title: Self-defined menopausal status in a multi-ethnic sample of midlife women.
abstract: OBJECTIVE
  This study aimed to identify factors associated with women's perceived menopausal status and to evaluate agreement between women's self-designation and a menstrually-based classification in a multi-ethnic sample of women.
  
  
  METHODS
  A cross-sectional survey was conducted as part of a large, seven-site, multi-ethnic study, the Study of Women's Health Across the Nation (SWAN). All variables were assessed by self-report in 13952 women aged 40-55 years. Multiple linear regression was used to assess determinants of self-defined menopausal status, stratifying by race/ethnicity within three anatomical/hormone use strata. Kappa statistics were used to evaluate agreement between the self-defined and menstrually-based classifications.
  
  
  RESULTS
  For women with an intact uterus, at least one ovary and not using hormones, menstrual patterns explained about half the variance in self-defined menopause status with older women classifying themselves later in the transition. Disagreement between menstrually-based and self-defined menopausal status was 39, 38, 36, 32 and 29% for Hispanic, African-American, Japanese, Caucasian, and Chinese women, respectively (kappa statistics=0.46, 0.41, 0.40, 0.53 and 0.58). Women with vasomotor symptoms tended to self-designate themselves as being in transition regardless of their menstrual patterns. Age and 12 months of amenorrhea explained about 40% of the variance in self-categorization among women using hormones with an intact uterus. Bilateral oophorectomy, age and time since surgery explained about 20% of the variance among post-surgical women.
  
  
  CONCLUSIONS
  Menstrual characteristics are strong predictors of women's self-perceived menopausal status. However, additional factors, including symptoms and cultural differences in the meaning of specific bleeding patterns, are also relevant and require further investigation.
authors.affiliation: Department of Epidemiology, University of Michigan, 109 Observatory St., Ann Arbor, MI 48109-2029, USA. harlow@umich.edu
authors.forename: S D
authors.initials: SD
authors.lastname: Harlow
authors.forename: S L
authors.initials: SL
authors.lastname: Crawford
authors.forename: B
authors.initials: B
authors.lastname: Sommer
authors.forename: G A
authors.initials: GA
authors.lastname: Greendale
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D005006:Ethnicity; D005260:Female; D006801:Humans; D016014:Linear Models; D008593:Menopause / Q000208:ethnology*; D008598:Menstruation / Q000208:ethnology*; D008875:Middle Aged; D012649:Self Concept; D011795:Surveys and Questionnaires; D014481:United States; D016387:Women's Health