Violence against women (VAW) includes all psychological abuse, coercion, threats and violent acts of any kind (sexual or physical) [1]. Increasing evidence suggests that it is a global pandemic [2, 3].

The scale of the problem is reflected in the fact that more than one million women of all ages in the West have experienced VAW in recent years. In addition to those killed by VAW, the high number of women who are severely disabled by VAW is also of concern [4, 5].

Hormonal disturbances after VAW have also been described, so it is important to determine whether these are prolonged, and whether their consequences are like those of hypoestrogenism [6, 7].

In addition, VAW at any time in life has been found to worsen menopausal symptomatology and physical and sexual health conditions in later life [8, 9].

Given these observations, we propose the Hormonal Impact Maltreated European Mujer (HIMEM) study, which aims to make VAW visible in women’s health consultations in general and in endocrine gynaecology in particular. Furthermore, we suggest that active screening for VAW should be considered in any situation, particularly in women with symptoms of hypoestrogenism or impaired sexual function. In addition to the direct consequences of VAW, these women are at increased risk for other disabilities, which are sufficiently disturbing to warrant concern.

The HIMEM project began in 2021, but for reasons related to the COVID pandemic, the women contacted who have suffered from VAW were not attended to until February 2022. Apart from this impediment, the main difficulty encountered at the beginning of the project was the lack of collaboration from the affected women, not so much because of the discomfort of the project itself but because of the shame and fear felt by most of the participants.

Nonetheless, it has been possible to contact most women currently being monitored in one of the most representative gender violence units in our study area. As this is the first centre of its type and because it includes almost all the women being treated for gender violence in that region, we will report on the characteristics and challenges faced by 23 survivors of VAW. This was their experience.

All of them have suffered VAW in the family environment, by their partners or ex-partners. Apart from unanimously agreeing that they are ashamed and fearful of the VAW they have suffered, they have all excluded sexuality from their lives. Put simply, none of them have fully recovered their sexuality. Part of the study involves analysing the participant’s responses to a FSFI. This test revealed that all participants have “severe sexual dysfunction”. And while this is an expected finding for a discipline such as ours, it is still a remarkable and significant observation.

In addition to generalised sexual dysfunction, all the women observed reported menstrual irregularity (including two cases of premature ovarian failure) since the VAW episode. Although most of them have children (now in their care), half of them have acknowledged reproductive difficulties while living with their aggressor.

Half of the women who attended were of menopausal age or had reached menopausal status after VAW, and all reported much more intense symptoms than normal. More than 80% reported taking psychotropic drugs.

Recorded hormonal levels indicate hypoestrogenism and a decline in DHEA in 80% of the women observed. In addition, osteoporosis has been diagnosed by bone densitometry in 40% of the sample.

From a demographic standpoint, almost all the women affected admitted to having the minimum income indicated in this survey (less than €1000 per month). These figures were reported after the VAW episode because if we look at their income pre-VAW, it does not point to any particularly unprotected sector of the population. In addition, no differences were found between women from rural and urban areas.

Similarly, women of higher economic, social, cultural, and education level are not protected against VAW.

Despite the growing importance of VAW for overall health, few studies have focused on its gynaecological measures, particularly regarding the health problems resulting from the cessation of endocrine function in women. Therefore, this project aims to determine what percentage of women who have experienced VAW show hormonal alterations (mainly hypoestrogenism) and the associated consequences.

Apart from the physical or psychological consequences of VAW, women are also at greater risk of other injuries and disabilities [10, 11].

The great strength of this project lies in the analysis between VAW and any ovarian cycle disorders that could be responsible for endocrine or reproductive problems of various types, including symptoms of hypoestrogenism, anovulation, reproductive difficulty, menstrual alterations, and late consequences of hypoestrogenism such as osteoporosis, cognitive deterioration, or cardiovascular disease. In addition, some conditions already seem to be recognized as being caused by VAW, such as sexually transmitted infections, vaginal bleeding, pelvic pain, and urinary tract infections, together with an increased risk of cervical cancer [12, 13].

This project was initially designed for Spanish women who have suffered abuse and has already been approved by two different ethical committees. However, our goal is to develop a project of supranational scope, with the possibility of extending our sample and collaborating with other Spanish or European clinical research groups on women’s health.

VAW is a pandemic that affects all women equally, regardless of their age, status, social background, or education. Despite the claims made by certain groups, VAW does not depend on women, but rather it affects women and is clearly harmful to their sexual, reproductive, and general health.

All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.

LMH, NM—conception and design of the idea, data interpretation, statement and approved the final version of the manuscript.

This study protocol was reviewed and approved by the Ethics and Research Committees of the provinces of Granada (code number: 6hWMS752PFIRMAVHc6wPtZT2+f1x4Y) and Jaen (23.Feb 21.CEI). Written informed consent was obtained from participants to participate in the study.

This article has been translated and edited by Your English Lab.

The project has received financial support from the Vice-rectorate for Equality of the University of Granada (grant number CTS.515-30G5700009).

The authors declare no conflict of interest. NM is serving as one of the Guest editors of this journal. We declare that NM had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to MHD.