The already bothersome, and often painful, effects of menopause can be exacerbated by abuse from a spouse or partner and by post-traumatic stress disorder, according to a recent study published in JAMA Internal Medicine.

The study looked at 2,000 women in a California health system, all ages 40 to 80. In the United States, the average age for a woman to begin menopause is 51. A woman is considered to be in menopause after she has experienced 12 consecutive months without a menstrual cycle.

The researchers looked at whether the women had ever reported having experienced emotional or physical abuse, specifically from an intimate partner, or sexual abuse. They also noted whether a woman said she had current symptoms of PTSD.

Just over 20 percent of the women reported having suffered both abuse and PTSD. About 19 percent of the women had endured physical abuse alone, while around 15 percent said they had been sexually assaulted.

Each of these traumas made a woman more likely to experience some of menopause’s most difficult symptoms, compared with women who had none of these factors. The affected women reported greater rates of sleep disruptions, painful intercourse, hot flashes and night sweats.

Of course, women with no abuse or trauma in their past can and do suffer from these difficulties in menopause, and all women handle these hormonal disruptions in their own way.

But the study shows a significant number of women endure the hardships of menopause with additional physical and psychological burdens. The study’s authors said clinicians should recognize this when caring for midlife and older women, who might be reluctant to volunteer this important information.