番茄社区

Traumatic experiences among older women, such as intimate partner violence, sexual assault, and post-traumatic stress disorder (PTSD), heightened a woman's risk of menopausal symptoms, researchers found.

A lifetime history of emotional or physical intimate partner violence, sexual assault, and current clinically significant PTSD symptoms were all linked with an increased risk of menopause symptoms, reported Carolyn Gibson, PhD, MPH, of the San Francisco VA Medical Center, and colleagues.

Moreover, one in five women reported lifetime emotional intimate partner violence (21%), 15.7% reported physically abusive partners, 18.9% reported sexual assault, and 22.5% had current, clinically significant posttraumatic stress disorder (PTSD) symptoms, the authors wrote in .

"A surprisingly large number [of women] had clinically significant PTSD symptoms as well as past experience of emotional IPV, physical IPV, or sexual assault, and all of those exposures were associated with a range of menopause symptoms that can really affect health functioning and well being for women during this period," Gibson told 番茄社区. "The important thing here is that it's turning attention to these experiences among midlife and older women who we don't often think of as much when thinking about how trauma affects health and functioning."

Gibson said traumatic histories may make the menopausal transition more difficult for some women, and that current PTSD symptoms such as hypervigilance or trouble with intimacy and trust, may present additional challenges. Additionally, menopausal symptoms such as hot flashes or difficulty sleeping, could heighten existing PTSD symptoms and be triggering for women who have suffered trauma, she said.

Gibson added that this data demonstrates just how prevalent traumatic histories are in mid-life women, something providers, particularly in primary care settings where much of these experiences would be reported, should be aware of in order to facilitate proper treatment. While she acknowledged that it may not be realistic to implement universal screening for histories of violence in all women, she noted the importance of a more widespread adoption of trauma-informed care.

"Current screening guidelines focus on physical IPV in the past year among reproductive-aged women," the authors wrote. "Although this guideline may address acute safety concerns, our study suggests that emotional IPV may be a common and important risk factor broadly affecting the development and exacerbation of health-related symptoms."

In an , Rebecca Thurston, PhD, and Elizabeth Miller, MD, PhD, of the University of Pittsburgh, argued that potential methods to increase awareness of these problems include clinician training in assessment for IPV and sexual violence, using electronic health records to integrate IPV assessment into routine practice, and recruiting behavioral health clinicians who can provide appropriate integrated care.

In this study, researchers collected data within the The Reproductive Risks of Incontinence Study at Kaiser Permanente Northern California (). Lifetime intimate partner violence and sexual assault were assessed through standard questionnaires. Questions used to assess intimate partner violence and sexual assault were as follows:

• Emotional intimate partner violence: "Have you ever been made fun of, severely criticized, told you were a stupid or worthless person, or threatened with harm to yourself, your possessions, or your pets, by a current or former spouse or partner?"
• Physical intimate partner violence: "Have you ever been hit, slapped, pushed, shoved, partner violence punched, or threatened by a weapon by a current or former spouse or partner?"
• Sexual assault: "Has anyone ever touched sexual parts of your body after you said or showed you didn't want them to without your consent?"

Symptoms of PTSD were assessed using the self-administered PTSD Checklist for DSM-IV, Civilian Version, the authors said.

Overall, researchers examined data from 2,016 women, 39.4% of which were non-Latina white, 20% were Latina or Hispanic, 21.3% were black, and 19.2% were Asian. The average age was around 60, and the majority of women were postmenopausal (82.1%). Additionally, researchers recruited women from the KPNC Diabetes Registry to ensure that a sufficient number of women in the sample (26.5%) had type 2 diabetes. A small portion were smokers (5.5%), had cardiovascular disease (6.9%), or reported current moderate to heavy alcohol use (11.6%), the authors stated.

Women with a history of emotional intimate partner violence were more likely to have difficulty sleeping (OR 1.36, 95% CI 1.09-1.71), night sweats (OR 1.50, 95% CI 1.19-1.89), and pain during intercourse (OR 1.60, 95% CI 1.14-2.25).

Those women who experienced physical intimate partner violence had higher odds of experiencing night sweats (OR 1.33, 95% CI 1.03-1.72) and those who had been sexually assaulted were more likely to develop vaginal dryness (OR, 1.41, 95% CI 1.10-1.82), vaginal irritation (OR 1.42, 95% CI 1.04-1.95), and pain with intercourse (OR 1.44, 95% CI, 1.00-2.06).

In addition, women with post-traumatic stress disorder had about a three-fold increased risk of reporting difficulty sleeping (OR 3.02, 95% CI 2.22-4.09), as well as as increased risk of vasomotor symptoms (hot flashes: OR 1.69, 95% CI 1.34-2.12; night sweats: OR 1.72, 95% CI 1.37-2.15) and vaginal dryness (OR 1.73, 95% CI 1.37-2.18).

Due to the cross-sectional nature of the data, this study did not measure the elapsed time since trauma, the duration or intensity of menopause symptoms and trauma experiences, or whether the patients received treatment, which could impact health and functioning, the authors reported. Additionally, the questions used to determine intimate partner violence and sexual assault did not undergo psychometric evaluation. The authors also noted that menopause symptoms "were not assessed with a validated instrument, and may not reflect clinical significance or meet diagnostic criteria."