In recent years, a burgeoning field of study has hypothesized a connection between adverse childhood events, also known as ACEs, and a more difficult menopause transition.

An ACE could be one of various circumstances, including physical, sexual or emotional abuse, physical and emotional neglect, and parental separation and divorce. In “Researchers Find Link between Childhood Trauma, Recent Abuse and More Severe Menopause Symptoms,” Madison Okuno, a Mayo Clinic researcher, said: “We found that women with a history of abuse, whether in childhood or recent, are more likely than women without these histories to experience more severe menopausal symptoms and more psychological symptoms.”

In their research, the Mayo Clinic studied more than 1,600 women between the ages of 40-65. Nearly 60 percent of research participants reported having endured a prior ACE. Similarly, researchers at the Perelman School of Medicine at the University of Pennsylvania found that “trauma and stress in the teen years increases the risk of depression during menopause.” Teen girls who had experienced traumatic events during childhood or adolescence were more at risk for perimenopausal depression: “In particular, women who experienced their first traumatic event in their teens are especially susceptible to depression during perimenopause, even if they had never previously had depression.”

Past Trauma Leading to Future Health Implications

To what extent are these women more apt to experience depression? More than two times as likely when compared to women who either experienced such events much earlier in life (as infants or toddlers), or never at all. The Penn State team determined that the timing of such events is a critical window into the significant and long-lasting effects on brain development, particularly in the areas responsible for emotions, mood and memory.

Penn State studied the women participants for a long time – 16 years. Each participant was assessed regularly for cognition and mood, and blood samples were collected to determine hormone levels routinely. Approximately 22 percent had experienced one ACE, and almost 40 percent had gone through two or more adverse childhood events. And most of the adverse events occurred before puberty.

Of these women, almost 21 percent experienced depression for the first time during perimenopause, while 22.4 percent were diagnosed with depression before perimenopause started: “Notably, women who reported two or more ACEs after the onset of puberty were 2.3 times more likely to have their first experience of clinical depression during perimenopause, compared to those who did not experience any ACEs.”

Sadly, ACEs Are Common Events
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The most commonly reported ACEs were parental separation or divorce, emotional abuse, and living with an alcoholic or someone with another substance abuse disorder.

Unfortunately, adverse childhood events may seem like an outlier, but they are much more common than many would like to believe. According to the Crimes Against Children Research Center, 20 percent of all girls are victims of child sexual abuse, and during the course of their lifetime, 28 percent of all 14-17 year-olds (male and female) have been sexually victimized. Those most vulnerable to child sexual abuse are between 7-13 years old.

Then, beyond sexual abuse, are these sobering stats, which illuminate other potential types of adverse childhood events:

• 14.4 percent of U.S. children are in poverty (Children’s Defense Fund)
• 10.5 percent of all U.S. households experience food insecurity, or not having enough food to eat (USDA)
• 2.7 million children in the U.S. have a parent who is incarcerated (National Institute of Corrections)
• 424,000 U.S. children are in foster care (Children’s Rights)
• Hundreds of thousands of children experience stress and sadness due to racism, sexism, lookism (being appraised by one’s appearance and conformity to prevailing beauty standards) and homophobia (life experience)

Why Now, If Not Then?

This is a logical question: If the groundwork for mental-emotional challenges was laid during childhood or adolescence, why does it wait to crop up when women are in midlife?

Given these emerging and new insights into the role of ACEs on future risk of perimenopausal depression, and the role of ACEs on brain development, I have a few of my own thoughts about why this happens to some women:

• The relative predictability of hormones, even with monthly cycles, before the onset of perimenopause help to “shield” a woman from succumbing to the more drastic and unpredictable hormonal highs and lows of perimenopause. By the time perimenopause starts, her body and brain might have already been treading water for quite some time – coping well on the outside with not much resilience left inside.
• Women with ACEs are already more biochemically compromised than women who haven’t endured any ACEs. Perimenopause is akin to taking the brakes off the car; the “wheels” of a woman’s physiology (her brain and its neurotransmitters, her neuroendocrine system and its chemicals) can no longer hold it all in check; there are just too many moving parts at once, and prior coping mechanisms are inadequate.
• Women at this stage of life are already under major stress – financial obligations, career demands, childrearing, maturing marriages, new health diagnoses, aging parents, dying friends or relatives. In the context of also having had ACEs, the added stress of the hormonal hijinks of perimenopause just proves too much.

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What to Do About It?

The past cannot be scrubbed clean and deleted. Women at this phase of life often have some housekeeping to do, and this is true even for those with no ACE history. During a woman’s 40s and 50s, she may be in a new state of flux, and anecdotally, this is a time when women begin making some critical life changes. They take an inventory of their past, present and future, and may start to redesign and revise life according to her terms. This may look like:

• Pivoting careers, perhaps going from a high-stress corporate role to a less stressful consulting job
• Returning to school to retrain to do something else, or learn something new to ignite a hobby or passion
• No longer doing disproportionate amounts of cooking, housework or the emotional labor involved in keeping a household or family going
• Getting a pet for added emotional support and as a comforting companion
• Discontinuation of micromanaging her children, including their activities, classwork, homework, grades, extracurricular activities or social lives
• Taking up new self-care practices, like meditation, yoga or regular exercise
• Increasing reliance on and active practice of her faith, whatever that may be

At the same time, these personal changes are not always enough, especially for women battling moderate to severe perimenopausal depression or anxiety, with a history of ACEs. In such cases, it is advised that they seek the help of a healthcare professional to consider therapy and other interventions.
 

​I recently volunteered to take part in a market research study for a brand-new development on the horizon for perimenopausal and menopausal symptoms. The upcoming product appears to be a first-in-its-class medication to treat the vasomotor symptoms of this time of hormonal change – vasomotor meaning, in everyday language, hot flashes and night sweats.

I was excited and eager to contribute in some small way to this historic happening in the world of menopausal medicine. As a newly declared perimenopausal woman (who’s likely had symptoms for at least the past two years), I believe that advocacy, information, education and the availability of proven options are paramount for women dealing with the symptoms associated with the drop in estrogen and progesterone – insomnia, first-ever experiences of anxiety or depression, skin changes, potential bone loss and much more.

I am an ardent researcher in matters perimenopause and menopause. I read medical journal articles, clinical trial reports, mass-market stories, medical society websites and personal stories of brave women who’ve spoken openly about their own experience. So when I heard about this market research study being conducted on behalf of a pharmaceutical company, I knew I wanted to help.

So, here are the details, as best as I can divulge.

The name of the company behind this is not clear. The market research interview was performed by a third-party company working with the pharmaceutical company. As a result, I don’t know which pharma company plans to release this new product or when they may do so.

It’s going to address vasomotor symptoms. As the questions continued, it became clear that this new product is one I’ve already read about. It will be a new class of medication focused on treating hot flashes and night sweats in particular. It is a non-hormonal drug called fezolinetant that has either concluded or is in the final stages of pre-market trials.

This is important because, to date, the most common options to treat hot flashes and night sweats are the gold standard, hormone replacement therapy (HRT), followed by antidepressants. Most antidepressants, usually in the SSRI class (but sometimes in the SNRI class, too) are prescribed “off label” for the treatment of hot flashes. “Off label” means that a medication is being used for a clinical purpose other than what it was originally created to treat. Brisdelle ® is the only SSRI antidepressant actually created to treat vasomotor symptoms; indeed it is a low dose (7.5 mg) of the antidepressant Paxil (generic Paroxetine). Other antidepressants commonly offered to treat hot flashes are Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine) and Effexor (venlafaxine).

Some women choose antidepressants over HRT for various reasons, including a personal history of cancer, prior embolisms and outdated and disproven information about the risks of hormone therapy (See WHI Wrong on HRT). At the same time, antidepressants can come with their own side effects – results that for some women are worse than the condition they’re intended to treat. So there is certainly a need for an alternative effective medication.

The pharmaceutical company is trying to get the right language and terminology together. Most of the questions I was asked pertained to certain word choices, phrases and definitions that team must be considering. I was asked to weigh and rank various words, sentences and themes. What I recall most are two things:

1. They referred to hot flashes and night sweats as a standalone “medical condition.” I didn’t agree that these should be categorized as a separate entity, but rather as a symptom of perimenopause and menopause. Maybe this is an attempt to further “medicalize” menopausal symptoms in order for insurance companies to cover the treatment or something else. But I felt like this ran the risk of splitting women’s bodies literally into parts and not looking at this stage of life as a total-body process, of which hot flashes and night sweats are symptoms. For this reason already, many women end up taking multiple medications, vitamins, supplements and more to treat each discrete symptom when, in reality, they could benefit from only HRT alone, or maybe just one or two medications.
2. They kept using the word menopause or menopausal, not perimenopause or perimenopausal. I thought this was a vulnerability and critical error since women become symptomatic many years before reaching actual menopause (12 months in a row without a menstrual cycle). Some women (and doctors) could mistakenly think such women didn’t qualify for the medication as a result. I advocated the use of the term perimenopause and menopause to ensure clarity and inclusion and reduce confusion.

There were many other specifics and nuances in the word choices, language and even the number of scientific and medical facts the company is thinking about including in its promotion of the medication.

It’s not clear if the medication will treat anything other than hot flashes or night sweats. Vasomotor symptoms was the central theme in the market research study. While the interviewer mentioned the impact of hot flashes and night sweats on quality of life, they did not state or imply that the new drug will treat other symptoms like mood changes, hair thinning, skin quality, vaginal dryness or any of the other dozens and dozens of potential perimenopausal and menopausal symptoms. So I think this drug must be laser-focused on night sweats and hot flashes alone. Of course, for some women, remediating those symptoms alone will have a major payoff in everyday life, so I don’t want to discount the benefit.

I bet the medication will be expensive, and most insurance companies won’t cover it. I have little factual basis for my claim here, but with many medications that are new to the market, they are prohibitively expensive for most people. And since they are new, and no generics are yet available, insurance companies may not cover it. Instead, I fear that women will want to try this new medication and won’t be able to because insurance only covers generics and / or they will route the woman to try an existing antidepressant used for that purpose instead. It may take years for the cost to come down or for there to be a widely available generic option.
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So these are my takeaways for now. I will likely be part of a follow-up survey and may have even more to say about it as the drug gets ready for its official launch. I am glad there is progress being made in learning more about – and developing solutions for – the symptoms of perimenopause and menopause. By the time my daughters reach this phase of life, hopefully there will be a full menu of hormonal and non-hormonal options for them that they don’t have to fight tooth and nail to access. 

Researching perimenopause and menopause is like a minefield of do's, don'ts, musts and won'ts. There are so many websites, video channels, social media groups, medical practices, natural health institutes and others out here - all claiming to be the most veritable, empirical source on all things related to the perimenopausal or menopausal woman.

It helps less that most conventional internal medicine doctors, family practitioners and primary care physicians are pretty ill-informed about menopause, with most of them receiving very little training on the subject in medical school. This leaves many women getting either no or bad input from the average doctor, leaving them in an informational rut and yearning for legitimate answers and advice.

Below are some credible organizations, leaders and emerging voices on perimenopause and menopause today. They use real scientific and medical research, and/or experience to back their claims and guidance. While some do offer paid consultations, they all produce and make available an incredible amount of data and information for free. All you must do is take the time to read, listen and make use of the information they've put together for you.

This list of resources is continually updated.

A Vogel UK – From across the pond, menopause advisor Eileen Durward offers advice on lifestyle, homeopathic help, diet and more for perimenopause and post-menopause – https://www.youtube.com/c/AvogelCoUk/videos

Australasian Menopause Society – “Empowering Menopausal Women,” this consortium of physicians and healthcare professionals have a special interest in women’s midlife health and menopause – https://www.menopause.org.au/about-ams  

Ellen Dolgen – A nationally recognized leading voice and author on menopause and women’s health – https://ellendolgen.com/
Her blog is here – https://ellendolgen.com/blog/

International Menopause Society (IMS) – A global collaborative bringing together leading experts on women’s health and menopause, advocating evidence-based treatments and best practices, generally more progressive than U.S.-focused standards - https://www.imsociety.org/
IMS on YouTube: https://www.youtube.com/channel/UC-4OHO-C2exmMFhKwVFgX6A/videos

Jumpstart AIP – The online destination of Kitty Anderson, a self-described Board-certified menopause coach - https://www.jumpstartaip.com/
She also runs a YouTube channel, Create a Menopause Recovery: https://www.youtube.com/channel/UCizbP_luUAbrYisSYUwmolw

KE Garland - Navigating the Change - An inclusive site that aims to reflect the experiences of all women, including those from less represented backgrounds, blending literary content with informational, fact-driven guidance - https://navigatingthechange.com/

Let's Talk Menopause - Founded by Donna Klassen, Christine Maginnis and Samara Daly, a springboard for its eponymous podcast, resources and more, including being the launching pad for the first menopause awareness campaign in New York City. They also have clinical professionals on the Board of Directors - https://www.letstalkmenopause.org/ 

​Menopause Taylor – Retired gynecologist Barbara Taylor, MD, is a vocal proponent of helping midlife women live their best lives, giving guidance on lifestyle, brain health, hormone replacement therapy, diet, exercise and more - https://menopausetaylor.me/
Menopause Taylor on YouTube: https://www.youtube.com/channel/UCSJItwa6IVPGxUVfTHKbwLg

My Second Spring – Started by an Irish mother of four and former investor relations / PR maven as a hub for all things menopausal since 2013, with a decidedly naturopathic bent - https://mysecondspring.ie/
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North American Menopause Society (NAMS) – Nonprofit, multidisciplinary organization focused on the health and quality of life of women at midlife and beyond, offering training for physicians to become certified menopause specialists  - https://www.menopause.org/