Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA; Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
J Psychosom Res. 2022 Aug;159:110947. doi: 10.1016/j.jpsychores.2022.110947. Epub 2022 May 21.
Earlier menopause, either natural or through gynecologic surgeries, has been associated with various negative health sequelae. While posttraumatic stress disorder (PTSD) has been linked to dysregulated biological processes, including reproductive system changes that could alter menopausal timing, little work has examined whether trauma and PTSD are associated with greater risk of early cessation of menses.
Data are from 46,639 women in the Nurses' Health Study II, a prospective cohort study of women followed for up to 26 years. Lifetime trauma and PTSD symptoms were assessed with the Brief Trauma Questionnaire and a PTSD symptom screener in 2008. Age at cessation of menses and reason for cessation of menses (i.e., natural menopause, gynecologic surgery including hysterectomy and/or bilateral salpingo-oophorectomy [BSO]) were assessed. Cox proportional hazards models estimated hazards ratios (HR) of cessation of menses (separately for naturally or surgically) associated with trauma alone or PTSD symptoms, relative to no trauma, adjusting for covariates.
Trauma/PTSD status was associated with earlier cessation of menses due to surgery, but not natural menopause. Women with trauma exposure, low, and high PTSD symptoms had higher hazard of cessation of menses due to surgery relative to those with no trauma exposure (HR = 1.16, 95%CI 1.07-1.26; HR = 1.25, 95%CI 1.15-1.36; HR = 1.29, 95%CI 1.17-1.42). Trauma exposure and PTSD symptoms were associated with similarly increased risk of hysterectomy and BSO surgeries.
Women who experienced trauma and PTSD may be at elevated risk for common gynecological surgeries premenopausally, potentially due to increased clinical indications or gynecological conditions.
无论是自然绝经还是妇科手术导致的早期绝经，都与各种负面健康后果有关。虽然创伤后应激障碍（PTSD）与失调的生物过程有关，包括可能改变绝经时间的生殖系统变化，但很少有研究探讨创伤和 PTSD 是否与更早停经的风险增加有关。
本研究数据来自护士健康研究 II（Nurses' Health Study II）中的 46639 名女性，这是一项针对女性的前瞻性队列研究，随访时间长达 26 年。使用简短创伤问卷（Brief Trauma Questionnaire）和 PTSD 症状筛查器在 2008 年评估终生创伤和 PTSD 症状。记录停经年龄和停经原因（即自然绝经、包括子宫切除术和/或双侧输卵管卵巢切除术[BSO]的妇科手术）。使用 Cox 比例风险模型，在校正协变量后，分别评估单独创伤或 PTSD 症状与自然或手术绝经相关的停经风险比（HR）。
创伤/PTSD 状态与手术引起的更早停经有关，但与自然绝经无关。与无创伤暴露的女性相比，有创伤暴露、低 PTSD 症状和高 PTSD 症状的女性手术绝经的风险更高（HR=1.16，95%CI 1.07-1.26；HR=1.25，95%CI 1.15-1.36；HR=1.29，95%CI 1.17-1.42）。创伤暴露和 PTSD 症状与子宫切除术和 BSO 手术的风险增加相似。
经历过创伤和 PTSD 的女性可能在绝经前面临更高的常见妇科手术风险，这可能是由于临床指征增加或妇科疾病所致。
