Association of adverse childhood experiences with menopausal symptoms: Results from the Data Registry on Experiences of Aging, Menopause and Sexuality (DREAMS)

Ekta Kapoor; Madison Okuno; Virginia M Miller; Liliana Gazzuola Rocca; Walter A Rocca; Juliana M Kling; Carol L Kuhle; Kristin C Mara; Felicity T Enders; Stephanie S Faubion

doi:10.1016/j.maturitas.2020.10.006

Association of adverse childhood experiences with menopausal symptoms: Results from the Data Registry on Experiences of Aging, Menopause and Sexuality (DREAMS)

Maturitas. 2021 Jan:143:209-215. doi: 10.1016/j.maturitas.2020.10.006. Epub 2020 Oct 14.

Authors

Affiliations

¹ Center for Women's Health, Mayo Clinic, 200 First St SW, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, USA; Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic, 200 First St SW, Rochester, MN, USA. Electronic address: Kapoor.ekta@mayo.edu.
² University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, USA.
³ Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, 200 First St SW, Rochester, MN, USA.
⁴ Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, USA.
⁵ Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, USA; Women's Health Research Center, Mayo Clinic, 200 First St SW, Rochester, MN, USA; Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, USA.
⁶ Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA.
⁷ Center for Women's Health, Mayo Clinic, 200 First St SW, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, USA.
⁸ Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St SW, Rochester, MN, USA.
⁹ Center for Women's Health, Mayo Clinic, 200 First St SW, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, USA.

Abstract

Objective: To examine the association of adverse childhood experiences (ACEs) with overall menopausal symptom burden in midlife women.

Study design: This was a cross-sectional study of women between the ages of 40 and 65 years who were seen for specialty consultation in the Menopause and Women's Sexual Health Clinic, Mayo Clinic, Rochester, MN between May 1, 2015 and December 31, 2016.

Main outcome measures: Participants completed the ACE questionnaire to assess childhood abuse and neglect, the Menopause Rating Scale (MRS) to assess menopausal symptom burden, the Patient Health Questionnaire (PHQ-9) to assess depression, the Generalized Anxiety Disorder questionnaire (GAD-7) to assess anxiety, and provided information on current abuse (physical, sexual and verbal/emotional).

Results: Women meeting inclusion criteria (N = 1670) had a median age of 53.7 years (interquartile range: 49.1, 58.0). Of these women, 977 (58.5 %) reported any ACE and 288 (17.2 %) reported ≥4 ACEs. As menopausal symptoms increased in severity from the first to fourth quartile, the odds ratio of ACE 1-3 (vs. 0) increased from 1 to 2.50 (trend p < 0.01), and the odds ratio of ACE ≥ 4 (vs. 0) increased from 1 to 9.61 (trend p < 0.01), a pattern that was consistent across all menopausal symptom domains. The association between severe menopausal symptoms and higher childhood adversity (ACE score 1-3 or ≥4 vs. ACE = 0) remained significant after adjusting for age, partner status, education, employment, depression, anxiety, and hormone therapy use (OR 1.84 and 4.51, p < 0.01).

Conclusion: In this large cross-sectional study, there was a significant association between childhood adversity and self-reported menopausal symptoms that persisted even after adjustment for multiple confounders. These associations highlight the importance of screening women with bothersome menopausal symptoms for childhood adversity, and of offering appropriate management and counseling for the adverse experiences, when indicated.

Keywords: Adverse childhood experiences; Child abuse; Hot flashes; Menopausal symptoms; Vasomotor symptoms.

MeSH terms

Adult
Adverse Childhood Experiences*
Aged
Aging* / physiology
Aging* / psychology
Anxiety / epidemiology
Child
Child Abuse
Cross-Sectional Studies
Depression / epidemiology
Female
Humans
Menopause* / physiology
Menopause* / psychology
Middle Aged
Sexuality

Grants and funding

U54 AG044170/AG/NIA NIH HHS/United States