Cisgender women are raised to see pain as their birthright. Menstruation can bring agonizing cramps and painful bloating. Pregnancy and birth are both fraught with agonies from the mild to the dramatic. Even menopause exacts a last toll with its hot flashes, mood swings, and vaginal dryness. It’s no wonder that women with chronic pelvic or abdominal pain might seek a quick fix to end their suffering.
However, in the rush for relief, some women may be glossing over an important link. New research has discovered that women who have been abused are more likely to get their ovaries removed.
Specifically, women with a history of abuse — but no serious illness per se — were 62 percent more likely to have their ovaries removed before the onset of menopause (i.e., “bilateral oophorectomy”). The study, published in BMJ Open, was the brainchild of Walter Rocca, a neurologist and epidemiologist at the Mayo Clinic.
Aware of a “large literature linking adverse experiences in the past with psychiatric and somatic conditions developing later in life,” Rocca and his colleagues set out to compare the history of women with bilateral oophorectomy to women who did not have the surgery.
Having both ovaries removed before the natural age of menopause without serious illness such as cancer is not advised, as it causes an abrupt and complete deficiency of estrogen and other hormones, and essentially “accelerates aging of all tissues and organs of the body,” said Rocca by email. This can lead to symptoms ranging from cardiovascular and metabolic diseases such as coronary artery disease, which leads to heart attacks, asthma, chronic obstructive pulmonary disease (COPD), osteoporosis, and more.
Women often present to their doctor with symptoms such as abdominal pain, excessive bleeding, or irregular bleeding. These are often benign conditions such as fibroids, said Rocca, but “the problem is that the women perceive their reproductive organs as a burden or a source of stress or discomfort” — as though removing them will ease more than just physical conditions. While the surgery is considered elective — sometimes patients ask for it, other times a physician recommends it — Rocca points out that “it is not performed to treat a specific disease of the ovaries.”
The problem is, women with a history of abuse are often unable to connect their present symptoms to their past history, and unlikely to know of the links between abuse and gynecological symptoms.
“Unfortunately even a superficial psychiatric evaluation may miss the problem completely because the women may not be able in a short time to share their history,” Rocca pointed out. Rocca sees this as a failing of modern medicine, since most physicians are pressed for time and are unable to collect a detailed medical history.
Of course, in a culture that often punishes women for speaking out about abuse or questions their validity, it’s no wonder women often avoid bringing up their history.
Elizabeth Jeglic, a clinical psychologist who teaches sexual violence prevention at John Jay College of Criminal Justice, said it may not be as simple as pointing the fingers at doctors. “I’m sure most medical professionals are acting within the ethics of their professions. Doctors either don’t have adequate training or it’s a process that takes time [for women] to realize their symptoms have something to do with abuse,” she said by phone.
Jeglic hopes women with a history of abuse will consider that “a doctor is not there to interrogate whether [abuse] is valid or not. It’s a much safer space than many others.” She encourages women to be as forthcoming as they can when seeking physical care, to allow for the widest possible range of treatment options.
“If a doctor suggests psychological treatment it doesn’t mean they don’t believe you — but it might be worth exploring as part of your treatment.”
