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Emotional abuse linked to worse menopause symptoms

Menopause symptoms may be even more severe for women who have suffered abuse at the hands of their partner.

A new study of 2,000 women found emotional abuse increased the odds of sleeplessness, hypertension and vaginal issues by 60 percent.

Those who’d been physically abused were 50 percent more likely to suffer night sweats, the study found.

Women with symptoms of PTSD after suffering abuse had triple the risk of suffering the most debilitating symptoms that often accompany the final stage of a woman’s fertility journey.  

The findings from UC San Francisco come just months after a study by Pitt School of Medicine found sexual assault and inter-partner violence had a life-long impact on women’s health, doubling a woman’s risk of hypertension and anxiety. 

A new diverse study in San Francisco of 2,000 women from various backgrounds found both emotional and physical abuse increased the odds of women suffering severe menopause symptoms (file image)

‘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,’ she said.

Menopause symptoms vary from woman to woman, and while researchers have spent years trying to predict who is more likely to suffer what, it’s still largely a mystery. 

When a woman comes to the end of reproductive age, many experience psychological and physical symptoms, but for some it can be milder than others. For some, it starts in their mid-40s, others not until their mid-50s. Some endure menopause for a year or two, and for others it takes a decade. 

It’s near impossible to predict what any given woman can expect from that stage.  

Some say women who suffer painful periods (also an elusive phenomenon with no clear cause) may be more likely to suffer during menopause, but studies and experience show that’s not always the case.  

Some say the number of children you have, and when you have them, is a factor – but again, women with plenty of children cannot be guaranteed one kind of experience, vice versa for women with few or no children. 

As with most things in women’s health, it’s complicated and multifactoral and under-researched. It could be race, it could be stress, it could be diet, it could be hormones, it could be genetics.

This study, a review of data collected by the Kaiser Permanente Northern California health care system between 2008 and 2012, was an attempt to quantify how one factor – abuse – could be one predictor. It also draws more attention to abuse – whether it’s a physical blow or chiding – as a public health issue. 

Kaiser Permanente Northern California serves about 30 percent of the region’s population. The study enrolled 2,000 women of diverse backgrounds. 

The average age was 61, 77 percent of them were postmenopausal, most were college-educated (81 percent), and most were overweight or obese (74 percent). Just over a third of the women were white (39 percent), 21 percent were black, 20 percent were Hispanic, and 19 percent were Asian.

A fifth of the women surveyed (21 percent, or: 423 of them) said that they had been emotionally abused by 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.’

Almost a quarter (23 percent, or: 450 of them) reported PTSD symptoms. Sixteen percent of them (316) said they’d suffered domestic violence and 19 percent (382) had experienced sexual assault.

Those women had much higher odds of enduring severe symptoms during their menopause. 

One issue with the research is that the cohort was not designed to explore menopause symptoms and abuse: it was a study of urinary incontinence.

However, experts say the data did present a clear correlation that is valid. 

Above all, Dr Gibson has been praised for calling attention to the issue.  

Writing in an editorial published alongside the study in JAMA today, Rebecca C. Thurston, PhD – author of the recent study that found sexual assault led to life-long health effects – hailed the study for shining a light on under-studied factors. 

Writing with Elizabeth Miller, MD, PhD, Dr Thurston said this study is a stepping stone towards broadening our understanding of what influences menopause symptoms – and how even non-physical violence can have a deep-rooted impact that triggers physical symptoms years later.

‘A notable strength of the study is the examination of both emotional and physical IPV; emotional IPV is often overlooked despite its strong adverse effect,’ they wrote.

‘Clinicians should be aware of the prevalence of IPV and sexual assault and their roles in educating patients and making resources available,’ they added.

‘Ongoing awareness of the ways that such violence affects health (including menopausal symptoms), considering such violence in their differential diagnoses, and connecting survivors to available resources are important, but are likely inadequate without additional measures.’ 

They warn that states vary in their rules on when and how clinicians can report abuse, and urge doctors that, since abuse can have medical consequences, they should feel empowered to take a more proactive role.