title: Symptoms, menopause status, and country differences: a comparative analysis from DAMES.
abstract: OBJECTIVE
  To investigate reported frequencies of menopausal symptoms among women in four countries, namely Lebanon, Morocco, Spain, and the United States, and to assess the relative role of menopause status, country of residence, and other factors in explaining differences in symptomatology.
  
  
  METHODS
  Surveys of representative samples of approximately 300 women aged 45 to 55 years in each site were conducted, using an instrument that includes demographic, health, and menopausal variables, in addition to perceptions and attitudes toward menopause. Statistical and textual analyses are used to examine differentials and the factors that influence them.
  
  
  RESULTS
  The burden of symptoms and the frequencies of symptoms differ across sites, but hot flashes are reported everywhere by just under one half of the respondents. The most frequent symptoms are joint pain, fatigue, impatience/nervousness, sleep disturbances, memory loss, and one or more emotional symptoms. Menopause status is significantly associated with hot flashes and vasomotor symptoms and to a lesser extent with emotional and sexual symptoms. Smoking, schooling, employment, and age are also associated with the frequency of selected symptoms. Country of residence influences reported symptoms over and above other factors.
  
  
  CONCLUSIONS
  Similarities among core symptoms and differences in the expression of symptoms were found across sites. Both biological (menopause status) and cultural (country of residence) variables influence symptomatology.
authors.affiliation: Department of Population and International Health, Harvard University, Boston, MA, USA. coberm@hsph.harvard.edu
authors.forename: Carla Makhlouf
authors.initials: CM
authors.lastname: Obermeyer
authors.forename: David
authors.initials: D
authors.lastname: Reher
authors.forename: Matilda
authors.initials: M
authors.lastname: Saliba
mesh_terms: D003431:Cross-Cultural Comparison; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007861:Lebanon / Q000453:epidemiology / Q000208:ethnology; D008593:Menopause / Q000208:ethnology*; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology / Q000208:ethnology; D013030:Spain / Q000453:epidemiology / Q000208:ethnology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology / Q000208:ethnology