Associations of birth characteristics with perimenopausal disorders: a prospective cohort study.

M Gao,G Mishra,A Goodman,I Koupil

doi:10.1017/s204017441800065x

Abstract

Perimenopausal disorders (PDs) are prevalent and importantly affect quality of life among middle-aged women. Yet, very little is known about the developmental origins of these disorders. The objective of this study was to investigate the associations of birth characteristics with PDs. This cohort study is based on archived birth records for birth weight and gestational age, and followed prospectively in Swedish inpatient and outpatient registers for 8 years (n=3212). The main outcomes were menopausal and climacteric states (e.g. flushing, sleeplessness), perimenopausal bleeding and other PDs (e.g. atrophic vaginitis). Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for three subtypes of PDs separately. During the follow-up, 218 women had PDs, among whom 125 had menopausal and climacteric states, 61 had perimenopausal bleeding and 58 had other PDs as first recorded disorder. Birth weight was linearly associated with incidence rate of menopausal and climacteric states [HR=1.66 per 1 kg increase, 95% confidence interval (95% CI)=1.14-2.41]. Gestational age (rather than birth weight) was associated with incidence rate of other PDs (HR=0.87 per 1 week increase, 95% CI=0.79-0.95). Neither birth weight nor gestational age was associated with perimenopausal bleeding. Similar results were found after adjustment for other early-life and adult socio-demographic characteristics. This observational study provides, for the first time, evidence regarding the developmental origins of PDs. Future research is required to investigate the underlying causal mechanisms, which may shed further light on the etiology of this class of disorders.

Highlights

Perimenopausal disorders (PDs) result from variations in reproductive hormones levels or from gynecological lesions occurring during and after the menopausal transition period.[1,2,3]They typically present with a range of vasomotor, psychological, somatic and vaginal symptoms.[1,4,5] The International Classification of Diseases categorizes PDs into three main subtypes: menopausal and climacteric states; perimenopausal bleeding and other PDs
The current study addresses this research gap by using a wellestablished cohort, examining the developmental origins of three subtypes of diagnosed PDs recorded in the Swedish national patient registers, namely menopausal and climacteric states, perimenopausal bleeding and other PDs
125 were diagnosed with menopausal and climacteric states, 61 with perimenopausal bleeding and 58 with symptoms linked to atrophic vaginitis or other unspecified PDs, and 26 women received more than one PD diagnosis

Summary

Introduction

Perimenopausal disorders (PDs) result from variations in reproductive hormones levels or from gynecological lesions occurring during and after the menopausal transition period.[1,2,3]. They typically present with a range of vasomotor, psychological, somatic and vaginal symptoms.[1,4,5] The International Classification of Diseases categorizes PDs into three main subtypes: menopausal and climacteric states (e.g. flushing, sleeplessness, headaches and poor concentration); perimenopausal bleeding (i.e. abnormal vaginal bleeding in peri- and postmenopausal period) and other PDs (e.g. atrophic vaginitis, atrophy of cervix or endometrium and other unspecified disorders). These highly prevalent symptoms, and the corresponding disorders, can have a substantial negative impact on women’s general health and quality of life, with related costs to families, the health care system and society.[7,8] Understanding the etiology of clinical diagnosed disorders, including their potential developmental origins, is one important step towards reducing the health burden

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