PTSD in female veterans associated with early menopause

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A new study revealed that women veterans with probable post-traumatic stress disorder (PTSD) are twice as likely to experience early menopause and its associated health challenges. The findings, which are being presented at the 2024 Annual Meeting of The Menopause Society in Chicago from September 10-14, highlight the long-term physical consequences of PTSD in female military personnel, particularly those who served in the Persian Gulf War.

Study design

The study, which included over 2,000 women veterans, sought to understand the relationship between military exposure and early menopause. Researchers focused on whether the stressors these women experienced could lead to premature ovarian aging, as well as an increased menopause symptom burden. Early menopause, which occurs before the age of 45, can have serious health implications, including fertility loss, higher risk of cardiovascular disease, osteoporosis, sexual dysfunction, depression, and even premature death.

The study concentrated on Persian Gulf War (GW) women veterans, whose unique experiences—such as exposure to burn pits, oil fires, and the associated Gulf War Illness (GWI)—are linked to various health issues. GWI is characterized by joint pain, gastrointestinal issues, headaches, and rashes, alongside mood disturbances. These health problems, combined with psychological stressors like military sexual trauma (MST), have compelled researchers to explore whether such factors contribute to early menopause.

Results

The Gulf War Longitudinal Study, conducted by the VA Office of Health Outcomes Military Exposures, surveyed 2,013 women veterans from both Gulf War-deployed and Gulf War-era cohorts. At baseline in 1995, the average age of participants was 31.39 years, with a majority being non-Hispanic White (61.1%). Of those surveyed, 65% reported environmental exposures, 61% suffered from Gulf War Illness, and 22% experienced military sexual trauma. Additionally, 27% met the criteria for probable PTSD, which was determined by the PTSD Checklist–Civilian Version (PCL-C). The results revealed that just over 5% of participants had experienced early menopause, defined as occurring before age 45 years.

Researchers also found that probable PTSD was strongly associated with early menopause, with an odds ratio (OR) of 1.83 (95% CI 1.13-2.96), meaning that women with PTSD were almost twice as likely to undergo early menopause compared to those without the disorder. Other military-related factors, including Gulf War deployment, environmental exposures, Gulf War Illness, and military sexual trauma, were not significantly linked to early menopause.

Conclusion

Results of the study showed that women veterans with probable PTSD were found to have nearly double the odds of experiencing early menopause. Importantly, there were no significant associations between Gulf War deployment, Gulf War exposures, Gulf War illness, or military sexual trauma and early menopause, suggesting that PTSD itself plays a critical role.

Caitlin Elizabeth Haas, the study’s lead researcher from the San Francisco VA Health Care System, stated, “This work adds to the growing body of literature implicating PTSD in adverse menopause and reproductive health outcomes across the lifespan. One possible explanation is that PTSD is indicative not just of trauma but of symptom burden, possibly prolonging the biological sequalae associated with the stressful event."

Stephanie Faubion, MD, MBA, medical director for The Menopause Society, stressed the need for heightened awareness of these factors in clinical care. "This study, among other things, highlights the need for healthcare professionals to thoroughly review their patients' histories and be aware of any external stressors that could impact their menopause experience and related symptoms.”

Reference:

Haas CE, Gibson CJ, Cao G, et al. Military Exposures and Early Menopause: Findings from the Gulf War Cohort Study. Presented at: 2024 Annual Meeting of The Menopause Society. Chicago, Illinois. September 10-14, 2024.