Do Adverse Childhood Events Portend a More Severe Perimenopause?

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.
 

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