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Military Sexual Trauma and Menopause Symptoms Among Midlife Women Veterans

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Abstract

Background

Sexual assault and/or sexual harassment during military service (military sexual trauma (MST)) can have medical and mental health consequences. Most MST research has focused on reproductive-aged women, and little is known about the long-term impact of MST on menopause and aging-related health.

Objective

Examine associations of MST with menopause and mental health outcomes in midlife women Veterans.

Design

Cross-sectional.

Participants

Women Veterans aged 45–64 enrolled in Department of Veterans Affairs (VA) healthcare in Northern California between March 2019 and May 2020.

Main Measures

Standardized VA screening questions assessed MST exposure. Structured-item questionnaires assessed vasomotor symptoms (VMS), vaginal symptoms, sleep difficulty, depressive symptoms, anxiety symptoms, and posttraumatic stress disorder (PTSD) symptoms. Multivariable logistic regression analyses examined associations between MST and outcomes based on clinically relevant menopause and mental health symptom thresholds.

Key Results

Of 232 participants (age = 55.95 ± 5.13), 73% reported MST, 66% reported VMS, 75% reported vaginal symptoms, 36% met criteria for moderate-to-severe insomnia, and almost half had clinically significant mental health symptoms (33% depressive symptoms, 49% anxiety, 27% probable PTSD). In multivariable analyses adjusted for age, race, ethnicity, education, body mass index, and menopause status, MST was associated with the presence of VMS (OR 2.44, 95% CI 1.26–4.72), vaginal symptoms (OR 2.23, 95% CI 1.08–4.62), clinically significant depressive symptoms (OR 3.21, 95% CI 1.45–7.10), anxiety (OR 4.78, 95% CI 2.25–10.17), and probable PTSD (OR 6.74, 95% CI 2.27–19.99). Results did not differ when military sexual assault and harassment were disaggregated, except that military sexual assault was additionally associated with moderate-to-severe insomnia (OR 3.18, 95% CI 1.72–5.88).

Conclusions

Exposure to MST is common among midlife women Veterans and shows strong and independent associations with clinically significant menopause and mental health symptoms. Findings highlight the importance of trauma-informed approaches to care that acknowledge the role of MST on Veteran women’s health across the lifespan.

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Funding

This research was supported in part by VA Health Services Research & Career Development Award IK2 HX002402 (CJG), National Institute of Aging K24AG068601 (AJH), and VA Research Career Scientist Award IK6 CX002386 (ALB). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of California San Francisco Weill Institute for Neurosciences, San Francisco, CA, USA

    Kate J. Travis MD, Shira Maguen PhD, Sabra Inslicht PhD, Amy L. Byers PhD, MPH, Karen H. Seal MD, MPH & Carolyn J. Gibson PhD, MPH

  2. Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Alison J. Huang, Amy L. Byers PhD, MPH & Karen H. Seal MD, MPH

  3. San Francisco Veteran Affairs Health Care System, San Francisco, CA, USA

    Shira Maguen PhD, Sabra Inslicht PhD, Amy L. Byers PhD, MPH, Karen H. Seal MD, MPH & Carolyn J. Gibson PhD, MPH

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  1. Kate J. Travis MD
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Correspondence to Carolyn J. Gibson PhD, MPH.

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Conflict of Interest

Dr. Gibson has served as an unpaid consultant to Astellas Pharmaceuticals for projects unrelated to the current manuscript. The authors have no other disclosures to report.

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Prior presentations: Preliminary findings from this project were presented as part of a symposium.  “Trauma and Health among Midlife and Aging Women,” at the American Psychosomatic Society 2022 Annual Meeting.

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Travis, K.J., Huang, A.J., Maguen, S. et al. Military Sexual Trauma and Menopause Symptoms Among Midlife Women Veterans. J GEN INTERN MED 39, 411–417 (2024). https://doi.org/10.1007/s11606-023-08493-w

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  • DOI: https://doi.org/10.1007/s11606-023-08493-w

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