Patterns of Symptoms Often Associated with Menopause

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Summary and Comment

Patterns of Symptoms Often Associated with Menopause

Hot flushes, depressed mood, and aches, joint pain, and stiffness were independently associated with menopausal stage.

Although the existence of menopausal symptoms is widely acknowledged, little information exists about their severity and frequency. In the Penn Ovarian Aging Study, investigators followed a cohort of more than 400 women for 9 years to document symptoms associated with the transition from premenopause to postmenopause.

At study onset, subjects ranged in age from 36 to 49 years (mean age, 42 years). The prevalence of hot flushes and aches, joint pain, and stiffness increased throughout the transition, with the prevalence of each symptom peaking at about 80%. Depressed mood was experienced by about 60% of women during the menopausal transition, when menses and hormonal levels fluctuate wildly, and the prevalence decreased in the postmenopause stage. Fluctuations in estradiol, decreased levels of inhibin (an ovarian hormone that suppresses follicle-stimulating hormone [FSH]), and increased levels of FSH were independently associated with these symptoms, indicating declining ovarian function. Surprisingly, poor sleep, decreased libido, and vaginal dryness were not associated with the transition to menopause.

Comment: This study highlights the patterns of symptoms associated with the menopausal transition. The surprising finding is how well aches, joint pain, and stiffness correlated with menopausal stage, and how poorly vaginal dryness did. In fact, only about 20% of women complained of vaginal dryness, even though it is a common reason for menopausal women to seek medical assistance. As noted by an editorialist, short-term use of estrogen is effective in providing benefits to symptomatic women as they transition to menopause.

— Robert W. Rebar, MD

Published in Journal Watch General Medicine August 14, 2007