Francisco study finds that menopausal women who have experienced intimate partner violence, sexual assault, or symptoms of post-traumatic stress disorder (PTSD) report more intense menopause symptoms, including night sweats, sleep problems and painful intercourse.
Source: UCSF
New research from the University of California, San Francisco shows that emotional abuse, intimate partner violence and trauma-related symptoms are linked with worse menopausal symptoms in midlife and older women.
In a cross-sectional analysis of more than 2,000 women aged 40 to 80 enrolled in Kaiser Permanente Northern California, researchers found substantial associations between lifetime traumatic exposures and common menopause complaints. One in five participants reported emotional abuse by a current or former partner. Those women had about 50 percent higher odds of experiencing night sweats and roughly 60 percent higher odds of pain during intercourse compared with women without that history.
Women with current clinically significant PTSD symptoms were particularly affected. They had just over three times the odds of difficulty sleeping and more than twice the odds of reporting vaginal irritation and pain during sex. Women who reported sexual assault or physical violence from a partner also had notably higher odds of vaginal symptoms and painful intercourse.
“Menopausal symptoms are often attributed to hormonal changes, mood differences, or health behaviors,” said Carolyn Gibson, PhD, the study’s first author and a clinical research psychologist in the UCSF Department of Psychiatry. “Our findings indicate that a history of emotional abuse, interpersonal violence, and PTSD may influence both biological vulnerability and the subjective experience of menopause-related symptoms.”
Gibson and colleagues grouped menopause complaints into three categories for analysis: sleep problems, vaginal symptoms (including dryness, irritation and pain with intercourse), and vasomotor symptoms (hot flashes and night sweats). They adjusted analyses for age, race and ethnicity, education, body mass index, menopausal status, hormone therapy use, and parity to isolate the associations with traumatic exposures.
High prevalence of trauma and PTSD symptoms among a relatively advantaged sample
The study participants were generally postmenopausal (77 percent), well-educated (81 percent had a college degree), and largely overweight or obese (74 percent). The average age was 61. The cohort was multiethnic: about 39 percent identified as non-Hispanic white, 20 percent as Hispanic, 21 percent as Black, and 19 percent as Asian.
Despite being relatively healthy and having good access to care, traumatic exposures and PTSD symptoms were common. Twenty-one percent of women reported lifetime emotional intimate partner violence, defined in the study as being demeaned, severely criticized, called worthless or threatened with harm to themselves, their possessions or pets. Approximately 23 percent screened positive for PTSD symptoms consistent with a clinical diagnosis, 16 percent reported physical domestic violence, and 19 percent reported sexual assault.
“These data show that emotional and physical forms of partner violence, sexual assault, and clinically significant PTSD symptoms are common among midlife and older women and can have lasting effects on health,” said Gibson, who also works with the San Francisco VA Health Care System. She emphasized that routine screening for lifetime traumatic exposures and PTSD could help clinicians better manage bothersome menopause symptoms.
Co-author Brigid McCaw, MD, medical director of the Kaiser Permanente Family Violence Prevention Program, noted that the results support current recommendations to screen for emotional and physical abuse, given the long-term health consequences linked to trauma.
Funding: The study received support from the UCSF-Kaiser Permanente Grants Program for Delivery Science, the Office of Research on Women’s Health Specialized Center of Research, the National Institute of Diabetes and Digestive and Kidney Diseases, and the VA Advanced Fellowship Program in Women’s Health, among other sources.
Disclosures: One author reported research grants from pharmaceutical companies unrelated to this study. The content reflects the authors’ conclusions and not necessarily the views of funding agencies or the Department of Veterans Affairs.
Original research: The study, titled “Associations of Intimate Partner Violence, Sexual Assault, and Posttraumatic Stress Disorder With Menopause Symptoms Among Midlife and Older Women,” was authored by Carolyn J. Gibson, PhD, MPH; Alison J. Huang, MD, MAS; Brigid McCaw, MD, MPH, MS; Leslee L. Subak, MD; David H. Thom, MD, PhD, MPH; and Stephen K. Van Den Eeden, PhD, and was published in JAMA Internal Medicine in November 2018. doi:10.1001/jamainternmed.2018.5233
Abstract
Associations of Intimate Partner Violence, Sexual Assault, and Posttraumatic Stress Disorder With Menopause Symptoms Among Midlife and Older Women
Importance: There is limited information about how common traumatic exposures are among midlife and older women and how these exposures relate to health problems during menopause.
Objective: To examine the relationships between lifetime intimate partner violence (physical and emotional), sexual assault, current PTSD symptoms, and menopause-related symptoms in a multiethnic cohort of women aged 40–80.
Design, setting, and participants: This cross-sectional analysis used data collected from November 15, 2008, to March 30, 2012, from 2,016 women enrolled in the Kaiser Permanente Northern California health system. Statistical analyses were conducted between June 2016 and September 2017.
Exposures: Lifetime emotional or physical intimate partner violence, history of sexual assault, and current PTSD symptoms measured with validated questionnaires.
Main outcomes and measures: Standardized questionnaires assessed difficulty sleeping, vasomotor symptoms (hot flashes and night sweats), and vaginal symptoms (dryness, irritation, and pain with intercourse).
Results: The mean participant age was 60.5 years. Lifetime emotional intimate partner violence was reported by 21.0% (423 women), lifetime physical IPV by 15.7% (316), sexual assault by 18.9% (382), and 22.5% (450 of 2,000) had clinically significant current PTSD symptoms. After adjusting for demographic and clinical factors, PTSD symptoms were associated with greater odds of difficulty sleeping (OR, 3.02), vasomotor symptoms (hot flashes OR, 1.69; night sweats OR, 1.72), and multiple vaginal symptoms (dryness OR, 1.73; irritation OR, 2.20; pain with intercourse OR, 2.16). Emotional IPV was associated with difficulty sleeping (OR, 1.36), night sweats (OR, 1.50), and pain with intercourse (OR, 1.60). Physical IPV was linked to night sweats (OR, 1.33), and sexual assault was associated with vaginal symptoms, including pain with intercourse (OR range about 1.41–1.44).
Conclusions and relevance: Lifetime intimate partner violence, sexual assault, and current PTSD symptoms are common in this cohort and are associated with more severe menopause symptoms. Clinicians who care for midlife and older women should be aware of these associations and consider routine assessment for traumatic exposures and PTSD when managing menopausal complaints.