Sexual assault and the menopause experience

©Cheryl Casey - stock.adobe.com

Violence against women is a major public health issue and an estimated 25% of women will experience intimate partner violence (IPV) or sexual assault in their lifetime. In addition, 1 in 10 women will develop posttraumatic stress disorder (PTSD) after these or other traumatic experiences. Studies have found that IPV, sexual assault and PTSD can have long-term effects on health and may compound the effect of aging-related health problems. However, most research is focused on reproductive-age rather than midlife and older women.  A cross-sectional analysis, recently published in JAMA Internal Medicine, examined how common IPV, sexual assault, and PTSD are among this population and whether these exposures are associated with a woman’s menopause experience. 

The participants were members of Kaiser Permanente Northern California (KPNC), approximately 20% of whom were purposefully recruited from the KPNC Diabetes Registry. Data on exposures and outcomes were based on self-administered or interviewer-administered questionnaires that assessed lifetime IPV and sexual assault exposure. Positive responses were further probed to assess IPV in the previous 12 months and the participant’s age at the last occurrence of sexual assault. Symptoms associated with menopause were assessed using interviewer-administered structured-item questionnaires. The authors prioritized three types of symptoms associated with the menopause transition: difficulty sleeping, vasomotor symptoms, and vaginal symptoms. 

Of the participants, 792 (39.4%) were non-Latina white, 429 (21.3%) black, 403 (20.0%) Latina or Hispanic, and 387 (19.2%) were Asian. The women were largely postmenopausal (1643 of 2002, [82.1%]) and had a mean age of 60.5. A majority were overweight and had at least some college education. Fewer than 10% had clinically significant depressive symptoms and 18.4% reported anxiety. 

Lifetime emotional IPV was reported by 423 women (21.0%), lifetime physical IPV was reported by 316 (15.7%), and 256 of 1790 women (14.3%) reported both emotional and physical IPV. Sixty-four women reported IPV within the past 12 months. Sexual assault was reported by 382 women (19.0%) and nearly three-quarters of the attacks occurred when the victims were younger than 25. Overall, 22.5% of women met criteria for current clinically significant symptoms of PTSD. The authors also noted significant variation between the rates of lifetime IPV and sexual assault between racial/ethnic groups, with Asian women reporting the lowest rates. However, there were no significant difference among observed rates of PTSD across racial/ethnic groups. 

In regard to menopause symptoms, 1148 women (57.1%) reported difficulty sleeping, 802 (39.9%) reported hot flashes, 692 (34.4%) reported night sweats, 633 (31.5%) reported vaginal dryness, 260 (12.9%) reported vaginal irritation, and 257 of 1457 sexually active women (17.6%) reported pain with intercourse. The authors observed significant variation in rates of some menopausal symptoms with vasomotor symptoms most common among black women.

 Looking at associations between traumatic exposures and menopause symptoms, the authors found that women who had lifetime emotional IVP were more likely to report difficulty sleeping, night sweats and pain with intercourse. Women who reported lifetime physical IPV were more likely to have night sweats and women who reported lifetime sexual assault were more likely to have vaginal dryness, vaginal irritation, and pain with intercourse. Symptoms of PTSD were associated with all menopause symptoms (difficulty sleeping, hot flashes, vaginal dryness and irritation, and pain with intercourse.

A few strengths and limitations to the study were observed. Among the noted limitations were that longitudinal trends, including elapsed time since the trauma, duration or chronicity of menopause symptoms and traumatic exposures, cannot be determined from the data. It is also unknown whether assessed symptoms of PTSD are associated with reported IPV and/or sexual violence among women with both exposures. The authors were unable to determine whether participants had disclosed traumatic experiences, had previously identified diagnoses of PTSD, and/or had previously engaged in trauma-focused treatment. Strengths of the study include characterizing varied aspects of the experience of menopause symptoms, traumatic exposures and symptoms of PTSD in a large, ethnically diverse cohort. 

The authors believe that their findings illustrate that IPV, sexual assault, and symptoms of PTSD may be associated with development and experience of menopause symptoms. While menopausal symptoms are largely related to biological and hormonal changes related to menopause and aging, a woman who has experienced IPV or sexual assault may have alterations in her physiological response to stress. These changes may make her more susceptible to symptoms of aging and menopause. The results from this study also reinforce the need for better recognition of these exposures by clinicians caring for middle-aged and older women. They also suggest a need for stronger efforts to provide better and more informed care to all women across the aging spectrum who are suffering from traumatic exposure.