Abuse, financial instability associated with worse menopausal symptoms, health in midlife
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Women with a history of abuse or financial instability were more likely to have worse menopausal symptoms and overall well-being, according to data published in Menopause.
Previous studies on the long-term impact of abuse have been small or limited to current abuse, according to a press release from NAMS. The most recent study adds to what is known about the impact of abuse by focusing “on the history of stressors as reported at the time of pregnancy and their connection with a woman’s health during midlife 15 to 20 years later.”
Psychosocial stressors, midlife symptoms
Sabrina Faleschini, PhD, who was a postdoctoral research fellow at Harvard Medical School in Boston at the time of the study, and colleagues included 682 women who had been recruited during pregnancy between 1999 and 2002 for Project Viva, a prospective cohort study of mothers and their children with ongoing follow-up. These women reported past and recent history of physical and sexual abuse and financial instability at study visits during pregnancy.
At study visits between 2017 and 2021, women who were postmenopausal or aged 45 years or older self-reported menopausal symptoms using the Menopause Rating Scale (MRS). The MRS uses a cumulative 44 points to indicate the severity of menopause-related somatovegetative symptoms, such as hot flashes, heart discomfort, sleeping disorders and joint and muscle complaints; psychological symptoms; and urogenital symptoms.
Additionally, women self-reported their general health; their anxiety symptoms through the Generalized Anxiety Disorder-7 (GAD-7); and their depressive symptoms through the Patient Health Questionnaire-9 (PHQ-9).
Midlife impact of abuse, financial struggles
Overall, 37.3% of women reported physical abuse, 7.7% reported sexual abuse and 10.8% reported financial instability.
Compared with women reporting no psychosocial exposures, women who reported physical abuse also reported worse somatovegetative (OR = 0.46 points; 95% CI, 0.04-0.87) and psychological menopause symptoms (OR = 0.52 points; 95% CI, 0.07-0.97), as well as worse overall health (OR = 1.73; 95% CI, 1.17-2.55) and worse depressive symptoms (OR = 1.74; 95% CI, 1.05-2.87).
Sexual abuse was also associated with worse general menopausal symptoms (OR = 2.81 points; 95% CI, 1.05-4.56) and worse general health (OR = 2.04; 95% CI, 1.04-4.03) compared with no exposure to psychosocial stressors. However, sexual abuse was not associated with depressive symptoms.
Similarly, women who reported financial instability had worse general menopausal symptoms (OR = 1.92 points; 95% CI, 0.49-3.34), worse overall health (OR = 2.16; 95% CI, 1.24-3.75) and worse depressive symptoms (OR = 2.68; 95% CI, 1.44-4.98) compared with women who reported no abuse or financial instability.
For all psychosocial stressors assessed, Faleschini and colleagues found no correlation with general anxiety symptoms at midlife.
“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,” the researchers wrote.
References:
- Faleschini S, et al. Menopause. 2022;doi:10.1097/GME.0000000000002056.
- Past History of Abuse Leads to Worse Menopause Symptoms. https://www.eurekalert.org/news-releases/964532. Published Sept. 14, 2022. Accessed Sept. 14, 2022.
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This study involved 682 women followed prospectively from the time of a pregnancy about 20 years ago to the present. The women were queried about psychosocial stressors such as physical and sexual abuse and financial insecurity that occurred from childhood to the time of the pregnancy. They were then asked about menopause symptoms, well-being and mood symptoms nearly 20 years later. The authors found that exposure to psychosocial stressors earlier in life was associated with worse menopause symptoms nearly two decades later. These results are consistent with a growing body of evidence that suggests that adversity early in life has a lasting unfavorable effect on multiple aspects of health and well-being. We know that chronic stress in childhood is linked with adverse health outcomes in later life such as CVD, diabetes, cancer and early mortality. Potential mechanisms mediating the relationship between early life exposure to adversity and health outcomes in later life may include neurodevelopmental disruption, epigenetic changes and reprogramming of stress and immune regulatory systems.
More research is needed to better understand how factors such as type, timing and duration of exposure to adversity influence risk for poorer health in adulthood and whether preventive strategies and health interventions can alter these outcomes. From a clinical care standpoint, clinicians need to be aware that childhood adversity may impact health in adulthood. Further, women in midlife who experienced childhood adversity may benefit from anticipatory guidance on menopause symptom management.
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