Message to our Patients who are Survivors of Sexual Violence: The Impact of Trauma on Menopausal Symptoms

Why is the News about Sexual Violence Affecting Midlife Women

The recent events can be particularly impactful for menopausal aged women who are survivors of sexual violence for many reasons:

Generational trauma and misogyny. 

The generation of women who are Boomers and Gen Xers grew up in a world where opportunities and personal safety diverged for girls starting early in life. Despite the protections that were mandated in educational institutions in 1972 with Title IX, it was still very socially acceptable for girls and young women to be victims of sexual harassment and violence, whether coming from inside their home, with romantic partners, or in the workplace. The message reinforced to women and girls was pretty clear:  if you were a victim of sexual assault then it was your fault for enjoying a drink, wearing provocative clothing, or being negligent by accessing spaces (including anywhere at night or alone) that were off limits to you. Additionally, girls were ridiculed for their bodies and the natural hormonal changes of puberty (that was repeated later as older women in menopause), due to systemic misogyny that became internalized as shame and guilt.  Lastly, there was pressure from society to cover up any sexual violence experienced by girls and women in order to smooth things over for the perpetrators or institutions involved – in other words, don’t break apart a family, call out an upstanding person, demote a leader or disrupt an office by bringing up your victimization. Additionally, there were strong disincentives to get justice or hold perpetrators accountable. In Pagan Kennedy’s book, The Secret History of the Rape Kit: A True Crime Story, she enlightens us with the culture of obstruction and gaslighting towards victims of sexual assault in the late 20th century, that still continues today. It was just too often accepted that a woman’s lot in life was to suffer these traumatic experiences as a girl or young adult and nothing could be done. Unfortunately, this was strongly present in police departments where victims were not believed and discouraged from reporting or pressing charges for gender based violent crime, like rape. This attitude perpetuated gender based violence on a massive scale as perpetrators or sexual assault or abuse could repeatedly harm and get away with it. A lot has changed for the good in trusting survivors since the Me Too movement started by Tarana Burke in 2006 and the SAFER Act of 2018 to address the shameful national backlog of untested rape kits, but not enough. When hearing these appalling reports of sexual violence in the news, many women from these midlife generations are being triggered as they recall past traumatic experiences that were suppressed or never fully resolved.

Being parents and grandparents.

This same generation of women are also now mothers and grandmothers. When teaching about trauma, I often say that our collective or historical trauma often comes from our families of origin or the groups with whom we identify; so, even if one has personally not experienced discrimination or abuse, just knowing that someone who shares the same identity with you and has been harmed because of that identity, is a source of trauma.  When stories of such depravity and evil being committed against children and young adults are reported, it’s not a big leap to consider how there are still hidden, undisclosed predators out in the world who could and would do that to children, maybe even yours. That is why this tragedy, even if decades old, has become so very personal to so many middle-aged women, even if not impacted by sexual violence themselves, and is causing them tremendous collective trauma.

I want to acknowledge here that exploitation and abuse is ongoing and although the stories being reported now are extreme, this level of violence and torture is not unusual for victims of trafficking. I’m not saying this to minimize what happened to these now adult women, but to remind us that every single day in this country violent actions are happening to children and teens being trafficked right now. These trafficking victims don’t get the national attention because they are disproportionately the most marginalized among us: young women and children who are Black, Latinx or Indigenous/Native American, undocumented immigrants, runaways/foster youth, and individuals with substance use or mental health disorders. Too often society has found it easier to look away, rather than help these victims or deal with the systems and institutions that promote oppression and lead to the exploitation of the most vulnerable by those with the most power.

History of Medical Gaslighting  

Menopause transition itself is a period of feeling disconnected from self and having heightened body shame due to the changes, like weight gain, acne, and new body odors, caused by hormonal alterations (“midlife puberty”). Disrupted sleep, brain fog, weight gain, erratic cycles, sexual dysfunction and other odd symptoms can also contribute to a disconcerting sense of loss of control and diminishing confidence. A loss of control is also a common feeling shared by individuals who have had highly traumatic experiences. 

Survivors with trauma histories have higher depression and PTSD rates in perimenopause and menopause, as well as more severe menopausal symptoms, including vasomotor symptoms. (1) However, when seeking help for these severe symptoms and mood alterations, many menopausal survivors are retraumatized when they experience the minimization of their symptoms and gaslighting from medical professionals. These similar responses from those in positions of power to their distress reinforces the past trauma of being silenced or not believed and denying the magnitude of their suffering.

What is a Trauma Reaction?

In menopause, due to normal hormonal changes, there is a heightened activation of the sympathetic nervous system at baseline which leads to symptoms like anxiety, panic attacks, insomnia, feeling wired, palpitations, flushing or sweats. (2)  These physical symptoms can be exacerbated by the sympathetic system being triggered further during trauma reactions. If you have recently been having unexpected or worsening menopausal symptoms, it may not be that  your hormone levels are suddenly off, but that you are experiencing similar symptoms from your sympathetic nervous system being in overdrive.

Trauma reactions can also present as flight, fight, freeze and fawn responses. Think about how you are reacting when reading about the latest batch of released emails: Do you find your mind racing and feel scattered like you can’t concentrate? Are you wanting to curl up in a ball and hide under the covers? Are you feeling immobilized and frozen with inability to start tasks or accomplish anything? Are you spending hours on social media enraged and yelling at those who are protecting the abusers? Are you overcompensating for your pain and trying to take care of everyone and everything but yourself? These can all be ways we deal with trauma due to the flooding of neurochemicals in our bodies due to the connections our brains make in response to sensing information we recognize as being dangerous in our past.

What can You do to Protect Yourself?  

Taking care of yourself during this time as a survivor (or an ally) can be difficult. It is helpful to not be consumed by the news every hour of every day. I am not saying to look away or ignore the information as I strongly believe we must all be witnesses to these events. The way we can best support these brave survivors is by acknowledging their suffering and continuing to demand accountability. 

However, what you can do as a survivor (or ally) who might be easily retraumatized is:

1) Limit your time spent on social media or however you get your updates on the news.  Set aside some time, 30 minutes or less a day, to review, respond if you feel the need, and then move on to something that brings you joy or supports you or humankind.

2) Don’t feel you have to read every email or look at every photo released as that is not required to be a witness. You can find a reputable source that can relay what has come out without all the sordid details. You already know how depraved sexual violence is, so limit the repeat exposure to protect your brain, heart and soul. 

 3) Try not to engage in the culture of fear, anger and hate that is at the core of violence against others. I am not saying to not be angry. You have every right to be irate and to express that to whomever will listen, preferably those in power to hold perpetrators of violence accountable. What I encourage for survivors and allies is, if you can, to not make that your 24-7 emotion. Instead use some percentage of that pissed off energy that motivates you to push for changes in our culture of misogyny, to demand justice and to promote healing for those harmed in the past and also to protect those being harmed right now. 

4) Do breathing and grounding exercises daily or use Apps like Calm or Headspace or Buddhify. These can help calm your sympathetic nervous system and help ease some of the emotional and physical symptoms that you might be feeling. Please give yourself a big self-hug and be gentle on yourself during this time and always. 

We have a choice to focus on these events all the time or just some of the time. I believe it is more constructive to use most of our energy engaging in acts of kindness and generosity towards others and protecting those who are the most vulnerable to exploitation. Positive, uplifting actions have a ripple effect which uproots those who have such a strong need for power and control over others that is at the root of most gender-based violence. However, keeping aware and demanding accountability of abusers now will ultimately help counter the exploitation and violence happening to those being victimized right now and in the future.

So, for our survivor patients, I hope this has helped you understand why you may have been feeling so much more physical distress or wondering why your menopausal symptoms have intensified recently. Please know that the doctors and staff at Alloy believe you. We see and recognize your pain. We commit to being your ally, to listen to your concerns, and to not be part of the gaslighting and silencing that you may have experienced when seeking menopausal care in the past. 

Dr Traci Kurtzer is an anti-trafficking medical expert and the immediate past president of the American Medical Women’s Association - Physicians Against the Trafficking of Humans (AMWA-PATH). - link to bio. 

References

1.    Arnold, A. et al. A systematic review on the bidirectional relationship between trauma related psychopathology and reproductive aging. J Mood Anxiety Disord 2024;8:100082.

2.    Hautamaki, H. et al. Cardiovascular autonomic responsiveness in postmenopausal women with and without hot flashes. Maturitas 2011; 68: 368-73.