title: Classifying menopause stage by menstrual calendars and annual interviews: need for improved questionnaires.
abstract: OBJECTIVE
  This study aims to assess the agreement between the menopausal transition stages defined by annual interviews or annual follicle-stimulating hormone levels and the menopausal transition stages defined by monthly menstrual calendars, as well as factors associated with discordance.
  
  
  METHODS
  These analyses used daily self-recorded menstrual calendar data from 1996 to 2006, annual interviews, and annual follicle-stimulating hormone levels. Participants were recruited from four study sites of the Study of Women's Health Across the Nation (Boston, southeastern Michigan, Oakland, and Los Angeles) and four racial/ethnic groups (African American, white, Chinese, and Japanese). Women who had a defined final menstrual period and who never had hormone therapy were included (n = 379). Cohen's κ statistics for 2 × 2 tables were calculated for two definitions of agreement. Logistic regression was used to identify factors associated with discordance.
  
  
  RESULTS
  Poor agreement between annual interview and menstrual calendar data was found for early menopausal transition (κ = -0.13; 95% CI, -0.25 to -0.02) and late menopausal transition (κ = -0.18; 95% CI, -0.26 to -0.11). For late stage, Chinese women (odds ratio [OR], 2.16; 95% CI, 1.08 to 4.30), African-American women (OR, 2.39; 95% CI, 1.00 to 5.71), and women with high school education or less (OR, 2.16; 95% CI, 1.08 to 4.30) were more likely to be discordant. Poor agreement between annual follicle-stimulating hormone levels and menstrual calendars was also found for early menopausal transition (κ = -0.44; 95% CI, -0.57 to -0.30) and late menopausal transition (κ = -0.32; 95% CI, -0.42 to -0.23).
  
  
  CONCLUSIONS
  New questions need to be developed to accurately identify the start of the menopausal transition and should be evaluated in a multiethnic population with varying educational backgrounds.
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA. pparams@umich.edu
authors.forename: Pangaja
authors.initials: P
authors.lastname: Paramsothy
authors.forename: Siobán D
authors.initials: SD
authors.lastname: Harlow
authors.forename: Michael R
authors.initials: MR
authors.lastname: Elliott
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Lisabeth
authors.forename: Sybil L
authors.initials: SL
authors.lastname: Crawford
authors.forename: John F
authors.initials: JF
authors.lastname: Randolph
mesh_terms: D000328:Adult; D001741:Black or African American; D001213:Asian; D002681:China / Q000208:ethnology; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D007564:Japan / Q000208:ethnology; D008593:Menopause; D008597:Menstrual Cycle; D008598:Menstruation; D008875:Middle Aged; D011795:Surveys and Questionnaires; D044465:White People; D016387:Women's Health
chemical_list: D005640:Follicle Stimulating Hormone