title: A symptomatic approach to understanding women's health experiences: a cross-cultural comparison of women aged 20 to 70 years.
abstract: OBJECTIVE
  To determine patterns of symptoms across age groups, identify symptom groups associated with ovarian hormonal depletion or other variables, and develop a prediction model for each symptom.
  
  
  METHODS
  This was a cross-sectional survey of 4,517 women ages 20 to 70 years recruited from market research panels in the United States, United Kingdom, Germany, France, and Italy using a self-report questionnaire that included general health information and a checklist of 36 symptoms. Stepwise regression was used to determine for each symptom how prevalence varied with age, indicators of menopausal hormonal changes, and the effects of other explanatory variables, including body mass index, morbidity, and country. Hierarchical clustering was used to group symptoms.
  
  
  RESULTS
  Six groups of symptoms were found, of which two groups, with seven symptoms in total, were related to markers of menopausal hormonal change: a group consisting of hot flashes and night sweats and a second group including poor memory; difficulty sleeping; aches in the neck, head, and shoulders; vaginal dryness; and difficulty with sexual arousal. Physical and mental morbidity affected estimates of the prevalence of all symptoms. Psychological symptoms declined with age from a maximum prevalence before age 40. Certain physical symptoms increased with age and body mass index. Clustering identified three country groups: (1) US and UK women; (2) French and Italian women; and (3) German women. There were marked differences in prevalence between countries for certain physical and psychological symptoms.
  
  
  CONCLUSIONS
  The seven symptoms most linked to menopausal hormonal change should form part of any future menopause symptom list. Physical and mental morbidity affect symptom prevalence and should be measured.
authors.affiliation: Office for Gender and Health, Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia. ldenn@unimelb.edu.au
authors.forename: Lorraine
authors.initials: L
authors.lastname: Dennerstein
authors.forename: Philippe
authors.initials: P
authors.lastname: Lehert
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Koochaki
authors.forename: Alessandra
authors.initials: A
authors.lastname: Graziottin
authors.forename: Sandra
authors.initials: S
authors.lastname: Leiblum
authors.forename: Jeanne Leventhal
authors.initials: JL
authors.lastname: Alexander
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D019584:Hot Flashes / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D015995:Prevalence; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology / Q000208:ethnology; D014481:United States / Q000453:epidemiology / Q000208:ethnology