Abdominal pain during the menopause transition and early postmenopause: observations from the Seattle Midlife Women\u2019s Health Study

Nini G L Callan,Margaret M Heitkemper,Ellen S Mitchell,Nancy F Woods

doi:10.1186/s40695-019-0046-5

Abstract

ObjectiveTo assess the relationship between abdominal pain severity during the menopausal transition (MT) and age, MT stage, reproductive biomarkers, stress biomarkers, and stress perceptions.MethodsWomen ages 35–55 were recruited from multiethnic neighborhoods in the greater Seattle area from 1990 to 1992, for an original study cohort of 508. From 1990 to 2013, a subset of this cohort consented to ongoing annual data collection by annual health questionnaire, health diary, and daily menstrual calendar. Beginning in 1997, a portion of these women also provided a first morning voided urine specimen to be assayed for levels of estrone glucuronide (E1G), follicle stimulating hormone (FSH), testosterone, cortisol, norepinephrine, and epinephrine. To identify how changes in abdominal pain severity changed over time in relation to age, MT stage, reproductive biomarkers, stress-related biomarkers, and stress-related perceptions, mixed effects modeling was used.ResultsIn a univariate model, E1G (p = 0.02) and testosterone (p = 0.02) were significantly and negatively related to abdominal pain severity, while perceived stress (p = 0.06), tension (p < 0.001), and anxiety (p < 0.001) were significantly and positively associated. In a multivariate model, increasing age (p = 0.001) and E1G (p = 0.04) were negatively associated with abdominal pain severity, and anxiety (p = 0.00) positively associated. Testosterone did not improve the fit to the final model, nor did tension or perceived stress.ConclusionsThese results suggest that age, anxiety, and E1G each show a significant association with abdominal pain severity in the MT. In contrast, stress perception, tension, testosterone, stress biomarkers, and MT stage do not. These factors should be evaluated further in research on abdominal pain experienced during the MT and early postmenopause years.

Highlights

In the United States (US), it is estimated that approximately 3 million women enter into the menopause transition (MT) each year [1]
Women included in the analyses had more formal education and higher income, and were more likely to describe themselves as White, than those who were ineligible for inclusion
The results presented here are the first reported on abdominal pain experienced during the MT and early Early postmenopause (PM) captured in a longitudinal study, the analysis of which involved multiple repeated measures of symptom severity, MT stages, reproductive hormone biomarkers, stress-related biomarkers, and stress-related perceptions

Summary

Introduction

In the United States (US), it is estimated that approximately 3 million women enter into the menopause transition (MT) each year [1]. In a representative sample of 4581 Danish men and women of varying ages, abdominal pain occurred significantly more often among women compared to men (49%, versus 38%), resolved less frequently in women compared to men (31% versus 43%), and revealed a decrease in prevalence with advancing age, starting with highest prevalence occurring in the age 30 group and lowest prevalence occurring in the age 60 group for both women and men (52 and 48% versus 43 and 30%) [8] These findings suggest sex- and age-specific etiological factors in the development of abdominal pain. It is unclear whether abdominal pain experienced in the MT is due to the normal aging process, or to the physiological changes specific to the MT (i.e. decreasing estrogen and progesterone due to follicular depletion in the ovaries, and increasing FSH.) [9, 10]

Methods

Results

Conclusion