Study objective: To investigate of the extent to which violence over the life course accelerates the onset of perimenopause, as measured by menstrual changes.
Design: Prospective cohort study.
Setting: Boston, Massachusetts.
Participants: 603 premenopausal women aged 36–45 years at baseline who completed a cross sectional survey on childhood and adult violence history.
Main outcome measure: Time to perimenopause, defined as time in months from baseline interview to a woman’s report of (1) an absolute change of at least seven days in menstrual cycle length from baseline or subjective report of menstrual irregularity; (2) a change in menstrual flow amount or duration; or (3) cessation of periods for at least three months, whichever came first.
Main results: Experience of abuse was associated with delayed onset of menstrual changes indicative of onset of perimenopause. Women reporting childhood or adolescent abuse entered perimenopause about 35% slower than women who reported no abuse (IRRadj = 0.65, 95% CI 0.45 to 0.95) after adjusting for age, age at menarche, ever live birth, ability to maintain living standard, smoking, BMI, and depression. There was a similar association among women who reported first abuse during adulthood (IRRadj = 0.72, 95% CI 0.28 to 1.80). These findings persisted when the cohort was restricted to non-depressed women (childhood/adolescent IRRadj = 0.57, 95% CI 0.36 to 0.90; adulthood IRRadj = 0.63, 95% CI 0.23 to 1.77).
Conclusions: This study is the first longitudinal analysis of the timing of perimenopause to show an association with a history of physical or sexual abuse. Further study of the relation between violence and reproductive aging is needed.
- HSMC, Harvard study of moods and cycles
- SIPR, survey of interpersonal relationships
- OC, oral contraceptive
- BMI, body mass index
- CESD, Center for Epidemiology study of depression
- IRR, incidence rate ratios
- HPA, hypothalamic-pituary-adrenal
- FSH, follicle stimulating hormone
- allostatic load
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Funding: this study was funded by the National Institute of Mental Health, grants R01-MH577351 and R01-MH-50013.
Conflicts of interest: none declared.