Study Finds Link Between Child Abuse And The Timing Of Menstruation

Based on a new study out of Boston University, it sure looks that way.

Researchers have uncovered a connection between child abuse and disruptions in the timing of menarche, the final phase of puberty, when menstruation begins.

The new findings, published online in The Journal of Adolescent Health, suggest that a woman's hormonal pathways can be derailed by trauma and stress; and the research underscores the importance of a comprehensive approach to treating abuse survivors in which the severity and specific type of violation is considered.

Renée Boynton-Jarrett, MD, assistant professor of pediatrics at the BU School of Medicine and the study's lead author, reports a 49 percent increase in risk for early onset menarche (defined here as menstrual periods prior to age 11) among women who reported childhood sexual abuse compared to those who were not abused.

Abuse was also linked to girls getting their first period later than average. The researchers report a 50 percent increase in risk for late onset menarche (menstrual periods after age 15) among women who reported severe physical abuse in childhood.

The prospective study included 68,505 women who were part of the well-known Nurses' Health Study.

Though the precise mechanism that might enable the act of child abuse to throw off the timing of menstruation wasn't examined here, Dr. Boynton-Jarrett said that trauma-related stress likely plays a major role.

"What we think is that different types of stress may either accelerate or delay timing of puberty because of its impact on the hormonal system in the body," said Boynton-Jarrett, whose research focuses on the enduring health impacts of adversities in childhood, including the connections between child abuse and obesity and abuse and fibroids. "Also, it appears that the effects of abuse are more diverse than we might have expected — not homogenous at all."

Indeed, the different types (physical or sexual) and severity (moderate or severe) of abuse were associated with unique timing problems related to first menstruation. Specifically, the study found:

-- Severe physical abuse was associated with a 22 percent increase in risk for early menarche.
-- Sexual touching was associated with a 20 percent increase in risk; and forced sexual activity was associated with a 49 percent increase in risk for early menstruation.

The researchers found no association between sexual abuse and late menarche, but did find what looks almost like a "dose-response" association between the severity of physical abuse and risk for late menstruation, after age 15.

All of this matters because it is becoming increasingly clear that a woman's age at the start of her reproductive cycle has all sorts of health implications. "Mounting evidence has established the significance of this once symbolic lever as both a footprint for chronic disease risk and compass for health and developmental trajectory," the new study says.

Early menarche, for instance, has been associated with a greater risk for breast cancer, all-cause mortality, metabolic disorders, cardiovascular disease, depression and certain high-risk behavior in adolescence, researchers note. While late periods have been linked to a higher risk for depression, mood disorders, low bone mineral density and bone fractures.

And, interestingly, although the initial onset of puberty appears to be declining, as has been recently reported, the age of menarche has remained fairly stable, beginning, on average, at age 12.

A major theme in Boynton-Jarrett’s work as a pediatrician and researcher is that “child abuse is a life course social determinant of health and associated with a significant health burden.”

So what's the additional benefit of studying this phenomenon in particular?

"We've thought of child abuse as this immediate insult and that there are these immediate effects of the trauma," she says. "But what this study shows is that there can be later effects of the trauma that can impact well-being through adolescence and into adulthood. Treatment, then, should be focused in a more comprehensive way that takes into account the type and severity of exposure as well as the other unique characteristics of the person and the social context."

She adds: "You'd think this [onset of menarche] was mainly determined by genetics but the fact that it can be determined by a social exposure should humble our response."