From the Journals

Intimate partner violence and PTSD increase menopausal symptom risk

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Be alert to intimate partner violence

An estimated 33% of women in the United States have been sexually assaulted, and an estimated 25% have experienced IPV, so be aware of how common this “wicked problem” is, the way it impacts health, and what role you can play in educating and helping patients by connecting them to available resources.

But that is not enough. Consider measures such as training yourself and staff in how to assess for IPV and sexual assault and use of EHR to integrate IPV assessment into routine clinical care, as well as developing protocols to be followed when a patient discloses IPV or sexual assault. A multidisciplinary approach also can help, including victim service advocates and behavioral health clinicians to provide care and support.

State requirements for reporting partner and sexual violence differ, so be aware of your state laws.

A strength of this study is that it included emotional as well as physical IPV, which often is left out although it has serious impacts.

Rebecca C. Thurston, PhD, is from the department of psychiatry at the University of Pittsburgh, and Elizabeth Miller, MD, PhD, is from the division of adolescent and young adult medicine at the UPMC Children’s Hospital of Pittsburgh. These comments were taken from an accompanying editorial (JAMA Intern Med. 2018 Nov 19. doi: 10.1001/jamainternmed.2018.5242). Dr. Thurston declared research support from the National Institutes of Health and consultancies for Pfizer, Procter & Gamble, and MAS Innovations.



Intimate partner violence or sexual assault may have a significant effect on menopausal symptoms in women, according to a cohort study published in JAMA Internal Medicine.

Karen Winton/iStockphoto

Researchers analyzed data from 2,016 women aged 40 years or older who were enrolled in the observational Reproductive Risks of Incontinence Study; 40% were non-Latina white, 21% were black, 20% were Latina or Hispanic, and 19% were Asian. Of this cohort, 21% had experienced emotional intimate partner violence (IPV) – 64 (3.2%) in the past 12 months – 16% had experienced physical IPV, 14% had experienced both, and 19% reported sexual assault. More than one in five women (23%) met the criteria for clinically significant PTSD.

Women who had experienced emotional domestic abuse were 36% more likely to report difficulty sleeping, 50% more like to experience night sweats, and 60% more likely to experience pain with intercourse, compared with women who had not experienced any abuse.

Physical abuse was associated with 33% higher odds of night sweats, and sexual assault was associated with 41% higher odds of vaginal dryness, 42% higher odds of vaginal irritation, and 44% higher odds of pain with intercourse.

Women with clinically significant PTSD symptoms were significantly more likely to experience all the symptoms of menopause, including twofold higher odds of pain with intercourse and threefold higher odds of difficulty sleeping. When authors accounted for the effect of PTSD symptoms in the cohort, they found that only the association between emotional abuse and night sweats or pain with intercourse, and between sexual assault and vaginal dryness, remained independently significant.

Carolyn J. Gibson, PhD, MPH, of the San Francisco Veterans Affairs Health Care System, and coauthors said that the biological and hormonal changes that underpin menopausal symptoms, as well as health risk behaviors, cardiometabolic risk factors, and other chronic health conditions associated with menopause, all are impacted by trauma and its psychological effects.

“Chronic hyperarousal and hypervigilance, common in individuals who have experienced trauma and characteristic symptoms of PTSD, may affect sleep and symptom sensitivity,” they wrote.

The reverse is also true; that the symptoms of menopause can impact the symptoms of PTSD by affecting a woman’s sense of self-efficacy, interpersonal engagements, and heighten the stress associated with this period of transition.

“The clinical management of menopause symptoms may also be enhanced by trauma-informed care, including recognition of challenges that may impair efforts to address menopause-related concerns among women affected by trauma,” the authors wrote.

Clinicians also could help by providing education about the link between trauma and health, providing their patients with a safe and supportive treatment environment, and facilitating referrals for psychological or trauma-specific services when needed, they said.

The research was supported by the San Francisco Veterans Affairs Medical Center and Kaiser Permanente Northern California, and funded by the University of California San Francisco–Kaiser Permanente Grants Program for Delivery Science, the Office of Research on Women’s Health Specialized Center of Research, and grants from the National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCE: Gibson C et al. JAMA Intern Med. 2018 Nov 19. doi: 10.1001/jamainternmed.2018.5233.

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