How Can Trauma Affect the Menopausal Transition?

Trauma is common yet underrecognized and undertreated, and it can significantly impact the health of women going through menopause.

In a session at The Menopause Society 2025 Annual Meeting, Rebecca C. Thurston, PhD, FABMR, FAPS, assistant dean for women’s health research and Pittsburgh Foundation chair in women’s health and dementia, University of Pittsburgh, presented longitudinal and multimodal data showing that trauma exposure—especially sexual violence—shapes symptom burden and accelerates cardiometabolic and neurologic risk during the menopausal years.¹

“Trauma is a major women’s health issue,” Thurston said, noting that upwards of 70% of women experience some form of trauma their lifetime. Sexual violence is particularly common, with about 40% of women experiencing contact sexual violence. Childhood neglect and abuse is also widely prevalent, affecting about half of women.

Do Women With Trauma Histories Experience Menopause Differently?

Evidence from several complementary cohorts points to yes. In the Study of Women’s Health Across the Nation (SWAN), a longitudinal cohort of more than 3300 women followed for up to 30 years, nearly half reported some form of childhood mistreatment, including:

• Emotional or physical neglect
• Sexual, emotional, or physical abuse
• Any form of abuse or neglect²

Women with these histories had 55% higher odds of hot flashes over the early transition compared with women without histories.

Findings were corroborated with objective measures. In the MS-Heart study in Pittsburgh, which included both peri- and postmenopausal women, ambulatory physiologic monitoring showed that women with histories of sexual or physical abuse had significantly more objectively assessed hot flashes, particularly at night.³

Sleep problems also clustered with trauma. In SWAN, women with childhood trauma had 87% higher odds of persistent insomnia across about 15 years; in the MS-Heart study, childhood abuse or neglect was tied to nearly 2.5 times higher odds of persistent wake after sleep onset (> 30 minutes).

Sexual health was similarly affected.¹ Women with adverse childhoods were less likely to engage in sexual activity—around 30% less likely, depending on the type of trauma—and when they did, many of them reported less emotionally satisfying experiences compared with unexposed peers. These women were also 2.5 times as likely to meet criteria for major depressive disorder during the menopausal transition.

How Does Trauma Intersect With Cardiovascular Risk?

Menopause is a period of accelerated vascular change, and trauma seems to amplify these changes. Using subclinical cardiovascular disease markers that predict events later in life, Thurston’s team found that women with childhood abuse or neglect had significantly higher carotid intima-media thickness (IMT), even after accounting for blood pressure, adiposity, smoking, sleep, and depression. In adulthood, increased trauma exposure was associated with lower flow mediation dilation, indicating poorer endothelial function independent of traditional risk factors.

Sleep emerged as a key modifier—not just in this session, but across the conference. The combination of objectively measured short sleep (< 6 hours) and trauma history was tied to markedly higher IMT. “However, speaking more optimistically, if you had a history of abuse and you were sleeping adequately, those women's vessels looked like their nonexposed counterparts,” Thurston said.

Sexual violence was the standout exposure, with Thurston calling it the “most potent risk factor” for women. In MS-Heart, sexual assault was associated with a quadrupled likelihood of carotid plaque at baseline and accelerated plaque progression over midlife. In older SWAN follow-up, childhood abuse corresponded to a 65% increased risk of heart attack or stroke, which doubled with sexual abuse specifically. “This is above and beyond the effects of standard cardiovascular disease risk factors,” Thurston noted.

Intimate partner violence—largely emotional—was linked to higher blood pressure and doubling of cardiovascular events, demonstrating the substantial physiologic toll of noncontact forms of violence.

Brain Health and Biological Aging

The brain-heart connection was evident. In the MsBRAIN imaging study of 145 women, those with a history of sexual assault had greater white matter hyperintensities—MRI markers of cerebral small-vessel disease tied to cognitive decline, stroke, and dementia—independent of peripheral risk factors.³ Higher PTSD symptom burden related to more white matter hyperintensities and poorer performance across cognitive domains.

Beyond clinical phenotypes, trauma tracked with accelerated biological aging: women with 2 or more lifetime trauma exposures showed an extra 1.8 years of epigenetic age, rising to 2.25 years among those with childhood sexual abuse, after controlling for chronological age.¹

What Should Clinicians Do?

For clinicians, Thurston underscored the importance of assessing both childhood and adult trauma history during midlife care, even if disclosure takes time. Trauma-informed approaches can improve patient engagement and trust, while proactive management of sleep, vasomotor, and mood symptoms may help mitigate long-term risks.

“Treat any mental health concerns that women may have,” Thurston emphasized. “Whether it's depression, anxiety, or PTSD, trauma is a risk factor for every single mental health disorder in the book, so really attend to any mental health concerns. And ideally do this in a collaborative care model, so either partner with the mental health providers in your clinic or develop strong community partnerships.”

Given the prevalence of trauma faced by women in these studies and its impact on their health, Thurston closed by emphasizing the importance of trauma prevention as a tool for advancing the mental and physical health of women.

“Women have a right to live their lives,” Thurston started, interrupted with applause before she could even get her full sentiment out, “free of violence.”

References

1. Thurston RC. Trauma exposure and its implications for women’s health during the menopause transition. Presented at: The Menopause Society 2025 Annual Meeting; October 22, 2025; Orlando, FL.
2. Thurston RC, Chang Y, Matthews KA, et al. Interpersonal trauma and risk of incident cardiovascular disease events among women. J Am Heart Assoc. 2022;11(7):e024724. doi:10.1161/JAHA.121.024724
3. Thurston RC. Vasomotor symptoms and cardiovascular health: findings from the SWAN and the MsHeart/MsBrain studies. Climacteric. 2024;27(1):75-80. doi:10.1080/13697137.2023.2196001