Late Menopausal Transition Stages Research Articles

Menstrual cycle phase, menopausal transition stage, self-reports of premenstrual syndrome and symptom severity: observations from the Seattle Midlife Women's Health Study.

The aim of this study was to determine the effects of menstrual cycle phases (postmenses and premenses), self-report of premenstrual syndrome (PMS), late reproductive stages (LRS1 and LRS2), and early menopausal transition (EMT) stage (Stages of Reproductive Aging Workshop [STRAW]) on severity of five symptom groups. A subset of Seattle Midlife Women's Health Study participants (n = 290) in either LRS1 or LRS2 or EMT (STRAW+10 criteria) provided daily symptom data for at least one full menstrual cycle during the first year of the study and reported current PMS. Symptom severity was rated (1-4, least to most severe) in the daily diary for five symptom groups (dysphoric mood, neuromuscular, somatic, vasomotor, and insomnia) identified earlier with the same sample ( Maturitas 1996;25:1-10). A three-way analysis of variance was used to test for within- and between-participants effects on symptom severity. Stage had no effect on severity for any of the five symptom groups. Dysphoric mood and neuromuscular and somatic symptom severity (but not vasomotor or insomnia severity) differed significantly across menstrual cycle phases, increasing from postmenses to premenses. Current PMS and premenses cycle phase had significant interactive effects on dysphoric mood and neuromuscular symptoms, but there were no significant interaction effects on somatic, vasomotor, or insomnia symptom severity. Dysphoric mood, neuromuscular, and somatic symptoms exhibit cyclicity and are influenced by current PMS. Late reproductive stages and EMT stage do not have significant effects on the five symptom groups. Vasomotor or insomnia symptoms do not exhibit significant cyclicity from postmenses to premenses and are not affected by current PMS. Future studies of symptom cyclicity and reproductive aging including daily symptom data across an entire menstrual cycle in samples including women in late menopausal transition stage are essential to capture the effects of both cyclicity and self-reported PMS to capture symptom severity reports at their peak.

Depressive symptoms and suicidality by menopausal stages among middle-aged Korean women.

There has been increasing evidence of hormonal changes during reproductive events that lead to mood changes. However, studies on the severity of psychological problems according to the menopausal stage are limited. Thus, this study aimed to investigate the association between menopausal stages, depression and suicidality. A total of 45 177 women who underwent regular health check-ups between 2015 and 2018 at Kangbuk Samsung Hospital were included. Participants were stratified into four groups (pre-menopause, early transition, late transition and post-menopause) based on the Stages of Reproductive Aging Workshop Criteria. The Center for Epidemiological Studies-Depression scale (CESD) was used to evaluate depressive symptoms, and the degree of depressive symptoms was classified as moderate (CESD score 16-24) or severe (CESD score ⩾ 25). To measure suicide risk, we administered questionnaires related to suicidal ideation. Overall, the prevalence of CESD scores of 16-24 and ⩾ 25 was 7.6 and 2.8%, respectively. Menopausal stages were positively associated with depressive symptoms in a dose-dependent manner. Multivariable-adjusted prevalence ratios (PRs, 95% confidence intervals) for CESD scores of 16-24 comparing the stages of the early menopausal transition (MT), late MT and post-menopause to pre-menopause was 1.28 (1.16-1.42), 1.21 (1.05-1.38) and 1.58 (1.36-1.84), respectively. The multivariable-adjusted PRs for CESD scores ⩾ 25 comparing the stages of the early MT, late MT and post-menopause to pre-menopause were 1.31 (1.11-1.55), 1.39 (1.12-1.72), 1.86 (1.47-2.37), respectively. In addition, the multivariable-adjusted PRs for suicidal ideation comparing the early MT, late MT and post-menopause stages to the pre-menopause stage were 1.24 (1.12-1.38), 1.07 (0.93-1.24) and 1.46 (1.25-1.70) (p for trend <0.001), respectively. These findings indicate that the prevalence of depressive symptoms and suicidal ideation increases with advancing menopausal stage, even pre-menopause.

Impact of age and menopausal stage on serum anti-Müllerian hormone levels in middle-aged women

Objective This study aimed to evaluate the association between age, menopausal stage and serum anti-Müllerian hormone (AMH) levels in middle-aged women. Methods In this cross-sectional study, the serum AMH levels of 288 healthy women aged 40–55 years (divided into age groups: 40–44, 45–49 and 50–55 years) were evaluated. Stages of Reproductive Aging Workshop + 10 criteria were used to categorize these women into menopausal stages: late reproductive, menopausal transition and early postmenopausal stages. The impact of age, menopausal stage and hormone replacement therapy on serum AMH levels was analyzed using multi-factor analysis of variance. Effects of body mass index, smoking status and oral contraceptive use were simultaneously considered. Results The median AMH level was 0.140 ng/ml. Log-AMH levels varied according to age group (variance = 20.113, F = 88.538, p < 0.001) and menopausal stage (variance = 5.543, F = 24.501, p < 0.001). An exponential model defined as AMH = 227,421.757 × e(−0.301 × age) was fit to describe the decline in AMH level with age. The 5th–95th percentiles of the AMH levels ranged from less than 0.020 to 3.150, less than 0.020 to 1.944 and less than 0.020 to 0.030 ng/ml in the aforementioned menopausal stages, respectively. Conclusion Age and menopausal stage were associated with AMH levels; age had a greater impact on AMH than menopausal stage in middle-aged women.

Stages of menopause and abnormal lung function: a cross-sectional study of middle-aged women.

Whether hormonal changes during menopausal transition postmenopause stages influence pulmonary function is not clearly understood. We evaluated the association between each stage of menopause and the prevalence of abnormal lung function in healthy middle-aged women. We hypothesized that the prevalence of abnormal lung function would increase from the late menopausal transition stage during menopausal transition postmenopause stages. The study population included women 40 to 65 years of age who underwent comprehensive health screening examination at the Kangbuk Samsung Hospital Total Healthcare Centers from January 2015 to December 2017. Stages of menopause (premenopausal, early menopausal transition, late menopausal transition, and postmenopausal) were defined using the 2011 Stages of Reproductive Aging Workshop (STRAW + 10) criteria. Abnormal lung function was defined based on spirometry as forced expiratory volume in 1 second/forced vital capacity less than70% or forced vital capacity less than 80% predicted. Prevalence ratios (PRs) for abnormal lung function by stages of menopause were estimated from logistic regression models adjusted for age, anthropometric measurements, lifestyle factors, medical history, lipid and inflammatory biomarkers, and reproductive factors. Among 43,822 participants, there were 4,615 participants (10.5%) with restrictive ventilatory disorder and 653 participants (1.5%) with obstructive ventilatory disorder. The fully adjusted PRs (95% confidence interval) for abnormal ventilatory disorder comparing early menopausal transition, late menopausal transition, and postmenopausal stage to premenopausal stage were 1.01 (0.94-1.08), 1.13 (1.03-1.22), and 1.10 (0.98-1.22), respectively. The fully adjusted PRs for restrictive ventilatory disorder comparing early menopausal transition, late menopausal transition, and postmenopausal stages to premenopausal stage were 1.02 (0.94-1.11), 1.18 (1.06-1.30), and 1.15 (1.00-1.31), respectively. There was, however, no clear association between stages of menopause and obstructive ventilatory disorder. In this large study of middle-aged women, the fully adjusted prevalence of abnormal lung function, particularly that of restrictive ventilatory disorder, was higher in women in late menopausal transition and menopausal stages compared to women in premenopausal stage.

The Prevalence of Hyperuricemia Sharply Increases from the Late Menopausal Transition Stage in Middle-Aged Women.

The impact of menopausal transition on change of serum uric acid level remains unknown. The present study evaluated the relationship of menopausal stages with prevalent hyperuricemia in middle-aged women. This cross-sectional study included 58,870 middle-aged Korean women, aged ≥40, who participated in a health examination from 2014 to 2016. Menopausal stages were obtained with a standardized, self-administered questionnaire and were categorized according to the criteria of the Stages of Reproductive Aging Workshop (STRAW+10). Hyperuricemia was defined as a serum uric acid level of ≥6 mg/dL. The prevalence of hyperuricemia increased as menopausal stage increased. The multivariable-adjusted odds ratios (95% confidence intervals) for prevalent hyperuricemia comparing early transition, late transition, and post-menopause to pre-menopause were 1.19 (0.80–1.77), 2.13 (1.35–3.36), and 1.65 (1.33–2.04), respectively. This association was stronger among non-obese compared to obese participants and in those with low high-sensitivity C-reactive protein (hsCRP) levels (<1.0 mg/L) compared to those with elevated hsCRP levels of ≥1.0 mg/L (p for interaction = 0.01). In this large sample of middle-aged women, the prevalence of hyperuricemia significantly increased from the menopausal stage of late transition, independent of potential confounders. Appropriate preventive strategies for reducing hyperuricemia and its related consequences should be initiated prior to menopause.

Impact of Menopause on Quality of Life in Community-based Women in China: 1 Year Follow-up

Quality of life (QOL) throughout menopause has become an outcome variable requiring measurement in clinical care. Staff nurses can provide earlier nursing during the menopausal transition (MT) stage. The purpose of this study was to describe the changes of QOL in different stages of the MT according to The Stages of Reproductive Aging Workshop (STRAW) in Chinese women in community settings. Prospective longitudinal study design was used to analyze QOL of 327 community women age 30–65years old. They were followed up at 1-year. An instrument including the Chinese version of the Menopause-Specific Quality of Life Questionnaire was used to obtain data. A gradual decline in QOL was seen from premenopausal to menopausal transition (MT) and in postmenopausal women. Significant differences were observed in vasomotor, physical and sexual scores at baseline and follow-up (P<0.05). Significant differences in vasomotor scores were observed between baseline and follow-up for women in the premenopausal and Late MT stages (P<0.05). There were significant differences in psychosocial and physical scores between baseline and follow-up in the Late MT stage (P<0.05). Menopause might have a negative impact on QOL independent of age in community-based women in China. There seemed to be a potential model of the relationship of menopause status to change in QOL, but this needs supporting evidence from longer longitudinal studies.

Hot flush severity during the menopausal transition and early postmenopause: beyond hormones

Background Understanding factors promoting symptom severity is essential to developing innovative symptom management models.Aim To investigate hot flush severity during the menopausal transition (MT) and early postmenopause and effects of age, MT stages, age of onset of late stage and final menstrual period (FMP), estrogen, follicle stimulating hormone (FSH), cortisol, anxiety, perceived stress, body mass index, smoking, alcohol use and exercise.Methods A subset of participants in the Seattle Midlife Women's Health Study (n = 291 with up to 6973 observations) provided data during the late reproductive, early and late MT stages and early postmenopause, including menstrual calendars, annual health questionnaires, and symptom diaries and urine specimens assayed for hormones several times per year. Multilevel modeling with an R program was used to test models accounting for hot flush severity.Results Hot flush severity persisted through the MT stages and peaked during the late MT stage, diminishing after the second year postmenopause. In individual analyses, hot flush severity was associated with being older, being in the late MT stage or early postmenopause, beginning the late MT stage at a younger age and reporting greater anxiety. In a model including only endocrine factors, hot flush severity was significantly associated with higher FSH and lower estrone levels. An integrated model revealed dominant effects of late MT stage and early postmenopause, with anxiety contributing to hot flush severity.Conclusions and implications Hot flush severity was affected largely by reproductive aging and anxiety, suggesting symptom management models that modulate anxiety and enhance women's experience of the menopausal transition and early postmenopause.

Menopausal stages and serum lipid and lipoprotein abnormalities in middle-aged women

ObjectivesWhether menopausal stage is associated with abnormalities in serum lipid and lipoprotein profiles remains unclear; studies have been conducted mostly in Western populations. This study aimed to examine the prevalence of lipid and lipoprotein abnormalities by recently updated menopausal stages in middle-aged women. Study designThis study was cross-sectional analysis of 1553 women aged 44–56 years, who underwent a comprehensive health screening examination in the Kangbuk Samsung Hospital Total Healthcare Centers, Korea, during 2012–2013. Lipid and lipoprotein profiles including total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), lipoprotein (a) (Lp(a)), apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B) were assessed. Prevalence ratios and 95% confidence intervals for lipid and lipoprotein abnormalities were estimated by menopausal stages as defined by the 2011 Stages of Reproductive Aging Workshop+10 criteria. ResultsIncreased prevalence of lipid and lipoprotein abnormalities were observed across menopausal stages. The increased prevalence of high non-HDL-C was associated with the late menopausal transition and post-menopausal stages and was more pronounced in women with body mass index (BMI) <23kg/m2 than in those with BMI ≥23kg/m2 (P for interaction=0.006). Similarly, there was an interaction between BMI and menopausal stages in relation to high Apo B (P for interaction=0.05) and high Apo B/Apo A1 ratio (P for interaction=0.06). ConclusionsOur findings extend previous results and suggest that the increased prevalence of lipid and lipoprotein abnormalities was associated not only with the post-menopausal stage but also late menopausal transition period.

Cognition in perimenopause

The aims of this cross-sectional study were to determine if cognitive function differs across stages of reproductive aging and to evaluate whether hormones or menopausal symptoms predict cognition in perimenopause. We hypothesized that women in late menopausal transition and early postmenopause would perform more poorly than those in the late reproductive stage on attention and verbal memory tasks, and that estradiol, depressive symptoms, anxiety symptoms, hot flashes, and sleep disturbance would predict cognitive performance on those tasks. One hundred seventeen middle-aged women enrolled in the Rochester Investigation of Cognition Across Menopause were categorized into late reproductive stage (n = 34), early menopausal transition stage (n = 28), late menopausal transition stage (n = 41), or early postmenopause stage (n = 14) according to criteria from the Stages of Reproductive Aging Workshop +10. We administered a neuropsychological battery assessing six domains of cognition, assessed menopausal symptoms, and measured serum levels of estradiol and follicle-stimulating hormone. Multivariate regressions were conducted to determine the impact of menopausal stage and symptoms on cognition. Women in the first year of postmenopause performed significantly worse than women in the late reproductive and late menopausal transition stages on measures of verbal learning, verbal memory, and motor function. They also performed significantly worse than women in the late menopausal transition stage on attention/working memory tasks. Cognitive function does not change linearly across perimenopause. Decreases in attention/working memory, verbal learning, verbal memory, and fine motor speed may be most evident in the first year after the final menstrual period.

Identifying symptom clusters during the menopausal transition: observations from the Seattle Midlife Women's Health Study

Objectives First, to explore the variability in how symptoms clustered together over the late reproductive stage, early and late menopausal transition (MT) stages, and early postmenopause; second, to determine whether the symptom factor structure of the preceding MT stage would predict the symptom factor structure of the MT stage immediately following.Methods The sample consisted of a subset of Seattle Midlife Women’s Health Study participants who were in late reproductive or early or late menopausal transition stages or early postmenopause and provided self-reported data on symptoms experienced between 1990 and 2005. Principal components analysis was used to determine how symptoms clustered together across the stages. Variables predicting the symptom factor structure were analyzed by multiple regression.Results Principal components analysis with varimax rotation revealed different factor structures for each of the four stages. The three-factor solution in the late reproductive stage explained a total of 54.9% of the variance. The four-factor solutions in the early and late menopausal transition stages and postmenopause explained a total of 56.5%, 59.3%, and 60.7%, respectively.Conclusions This analysis revealed similar factor structures across the four stages in that each stage revealed a mood component, a vasomotor component, and a pain component. However, the symptoms differed somewhat in how they grouped from stage to stage. Regression analysis demonstrated that a relationship exists between the symptom factor structures across stages. Controlling for demographic and lifestyle variables, it was revealed that the symptom clusters at the early and late menopausal transition stages and early postmenopause were best predicted by the symptom factor structure of the previous stage.

Symptom clusters during the late reproductive stage through the early postmenopause

The aim of this study was to identify symptom clusters that characterize women's experiences through the late reproductive stage, the menopausal transition, and early postmenopause and to explore the influence of the menopausal transition stages and early postmenopause, compared with that of the late reproductive stage, on the clusters of symptoms women experience. Participants from the Seattle Midlife Women's Health Study whose symptom calendars were staged for the menopausal transition provided data for a total of 6,857 occasions. Multilevel latent class analysis was used to identify classes using scores for hot flashes and symptom factors (sleep, cognitive, mood, pain, tension). Class 1 included observations of low severity levels for all symptoms, whereas class 2 included low-severity hot flashes and moderate-severity levels for all other symptom factors. Class 3 included high severity hot flashes with lower severity levels of all other symptom factors. During the early and late menopausal transition stages and early postmenopause, the likelihood of being in class 3 was significantly greater than being in class 1 relative to the late reproductive stage. There were no significant effects of the menopausal transition stages on the likelihood of being in class 2. This effort is the first to examine the latent classes or clusters of symptoms during the prolonged period from late reproductive stage to early postmenopause. As such, the data contribute to the understanding of symptom experiences beyond our early efforts to characterize the late menopausal transition stage.

Symptom interference with work and relationships during the menopausal transition and early postmenopause

The aim of this study was to describe the changes in symptom interference during the menopausal transition (MT) stages and early postmenopause (PM), including the effects of age, MT-related factors (estrone, follicle-stimulating hormone, testosterone, MT stages), symptoms (hot flashes, depressed mood, awakening during the night, anxiety, backache, joint pain, forgetfulness, and difficulty concentrating), health-related factors (perceived health), and stress-related factors (perceived stress, cortisol). A subset of Seattle Midlife Women's Health Study participants provided data during the late reproductive, early and late MT stages, or early PM (n = 184), including menstrual calendars for staging the MT; annual health reports completed between 1990 and 2008; morning urine samples assayed for estrone glucuronide, follicle-stimulating hormone, and cortisol; and symptom diary ratings several times each year. Interference was rated in the diary along with symptoms, perceived health, and stress. Multilevel modeling with an R program was used to test the patterns of symptom interference related to age, MT-related factors, symptoms, and health- and stress-related factors, with as many as 5,656 observations. Median age was 47.4 years. Interference with work was significantly associated with individual covariates such as perceived health, stress, hot flashes, depressed mood, anxiety, difficulty getting to sleep, awakening during the night, early morning awakening, backache, joint pain, forgetfulness, and difficulty concentrating (for hot flashes, P = 0.01; all others, P < 0.001). A final multivariate model included perceived health, stress, depressed mood, and difficulty concentrating. Interference with relationships was significantly associated with age and individual covariates such as perceived health, estrone, perceived stress, depressed mood, anxiety, sleep symptoms, backache, joint pain, forgetfulness, and difficulty concentrating (for estrone, P = 0.03; all others, P < 0.001). A final multivariate model included perceived health, stress, depressed mood, anxiety, difficulty concentrating, and awakening during the night. Women's reports of how much the way they felt interfered with work and relationships were influenced by both their perceived health and stress levels. Interference was also influenced by depressed mood and difficulty concentrating, suggesting that these two symptoms may be most important to address, to enhance functioning during the MT and early PM.

Cognitive symptoms during the menopausal transition and early postmenopause

Purposes To describe changes in levels of cognitive symptoms (forgetting and difficulty concentrating) during the menopausal transition (MT) stages and early postmenopause, including effects of age, MT-related factors (MT stages, estrone, follicle stimulating hormone (FSH), testosterone), symptoms (hot flush, sleep, mood), health-related factors (alcohol use, smoking, exercise, perceived health), stress-related factors (perceived stress, history of sexual abuse, cortisol, catecholamines) and social factors (partner and parenting status, education, employment).Methods A subset was studied of Seattle Midlife Women's Health Study participants who provided data during the late reproductive, early and late MT stages or postmenopause (n = 292) including menstrual calendars for staging the MT, annual health questionnaires for social factors, morning urine samples assayed for estrone glucuronide (E1G), testosterone, FSH, cortisol and catecholamines and health diaries for rating symptoms several times each year. Multilevel modeling (R program) was used to test patterns of cognitive symptoms related to age, MT-related factors, symptoms, health-related, stress-related and social factors with as many as 6811 observations.Results As individual covariates and in the multivariate model, age, anxiety, depressed mood, night-time awakening, perceived stress, perceived health, and employment were each significantly related to difficulty concentrating. Hot flushes, amount of exercise and history of sexual abuse had a significant effect as individual covariates but not in the final multivariate model. The best predictors of forgetfulness when analyzed as individual covariates and in the multivariate model were age, hot flushes, anxiety, depressed mood, perceived stress, perceived health and history of sexual abuse. Awakening during the night, although significant as an individual covariate, had no significant effect on forgetfulness in the final multivariate model.Conclusions Menopausal transition-related factors were not significantly associated with difficulty concentrating or forgetfulness. Consideration of women's ages and the context in which they experience the menopausal transition may be helpful in understanding women's experiences of cognitive symptoms.

Symptom clusters during the late menopausal transition stage

The aims of this study were to identify groups of women in the late menopausal transition stage who experienced the same cluster of symptoms and to identify indicators that predicted membership in these distinct groups. The sample consisted of a subset of Seattle Midlife Women's Health Study participants who were in the late menopausal transition stage and provided self-report data on symptoms experienced between 1990 and 2005. Latent class analysis (LCA) was used to identify groups of women who experienced similar clusters of the following five symptoms: problem concentrating, hot flashes, joint ache, mood changes, and awakening at night. LCA with multivariate logistic regression was used to identify covariates that predicted membership in each group. Four groups of women were identified: (1) low severity for all symptoms except for joint ache, which was moderate (65%); (2) high severity for all symptoms except for hot flashes, which was moderate (13%); (3) high severity for hot flashes, joint ache, and awakening at night (12%); and (4) high severity for problem concentrating and joint ache (10%). A clear delineation between groups based on individual characteristics was not fully elucidated. This analysis demonstrates that LCA may be useful to identify women who may experience poorer outcomes related to a higher propensity for severe symptoms. Shifting the focus from single symptoms to symptom clusters will aid in the identification of phenotypic profiles, thus facilitating symptom management strategies that can be tailored to meet the needs of individual women.

Pain symptoms during the menopausal transition and early postmenopause

Aim The aim of this study was to describe changes in levels of back pain and joint pain during the stages of menopausal transition stages and early postmenopause, including the effects of age, menopausal transition-related factors (estrone, follicle stimulating hormone (FSH), testosterone), menopausal transition stages, symptoms (hot flush, sleep, mood, cognitive), health-related factors (body mass index, alcohol use, smoking, well-being), stress-related factors (perceived stress, history of sexual abuse, cortisol, catecholamines) and social factors (partner and parenting status, education).Methods A subset was studied of the participants in the Seattle Midlife Women's Health Study who provided data during the late reproductive, early and late menopausal transition stages or postmenopause (n = 292) including menstrual calendars for staging the menopausal transition, annual health reports completed between 1990 and 2006, and morning urine samples assayed for estrone glucuronide (E1G), testosterone, FSH, cortisol and catecholamines, and symptom diary ratings several times each year. Multilevel modeling with an R program was used to test patterns of pain symptoms related to age, menopausal transition-related factors, symptoms, health-related, stress-related and social factors, with as many as 6812 observations. Age was centered at 47.4 years.Results Women experienced a slight, non-significant rise in back pain with age and a significant increase in back pain during the early (p = 0.003) and late menopausal transition stages (p = 0.002) and early postmenopause (p = 0.02), but urinary E1G, FSH and testosterone levels were unrelated. Of the stress-related factors, perceived stress (p = 0.01) and lower overnight urinary cortisol levels were associated with more severe back pain (p = 0.03); history of sexual abuse and catecholamines did not have a significant effect. Those most troubled by symptoms of hot flushes, depressed mood, anxiety, night-time awakening, and difficulty concentrating reported significantly greater back pain (all p < 0.0001). Of the health-related factors, having worse perceived health (p < 0.0001), exercising more (p = 0.005), using analgesics (p < 0.0001), and having a higher body mass index (p < 0.0001) were associated with more back pain, but alcohol use and smoking did not have significant effects. Of the social factors, only having a more formal education (p = 0.004) was associated with less back pain; parenting, having a partner, and employment were not significant. Factors associated with joint pain included age (p < 0.0001), but not menopausal transition-related factors. Symptoms of hot flushes, night-time awakening, depressed mood, and difficulty concentrating were each significantly associated with joint pain (p < 0.0001). Poorer perceived health, more exercise, higher body mass index, and greater analgesic use were all associated similarly with joint pain. History of sexual abuse was the only stress-related factor significantly related to joint pain severity (p = 0.024).Implications Clinicians working with women traversing the menopausal transition should be aware that managing back and joint pain symptoms among mid-life women requires consideration of their changing biology as well as their ongoing life challenges and health-related behaviors.

Sleep symptoms during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study.

Describe the severity of getting to sleep, nighttime awakening, and early morning awakening across the menopausal transition (MT) and early postmenopause (PM) and their relationship to age, menopausal transition factors, symptoms, stress-related factors, and health related factors. Cohort. community. 286 women from the Seattle Midlife Women's Health Study cohort. Participants completed annual menstrual calendars for MT staging, diaries in which they rated their symptoms, stress levels, and perceived health multiple times per year from 1990-2007 and provided first morning urine samples assayed for E1G, FSH, cortisol, and catecholamines. Multilevel modeling (R program) was used for data analysis. Severity of self-reported problems going to sleep was associated with all symptoms, perceived stress, history of sexual abuse, perceived health (-), alcohol use (-) (all P < 0.001), and lower cortisol (P = 0.009), but not E1G or FSH. Severity of nighttime awakening was significantly associated with age, late MT stage, and early PM, FSH, E1G (-), hot flashes, depressed mood, anxiety, joint pain, backache, perceived stress, history of sexual abuse, perceived health (-), and alcohol use (-) (all P < 0.001, except E1G for which P = 0.030). Severity of early morning awakening was significantly associated with age, hot flashes, depressed mood anxiety, joint pain, backache, perceived stress, history of sexual abuse, perceived health (-) (all P < or = 0.001, except E1G for which P = 0.02 and epinephrine (P = 0.038), but not MT stages or FSH. Multivariate models for each symptom included hot flashes, depressed mood, and perceived health. Sleep symptoms during the MT may be amenable to symptom management strategies that take into account the symptom clusters and promote women's general health rather than focusing only on the MT.

Sexual Desire During the Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife Women's Health Study

To describe levels of sexual desire across the menopausal transition (MT) and early postmenopause (PM), including effects of age, MT-related factors, health, stress, symptoms (hot flash, sleep, mood), and social opportunity factors. A subset of Seattle Midlife Women's Health Study (SMWHS) participants who provided data during the early reproductive, early and late menopausal transition stages, or postmenopause (n = 286), including menstrual calendars for staging the MT, annual health reports between 1990 and 2005, and morning urine samples assayed for estrone glucuronide (E(1)G), testosterone (T), and follicle-stimulating hormone (FSH) was included. Multilevel modeling using the R program was used to test factors related to sexual desire. Women experienced a significant decrease in sexual desire during the late MT stage (p < 0.01) and early PM (p < 0.0001). Those with higher urinary E(1)G and T reported significantly higher levels of sexual desire, whereas those with higher FSH levels reported significantly lower sexual desire (p < 0.0001, 0.06, and 0.0002, respectively). Women using hormone therapy also reported higher sexual desire (p = 0.02). Those reporting higher perceived stress reported lower sexual desire (p < 0.0001), but history of sexual abuse did not have a significant effect. Those most troubled by symptoms of hot flashes, fatigue, depressed mood, anxiety, difficulty getting to sleep, early morning awakening, and awakening during the night also reported significantly lower sexual desire (p range from <0.03 to 0.0001), but there was no effect of vaginal dryness. Women with better perceived health reported higher sexual desire (p < 0.0001), and those reporting more exercise and more alcohol intake also reported greater sexual desire (p < 0.0001). Having a partner was associated with lower sexual desire. Clinicians working with women traversing the MT should be aware that promoting healthy sexual functioning among midlife women requires consideration of their changing biology as well as ongoing life challenges.

Is the menopausal transition stressful? Observations of perceived stress from the Seattle Midlife Women's Health Study.

To describe changes in the levels of perceived stress in relation to menopausal transition (MT)-related factors (MT stage, hot flash severity, urinary estrone glucuronide, urinary follicle-stimulating hormone, hormone therapy), aging and age-related changes, and psychosocial factors (income adequacy, role burden, social support, parenting, employment, history of sexual abuse, depressed mood). A subset of participants (N = 418) in the longitudinal Seattle Midlife Women's Health Study provided data during the late reproductive and early and late MT stages or early postmenopause (PM) from 1990 to 2005, including menstrual calendars for staging the MT, annual health reports, and first morning urine specimens (assayed for estrone and follicle-stimulating hormone). Multilevel modeling was used to test patterns of perceived stress related to MT-related and aging-related factors and psychosocial factors with as many as 1,814 observations from 418 women per factor. Age was centered at 47.9 years. The effects of the MT-related factors were not significant, although the stress ratings decreased during PM by 0.11 units (P = 0.06). In analyses with age as a covariate and with each covariate added separately, employment was associated with significantly higher levels of stress (beta = 0.14, P < 0.0001), as was history of sexual abuse (beta = 0.11, P = 0.03) and depressed mood (beta = 0.02, P < 0.0001). Improvement in each of the factors of role burden, social support, and income adequacy was associated with significantly lower perceived stress (beta = -0.19, -0.13, and -0.10, respectively; P < 0.0001 for all). Negative appraisal of aging changes and perceived poorer health were both associated with significantly higher stress levels (beta = 0.08, P < 0.0001 for both) and depressed mood (beta = -0.02, P < 0.0001). A multivariate model included significant effects of employment, perceived health, and depressed mood (beta = 0.24, -0.04, and 0.02, respectively; P < 0.0001 for all). Being employed, experiencing depressed mood, and perceiving one's health as poor were more important in women's evaluation of their daily stress than severity of hot flashes, MT-related factors, or other social factors. Clinicians working with women going through the MT should remain vigilant to the impact of social circumstances of women's lives, especially employment, as well as focusing on the psychosocial and endocrine features of this transition.

Depressed mood during the menopausal transition and early postmenopause

To characterize patterns of depressed mood during the menopausal transition (MT) in relation to age and MT-related factors and to assess the contribution of factors related to depressed mood at earlier points in the life span. Women (N = 508) were recruited from 1990 to 1992 from multiethnic neighborhoods and followed annually through 2005: 302 met the eligibility criteria for analyses reported here. The Center for Epidemiologic Studies Depression scale (CES-D) and a menstrual calendar were completed annually throughout the study. A subset of women provided a first morning voided urine specimen from 1997 through 2005. Urine samples were assayed for estrone glucuronide, follicle-stimulating hormone, testosterone, and cortisol. Mixed effects modeling was used to identify changes in CES-D scores over time, including the relationship to age, MT-related factors, and factors related to depression at other points in the life span (postpartum depression/blues, life stress, or family history of clinical depression). Age was modestly and negatively related to CES-D scores, but MT stage alone was not, except that the late MT stage was significantly related to depressed mood. Hot flash activity, life stress, family history of depression, history of "postpartum blues," sexual abuse history, body mass index, and use of antidepressants were also individually related to depressed mood; the hormonal assays and age of entry into and duration of late MT stage were unrelated. Although women in the late MT stage are vulnerable to depressed mood, factors that account for depressed mood earlier in the life span continue to have an important influence and should be considered in studies of etiology and therapeutics.

Factors affecting reproductive hormones in HIV-infected, substance-using middle-aged women

To determine whether reproductive hormone levels are affected by human immunodeficiency virus (HIV) and drug use. HIV-infected and uninfected women (N=429), median age 45, were interviewed on menstrual frequency, demographic and psychosocial characteristics, and drug use behaviors. Serum was obtained on cycle days 1 to 5 in women reporting regular menses. Premenopausal-, early menopausal, and late menopausal transition and postmenopausal stages were assigned based on menstrual history. Serum was assayed for follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH), prolactin, thyroid-stimulating hormone, and inhibin B. Body mass index, HIV serostatus, and CD4+ counts were measured. Factors associated with hormone concentrations were assessed using uni- and multivariable analyses. Hormone concentrations were compared within menstrual status categories using nonparametric comparisons of means. In this cross-sectional analysis, LH and FSH increased, and E2 and inhibin B were significantly lower in women of older age and more advanced menopausal status. Increased body mass index was strongly associated with decreased LH. Opiate use was significantly associated with lower inhibin B and E2 and increased prolactin. Poorer self-rated health was statistically significantly associated with lower LH and FSH, but increased education was associated with higher LH and FSH. Among HIV-seropositive women, opiate users had detectably lower FSH and LH than nonusers, and use of highly active antiretroviral therapy was significantly related to higher LH, FSH, and E2, whereas cocaine use was associated with lower E2. Age and menopausal status are strongly related to reproductive hormones. Body mass index and use of opiates, cocaine, and highly active antiretroviral therapy as well as educational attainment and perceived health can significantly modify reproductive hormones during the menopausal transition and need to be considered when interpreting hormone levels in middle-aged women.