The menopausal transition: a dynamic approach to the pathogenesis of neurovegetative complaints

Abstract

In our cross-sectional study we investigated the separate influence of three main factors, namely menopausal and estrogen status, and chronological age, on ten neurovegetative climacteric complaints reported in the scale of Kupperman et al. A multivariate statistical analysis was performed by a multivariate statistical approach on 1161 untreated women seen at the Menopause Center of the Ferrara University Hospital. Ninety women (age range, 41–54 years) were premenopausal; 492 women (age range, 38–55 years) were perimenopausal with irregular periods or amenorrhea for less than 12 months; 468 women (age range, 41–69 years) had a spontaneous menopause (age range, 37–66 years); 111 had had hysterectomy with bilateral ovariectomy while still regularly menstruating. Serum estrone was used as the indicator of the patients' estrogen status. A clear positive trend was demonstrated between menopausal status and the prevalence of depression, hot flushes, insomnia and joint pain. However, only the prevalence of hot flushes amongst these four symptoms was significantly related with the climacteric estrogen decline (β = −0.006, P = 0.001). Moreover, menopausal status appeared to influence the intensity of fatigue, hot flushes, insomnia and paresthesia. Age was found to significantly ( P = 0.053) co-vary only with the intensity of the hot flushes, with a positive relation (β = 0.092, r = 0.104, P = 0.003), whereas estrone values did not significantly co-vary with any symptom. Furthermore, while neurovegetative symptoms are largely present also in the absence of hot flushes, when these latter are present, they exacerbate both the intensity and the prevalence of all the other symptoms. We conclude that hot flushes seem to act on all of the other neurovegetative symptoms in two fashions. First, they elicit complaints already sub-clinically present; second, they worsen neurovegetative complaints clinically present. Menopausal status, on the other hand, appears to significantly influence both the prevalence and the intensity of hot flushes, whereas estrogen decline significantly influences the prevalence but not the intensity of this symptom, which appears to be related only to age.