The negative effects of a history of childhood abuse are related to mental illness, cardiovascular disease, premature mortality and other chronic illnesses in adulthood and reported in multiple studies across the span of the last twenty plus years. How childhood mistreatment relates to the menopause transition is less explored. The recent study tested whether childhood abuse and neglect are associated with menopausal vasomotor symptoms (VMS). 
Using both physiologic and prospective self-report measures, 295 nonsmoking perimenopausal and postmenopausal women aged 40 to 60 with and without VMS were studied. Measurements of psychosocial factors and VMS were utilized to test relationships between childhood abuse/neglect and vasomotor symptoms during waking times and sleep. Psychosocial measures included the Child Trauma Questionnaire, ambulatory physiologic (sternal skin conductance) and self-report measurement of VMS.
Results:
A disturbing 44% of the women reported abuse or neglect during childhood. For women who reported VMS, childhood sexual or physical abuse was associated with more frequent objectively recorded VMS during sleep. Among these women, those with a history of physical or sexual abuse had approximately 1.5 to 2 fold the number of sleep VMS compared to women without this past history. A history of childhood emotional abuse or neglect was not associated with the frequency of self-reported VMS, but rather only those women who experienced physical or sexual childhood abuse.
Commentary: This study was conducted in women of the MSHeart Study, which was originally designed to investigate the relationship between VMS and cardiovascular health. The participants in this current study were on average, 54 years old, white, overweight and postmenopausal. Approximately one quarter of the women were African American. One hundred twenty-nine or 44% of the sample reported some form of childhood abuse or neglect and 23% reported emotional abuse as the most common form of abuse/neglect.
One prior study has indicated a relationship between childhood abuse/neglect and retrospective self- reports of VMS with increased odds of VMS reports for the women with a history of abuse. Another study looked at PTSD and intimate partner violence in relationship to menopausal symptoms. None of the prior studies have utilized both self-reports of VMS in addition to physiologic testing.
Changes in the hypothalamic-pituitary-adrenal (HPA )axis have been associated with VMS physiology and childhood abuse is associated with sympathetic nervous system dysregulation, in addition to marked changes in the HPA axis. Therefore, it is not surprising that the impact of childhood abuse on the autonomic nervous system and HPA axis may lead to peri and postmenopausal women being more susceptible to bothersome nighttime VMS.
Since this study primarily detected an association between childhood abuse and VMS during sleep, it leads me to think I should expand my inquiry and understanding of those with chronic insomnia and sleep disruption due to VMS. Chronic insomnia in particular is very responsive to cognitive behavioral therapy (CBT). CBT helps one find out which thoughts and behaviors cause sleep problems or at least make them worse. A history of abuse could be part of the CBT process. One can learn how to replace those thoughts and behaviors with habits that support sound sleep and thus overcome the causes of sleep problems, not just taking pills – whether they be natural or pharmaceutical. This study is also an important reminder of the importance for clinicians to routinely screen for trauma history when working with midlife women.
Reference: Carson M, Thurston R. Childhood abuse and vasomotor symptoms among midlife women. Menopause 2019;Oct: 26(10): 1093-1099.
