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Abstract
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Adverse childhood experiences (ACE) are common, with a recently reported prevalence rate of 9.2 per 1000 children in the US [1]. In addition to the short-term effects on the health of the affected children, ACE have been linked to adverse health outcomes much later in life, including an increased risk of psychiatric disorders, substance abuse, eating disorders, autoimmune conditions, asthma, obesity, diabetes, and cardiovascular disease in adulthood [2,3]. Moreover, multiple studies evaluating the impact of ACE in midlife women have revealed a significant impact on their menopause experience and a higher risk of undergoing gynecological surgeries.
Women with a history of ACE tend to report more severe menopause symptoms across all domains, including somatic, psychological, and urogenital symptoms. In addition, the burden of childhood adversity correlates with the menopause symptom score [3]. When specifically evaluating the effect on vasomotor symptoms (VMS), the most common type of symptom of menopause, there is a definite association with a history of ACE. This has been demonstrated for self-reported VMS in the Study of Women's Health Across the Nation (SWAN) [4] and objectively measured VMS in the MsHeart Study [5]. The mechanisms for the link between ACE and menopause symptoms have not been elucidated, but some potential explanations have been suggested. Childhood adversity may be associated with changes in the sympathetic nervous system, and in the hypothalamic-pituitary-adrenal (HPA) axis. Changes in some of these same pathways have also been implicated in the pathophysiology of VMS. Therefore, childhood adversity-mediated changes in the sympathetic nervous system or the HPA axis may somehow impact VMS severity or perception or both. Long-term changes in the serotonergic pathways resulting from ACE can have a potential impact on women's executive function, which may manifest as cognitive complaints during the menopause transition. ACE may have other unknown consequences on the developing brain that somehow alter the menopause experience.
Childhood abuse and neglect have a strong association with psychiatric disorders, including depression and anxiety. It is therefore not surprising that midlife women with ACE experience more severe menopause-related psychological symptoms [3]. The greater burden of psychiatric morbidities may alter the overall perception of menopause and lead to an increase in the reporting of menopause symptoms. Additionally, women with greater childhood adversity are more likely to report recent abuse [6], which has independently been linked with worse menopause symptoms [7]. Finally, childhood adversity likely predisposes women to lifestyle-related risk factors that increase their chances of more severe menopause symptoms. As an example, smoking and obesity are both associated with more severe VMS...
Language: en |