Study Followed Women for 20 Years, Capturing Childhood and Early Adulthood
The researchers looked at data from?Project Viva, which enrolled 682 women who were in early pregnancy from 1999 to 2002, and followed this cohort for approximately 20 years.
They found that women who experienced abuse at some point from childhood up until early adulthood were much more likely to have significantly more difficult symptoms of hot flashes, sleep disturbances, depressive symptoms, urinogenital dryness, and sexual dysfunction, and showed worse general well-being.
“Basically, all menopause symptoms were made worse with the exception of generalized anxiety. We found no connection there,” says?Emily Oken, MD, MPH, one of the study authors and the principal investigator of the Project Viva cohort at the department of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston.
Effect of Traumatic Experiences in Adulthood Is Not Clear
Dr. Oken added that the research did not find associations with traumatic experiences in adulthood. “We did measure it, but we didn't see it. So this really goes along with this idea that early life experiences are especially traumatic and harmful,” she says.
Carolyn Gibson, PhD, an assistant professor of psychiatry at the University of California in San Francisco Weill Institute for Neurosciences, says, “I'd be wary of drawing too-strong conclusions about this, since we don't have information on interpersonal violence exposures in the 20 years of adulthood between the baseline assessment and later mood and menopause-related outcomes. In general, this is consistent with past studies showing the strongest effects of trauma exposure and other psychosocial stressors during critical periods early in the life span.” While Dr. Gibson was not involved in this particular study, she was part of another study on the effects of PTSD on menopause symptoms published January 2019 in JAMA?Internal Medicine.
How Does Abuse Connect to Menopausal Symptoms?
No one knows for sure, but one theory is that exposure to toxic stress (stress that doesn’t let up or resolve) affects the brain architecture. “We think about menopause as a hormonal circumstance, but where do hormones come from? The brain. We know that adverse childhood experiences can affect physical and mental health, but especially that neurological and mental health seem most strongly affected,” says Oken.
More Information May Lead to More Proactive Care
There is a positive side to this study, in that it will help healthcare practitioners serve their affected patients more thoroughly and possibly achieve better results. “We may be able to better anticipate which women will struggle more in the menopause transition and provide anticipatory guidance on menopause management … Overall, I think there is increasing evidence that adversity earlier in life has an adverse effect on overall health (including menopause symptoms) and that understanding this association will help practitioners identify women at risk for more adverse health outcomes,” says Stephanie Faubion, MD, the medical director of the North American Menopause Society.
Trauma-Informed Care Is Crucial
Oken says, “There's certainly a move towards trauma-informed medical care, which really takes into account a person's lifetime experiences. We need to encourage women to share their whole life history with their healthcare providers, and for the healthcare providers to be proactive about asking the right questions. Shared openness and expectations around getting better symptom relief is really important.”
Looking at a Woman’s Entire Life Span Is Key
Gibson notes that this study highlights the importance of looking at the impact of trauma on women's health across the life span. “I'm glad to see this focus on midlife and want to see more of it. I think this work tends to be focused on reproductive-age women. More attention to how these psychosocial stressors may affect long-term health and post-reproductive women is needed and important.”
Still Needed: Research on More Diverse Populations
Going forward, Gibson hopes that studies of this issue look at a more diverse sample population. “Like many studies, the sample was primarily white, and I think we need to look at what this looks like for everyone.”
RELATED: Menopausal Symptoms May Be Linked to Cognitive Performance
Breaking the Cycle of Trauma-Related Health Issues
Obviously, one way to reduce the likelihood of these worse health outcomes is to prevent exposure to abuse in the first place, which calls for more resources and structures to help struggling families. Oken says, “But even beyond that, I think we need more research into how to take people who have had these experiences and buffer them so that they don't have the downstream effects of what happened. We think there are ways through psychotherapy or other approaches to kind of prevent the adverse effects that we see and break the cycle.”
