An Executive Order signed in March 2024 put a strong emphasis on the role of evaluating and meeting the health needs of female service members and veterans.
According to the Executive Order on Advancing Women’s Health Research and Innovation, “the Secretary of Defense and the Secretary of Veterans Affairs shall evaluate the needs of women service members and veterans related to midlife health and shall develop recommendations to support improved treatment and targeted research of midlife health issues, including menopausal symptoms.” This Order was signed at a time as more data are emerging on the impact of military service on female health.
Stressful situations during military service are commonly reported among veterans, and these exposures have been linked with several potential adverse effects related to health, including reproductive health.
A study conducted with Persian Gulf War female military personnel and presented at the 2024 Annual Menopause Society held in Chicago demonstrates that women with probable posttraumatic stress disorder (PTSD) maybe as much as twice as likely to experience early menopause than women who were not in the Gulf War.
Caitlin Haas, who is a clinical research coordinator with the San Francisco VA Health Care System, reported on the findings at the Annual Menopause Society meeting, held in Chicago in September, noting that Gulf War deployment served as the focus of the study because of its link to health difficulties not found in nondeployed veterans of the same era. These include Gulf War Illness, which is characterized by joint pain, gastrointestinal issues, headaches, rashes, and mood symptoms speculated to be the result of environmental exposures to burn pits and oil fires.
This research utilizes data from the Gulf War Era Cohort Study, a prospective longitudinal study involving 30,000 veterans, including 668 women younger than age 45 years at the time of the 2012 data collection.
The primary objective of the study was to determine if early menopause, which is defined as menopause onset before age 45, is linked to military environmental exposures, such as smoke from fires and burning trash or feces. Early menopause is of concern because of its link with a number of negative health consequences, such as fertility loss, premature mortality, cardiovascular disease, osteoporosis, sexual dysfunction, and depression.
The researchers used logistic regression to calculate odds ratios for various exposures and their relationship to early menopause. The analytic sample included 668 women who completed the 1995 and 2012 surveys and were under age 45 years in 2012.
Haas and colleagues noted that 15% of the women in the study experienced early menopause, which is higher than the general population of 10%; women with PTSD were 2.5 times more likely to report early menopause; there were no significant associations between Gulf War deployment, Gulf War exposures, Gulf War illness, or military sexual trauma and early menopause.
The findings underscore the impact that military exposures, and trauma can have on reproductive health, and an increased need for monitoring of these situations, Haas and colleagues noted. The higher prevalence of early menopause among women veterans underscores the need for targeted menopausal care within the Veterans Affairs (VA) healthcare system.
Given the fact that women aged 45 to 64 years make up the largest group of women using VA care, at 46% compared with 15% in those women over the age of 65 years and 42% in those aged 18 to 44 years, and, that VA medical record data suggest hormone therapy use is 2 times that of the general community, it is crucial to address menopause as an important care consideration.2
Conclusion
These study findings emphasize the importance of recognizing and addressing the reproductive health needs of women veterans, particularly those affected by Gulf War Illness and PTSD.
“This study, among other things, highlights the need for healthcare professionals to thoroughly review their patients’ histories and be aware of any external stressors that could impact their menopause experience and related symptoms,” Dr. Stephanie Faubion, medical director for The Menopause Society, said in a press release about the findings.1
At a VA Women’s Health Research–sponsored discussion held earlier this year by Carolyn Gibson, PhD, MPH, MSCP, at San Francisco’s VA Health Care System, Gibson noted that findings like these underscore the importance of targeted screening.
“Menopause symptom burden is associated with chronic pain, psychoactive polypharmacy, and suicide risk, and may indicate underlying complex comorbidity,” she noted in her slides. “There is an opportunity for targeted screening, ongoing monitoring, and evaluation to optimize health among women presenting with bothersome symptoms.”
References
- The Menopause Society. Exploring the possible link between PTSD and early menopause. Press release. September 10, 2024. Accessed September 11, 2014. https://menopause.org/press-releases/exploring-the-possible-link-between-ptsd-and-early-menopause
- Gibson CJ, Patton EW. Veterans’ experience of menopause and menopause-related care: state of the research and future directions. Presented at: VA Women’s Health Research Network. July 31, 2024.
