Past Trauma Linked to Hot Flashes and Other Menopause Symptoms

New research suggests that how women experience common menopausal symptoms, such as hot flashes and trouble sleeping, may due to past or ongoing domestic violence or a sexual assault. The experiences, along with symptoms of post-traumatic stress disorder (PTSD), can increase the likelihood of some menopause symptoms, even if that abuse happened years earlier, according to a study published online today, November 19, 2018, in JAMA Internal Medicine.

Related: Menopausal Symptoms That May Surprise You

Are PTSD Symptoms in Women More Common Than Experts Previously Believed?

In the study population, 1 in 4 women experienced PTSD symptoms, twice that of women reporting depressive symptoms, and significantly higher than researchers expected. According to the authors, strong links were found between PTSD and every menopause symptom examined in the study. Emotional abuse was reported by 1 in 5 women, and these women had 50 percent higher odds of night sweats and 60 percent higher odds of painful sex.

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What Is Menopause and What Are Menopausal Symptoms?

In this study, women were considered menopausal if they met the criteria as defined by the North American Menopause Society (NAMS), that is, when a woman has missed her period for 12 consecutive months. The study also included women who had not menstruated in a year due to hysterectomy or oophorectomy.

Generally speaking, symptoms related to "the change" occur in the 10 or so years before menopause (perimenopause) as well as after a woman officially reaches menopause status. Fluctuating hormone levels trigger symptoms, which is one of the reasons midlife women face an increased risk for developing depression and other mood problems during this stressful life stage.

Related: First Ever Guidelines Address Depression in Midlife Women

High Prevalence of PTSD and Intimate Partner Violence (IPV) and Menopause Symptoms

The subjects of the observational study were a multiethnic group of about 2,000 women ages 40 to 80 who were enrolled in the Kaiser Permanente Northern California healthcare system from late 2008 to early 2012. Lifetime IPV and sexual assault were assessed through standardized, self-administered questionnaires adapted from earlier studies in similar populations.

Questions used to assess trauma:

• Emotional IPV 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 IPV Have you ever been hit, slapped, pushed, shoved, punched, or threatened with 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 evaluated with the self-administered PTSD checklist for DSM-IV, aka the Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition, published by the American Psychiatric Association, which includes all currently recognized mental health disorders.

PTSD symptoms were the most common, with 22.5 percent of women reporting clinically significant symptoms; 21.6 percent experienced emotional abuse, 16.1 percent of women reported domestic violence, and 19 percent of women experienced sexual assault.

It’s worth noting that such a large number of these women experience PTSD symptoms, says lead author Carolyn J. Gibson, PhD, MPH, a psychologist and health services researcher at the San Francisco VA in California. “This was not a high-risk population,” says Dr. Gibson. “It was a healthy, long-term-insured population of older women who had above average access to healthcare and were insured through the Kaiser system.”

Painful Sex, Sleep Trouble, Hot Flashes: Researchers Asked About a Range of Menopausal Symptoms

Researchers interviewed participants about their experience of a broad range of menopause symptoms, dividing them into three types: difficulty sleeping; vasomotor symptoms, such as hot flashes or night sweats; and vaginal symptoms, such as dryness or pain during sexual intercourse. Listed in order of most common to least common, participants reported the following:

• Difficulty sleeping (51.7 percent)
• Hot flashes (39.9 percent)
• Night sweats (34.4 percent)
• Vaginal dryness (31.5 percent)
• Pain during intercourse (17.6 percent of the women who reported being sexually active)
• Vaginal irritation (12.9 percent)

PTSD: Surprisingly Common and Linked to Heightened Experience of Menopause Symptoms

After accounting for risk factors such as socioeconomic status, education, and chronic health conditions, authors found that women with PTSD symptoms were 3 times more likely to report difficulty sleeping and had twice the odds of experiencing vaginal irritation and painful intercourse. Women with a history of physical IPV or sexual assault had a 40 to 44 percent higher odds of painful sex.

Related: Mindfulness May Help Improve Menopausal Symptoms

More Research Needed to Determine Reasons for Link Between Menopausal Symptoms and Trauma History

Because this was an observational study and the questions asked simply if women had experienced trauma and the symptoms, researchers can’t answer the “why” behind this connection. “It’s hard to say whether PTSD symptoms — for example, hyperarousal or hypervigilance, and difficulty sleeping — may make women more sensitive to the experience of menopause symptoms and set them up to have a more difficult experience of symptoms,” says Gibson.

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Are Hot Flashes and Other Menopausal Symptoms Trauma Triggers?

It could also be the reverse, she says. “The normal changes that women experience during menopause may make menopause an extremely vulnerable time for women who have had these traumatic experiences. They may be triggered by some of the symptoms,” she says. For example, experiencing hot flashes that make you feel like you’ve lost control of your body and that may be triggering, says Gibson.

Important Takeaway: High Prevalence of Sexual Assault, Partner Abuse, and PTSD Symptoms

“One important takeaway from this research is that intimate partner violence, sexual assault, and PTSD were so common in this sample,” says Gibson. “It suggests that these events are common for all women, independent of socioeconomic status, race and ethnicity, or age, and that they have long-term effects on health, functioning, and well-being for women across the lifespan,” she says. The fact that these are common and can affect all women is something that both patients and healthcare providers should be aware of, Gibson adds.

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Women who have experienced emotional or physical (or sexual) abuse should share this information with their trusted healthcare provider, says Rebecca C. Thurston, PhD, professor of psychiatry and psychology and the director of the Women’s Biobehavioral Health Laboratory at the University of Pittsburgh in Pennsylvania, as well as the coauthor of the invited commentary on this study in JAMA Internal Medicine.

“It is relevant information for their health, as research is increasingly indicating that women with a history of abuse have an increased risk for a range of mental and physical health conditions,” says Dr. Thurston. “If they are in an abusive relationship currently they should discuss with their provider or therapist approaches to getting out of it.”

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