title: Symptom interference with work and relationships during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study.
abstract: OBJECTIVE
  The aim of this study was to describe the changes in symptom interference during the menopausal transition (MT) stages and early postmenopause (PM), including the effects of age, MT-related factors (estrone, follicle-stimulating hormone, testosterone, MT stages), symptoms (hot flashes, depressed mood, awakening during the night, anxiety, backache, joint pain, forgetfulness, and difficulty concentrating), health-related factors (perceived health), and stress-related factors (perceived stress, cortisol).
  
  
  METHODS
  A subset of Seattle Midlife Women's Health Study participants provided data during the late reproductive, early and late MT stages, or early PM (n = 184), including menstrual calendars for staging the MT; annual health reports completed between 1990 and 2008; morning urine samples assayed for estrone glucuronide, follicle-stimulating hormone, and cortisol; and symptom diary ratings several times each year. Interference was rated in the diary along with symptoms, perceived health, and stress. Multilevel modeling with an R program was used to test the patterns of symptom interference related to age, MT-related factors, symptoms, and health- and stress-related factors, with as many as 5,656 observations. Median age was 47.4 years.
  
  
  RESULTS
  Interference with work was significantly associated with individual covariates such as perceived health, stress, hot flashes, depressed mood, anxiety, difficulty getting to sleep, awakening during the night, early morning awakening, backache, joint pain, forgetfulness, and difficulty concentrating (for hot flashes, P = 0.01; all others, P < 0.001). A final multivariate model included perceived health, stress, depressed mood, and difficulty concentrating. Interference with relationships was significantly associated with age and individual covariates such as perceived health, estrone, perceived stress, depressed mood, anxiety, sleep symptoms, backache, joint pain, forgetfulness, and difficulty concentrating (for estrone, P = 0.03; all others, P < 0.001). A final multivariate model included perceived health, stress, depressed mood, anxiety, difficulty concentrating, and awakening during the night.
  
  
  CONCLUSIONS
  Women's reports of how much the way they felt interfered with work and relationships were influenced by both their perceived health and stress levels. Interference was also influenced by depressed mood and difficulty concentrating, suggesting that these two symptoms may be most important to address, to enhance functioning during the MT and early PM.
authors.affiliation: Department of Biobehavioral Nursing, University of Washington, Seattle, WA 98195-7260, USA. nfwoods@u.washington.edu
authors.forename: Nancy Fugate
authors.initials: NF
authors.lastname: Woods
authors.forename: Ellen Sullivan
authors.initials: ES
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D015415:Biomarkers / Q000652:urine; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D004970:Estrone / Q000652:urine; D005260:Female; D043373:Follicle Stimulating Hormone, Human / Q000652:urine; D006304:Health Status; D019584:Hot Flashes / Q000453:epidemiology; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D008569:Memory Disorders / Q000453:epidemiology; D008875:Middle Aged; D017698:Postmenopause; D012720:Severity of Illness Index; D018582:Sick Leave / Q000706:statistics & numerical data*; D012893:Sleep Wake Disorders / Q000453:epidemiology; D014861:Washington / Q000453:epidemiology; D016387:Women's Health; D014931:Women, Working / Q000706:statistics & numerical data*; D014940:Work Schedule Tolerance; D016526:Workload
chemical_list: D015415:Biomarkers; D043373:Follicle Stimulating Hormone, Human; D004970:Estrone; D006854:Hydrocortisone