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Original Investigation
January 2019

Associations of Intimate Partner Violence, Sexual Assault, and Posttraumatic Stress Disorder With Menopause Symptoms Among Midlife and Older Women

Author Affiliations
  • 1Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
  • 2Mental Health Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
  • 3Department of Psychiatry, University of California, San Francisco
  • 4Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
  • 5Division of Research, Kaiser Permanente, Oakland, California
  • 6Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
  • 7Department of Family and Community Medicine, University of California, San Francisco
JAMA Intern Med. 2019;179(1):80-87. doi:10.1001/jamainternmed.2018.5233
Key Points

Question  How common are intimate partner violence, sexual assault, and posttraumatic stress among midlife and older women, and are these exposures associated with women’s experience of menopause?

Findings  In this cross-sectional analysis of a cohort of midlife and older women, intimate partner violence, sexual assault, and symptoms of posttraumatic stress disorder were common. Emotional intimate partner violence and posttraumatic stress were associated with sleep-related, vasomotor, and vaginal symptoms; physical intimate partner violence was associated with night sweats; and sexual assault was associated with vaginal symptoms.

Meaning  Intimate partner violence, sexual assault, and symptoms of posttraumatic stress disorder may be associated with the development and experience of menopause symptoms.

Abstract

Importance  Little is known about the prevalence of traumatic exposures among midlife and older women and the association of these traumatic exposures with health issues.

Objective  To examine the associations of intimate partner violence (IPV), sexual assault, and posttraumatic stress with menopause symptoms among midlife and older women.

Design, Setting, and Participants  A cross-sectional analysis of data from a multiethnic cohort of 2016 women 40 to 80 years of age in the Kaiser Permanente Northern California health care system was conducted from November 15, 2008, to March 30, 2012. Statistical analysis was conducted from June 8, 2016, to September 6, 2017.

Exposures  Lifetime physical or emotional IPV, sexual assault, and current symptoms of posttraumatic stress disorder, assessed with standardized questionnaires.

Main Outcomes and Measures  Difficulty sleeping, vasomotor symptoms, and vaginal symptoms, assessed with standardized questionnaires.

Results  Among the 2016 women enrolled, the mean (SD) age was 60.5 (9.5) years, and 792 of 2011 with race/ethnicity data (39.4)% were non-Latina white (403 [20.0%] Latina, 429 [21.3%] black, and 387 [19.2%] Asian). Lifetime emotional IPV was reported by 423 women (21.0%), lifetime physical IPV was reported by 316 women (15.7%), sexual assault was reported by 382 women (18.9%), and 450 of 2000 women (22.5%) had current clinically significant symptoms of posttraumatic stress disorder. In multivariable analyses adjusted for age, race/ethnicity, educational level, body mass index, menopause status, hormone therapy, and parity, symptoms of posttraumatic stress disorder were associated with difficulty sleeping (odds ratio [OR], 3.02; 95% CI, 2.22-4.09), vasomotor symptoms (hot flashes: OR, 1.69; 95% CI, 1.34-2.12; night sweats: OR, 1.72; 95% CI, 1.37-2.15), and vaginal symptoms (vaginal dryness: OR, 1.73; 95% CI, 1.37-2.18; vaginal irritation: OR, 2.20; 95% CI, 1.66-2.93; pain with intercourse: OR, 2.16; 95% CI, 1.57-2.98). Emotional IPV was associated with difficulty sleeping (OR, 1.36; 95% CI, 1.09-1.71), night sweats (OR, 1.50; 95% CI, 1.19-1.89), and pain with intercourse (OR, 1.60; 95% CI, 1.14-2.25). Physical IPV was associated with night sweats (OR, 1.33; 95% CI, 1.03-1.72). Sexual assault was associated with vaginal symptoms (vaginal dryness: OR, 1.41; 95% CI, 1.10-1.82; vaginal irritation: OR, 1.42; 95% CI, 1.04-1.95; pain with intercourse: OR, 1.44; 95% CI, 1.00-2.06).

Conclusions and Relevance  Lifetime history of IPV or sexual assault and current clinically significant symptoms of posttraumatic stress disorder are common and are associated with menopause symptoms. These findings highlight the need for greater recognition of these exposures by clinicians caring for midlife and older women.

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