Symptoms reported by women in midlife: menopausal transition or aging?

Objective: The aim of this study was to determine which symptoms commonly reported by women at midlife are associated with the menopausal transition, after adjusting for aging, life events, sociodemographics, and lifestyle factors.

Methods: Middle-aged women participating in the Australian Longitudinal Study on Women's Health between 1996 (survey 1, ages 45-50 y) and 2007 (survey 5) were included in the analyses if natural menopause status could be determined at any survey (n = 8,649 of 13,716 participants). Natural menopause status was determined from reported menstruation patterns. A survival function describing age at menopause was computed. Logistic regression models for repeated measures were used to estimate the association between menopausal stage and symptom prevalence.

Results: There were 6,814 (79%) women who reached natural menopause before 2007. The median age at menopause was 52 years. Compared with the premenopausal phase, menopause was associated with hot flushes (odds ratio, 8.6 [95% CI, 7.5-9.9]), night sweats (odds ratio, 5.5 [95% CI, 4.8-6.3]), and, to a lesser extent, stiff or painful joints (odds ratio, 1.6 [95% CI, 1.4-1.8]), difficulty sleeping (odds ratio, 1.4 [95% CI, 1.2-1.6]), and poor/fair self-rated health (odds ratio, 1.6 [95% CI, 1.3-1.9]), after controlling for confounders. Prevalence of some symptoms was still raised more than 7 years after menopause. Headaches/migraines were negatively associated with aging, and urinary incontinence was positively associated with aging.

Conclusions: Treatment such as hormone therapy should be targeted to vasomotor symptoms, which are most strongly associated with menopause rather than to less specific symptoms related to aging per se.