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Emotional Abuse, PTSD Linked with Menopause Misery

Study co-led by Kaiser Permanente researchers finds night sweats, painful sex, and hot flashes are more common when women are belittled, assaulted, traumatized.

A study of more than 2,000 midlife and older women found that 1 in 5 had been emotionally abused by their current or former partners, and that these women had 50 percent higher odds of night sweats and 60 percent higher odds of painful sex.

The study, “Intimate Partner Violence, Sexual Assault, and Posttraumatic Stress Disorder Among Midlife and Older Women: Prevalence and Impact on Menopause Symptoms,” was published today in the journal JAMA Internal Medicine.

Little has been known about the prevalence and health-related impact of traumatic exposures among midlife and older women; most research in this area has been focused on reproductive-aged women. For many midlife and older women, general health and daily functioning are affected by common, disruptive symptoms related to menopause and aging, including sleep difficulty, vasomotor symptoms, and vaginal symptoms. Previously known risk factors include smoking, obesity, and a sedentary lifestyle, but the new study identifies intimate partner violence, sexual assault, and posttraumatic stress disorder symptoms as contributors to adverse menopause experiences.

“These findings support the recent U.S. Preventive Services Task Force recommendation to screen for emotional or physical abuse given the significant and long-lasting health impact,” said study co-author Brigid McCaw, MD, medical director of the Kaiser Permanente Family Violence Prevention Program.

Among the key findings, emotional intimate partner violence was associated with 36 percent higher odds of sleep disruption, 50 percent higher odds of night sweats, and 60 percent higher odds of pain with intercourse. Women who experience physical sexual assault or violence by former or present partners had up to 44 percent higher odds of painful sex. Women who experience PTSD symptoms had just over three times the odds of sleep difficulties and more than twice the odds of reporting vaginal irritation and painful intercourse.

“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 affiliated with the UCSF Department of Psychiatry. “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.”

Some 21 percent of women in the study reported experiencing emotional abuse from their former or current partner. This was defined as “made fun of, severely criticized, told you were a stupid or worthless person, or threatened with harm to yourself, your possessions or your pets.” Some 23 percent reported symptoms that matched a diagnosis of PTSD, 16 percent said they had experienced domestic violence and 19 percent had experienced sexual assault.

“This research demonstrates the value of including questions about intimate partner violence, sexual assault, and PTSD in the ongoing research about all topics related to women’s health, particularly mid-life and older women, because unfortunately violence affects 1 in 4 women during their lifetime,” said senior author Stephen Van Den Eeden, PhD, a research scientist with Kaiser Permanente Northern California’s Division of Research.

Additional collaborators on the study include Alison Huang, MD, and David Thom, MD, PhD, of UCSF; and Leslee Subak, MD, of Stanford University School of Medicine.

The study was supported by the Kaiser Permanente Community Benefit Program, Office of Research on Women’s Health Specialized Center of Research, and the National Institute of Diabetes and Digestive and Kidney Diseases. Research was also supported by the VA Advanced Fellowship Program in Women’s Health and VA Health Services Research & Delivery CDA 17-018 (CJG).

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