Change In Menopausal Status Research Articles

Menopause and accelerated aortic stiffness

BackgroundThe menopausal transition is widely believed to increase the risk of cardiovascular disease, based on the notion that estrogen is cardioprotective in women. While aortic stiffness is an independent predictor of cardiovascular disease, it has been unclear whether this risk increases during menopause. ObjectiveThis study aimed to determine the association between changes in menopausal status and aortic stiffness. Main outcome measuresMenopausal status was classified using the Stages of Reproductive Aging in Women criteria in a stratified random sample of Australian women aged 40–80 years, at three time-points over 14 years (n = 469 in 2001–02 and 2005, and n = 323 in 2014). Aortic stiffness was measured non-invasively via carotid-femoral pulse wave velocity at each time point. Mixed modeling was employed to determine the independent associations between menopausal status and aortic stiffness accounting for multiple covariates including age, systolic blood pressure, heart rate, medications, cholesterol, waist circumference, smoking and diabetes status. ResultsThere was no evidence to support an association between the menopausal transition and an acceleration of aortic stiffness. However, there was an acceleration of aortic stiffness in the late (8+ years) postmenopause phase, after accounting for age and traditional cardiovascular risk factors (0.122 [95%CI: 0.106, 0.139] m/s/year; p < 0.001). ConclusionsThe menopausal transition is not associated with major changes in aortic stiffness beyond normal age-related effects. However, the clinically significant acceleration in aortic stiffness observed in late postmenopause may contribute to greater cardiovascular risk in this later life phase.Study registered in the Australian and New Zealand Clinical Trials Registry, reference ACTRN12618000005257.

Influence of the menopausal transition on polysomnographic sleep characteristics: a longitudinal analysis.

To evaluate how change in menopausal status related to spectral analysis and polysomnographic measures of sleep characteristics. The Study of Women's Health Across the Nation (SWAN) Ancillary Sleep Study evaluated sleep characteristics of 159 women who were initially pre- or early perimenopausal and repeated the assessment about 3½ years later when 38 were pre- or early perimenopausal, 31 late perimenopausal, and 90 postmenopausal. Participants underwent in-home ambulatory polysomnography for two to three nights. Average EEG power in the delta and beta frequency bands was calculated during NREM and REM sleep, and sleep duration, wake after sleep onset (WASO), and apnea hypopnea index (AHI) were based on visually-scored sleep. The women who transitioned to postmenopause had increased beta NREM EEG power at the second assessment, compared to women who remained pre-or early premenopausal; no other sleep measures varied by change in menopausal status. In multivariate models the associations remained; statistical controls for self-reported hot flashes did not explain findings. In secondary analysis, NREM beta power at the second assessment was greater among women who transitioned into the postmenopause after adjustments for initial NREM beta power. Sleep duration and WASO did not vary by menopause transition group across assessments. Consistent with prior cross-sectional analysis, elevated beta EEG power in NREM sleep was apparent among women who transitioned to postmenopause, suggesting that independent of self-reported hot flashes, the menopausal transition is associated with physiological hyperarousal during sleep.

Phthalate exposures and one-year change in body mass index across the menopausal transition

BackgroundThe menopausal transition is a hormonally sensitive period associated with changes in body weight. Phthalates are ubiquitous endocrine disrupting chemicals that could disrupt weight homeostasis, but it is unknown whether this occurs during the menopausal transition. ObjectivesOur objectives were to (1) determine if phthalate exposure in pre- and perimenopausal women was associated with one-year change in body mass index (BMI), and (2) determine if these associations differed across the menopausal transition. MethodsWe addressed our objectives using data from 524 participants enrolled in the Midlife Women's Health Study. We calculated change in BMI from baseline to first follow-up visit approximately one year later. Phthalate exposures were approximated by measuring urinary metabolites in pools of two-to-four spot urine samples collected across a four-week period at baseline. We molar-converted and summed mono-(2-ethylhexyl) phthalate (mEHP), mono (2-ethyl-5-hydroxyhexyl) phthalate (mEHHP), mono (2-ethyl-5-oxohexyl) phthalate (mEOHP), and mono (2-ethyl-5-carboxypentyl) phthalate (mECPP) to approximate exposure to di-(2-ethylhexyl) phthalate (∑DEHP); ∑DEHP, mono (3-carboxypropyl) phthalate (mCPP), and monobenzyl phthalate (mBzP) to approximate exposure to plasticizer phthalates (∑Plastics); and monoethyl phthalate (mEP), monobutyl phthalate (mBP), and monoisobutyl phthalate (miBP) to approximate exposure to phthalates from personal care products (∑PCP). We used multivariable linear regression models to evaluate associations of specific gravity-adjusted ln-transformed phthalate metabolites or sums with one-year BMI change, and also considered whether associations differed depending on each woman's menopausal status change from baseline to first follow-up. ResultsAt baseline, most women were premenopausal (67.8%), non-Hispanic white (67.9%), and college educated (65.8%). Overall, urinary phthalate metabolites or sums were not associated with one-year BMI change. Stratified analysis identified positive associations between ∑DEHP (and three of its metabolites: MEHP, MEHHP, and MEOHP) and one-year BMI change among women who transitioned from peri-to post-menopause from baseline to first follow-up. For example, in these women, with each doubling of ∑DEHP, BMI increased by 0.65 kg/m2 (95%CI: 0.17, 1.13) from baseline to first follow-up. Personal care product-associated phthalate metabolites (mBP and mEP) were negatively associated with one-year BMI change among women who remained perimenopausal from baseline to first follow-up, while miBP and mEP were positively associated with one-year BMI change among women who transitioned from peri-to post-menopause. ConclusionWe found the strongest associations between some phthalates and one-year BMI change in women who transitioned from peri-to post-menopause from baseline to first follow-up. This supports previous evidence that the menopausal transition is a hormonally sensitive period in women's lives. To establish whether phthalate exposure contributes to body weight changes associated with the menopausal transition, substantially more research is needed to corroborate our findings.

Metabolic syndrome, not menopause, is a risk factor for hypertension in peri-menopausal women

BackgroundIt has been long debated whether menopause itself is a risk factor for hypertension in peri-menopausal women. We aimed to assess the association between menopause and hypertension, and whether metabolic syndrome (MetS) has an influence on its effect.MethodsData for 1502 women aged 42 to 53 from the Korean Genome and Epidemiology Study (KoGES) database were retrospectively analyzed. The KoGES database consists of 10,038 participants, of which 52.6% (5275) were female. Subjects were followed up for 4 years, and compared according to menopausal status. Additionally, 1216 non-hypertensive subjects were separately analyzed to assess whether a change in menopausal status was associated with development of hypertension.ResultsThe prevalence of hypertension, diabetes, and MetS for menopausal and non-menopausal subjects at baseline was 24.4% vs. 16.7%, 5.8% vs. 2.9%, and 25.4% vs. 16.6%, respectively (p < 0.01 for all comparisons). Among non-hypertensive subjects at baseline, prevalence of hypertension at 4-year follow-up was 9.4%, 19.7%, and 13.1% for non-menopausal, those who became menopause during follow-up, and those who were menopause at baseline, respectively. Development of hypertension was positively correlated with MetS (HR 3.90, 95% CI 2.51–6.07) and increased BMI (HR 1.09, 95% CI 1.03–1.16), while association with menopause was not significant.ConclusionsMenopause is closely associated with increased incidence of hypertension, but the increase may not be attributable to menopause itself but to increased prevalence of MetS.

Perceived stress across the midlife: longitudinal changes among a diverse sample of women, the Study of Women\u2019s health Across the Nation (SWAN)

BackgroundIn women, midlife is a period of social and physiological change. Ostensibly stressful, cross-sectional studies suggest women experience decreasing stress perceptions and increasing positive outlook during this life stage. The aim of this paper was to describe the longitudinal changes in perceived stress as women transitioned through the midlife.MethodsPremenopausal women (n = 3044) ages 42–52 years at baseline, were recruited from seven sites in the Study of Women’s Health Across the Nation, and followed approximately annually over 13 visits with assessment of perceived stress and change in menopausal status. Longitudinal regression models were used to assess the effects of age, menopausal status and baseline sociodemographic variables on the trajectory of perceived stress over time.ResultsAt baseline, mean age was 46.4 ± 2.7 years; participants were white (47%), black (29%), Hispanic (7%), Japanese (9%), or Chinese (8%). Hispanic women, women with lesser educational attainment, and women reporting financial hardship were each more likely to report high perceived stress levels at baseline (all p < 0.0001). After adjustment for baseline sociodemographic factors, perceived stress decreased over time for most women (p < 0.0001), but increased for both Hispanic and white participants at the New Jersey site (p < 0.0001). Changing menopausal status was not a significant predictor of perceived stress.ConclusionsSelf-reported stress decreased for most women as they transitioned across the midlife; changing menopausal status did not play a significant role after adjustment for age and sociodemographic factors. Future studies should explore the stress experience for women by racial / ethnic identity and demographics.

Validity of Danish Breast Cancer Group (DBCG) registry data used in the predictors of breast cancer recurrence (ProBeCaRe) premenopausal breast cancer cohort study

Background: Validation studies of the Danish Breast Cancer Group (DBCG) registry show good agreement with medical records for adjuvant treatment data, but inconsistent recurrence information. No studies have validated changes in menopausal status or endocrine therapy during follow-up. In a longitudinal study, we validated DBCG data using medical records as the gold standard.Material and methods: From a cohort of 5959 premenopausal women diagnosed during 2002–2010 with stage I–III breast cancer, we selected 151 patients – 77 estrogen-receptor-positive and 74 estrogen-receptor-negative – from three hospitals. We assessed the validity of DBCG registry data on patient, tumor, and treatment factors, and follow-up information on menopausal transition, changes in endocrine therapy, and recurrence. We computed positive predictive values (PPVs) with 95% confidence intervals (95%CI).Results: Agreement was near perfect for tumor size, lymph node involvement, receptor status, surgery type, and receipt of radiotherapy, chemotherapy, or tamoxifen treatment. The PPV for a change in endocrine therapy in the DBCG was 96% (95%CI = 83, 100). The PPV for menopausal transition was 61% (95%CI = 42, 77). The PPV for DBCG-recorded recurrence was 100%. However, of 19 patients who had a recurrence documented in their medical record, 13 had the recurrence registered in DBCG.Conclusions: DBCG data are valid for most epidemiological studies of breast cancer treatment. Data on menopausal transition may be less valid, though this interpretation depends on the suitability of medical records for making this assessment. Although recurrence is missing for some, this would not bias most ratio measures of association.

Influence of Menopause and Fat Mass Distribution on Lipids and Lipoproteins in Normal-Weight Obese Women

Normal-weight obesity (NWO), defined as a normal body mass index (BMI), but possessing a high body fat percentage (BF), has been associated with increased risk for cardiovascular disease (CVD) comparable to women with obesity. Following menopause, fat redistribution and increased risk for dyslipidemia are common; however, the effect of menopausal-related shifts in fat distribution and lipids and lipoproteins in NWO women remains to be determined. PURPOSE: To determine the influence of menopausal status on changes in regional abdominal and hip fat masses and lipids and lipoproteins in NWO women. METHODS: Sedentary, non-smoking women (n=214), not taking medications for the treatment of dyslipidemia, were grouped based on two categories: 1) menstrual status: premenopausal (PRE) or postmenopausal (POST) and 2) BF status: non-obese (BMI <25 kg/m2 and BF <36%), NWO (BMI <25 kg/m2 and BF >36%), or obese (BMI >25 kg/m2 and BF >36%). Fasting (12 hr) serum samples were analyzed for lipid and lipoprotein-cholesterol concentrations. Percent BF and abdominal and hip regional fat masses were quantified by DXA. A 2x3 ANOVA was used to identify differences between groups. Statistical significance was set at P<0.05. RESULTS: Independent of menopausal status, both abdominal and hip fat mass in NWO was 27-39% (P<0.001) greater than non-obese women, but 37-43% (P<0.001) less than obese women. Cholesterol was greater in non-obese (186±33 vs. 212±28 mg/dL, P=0.001), NWO (196±35 vs. 219±26 mg/dL, P=0.028), and obese (201±34 vs. 223±25 mg/dL, P=0.005) POST women when compared to PRE women. LDL-C was not different between non-obese PRE and POST women; however, LDL-C was greater in POST women who are NWO (111±36 vs. 131±25 mg/dL, P=0.034) and obese (121±30 vs. 138±23 mg/dL, P=0.017) when compared to PRE women. In contrast, HDL-C was lower in only non-obese POST women (62±13 vs. 75±14 mg/dL, P < 0.001) when compared to non-obese PRE women. In POST women, only HDL-C was significantly lower (62±15 vs. 75±14 mg/dL, P=0.010) in NWO than non-obese women. CONCLUSIONS: Based on these findings, menopausal status was not associated with a change in fat distribution; however, the age-related changes in lipids and lipoproteins appear to be due to a change in menopausal status, not shifts in fat distribution.

Patterns and reasons for switching classes of hormonal therapy among women with early-stage breast cancer.

Breast cancer patients can switch hormonal therapy (HT) regimens due to treatment side effects or menopausal status change. We describe HT class switching from aromatase inhibitor (AI) to tamoxifen (TAM), and vice versa. In a cohort of 3,265 women diagnosed with hormone-receptor-positive breast cancer at Kaiser Permanente Northern California from 2005 to 2013, we analyzed prescription records, switching reasons, and treatment adherence post-switch by chart review, through 31 December 2014. There were 290 women who switched from AI to TAM (AI switchers), including 130 (45%) switchers during the first year of treatment; and 446 women who switched from TAM to AI (TAM switchers), including 120 (27%) switchers within the first year. After the switch, 136 (47%) AI switchers and 260 (58%) TAM switchers finished or remained on the planned therapy; 69 (24%) AI switchers and 99 (22%) TAM switchers discontinued therapy. AI side effects (73%), specifically joint pain/arthralgia and bone health issues, were the most common reasons for switching from AI to TAM, whereas from TAM to AI, it was menopausal status change (42%). Study findings highlight the need for better ways to control patient symptoms from HT to prevent discontinuation, and thus ensure best prognosis.

Estrogen, Stress, and Depression: A Neurocognitive Model.

The stress exposure model of depression suggests that depression is the result of biological vulnerability combined with the trigger of stressful life events. Altered function of brain regions important to the stress response have been consistently found in individuals with depression and include hypothalamic-pituitaryadrenal axis hyperactivity and insensitivity to negative feedback effects of cortisol. The cortisol response to stress shows sex differences and decreases during high-estradiol phases of the menstrual cycle. Women remain more sensitive than men to lower levels of cortisol following repeated stressors; thus, women may be more sensitive to mood dysregulation following psychosocial stress because of changing ovarian hormone effects on the hypothalamicpituitary-adrenal axis and brain circuits important for the stress response. Depressive symptoms and the risk of recurrent and new-onset depression increase during perimenopause. Studies with large multiethnic cohorts and long follow-up periods support the hypothesis that change in menopausal status is associated with increased risk of depressive symptoms independent of other factors. Studies of the menopause transition suggest that alterations in estradiol levels are associated with changes in cognition and mood regulatory disturbances and that early (or surgical) menopause may be particularly associated with a risk for depression. The menopause transition may present a period of vulnerability for emotional dysregulation, similar to other well-known vulnerability phases such as the premenstrual and the immediate postpartum periods. If the loss of normal estradiol cycling increases the risk of depression and/or stressinduced hypothalamic-pituitary-adrenal axis disruption, does replacing estradiol reduce the risk of mood dysfunction? While large prospective studies in major depression after menopause have not shown benefit of estradiol treatment, perimenopausal depression appears to benefit from such therapy. Thus, responses of depression in perimenopausal and postmenopausal women to estradiol may be different.

Effect of menopausal status on carotid intima-media thickness and presence of carotid plaque in Chinese women generation population.

Menopause is an important physiological stage in women's life. The potential association of menopause with carotid intima-media thickness as well as with occurrence and stability of carotid plaque in Chinese female population is unclear. We conducted a population-based, cross-sectional study by recruiting 2,131 participants aged above 40 years from northeast of China. Carotid intima-media thickness (CIMT), presence of carotid plaque and its stability were evaluated by carotid duplex sonography. Among the participants, 1,133 (53.2%) were identified to be postmenopausal. After adjusting for potential confounding factors, presence of CIMT at 50th- 75th and ≥75th percentiles, carotid plaque and its unstable status were found to be significantly associated with the postmenopausal status (P < 0.001). When matched the participants by age, post-menopausal status was still associated with a higher risk of having unstable plaque. Moreover, our data show that postmenopausal status is a risk factor for intracranial arterial stenosis when compared with premenopausal status in the univariate analysis (OR = 1.314, P = 0.043), and such relationship is lost when the confounding factors are adjusted (OR = 0.828, P = 0.225). In conclusion, the vascular risk factors increase as the menopausal status changes. Compared with premenopausal status, postmenopausal status is associated with higher morbidity of CIMT, carotid plaque and its unstable status.

Does Menopause Increase Diabetes Risk? Strategies for Diabetes Prevention in Midlife Women

Menopause is a significant milestone for midlife women. The characteristic changes in sex hormones and associated symptoms mark a time of increased risk for chronic disease, most notably cardiovascular disease. The diabetes epidemic, combined with recent epidemiologic studies linking sex hormone profiles with incident diabetes risk, have recently raised the possibility that the menopause may increase diabetes risk as well. This report reviews studies of menopause and diabetes risk, as well as the potential mechanisms through which menopause might affect traditional and more novel diabetes risk factors. Diabetes risk appears to be more strongly linked with factors associated with chronological aging and sex hormones rather than changes in menopausal status per se. Strategies to reduce diabetes risk, namely lifestyle changes, hormone therapy and other pharmacologic interventions are also discussed vis à vis midlife women and menopause.

Physical activity and change in quality of life during menopause -an 8-year follow-up study

Background and objectivesThe aim of this study was to study the role of menopausal status and physical activity on quality of life.MethodsA total of 1,165 Finnish women aged 45-64 years from a national representative population-based study were followed up for 8 years. Study participants completed the Health 2000 study questionnaire and follow-up questionnaire in 2008. Ordinal logistic regression analysis was used to measure the effect of menopausal status on global quality of life (QoL). Other variables included in the analyses were age, education, change of physical activity as assessed with metabolic equivalents, change of weight and hormone therapy (HRT) use.ResultsPeri- and postmenopausal women increased their physical activity (28% and 27%) during the eight-year follow up period slightly more often than premenopausal (18%) women (p = 0.070). Menopausal status was not significantly correlated with change of QoL. QoL of the most highly educated women was more likely to improve than among the less educated (eb = 1.28, 95%CI 1.08 to 1.51 p = 0.002). Women whose physical activity increased or remained stable had greater chances for improved QoL than women whose physical activity decreased (eb = 1.49, 95%CI 1.23 p < 0.001 to 1.80, eb = 1.46, 95%CI 1.24 to 1.73 p < 0.001 respectively). Women whose weight remained stable during follow-up also improved their QoL compared to women who gained weight (eb = 1.26, 95%CI 1.07 to 1.50 p > 0.01). Women who had never used HRT had 1.26 greater odds for improved QoL (95%CI 1.02 to 1.56 p = < 0.05).ConclusionImprovement of global QoL is correlated with stable or increased physical activity, stable weight and high education, but not with change in menopausal status.

Depression and midlife: Are we overpathologising the menopause?

Cross sectional and longitudinal studies have suggested that the menopausal transition is a period of vulnerability for the development of depressive symptoms in women. It has been proposed that depression at the time of transition to menopause is part of a distinct diagnostic group of 'reproductive-related depressive disorders'. Furthermore it is proposed that these disorders are so prevalent that that middle aged women should be routinely screened to improve detection. The aims of this paper were to explore key studies undertaken over the past three decades to examine what evidence exists to support the proposals that depression in midlife women occurs as a biological response to hormonal change and that it is so common that all middle aged women should be routinely screened for depression. A systematic search was carried out of electronic databases for original research using population-based studies examining the relationship between menopause and depression. Longitudinal change in menopausal status over time is associated with an increased risk of elevated depressive symptoms, independent of relevant demographic, psychosocial, behavioural and health factors. However, depressive symptoms have non-specific diagnostic significance, and even when severe do not always reflect a depressive syndrome. There is no clear evidence that depressive disorders occur more commonly in association with the menopause. Rather, it appears that the true rate of disorder is similar to that at other times in a woman's reproductive life. The studies identified here do not provide evidence for the delineation of depression at the menopausal transition as part of a distinctive diagnostic group of 'reproductive-related depressive disorders' which occur as a biological response to hormonal change. The most plausible explanation is a bio-psycho-socio-cultural model of the processes which might lead to a depressive disorder in midlife. Although depressive symptoms are common at this time, data do not support the call for screening of all women for depression at the time of the MT. Rather, given the frequency of depression in the general population, clinicians should be alert to the possibility of depression in every clinical encounter.

Lipid Changes During the Menopause Transition in Relation to Age and Weight: The Study of Women's Health Across the Nation

Few studies have prospectively examined lipid changes across the menopause transition or in relation to menopausal changes in endogenous hormones. The relative independent contributions of menopause and age to lipid changes are unclear. Lipid changes were examined in relation to changes in menopausal status and in levels of estradiol and follicle-stimulating hormone in 2,659 women followed in the Study of Women's Health Across the Nation (1995-2004). Baseline age was 42-52 years, and all were initially pre- or perimenopausal. Women were followed annually for up to 7 years (average, 3.9 years). Lipid changes occurred primarily during the later phases of menopause, with menopause-related changes similar in magnitude to changes attributable to aging. Total cholesterol, low density lipoprotein cholesterol, triglycerides, and lipoprotein(a) peaked during late peri- and early postmenopause, while changes in the early stages of menopause were minimal. The relative odds of low density lipoprotein cholesterol (> or =130 mg/dL) for early postmenopausal, compared with premenopausal, women were 2.1 (95% confidence interval: 1.5, 2.9). High density lipoprotein cholesterol also peaked in late peri- and early postmenopause. Results for estradiol and follicle-stimulating hormone confirmed the results based on status defined by bleeding patterns. Increases in lipids were smallest in women who were heaviest at baseline.

Effect of age, gender, menopausal status, and ovarian hormonal level on rTMS in treatment-resistant depression

This study examines how gender and menopausal status contribute to age effect on the antidepressant efficacy of repetitive transcranial stimulation (rTMS). Thirty-one women (17 premenopausal, 14 postmenopausal), and 16 men with treatment-refractory bipolar/major depression underwent 10 consecutive sessions of rTMS. Mood symptoms and female hormones were measured. ANOVA-R revealed a significant gender (p<0.05) and time effect (p<0.001) on the Hamilton Depression Rating Scale (HAM-D) score. Percentage reduction of the rating correlated negatively with age in women (p<0.001). While no difference in the rTMS response was observed between male and premenopausal female patients (68.8% and 70.6%, respectively), postmenopausal women responded least (0%). We also found that greater improvement of depression score was associated with a higher estradiol/progesterone ratio in premenopausal women (p<0.05), suggesting an important role of female hormones in the therapeutic response. Regression analysis revealed that menopausal status and ovarian steroid levels, but not age, were the main determinants of antidepressant efficacy of rTMS in females. This is the first study to specifically investigate the effect of female hormones on rTMS therapeutic effect. Our data support changes in menopausal status and ovarian steroid levels as effectors of mood and the CNS neural substrate response to rTMS in refractory depression. However, the restricted number of patients and the shorter duration of rTMS treatment and follow-up might influence its generalization. Further study examining the interactions between mood, ovarian hormones, and rTMS treatment is warranted.

Longitudinal Patterns of Weight Gain after Breast Cancer Diagnosis: Observations beyond the First Year

Many, but not all patients experience weight gain 1 year after a breast cancer diagnosis; clearly defined, clinically relevant groups at risk of weight gain have yet to be described. We set out to determine the factors associated with weight gain over time in patients with invasive breast cancer during a period of predominantly anthracycline-based adjuvant chemotherapy and to identify groups with differing weight gain risks. Breast cancer patients (stage I-IIIB) were identified in a retrospective chart review. Evaluated parameters included weight at diagnosis and 1, 2, and 3 years later, height, body mass index (BMI), age, menopausal and change in menopausal status, as well as therapy and pathologic stage. Regression models identified significant independent predictors of weight change. Recursive partitioning analysis (RPA) was employed to divide the dataset into relevant and significant groups. In 185 identified patients, regression models and RPA demonstrated that weight gain at 1 year was associated with younger age, adjuvant chemotherapy, and lower BMI. Weight gain at 2 years (n = 176) was greater than at year 1, and in addition to weight gain at year 1, was associated with younger age and adjuvant chemotherapy in regression analysis; RPA found that anthracycline therapy, age, and BMI were important. Weights at 3 years were similar to those seen at 2 years. Early-stage breast cancer patients treated with chemotherapy continue to gain weight 2 years after diagnosis, and this weight gain appears to be persistent at year 3. Observation beyond 1 year is needed to adequately evaluate weight gain in early-stage breast cancer patients, particularly for those receiving contemporary adjuvant chemotherapy.

Depressive symptoms during the menopausal transition: The Study of Women's Health Across the Nation (SWAN)

Background The influence of menopausal status on depressive symptoms is unclear in diverse ethnic groups. This study examined the longitudinal relationship between changes in menopausal status and the risk of clinically relevant depressive symptoms and whether the relationship differed according to initial depressive symptom level. Methods 3302 African American, Chinese, Hispanic, Japanese, and White women, aged 42–52 years at entry into the Study of Women's Health Across the Nation (SWAN), a community-based, multisite longitudinal observational study, were evaluated annually from 1995 through 2002. Random effects multiple logistic regression analyses were used to determine the relationship between menopausal status and prevalence of low and high depressive symptom scores (CES-D < 16 or ≥ 16) over 5 years. Results At baseline, 23% of the sample had elevated CES-D scores. A woman was more likely to report CES-D ≥ 16 when she was early peri-, late peri-, postmenopausal or currently/formerly using hormone therapy (HT), relative to when she was premenopausal (OR range 1.30 to 1.71). Effects were somewhat stronger for women with low CES-D scores at baseline. Health and psychosocial factors increased the odds of having a high CES-D and in some cases, were more important than menopausal status. Limitations We used a measure of current depressive symptoms rather than a diagnosis of clinical depression. Thus, we can only make conclusions about symptoms current at annual assessments. Conclusion Most midlife women do not experience high depressive symptoms. Those that do are more likely to experience high depressive symptom levels when perimenopausal or postmenopausal than when premenopausal, independent of factors such as difficulty paying for basics, negative attitudes, poor perceived health, and stressful events.

Associations of Hormones and Menopausal Status With Depressed Mood in Women With No History of Depression

Whether depressed mood reported in the transition to menopause by women with no history of depression is associated with menopausal status and changes in reproductive hormones is controversial and lacks scientific information. To identify new onset of depressive symptoms and diagnosed depressive disorders in the menopausal transition and to determine the associations of menopausal status, reproductive hormones, and other risk factors with these cases. A within-woman, longitudinal (8-year) study to identify risk factors of depressed mood. A subset of a randomly identified, population-based cohort. Premenopausal women with no history of depression at cohort enrollment. The Center for Epidemiological Studies of Depression scale (CES-D) was used to assess depressive symptoms, and the Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to identify clinical diagnoses of depressive disorders. High CES-D scores (> or=16) were more than 4 times more likely to occur during a woman's menopausal transition compared with when she was premenopausal (odds ratio, 4.29; 95% confidence interval, 2.39-7.72; P<.001). Within-woman change in menopausal status, increased levels of follicle-stimulating hormone and luteinizing hormone, and increased variability of estradiol, follicle-stimulating hormone, and luteinizing hormone around the woman's own mean levels were each significantly associated with high CES-D scores after adjusting for smoking, body mass index, premenstrual syndrome, hot flashes, poor sleep, health status, employment, and marital status. A diagnosis of depressive disorder was 2(1/2) times more likely to occur in the menopausal transition compared with when the woman was premenopausal (odds ratio, 2.50; 95% confidence interval, 1.25-5.02; P=.01); the hormone measures were also significantly associated with this outcome. Transition to menopause and its changing hormonal milieu are strongly associated with new onset of depressed mood among women with no history of depression.

Natural History of Menopause Symptoms in Primary Care Patients: A MetroNet Study

The association between changes in menopausal status and menopause-related symptom reporting over the course of the menopause transition is not well understood, especially whether there are any racial differences in this association. To determine (1) the prevalence and the natural history of menopause symptoms among primary care patients approaching, or at menopause; (2) the relationship between self-reported symptoms and menopausal status; and (3) whether this relationship varies in African American and white women. Cross-sectional self-report survey of 342 women aged 40 to 55 years (31.6% African American) were recruited from 8 family practice centers in 2000 and 2001. Among 251 women without surgical menopause, 133 (53.0%) were premenopausal, 72 (28.7%) were peri-menopausal, and 46 (18.3%) were postmenopausal. The most commonly reported symptoms were joint/muscle pain and headache, which did not vary by menopausal status. As many as 28.6% of the women with regular menstruation reported hot flashes, and 18.8% had night sweats; although both symptoms were strongly associated with changes in menopausal status (P < .01). During the natural menopausal transition, white women had increasing trends of nervousness, memory loss, vaginal dryness, loss of sexual interest, hot flashes, and night sweats while African American women only had increasing trend of painful sex and hot flashes. In multivariate analyses, loss of sexual interest was associated with postmenopause status in white but not in African American women. Symptoms are not uncommon among premenopausal women and become more prevalent as the transition through menopause occurs. The prevalence of vasomotor symptoms in premenopausal women may be an under-recognized aspect of the natural history of the menopause transition. African American and white women may present different symptoms through menopause transition.

Physical Activity and Changes in Weight and Waist Circumference in Midlife Women: Findings from the Study of Women's Health Across the Nation

Controversy exists regarding the extent to which age, menopausal status, and/or lifestyle behaviors account for the increased weight, fat mass, and central adiposity experienced by midlife women. To address this question, the authors longitudinally examined the relations of aging, menopausal status, and physical activity to weight and waist circumference in 3,064 racially/ethnically diverse women aged 42-52 years at baseline who were participating in the Study of Women's Health Across the Nation (SWAN), an observational study of the menopausal transition. Over 3 years of follow-up (1996-1997 to 1999-2000), mean weight increased by 2.1 kg (standard deviation (SD), 4.8) or 3.0% (SD, 6.5) and mean waist circumference increased by 2.2 cm (SD, 5.4) or 2.8% (SD, 6.3). Change in menopausal status was not associated with weight gain or significantly associated with increases in waist circumference. A one-unit increase in reported level of sports/exercise (on a scale of 1-5) was longitudinally related to decreases of 0.32 kg in weight (p < 0.0001) and 0.10 cm in waist circumference (not significant). Similar inverse relations were observed for daily routine physical activity (biking and walking for transportation and less television viewing). These findings suggest that, although midlife women tend to experience increases in weight and waist circumference over time, maintaining or increasing participation in regular physical activity contributes to prevention or attenuation of those gains.