title: Modeling Menstrual Cycle Length and Variability at the Approach of Menopause Using Hierarchical Change Point Models.
abstract: As women approach menopause, the patterns of their menstrual cycle lengths change. To study these changes, we need to jointly model both the mean and variability of cycle length. Our proposed model incorporates separate mean and variance change points for each woman and a hierarchical model to link them together, along with regression components to include predictors of menopausal onset such as age at menarche and parity. Additional complexity arises from the fact that the calendar data have substantial missingness due to hormone use, surgery, and failure to report. We integrate multiple imputation and time-to event modeling in a Bayesian estimation framework to deal with different forms of the missingness. Posterior predictive model checks are applied to evaluate the model fit. Our method successfully models patterns of women's menstrual cycle trajectories throughout their late reproductive life and identifies change points for mean and variability of segment length, providing insight into the menopausal process. More generally, our model points the way toward increasing use of joint mean-variance models to predict health outcomes and better understand disease processes.
authors.affiliation: Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109.
authors.forename: Xiaobi
authors.initials: X
authors.lastname: Huang
authors.affiliation: Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 ; Survey Methodology Program, Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI 48106.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Elliott
authors.affiliation: Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109.
authors.forename: Siobán D
authors.initials: SD
authors.lastname: Harlow
keywords: Change point model; Final Menstrual Period; Multiple Imputation; TREMIN
references.citation: J Womens Health (Larchmt). 2011 Feb;20(2):169-77
references.pmid: 21219248
references.citation: Menopause. 2004 Mar-Apr;11(2):186-97
references.pmid: 15021449
references.citation: Am J Epidemiol. 2003 Nov 15;158(10):947-50
references.pmid: 14607802
references.citation: Tumori. 2003 Nov-Dec;89(6):608-14
references.pmid: 14870825
references.citation: Biostatistics. 2010 Oct;11(4):741-55
references.pmid: 20400622
references.citation: Menopause. 2007 Jan-Feb;14(1):74-88
references.pmid: 17075433
references.citation: J Womens Health Gend Based Med. 2001 Nov;10(9):843-8
references.pmid: 11747678
references.citation: Biostatistics. 2006 Jan;7(1):100-14
references.pmid: 16020617
references.citation: J Clin Epidemiol. 1991;44(10):1015-25
references.pmid: 1940994
references.citation: J Clin Epidemiol. 2000 Jul;53(7):722-33
references.pmid: 10941950
references.citation: Climacteric. 2007 Apr;10(2):112-9
references.pmid: 17453859
references.citation: Menopause. 2007 May-Jun;14(3 Pt 1):415-24
references.pmid: 17303963
references.citation: Maturitas. 1998 Jun 3;29(2):115-23
references.pmid: 9651900
references.citation: J Clin Endocrinol Metab. 2006 Sep;91(9):3432-8
references.pmid: 16772350
references.citation: Stat Med. 2011 Mar 15;30(6):599-610
references.pmid: 21337356
references.citation: Menopause. 2000 Sep-Oct;7(5):334-49
references.pmid: 10993033
references.citation: Stat Methods Med Res. 2006 Apr;15(2):161-80
references.pmid: 16615655
references.citation: Menopause. 2002 Jan-Feb;9(1):32-40
references.pmid: 11791084
references.citation: Am J Obstet Gynecol. 1979 Dec 15;135(8):1021-4
references.pmid: 517585
references.citation: Am J Epidemiol. 2003 Oct 15;158(8):782-91
references.pmid: 14561668
references.citation: Fertil Steril. 2002 Aug;78(2):397-403
references.pmid: 12137880
references.citation: Fertil Steril. 2008 Jan;89(1):129-40
references.pmid: 17681300
references.citation: J Am Med Womens Assoc (1972). 2000 Spring;55(2):84-8, 105
references.pmid: 10808658
references.citation: J Clin Epidemiol. 2004 May;57(5):484-96
references.pmid: 15196619
references.citation: Am J Epidemiol. 1994 Dec 15;140(12):1091-5
references.pmid: 7998591
references.citation: Maturitas. 1981 Dec;3(3-4):249-64
references.pmid: 7334935
references.citation: Int J Fertil. 1967 Jan-Mar;12(1 Pt 2):77-126
references.pmid: 5419031
references.citation: Womens Health Issues. 2004 Nov-Dec;14(6):220-6
references.pmid: 15589772
references.citation: Qual Life Res. 2004 Jun;13(5):933-46
references.pmid: 15233507
references.citation: Med J Aust. 1993 Aug 16;159(4):232-6
references.pmid: 8412889
references.citation: J Clin Endocrinol Metab. 2006 Apr;91(4):1261-7
references.pmid: 16403818