Symptoms associated with menopausal transition and reproductive hormones in midlife women.
OBJECTIVE
To test the hypothesis that prevalence of women with menopausal symptoms of hot flushes; aches, joint pain, and stiffness; depressed mood; poor sleep; decreased libido; or vaginal dryness increases with progression through the menopausal transition.


METHODS
Women in the Penn Ovarian Aging Study were assessed longitudinally for 9 years. Data were obtained from structured interviews, a validated symptom questionnaire, menstrual bleeding dates and early follicular hormone measures (estradiol [E2], follicle-stimulating hormone [FSH], and inhibin b). Menopausal stages were based on menstrual bleeding patterns. Other risk factors included age, race, history of depression, current smoking, body mass index, and perceived stress. Generalized linear regression models for repeated measures were used to estimate associations among the variables with each symptom.


RESULTS
The prevalence of hot flushes; aches, joint pain, and stiffness; and depressed mood increased in the menopausal transition. Menopausal stage was associated with hot flushes (P<.001); aches joint pain, and stiffness (P<.001); and depressed mood (P=.002). Within-woman fluctuations of E2 were associated with hot flushes and aches. Poor sleep, decreased libido, and vaginal dryness were not associated with menopausal stages. There was 80% power to detect an absolute difference of 11% for libido and vaginal dryness and 17% for poor sleep in the prevalence of these symptoms in the late menopausal transition compared with premenopausal status.


CONCLUSIONS
The study highlights the role of menopausal stages for some symptoms of midlife women and indicates that stages in the transition to menopause are associated with hot flushes; aches, joint pain, and stiffness; and depressed mood. Fluctuations of E2, decreased levels of inhibin b, and increased FSH levels were associated with these symptoms.


METHODS
II.
Departments of Obstetrics/Gynecology, Psychiatry, University of Pennsylvania, 3701 Market Street, Philadelphia, PA 19104, USA. freemane@mail.med.upenn.edu
Ellen W
EW
Freeman
Mary D
MD
Sammel
Hui
H
Lin
Clarisa R
CR
Gracia
Grace W
GW
Pien
Deborah B
DB
Nelson
Li
L
Sheng
D000328:Adult; D018771:Arthralgia / Q000378:metabolism; D003863:Depression / Q000378:metabolism; D004958:Estradiol / Q000378:metabolism*; D005260:Female; D043373:Follicle Stimulating Hormone, Human / Q000378:metabolism*; D019584:Hot Flashes / Q000378:metabolism; D006801:Humans; D007265:Inhibins / Q000378:metabolism*; D007989:Libido / Q000502:physiology; D008137:Longitudinal Studies; D008875:Middle Aged; D047648:Perimenopause / Q000378:metabolism* / Q000523:psychology
D043373:Follicle Stimulating Hormone, Human; C422364:inhibin B; D004958:Estradiol; D007265:Inhibins