Elsevier

Obstetrics & Gynecology

Volume 96, Issue 3, 23 August 2000, Pages 351-358
Obstetrics & Gynecology

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A prospective population-based study of menopausal symptoms

https://doi.org/10.1016/S0029-7844(00)00930-3Get rights and content

Abstract

Objective: To identify symptoms that change in prevalence and severity during midlife and evaluate their relationships to menopausal status, hormonal levels, and other factors.

Methods: In a longitudinal, population-based study of 438 Australian-born women observed for 7 years with an 89% retention rate, 172 advanced from premenopause to perimenopause or postmenopause. Annual measures included a 33-item symptom check list; psychosocial, lifestyle, and health-related factors; menstrual status; hormone usage; and blood levels of follicle-stimulating hormone and estradiol (E2).

Results: Increasing from early to late perimenopause were the number of women who reported five or more symptoms (+14%), hot flushes (+27%), night sweats (+17%) and vaginal dryness (+17%) (all P < .05). Breast soreness-tenderness decreased with the menopausal transition (−21%). Trouble sleeping increased by +6%. The major change in prevalence was from early to late perimenopause, except for insomnia, which showed a gradual increase. Those variables most related to onset of hot flushes were number of symptoms at early perimenopause (P < .05), having an unskilled or no occupation (P < .05), more than 10 pack-years of smoking (P < .01), and decreased E2 (P < .01). The onset of night sweats increased with the change in E2 (P < .05). The onset of vaginal dryness decreased with more years of education (P < .05). Trouble sleeping was predicted by prior lower well-being (P < .01), belief at baseline that women with many interests hardly notice menopause (P < .01), and hot flushes (P < .01).

Conclusion: Although middle-aged women are highly symptomatic, the symptoms that appear to be specifically related to hormonal changes of menopausal transition are vasomotor symptoms, vaginal dryness, and breast tenderness. Insomnia reflected bothersome hot flushes and psychosocial factors.

Section snippets

Materials and methods

The study was approved by the Human Research Ethics Committee of The University of Melbourne, and procedures were in accordance with the ethical standards of the National Health and Medical Research Council. Subjects provided written informed consent for participation.

The study began in 1991 with the use of random telephone digital dialing to baseline interview 2001 Australian-born women between 45 and 55 years old and residing in Melbourne (71% response rate).2 Women at baseline who had menses

Results

The proportion of women who reported a particular symptom as bothersome in the previous 2 weeks for each category of menopausal status is given in Table 2.

By postmenopause, almost all women were reporting at least one symptom, and most were reporting five or more. The average total number of symptoms increased by 17%, from 4.2 to 4.9 (P < .001).

Figure 1 summarizes changes; 0 indicates no change. Severity scores for breast soreness were reduced in late perimenopause and postmenopause compared

Discussion

The findings of the present study were consistent with those of previous studies that middle-aged women were very symptomatic according to a checklist. Vasomotor symptoms were not the most frequently reported until 3 years after final menstrual periods. Our findings were similar to those of Avis et al,1 who reported the percentages of Massachusetts women who had five or more core symptoms as 23% for premenopausal women, 35% for perimenopausal women, and 32% for naturally postmenopausal women.

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    Funding sources: Public Health Research Project Grant from the National Health and Medical Research Council, Victorian Health Promotion Foundation, Australasian Menopause Society. Prince Henry’s Institute for Medical Research received a grant from Organon (Aust) Pty Ltd to measure the hormone levels.

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