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Does the menopausal transition affect health-related quality of life?
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Supplement preview: management of menopause-related symptoms
Washington, Seattle, Washington, USA This article examines published evidence from longitudinal studies of the menopausal transition that address the following questions: (1) Which symptoms do women report during the perimenopause, and how prevalent are these symptoms as women traverse the menopausal transition? (2) How severe are symptoms and for how long do they persist? (3) To what do women attribute their symptoms, and do their attributions match findings from epidemiologic studies of community-based populations? (4) How significant are these symptoms in women’s lives? Data from published longitudinal studies were examined for evidence bearing on each of these questions. Only vasomotor symptoms, vaginal dryness, and sleep disturbance symptoms varied in prevalence significantly across menopausal transition stages and the postmenopause in ⱖ1 population studied. A minority of women report severe symptoms. Given the limited follow-up data available, it is unclear how long symptoms persist after the menopause. Women attribute their symptoms to a variety of factors (biological and psychosocial), and their attributions correspond well to those correlates identified in epidemiologic studies of community-based populations. The significance of symptoms for women’s lives remains uncertain. The impact of symptoms during the perimenopause on well-being, role performance, adaptation to demands of daily living, and quality of life warrants additional study. The appraisal of the consequences of perimenopausal symptoms by women from different ethnic groups will be enhanced significantly as a result of the Study of Women’s Health Across the Nation (SWAN) and other investigations in progress.
Does the menopausal transition affect health-related quality of life? Karen A. Matthews, PhD, Joyce T. Bromberger, PhD Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA We address whether the menopausal transition affects healthrelated quality of life (HRQOL). To do this, we review how HRQOL is defined and measured, present HRQOL findings from the large, population-based studies of the menopause, and identify key gaps in knowledge. HRQOL is defined as the value assigned to duration of life as modified by impairments, functional states, perceptions, and social opportunities that are influenced by disease, injury, treatment, or policy. The specific domains of HRQOL include resilience or the capacity to respond to stress, health perceptions, physical functioning, and symptoms. The majority of menopause studies have operationalized HRQOL as frequency and severity of symptoms. Taken together, the findings from 12 crosssectional reports and 3 longitudinal studies suggest that the perimenopause is associated with higher levels of somatic symptoms. It is unclear whether the perimenopause is related to other domains of HRQOL. Only 1 longitudinal study reported an association between reduced physical functioning and the perimenopause. Studies typically compare premenopausal women with women in other status categories taken separately, thereby not addressing the question of further change in HRQOL after the cessation of menses. There is a clear need for understanding the effects of the menopause beyond the domain of symptoms and to consider whether some domains of HRQOL might improve.
A universal menopausal syndrome? Nancy E. Avis, PhD,a Sarah Brockwell, PhD,b
Alicia Colvin, MPHb Department of Public Health Sciences, Section on Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; and b Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA A variety of symptoms are reported frequently as being part of a menopausal syndrome. These include hot flashes, night sweats, menstrual irregularities, vaginal dryness, depression, nervous tension, palpitations, headaches, insomnia, lack of energy, difficulty concentrating, and dizzy spells. The question of whether and how symptoms occur together is an important one for women who want to know which symptoms can be attributed to menopause and which to aging generally or to other physical or psychosocial factors. To address this question, the present article examines the following avenues of research: (1) the clustering or grouping of symptoms; (2) the temporal association of different symptoms with stages of the menopausal transition; (3) the consistency of symptom reporting across culture, race, and ethnicity; and (4) the consistency of risk factors for symptoms. Results of the factor analysis studies do not support a single syndrome consisting of menopausal and psychological or somatic symptoms. The prevalence of symptom reporting across the transition also argues against a menopausal syndrome because vasomotor symptoms follow a unique pattern that differs from other symptoms. Crosscultural differences suggest that symptom reporting is not universal. Finally, although there is some overlap in risk factors for symptoms, menopausal status is more consistently related to vasomotor symptoms than psychological or physical ones. Results of these investigations all argue against a universal menopausal syndrome. Future research should focus on how symptoms are interrelated, what factors are uniquely related to vasomotor symptoms, and identifying whether there is a subgroup of women who are more likely to report symptoms.
a
Genitourinary symptoms in the menopausal transition Bradley J. Van Voorhis, MD Department of Obstetrics and Gynecology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA Irregular uterine bleeding is a common symptom among women in the menopausal transition. Women commonly transition from having regular cycles to having irregular cycles before the final menstrual period. In late perimenopause, anovulation becomes more common, leading to skipped menstrual cycles. Low-dose oral contraceptive pills are effective in decreasing the amount of menstrual blood loss and improving menstrual cycle regularity. It is unclear whether menorrhagia is associated with normal perimenopausal hormonal changes. Studies to date have failed to correlate menorrhagia with hormonal levels and pathology within the uterus. Because of the common association between uterine pathology and menorrhagia, this is an important area for future studies. Vaginal dryness is a common symptom, particularly in late perimenopause. The association between vaginal dryness and low estrogen levels is clear. Estrogen-based hormone replacement therapy is effective in treating this symptom. Locally released estrogen therapy may be preferred over systemic therapy due to lower systemic estradiol levels, reduced side effects, and high efficacy. The long-term safety of these products, particularly in women with a history of breast cancer, requires more study. The prevalence of incontinence increases as women age, but it is unclear whether the menopausal
Supplement preview: management of menopause-related symptoms
Washington, Seattle, Washington, USA This article examines published evidence from longitudinal studies of the menopausal transition that address the following questions: (1) Which symptoms do women report during the perimenopause, and how prevalent are these symptoms as women traverse the menopausal transition? (2) How severe are symptoms and for how long do they persist? (3) To what do women attribute their symptoms, and do their attributions match findings from epidemiologic studies of community-based populations? (4) How significant are these symptoms in women’s lives? Data from published longitudinal studies were examined for evidence bearing on each of these questions. Only vasomotor symptoms, vaginal dryness, and sleep disturbance symptoms varied in prevalence significantly across menopausal transition stages and the postmenopause in ⱖ1 population studied. A minority of women report severe symptoms. Given the limited follow-up data available, it is unclear how long symptoms persist after the menopause. Women attribute their symptoms to a variety of factors (biological and psychosocial), and their attributions correspond well to those correlates identified in epidemiologic studies of community-based populations. The significance of symptoms for women’s lives remains uncertain. The impact of symptoms during the perimenopause on well-being, role performance, adaptation to demands of daily living, and quality of life warrants additional study. The appraisal of the consequences of perimenopausal symptoms by women from different ethnic groups will be enhanced significantly as a result of the Study of Women’s Health Across the Nation (SWAN) and other investigations in progress.
Does the menopausal transition affect health-related quality of life? Karen A. Matthews, PhD, Joyce T. Bromberger, PhD Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA We address whether the menopausal transition affects healthrelated quality of life (HRQOL). To do this, we review how HRQOL is defined and measured, present HRQOL findings from the large, population-based studies of the menopause, and identify key gaps in knowledge. HRQOL is defined as the value assigned to duration of life as modified by impairments, functional states, perceptions, and social opportunities that are influenced by disease, injury, treatment, or policy. The specific domains of HRQOL include resilience or the capacity to respond to stress, health perceptions, physical functioning, and symptoms. The majority of menopause studies have operationalized HRQOL as frequency and severity of symptoms. Taken together, the findings from 12 crosssectional reports and 3 longitudinal studies suggest that the perimenopause is associated with higher levels of somatic symptoms. It is unclear whether the perimenopause is related to other domains of HRQOL. Only 1 longitudinal study reported an association between reduced physical functioning and the perimenopause. Studies typically compare premenopausal women with women in other status categories taken separately, thereby not addressing the question of further change in HRQOL after the cessation of menses. There is a clear need for understanding the effects of the menopause beyond the domain of symptoms and to consider whether some domains of HRQOL might improve.
A universal menopausal syndrome? Nancy E. Avis, PhD,a Sarah Brockwell, PhD,b
Alicia Colvin, MPHb Department of Public Health Sciences, Section on Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; and b Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA A variety of symptoms are reported frequently as being part of a menopausal syndrome. These include hot flashes, night sweats, menstrual irregularities, vaginal dryness, depression, nervous tension, palpitations, headaches, insomnia, lack of energy, difficulty concentrating, and dizzy spells. The question of whether and how symptoms occur together is an important one for women who want to know which symptoms can be attributed to menopause and which to aging generally or to other physical or psychosocial factors. To address this question, the present article examines the following avenues of research: (1) the clustering or grouping of symptoms; (2) the temporal association of different symptoms with stages of the menopausal transition; (3) the consistency of symptom reporting across culture, race, and ethnicity; and (4) the consistency of risk factors for symptoms. Results of the factor analysis studies do not support a single syndrome consisting of menopausal and psychological or somatic symptoms. The prevalence of symptom reporting across the transition also argues against a menopausal syndrome because vasomotor symptoms follow a unique pattern that differs from other symptoms. Crosscultural differences suggest that symptom reporting is not universal. Finally, although there is some overlap in risk factors for symptoms, menopausal status is more consistently related to vasomotor symptoms than psychological or physical ones. Results of these investigations all argue against a universal menopausal syndrome. Future research should focus on how symptoms are interrelated, what factors are uniquely related to vasomotor symptoms, and identifying whether there is a subgroup of women who are more likely to report symptoms.
a
Genitourinary symptoms in the menopausal transition Bradley J. Van Voorhis, MD Department of Obstetrics and Gynecology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA Irregular uterine bleeding is a common symptom among women in the menopausal transition. Women commonly transition from having regular cycles to having irregular cycles before the final menstrual period. In late perimenopause, anovulation becomes more common, leading to skipped menstrual cycles. Low-dose oral contraceptive pills are effective in decreasing the amount of menstrual blood loss and improving menstrual cycle regularity. It is unclear whether menorrhagia is associated with normal perimenopausal hormonal changes. Studies to date have failed to correlate menorrhagia with hormonal levels and pathology within the uterus. Because of the common association between uterine pathology and menorrhagia, this is an important area for future studies. Vaginal dryness is a common symptom, particularly in late perimenopause. The association between vaginal dryness and low estrogen levels is clear. Estrogen-based hormone replacement therapy is effective in treating this symptom. Locally released estrogen therapy may be preferred over systemic therapy due to lower systemic estradiol levels, reduced side effects, and high efficacy. The long-term safety of these products, particularly in women with a history of breast cancer, requires more study. The prevalence of incontinence increases as women age, but it is unclear whether the menopausal