Early History of Abuse Tied to Worse Menopausal Symptoms

Women who experience violence in their lifetime may face difficulties with menopausal symptoms, and have worse overall long-term well-being, according to a cohort-based study.

In an analysis of more than 600 women, those who reported physical abuse during their lifetime were more likely to also report a higher average menopause symptom rating score in the somatic (0.46 points, 95% CI 0.04-0.87) and psychological (0.52 points, 95% CI 0.07-0.97) domains, stated Sabrina Faleschini, PhD, of Harvard Medical School in Boston, and colleagues.

And women who dealt with sexual trauma scored nearly three points higher on the overall menopause rating scale (2.81 points, 95% CI 1.05-4.56), they said in Menopause.

Women who experienced physical or sexual abuse were almost twice as likely to report worse overall well-being later on in life, the authors noted, adding that financial instability also was tied with worse menopausal symptoms and general health. Specifically, study participants with a history of financial instability had a mean difference of 1.92 points on the menopausal rating scale (95% CI 0.49-3.34).

Faleschini's group also reported greater odds of worse general health later on in life for women with a history of physical abuse (OR 1.73) or sexual abuse (OR 2.04), while financial instability was tied to a greater risk of later-life poor general health (OR 2.16, 95% CI 1.24-3.75).

"These results highlight the long-lasting influence of adverse experiences on women's physical and mental health and emphasize the importance of past history of psychosocial stressors when considering the health of women in midlife," they wrote.

Rebecca Thurston, PhD, Pittsburgh Foundation chair in women's health and dementia at the University of Pittsburgh Medical Center, who was not involved in this study, said the findings are consistent with previous literature. Future, prospective studies are needed to holistically assess how stress and trauma impact women's health during midlife, she added.

"I think we really need a comprehensive investigation of how earlier life trauma affects women during the menopausal transition," Thurston told MedPage Today. In addition to investigations of physical and sexual abuse, Thurston said that further research should examine experiences of emotional abuse, which can be particularly prevalent.

Hot flashes, sleep disturbance, and sexual dysfunction are common in the perimenopausal period, and the authors wanted to see if traumatic experiences had an impact on those symptoms. They assessed participants of Project Viva, a cohort of women enrolled during pregnancy between 1999 and 2002. The participants and their children were followed for 2 decades, with women providing data on midlife health and well-being between 2017 and 2021.

During a mid-pregnancy visit, women self-reported psychosocial stressors, including a history of physical or sexual abuse and financial instability, from the time of childhood to their current pregnancy. Around 2 decades later, those women reported their menopausal symptoms using the Menopause Rating Scale, a 44-point scale which includes scoring for somatic, psychological and urogenital symptoms. Additionally, women also reported on their general well-being, depressive symptoms, and anxiety.

The researchers restricted the analysis to all women who were postmenopausal or ages 45 and up at the midlife follow-up, and adjusted for covariates such as age, race/ethnicity, education level, marital status, household income, and smoking status. Ultimately, 682 participants were included. They had a median age of 33 during pregnancy and 52 at the time they reported menopausal symptoms. Most of the study participants were white, with 80% reporting a college degree. The latter limited the generalizability of the results, especially to marginalized populations, the authors acknowledged.

Approximately 37% of women reported a history of physical abuse throughout their life, 8% reported sexual abuse, 11% reported financial instability, 12% reported generalized anxiety, and 16% reported depressive symptoms.

In terms of depression, a history of physical abuse and financial instability were both linked with midlife depressive symptoms. But there were no associations between psychosocial stressors and symptoms of generalized anxiety, according to the researchers.

Study limitations included the retrospective evaluation of psychosocial stressors, and that experiences of abuse or financial instability may be underreported.

Faleschini and colleagues said future studies should focus on the toll multiple psychosocial stressors take on menopausal symptoms and overall health in order to identify potential health initiatives.

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