SAN FRANCISCO — Female military personnel from the Persian Gulf War with probable post-traumatic stress disorder (PTSD) are nearly twice as likely to experience early menopause and related health consequences, according to study results presented at the 2024 Annual Meeting of The Menopause Society in Chicago in September.
The longitudinal study, titled “Military Exposures and Early Menopause: Findings from the Gulf War Cohort Study,” investigated the relationship between military exposures and early menopause among Persian Gulf War women veterans. A research paper with these results has been submitted to a peer-reviewed journal for publication. Study authors are affiliated with San Francisco (CA) VA Health Care System.1
In the study’s abstract, the authors explained that “chronic stress and environmental exposures may advance biological aging, including premature ovarian aging. Psychological and environmental stressors from military service could leave women veterans at risk for early menopause, which is menopause prior to age 45. Early menopause is associated with negative health consequences such as fertility loss, premature mortality, cardiovascular disease, osteoporosis, sexual dysfunction and depression.”
Female veterans of the Persian Gulf War “have unique military exposures, and Gulf War deployment (1990 to 1991) has been linked to health complications not observed in nondeployed veterans of the same era, such as Gulf War Illness, which results from environmental exposures including burn pits and oil fires, according to experts. Military sexual trauma, which is described as sexual assault and/or sexual harassment during military service, is a common military exposure strongly associated with PTSD. Military sexual trauma and PTSD, both linked to menopause symptom burden, may underlie premature ovarian aging, but their impact on early menopause has not been formally assessed,” the study authors pointed out.
This population-based cohort study, conducted by the VA Office of Health Outcomes Military Exposures, examined data from more than 2,000 veterans deployed to the Persian Gulf and nondeployed veterans of the Gulf War era. Three waves of data were included: an initial survey in 1995 and assessments in 2005 and 2012. Veterans included in the study were women ages 45 or younger in 2012. Military exposures were drawn from the 1995 baseline (Gulf War deployment, environmental exposures, Gulf War Illness and military sexual trauma identified by self-report). Probable PTSD was determined by a validated measure, the PTSD Checklist—Civilian Version, PCL-C. Early menopause was determined by self-reported menopause at the 2012 follow-up. The authors examined associations between military exposures and early menopause, adjusted for age, race and ethnicity.
Early Menopause More Likely
“In our sample, women veterans who met criteria for probable PTSD at baseline were nearly twice as likely to report early menopause (before age 45) at follow-up,” Caitlin Haas, lead researcher and a clinical research coordinator at the San Francisco VA Health Care System, told U.S. Medicine. “We know that Gulf War women veterans have unique health outcomes not found in women veterans of other service eras, but this research is still in its infancy. Military environmental exposures from the 1990-1991 Gulf War included persistent organic pollutants, industrial chemicals, and combustion byproducts (for example, smoke from oil well fires, burning trash/feces).”
“While these environmental exposures in military settings have not been previously examined in this context, similar environmental exposures from nonmilitary settings have been previously linked to hormone-related cancers and gynecological disorders as well as ovarian dysfunction and oocyte destruction, which may contribute to accelerated ovarian aging, in civilian populations,” Haas said. “However, impacts of Gulf War service on the timing of menopause have not been evaluated. In our study, we sought to examine links between military environmental exposures and trauma exposures on early menopause.”
The mean age of the study participants in 1995 was 31.39 years old. The majority were non-Hispanic White (61.1%), with 31.8% non-Hispanic Black, 3.5% Hispanic and 3.6% non-Hispanic women of other races. The veterans reported environmental exposures (65%), Gulf War Illness (61%) and military sexual trauma (22%), and 27% met criteria for probable PTSD. Just over 5% of participants had experienced early menopause, the study abstract reported.
Women veterans might benefit from menopause care with attention to veteran-specific considerations such as PTSD and Gulf War illness, Haas explained. However, she notes the study doesn’t have enough data for the authors to make recommendations to healthcare professionals based on this study alone.
“We know menopause care is important for our midlife women veterans, but if Gulf War women veterans are more likely to undergo early menopause, we may need to think about providing menopause care to younger women veterans, as well,” she said.
“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,” Stephanie Faubion, MD, MBA, medical director for The Menopause Society, said in a press release about the study.
More research is needed to determine whether these results are replicated in other studies with samples of both Gulf War women veterans and women veterans of other service eras, Haas pointed out. Replication in larger samples using a more detailed assessment of age at menopause is needed, the study authors wrote in the abstract.
While there’s very little data about the prevalence rate of early menopause in women veterans, the authors suspect it may equal or exceed the estimated prevalence of early menopause in U.S. women generally (5 to 10%) due to known risk factors of early menopause common to women veterans, such as cigarette smoking and high rates of hysterectomy (surgical menopause), she added.
“We also know that trauma exposures common to women veterans, such as PTSD and military sexual trauma, may have widespread downstream effects on reproductive health,” according to Haas. “Past work links trauma exposure to adverse reproductive health outcomes such as infertility, miscarriage and pregnancy complications. These may be caused by stress-related biological dysregulation, inflammation and endocrine function dysregulation. We speculated that abnormal functioning of these pathways could lead to premature ovarian aging.”
- Haas C., Gibson, C., Cao G., Inslicht S., Altman A., Schneiderman A., Dursa E. Military Exposures and Early Menopause: Findings from the Gulf War Cohort Study. 2024 Annual Meeting of The Menopause Society, 2024 Sept.
