Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives
2005; Elsevier BV; Volume: 118; Issue: 12 Linguagem: Inglês
10.1016/j.amjmed.2005.09.031
ISSN1555-7162
AutoresNancy Fúgate Woods, Ellen Sullivan Mitchell,
Tópico(s)Phytoestrogen effects and research
ResumoThis article examines published evidence from longitudinal studies of the menopausal transition that address the following questions: (1) Which symptoms do women report during the perimenopause, and how prevalent are these symptoms as women traverse the menopausal transition? (2) How severe are symptoms and for how long do they persist? (3) To what do women attribute their symptoms, and do their attributions match findings from epidemiologic studies of community-based populations? (4) How significant are these symptoms in women’s lives? Data from published longitudinal studies were examined for evidence bearing on each of these questions. Only vasomotor symptoms, vaginal dryness, and sleep disturbance symptoms varied in prevalence significantly across menopausal transition stages and postmenopause in >1 population studied. A minority of women report severe symptoms. Given the limited follow-up data available, it is unclear how long symptoms persist after menopause. Women attribute their symptoms to a variety of biologic and psychosocial factors, and their attributions correspond well to those correlates identified in epidemiologic studies of community-based populations. The significance of symptoms for women’s lives remains uncertain. The impact of symptoms during the perimenopause on well-being, role performance, adaptation to demands of daily living, and quality of life warrants additional study. The appraisal of the consequences of perimenopausal symptoms by women from different ethnic groups will be enhanced significantly as a result of the Study of Women’s Health Across the Nation (SWAN) and other studies in progress. This article examines published evidence from longitudinal studies of the menopausal transition that address the following questions: (1) Which symptoms do women report during the perimenopause, and how prevalent are these symptoms as women traverse the menopausal transition? (2) How severe are symptoms and for how long do they persist? (3) To what do women attribute their symptoms, and do their attributions match findings from epidemiologic studies of community-based populations? (4) How significant are these symptoms in women’s lives? Data from published longitudinal studies were examined for evidence bearing on each of these questions. Only vasomotor symptoms, vaginal dryness, and sleep disturbance symptoms varied in prevalence significantly across menopausal transition stages and postmenopause in >1 population studied. A minority of women report severe symptoms. Given the limited follow-up data available, it is unclear how long symptoms persist after menopause. Women attribute their symptoms to a variety of biologic and psychosocial factors, and their attributions correspond well to those correlates identified in epidemiologic studies of community-based populations. The significance of symptoms for women’s lives remains uncertain. The impact of symptoms during the perimenopause on well-being, role performance, adaptation to demands of daily living, and quality of life warrants additional study. The appraisal of the consequences of perimenopausal symptoms by women from different ethnic groups will be enhanced significantly as a result of the Study of Women’s Health Across the Nation (SWAN) and other studies in progress. As women complete the transition to menopause, an estimated 85% report ≥1 symptom, such as hot flashes, depressed mood, or sleep disruption, that prompts nearly 10% of women to visit a healthcare provider.1McKinlay S.M. Brambilla D.J. Posner J. The normal menopause transition.Maturitas. 1992; 14: 103-115Abstract Full Text PDF PubMed Scopus (732) Google Scholar In the post–Women’s Health Initiative Study (WHI) era, symptom management has become more complex owing to awareness of the risks associated with hormone therapy (HT).2North American Menopause SocietyRecommendations for estrogen and progestogen use in peri- and postmenopausal women October 2004 position statement of The North American Menopause Society.Menopause. 2004; 11: 589-600PubMed Google Scholar Women use a range of symptom management options, including such self-care strategies as use of over-the-counter preparations; complementary and alternative therapies, such as herbal preparations; exercise programs and other lifestyle modifications; and taking prescription drugs.1McKinlay S.M. Brambilla D.J. Posner J. The normal menopause transition.Maturitas. 1992; 14: 103-115Abstract Full Text PDF PubMed Scopus (732) Google Scholar, 3Bair Y.A. Gold E.B. Greendale G.A. et al.Ethnic differences in use of complementary and alternative medicine at midlife longitudinal results from SWAN participants.Am J Public Health. 2002; 92: 1832-1840Crossref PubMed Scopus (106) Google Scholar Contact with health professionals during the perimenopause creates an opportunity for women to consider strategies for both symptom management and promotion of healthy aging. The paucity of data about women’s experiences of symptoms and their efforts at symptom management during the perimenopause, however, limits health professionals’ awareness of typical experiences of community-based populations of women as contrasted with the subset of women seeking healthcare. Moreover, clinicians do not have access to data about the meanings women assign to their experiences. The purpose of this article is to examine published evidence of the prevalence of menopause-related symptoms reported by participants in longitudinal studies of the menopausal transition to address the following questions: (1) Which symptoms do women report during the perimenopause, and how prevalent are these symptoms as women traverse the menopausal transition? (2) How severe are symptoms and for how long do they persist? (3) To what do women attribute their symptoms, and do their attributions match findings from epidemiologic studies of community-based populations? (4) How significant are these symptoms in women’s lives? Data from published community-based longitudinal studies of the menopausal transition were reviewed for evidence bearing on each of the questions presented above.1McKinlay S.M. Brambilla D.J. Posner J. The normal menopause transition.Maturitas. 1992; 14: 103-115Abstract Full Text PDF PubMed Scopus (732) Google Scholar, 2North American Menopause SocietyRecommendations for estrogen and progestogen use in peri- and postmenopausal women October 2004 position statement of The North American Menopause Society.Menopause. 2004; 11: 589-600PubMed Google Scholar, 3Bair Y.A. Gold E.B. Greendale G.A. et al.Ethnic differences in use of complementary and alternative medicine at midlife longitudinal results from SWAN participants.Am J Public Health. 2002; 92: 1832-1840Crossref PubMed Scopus (106) Google Scholar, 4Matthews K.A. Wing R.R. Kuller L.H. et al.Influences of natural menopause on psychological characteristics and symptoms of middle-aged healthy women.J Consult Clin Psychol. 1990; 58: 345-351Crossref PubMed Scopus (215) Google Scholar, 5Kaufert P.A. Gilbert P. Tate R. The Manitoba Project a re-examination of the link between menopause and depression.Maturitas. 1992; 14: 143-155Abstract Full Text PDF PubMed Scopus (268) Google Scholar, 6Holte A. Influences of natural menopause on health complaints a prospective study of healthy Norwegian women.Maturitas. 1992; 14: 127-141Abstract Full Text PDF PubMed Scopus (123) Google Scholar, 7Woods N.F. Mitchell E.S. Anticipating menopause observations from the Seattle Midlife Women’s Health Study.Menopause. 1999; 6: 167-173PubMed Google Scholar, 8Hunter M. The South-East England longitudinal study of the climacteric and postmenopause.Maturitas. 1992; 14: 117-126Abstract Full Text PDF PubMed Scopus (232) Google Scholar, 9Dennerstein L. Smith A.M. Morse C.A. et al.Menopausal symptoms in Australian women.Med J Aust. 1993; 159: 232-236PubMed Google Scholar, 10Freeman E.W. Grisso J.A. Berlin J. et al.Symptom reports from a cohort of African American and white women in the late reproductive years.Menopause. 2001; 8: 33-42Crossref PubMed Scopus (86) Google Scholar, 11Harlow B.L. Cohen L.S. Otto M.W. et al.Prevalence and predictors of depressive symptoms in older premenopausal women the Harvard Study of Moods and Cycles.Arch Gen Psychiatry. 1999; 56: 418-424Crossref PubMed Scopus (135) Google Scholar, 12Sowers M. Crawford S. Sternfeld B. et al.SWAN A multicenter, multiethnic community-based cohort study of women and the MT.in: Lobo R. Kelsey J. Marcus R. Menopause Biology and Pathobiology. Academic Press, San Diego, CA2000: 175-188Crossref Google Scholar Where possible, the Staging Reproductive Aging Workshop (STRAW) criteria were used to approximate the stage of menopausal transition and to promote comparison of data specific to menopausal transition stages across multiple studies.13Soules M.R. Sherman S. Parrott E. et al.Executive summary Stages of Reproductive Aging Workshop (STRAW).Fertil Steril. 2001; 76: 874-878Abstract Full Text Full Text PDF PubMed Scopus (577) Google Scholar The STRAW stages are based on menstrual cycle patterns and include the following: (1) late reproductive stage, denoted by minor changes in cycle length, particularly decreasing length of the cycle; (2) early menopausal transition stage, indicated by increasing irregularity of menses without skipping periods (>7 days’ difference from the beginning of a given cycle to the next, experienced after previously regular cycles); (3) late menopausal transition stage, characterized by skipping periods (amenorrhea >60 days); and (4) postmenopause, spanning the time from a woman’s final menstrual period (FMP) to the end of her life. Classification of the menopausal transition stages for most studies was based on retrospective histories of menses, although some recent studies have incorporated daily diary recordings.7Woods N.F. Mitchell E.S. Anticipating menopause observations from the Seattle Midlife Women’s Health Study.Menopause. 1999; 6: 167-173PubMed Google Scholar, 12Sowers M. Crawford S. Sternfeld B. et al.SWAN A multicenter, multiethnic community-based cohort study of women and the MT.in: Lobo R. Kelsey J. Marcus R. Menopause Biology and Pathobiology. Academic Press, San Diego, CA2000: 175-188Crossref Google Scholar Women at midlife report hot flashes and sweats, depressed mood, sleep disturbances, sexual concerns or problems, cognitive symptoms, vaginal dryness, urinary incontinence, and somatic or bodily pain symptoms. Because women experience these symptoms at many other points in their lives (as do men, with the exception of the vaginal symptoms), none can be said to be specific to the perimenopause. The prevalence of hot flashes among women who had not begun the menopausal transition (STRAW late reproductive stage) ranges from 6%4Matthews K.A. Wing R.R. Kuller L.H. et al.Influences of natural menopause on psychological characteristics and symptoms of middle-aged healthy women.J Consult Clin Psychol. 1990; 58: 345-351Crossref PubMed Scopus (215) Google Scholar to 13%.14Dennerstein L. Dudley E. Hopper J. et al.A prospective population-based study of menopausal symptoms.Obstet Gynecol. 2000; 96: 351-358Crossref PubMed Scopus (380) Google Scholar As women progress from the early to late menopausal transition stages (from noting changes in their cycle regularity to skipping menstrual periods), the prevalence of hot flashes increased (late reproductive, 4% to 46%; late menopausal transition, 33% to 63%).1McKinlay S.M. Brambilla D.J. Posner J. The normal menopause transition.Maturitas. 1992; 14: 103-115Abstract Full Text PDF PubMed Scopus (732) Google Scholar, 14Dennerstein L. Dudley E. Hopper J. et al.A prospective population-based study of menopausal symptoms.Obstet Gynecol. 2000; 96: 351-358Crossref PubMed Scopus (380) Google Scholar For women who had completed menopause (STRAW postmenopause, defined as ≥1 year with no menses), the prevalence rose as high as 79%14Dennerstein L. Dudley E. Hopper J. et al.A prospective population-based study of menopausal symptoms.Obstet Gynecol. 2000; 96: 351-358Crossref PubMed Scopus (380) Google Scholar (Table 14Matthews K.A. Wing R.R. Kuller L.H. et al.Influences of natural menopause on psychological characteristics and symptoms of middle-aged healthy women.J Consult Clin Psychol. 1990; 58: 345-351Crossref PubMed Scopus (215) Google Scholar, 5Kaufert P.A. Gilbert P. Tate R. The Manitoba Project a re-examination of the link between menopause and depression.Maturitas. 1992; 14: 143-155Abstract Full Text PDF PubMed Scopus (268) Google Scholar, 6Holte A. Influences of natural menopause on health complaints a prospective study of healthy Norwegian women.Maturitas. 1992; 14: 127-141Abstract Full Text PDF PubMed Scopus (123) Google Scholar, 10Freeman E.W. Grisso J.A. Berlin J. et al.Symptom reports from a cohort of African American and white women in the late reproductive years.Menopause. 2001; 8: 33-42Crossref PubMed Scopus (86) Google Scholar, 14Dennerstein L. Dudley E. Hopper J. et al.A prospective population-based study of menopausal symptoms.Obstet Gynecol. 2000; 96: 351-358Crossref PubMed Scopus (380) Google Scholar, 15Gold E.B. Sternfeld B. Kelsey J.L. et al.Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40–55 years of age.Am J Epidemiol. 2000; 152: 463-473Crossref PubMed Scopus (676) Google Scholar, 16Kaufert P. Syrotuik J. Symptom reporting at the menopause.Soc Sci Med. 1981; 151: 173-184Google Scholar, 17Gold E. Block G. Crawford S. et al.Lifestyle and demographic factors in relation to vasomotor symptoms baseline results from the Study of Women’s Health Across the Nation.Am J Epidemiol. 2004; 159: 1189-1199Crossref PubMed Scopus (237) Google Scholar, 18Freeman E. Sammel M. Lin H. Gracia C.R. Kapoor S. Ferdusi T. The role of anxiety and hormonal changes in menopausal hot flashes.Menopause. 2005; 12: 258-266Crossref PubMed Scopus (181) Google Scholar, 19Lock M. Culture and the menopause.in: Aso T. Yanaihara T. Fujimoto S. The Menopause at the Millennium: The Proceedings of the 9th International Menopause Society World Congress on the Menopause: Yokohama, Japan, October 17–21, 1999. Parthenon, New York2000: 29-35Google Scholar, 20Guthrie J. Dennerstein L. Hopper J. et al.Hot flushes, menstrual status, and hormone levels in a population-based sample of midlife women.Obstet Gynecol. 1996; 88: 437-442Crossref PubMed Scopus (141) Google Scholar).Table 1Prevalence of vasomotor symptoms from selected longitudinal studiesSTRAW MT StageStudyStudy PopulationMeasuresLate ReproductiveEarly MTLate MTPostmenopauseHealthy Women Study4Matthews K.A. Wing R.R. Kuller L.H. et al.Influences of natural menopause on psychological characteristics and symptoms of middle-aged healthy women.J Consult Clin Psychol. 1990; 58: 345-351Crossref PubMed Scopus (215) Google Scholar460 women, aged 42–50 yr (19 black, 183 white), randomly selected from drivers’ licenses and census listsChecklist of 27 symptoms administered in follow-up clinical examination6%NANA43%Manitoba Project on Women and Their Health in the Middle Years5Kaufert P.A. Gilbert P. Tate R. The Manitoba Project a re-examination of the link between menopause and depression.Maturitas. 1992; 14: 143-155Abstract Full Text PDF PubMed Scopus (268) Google Scholar, 16Kaufert P. Syrotuik J. Symptom reporting at the menopause.Soc Sci Med. 1981; 151: 173-184Google Scholar469 women, aged 45–55 yr, selected from nonrandom mail survey, 145 with hysterectomyChecklist of symptoms19Lock M. Culture and the menopause.in: Aso T. Yanaihara T. Fujimoto S. The Menopause at the Millennium: The Proceedings of the 9th International Menopause Society World Congress on the Menopause: Yokohama, Japan, October 17–21, 1999. Parthenon, New York2000: 29-35Google ScholarHot flashes, 13.8%NA39.7%41.5%Night sweats, 10.6%NA27.6%22.2%Norwegian Menopause Project6Holte A. Influences of natural menopause on health complaints a prospective study of healthy Norwegian women.Maturitas. 1992; 14: 127-141Abstract Full Text PDF PubMed Scopus (123) Google Scholar200 women, aged 45–55 yr (of 1,886 women studied in 1981), followed annually for 5 yrSymptoms reported in interview, as well as frequency and whether troubled by symptomsHot flashes,Very troubled, 12%NANA46%NA67% (1 yr)61% (2 yr)18% (1 yr)12% (2 yr)Melbourne Women’s Midlife Health Project14Dennerstein L. Dudley E. Hopper J. et al.A prospective population-based study of menopausal symptoms.Obstet Gynecol. 2000; 96: 351-358Crossref PubMed Scopus (380) Google Scholar453 women, aged 45–55 yr, from a population-based Australian sampleSymptoms over past 2 wk, frequency/day, and bother20Guthrie J. Dennerstein L. Hopper J. et al.Hot flushes, menstrual status, and hormone levels in a population-based sample of midlife women.Obstet Gynecol. 1996; 88: 437-442Crossref PubMed Scopus (141) Google ScholarHot flashes (>1/day), 13%NA37%Bothered, 6%NA26%172 women who had made a transition to perimenopause or postmenopause (in 2000)As aboveHot flashes, 10%15%42%42% (1 yr) 41% (2 yr)Sweats, 10%14%30%35% (1 yr)24% (2 yr)SWAN15Gold E.B. Sternfeld B. Kelsey J.L. et al.Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40–55 years of age.Am J Epidemiol. 2000; 152: 463-473Crossref PubMed Scopus (676) Google Scholar, 17Gold E. Block G. Crawford S. et al.Lifestyle and demographic factors in relation to vasomotor symptoms baseline results from the Study of Women’s Health Across the Nation.Am J Epidemiol. 2004; 159: 1189-1199Crossref PubMed Scopus (237) Google Scholar16,065 women, aged 40–55 yr, from multiracial/ethnic sample, 7 sites, community-based sampling strategies to include African American, Chinese American, Japanese American, Hispanic, and European American womenSelf-reported questionnaires, asked whether they had hot flashes/sweats over the past 2 wk19.4%36.9%56.8%48.8%Penn Ovarian Aging Study10Freeman E.W. Grisso J.A. Berlin J. et al.Symptom reports from a cohort of African American and white women in the late reproductive years.Menopause. 2001; 8: 33-42Crossref PubMed Scopus (86) Google Scholar, 18Freeman E. Sammel M. Lin H. Gracia C.R. Kapoor S. Ferdusi T. The role of anxiety and hormonal changes in menopausal hot flashes.Menopause. 2005; 12: 258-266Crossref PubMed Scopus (181) Google ScholarWomen, aged 35–47 yr, randomly selected from community (African Americans = 219; European Americans = 217)Standardized menopause symptoms checklist regarding hot flashes over the past month/severityHot flashes (6 yr), 37%48%63%79%MT = menopausal transition; NA = estimate not available from published literature; STRAW = Staging Reproductive Aging Workshop; SWAN = Study of Women’s Health Across the Nation. Open table in a new tab MT = menopausal transition; NA = estimate not available from published literature; STRAW = Staging Reproductive Aging Workshop; SWAN = Study of Women’s Health Across the Nation. The peak prevalence of hot flashes occurs during the late menopausal transition stage (labeled “late perimenopause” in several of the studies) and during the early postmenopause. Because many studies have not included follow-up beyond the first 1 or 2 years of postmenopause, it is difficult to discern when or whether hot flashes cease. Where reproductive stage measures are available, the prevalence of depressed mood symptoms (e.g., feeling sad or blue) ranged from 19% to 29%. For women in the early or late menopausal transition stages, prevalence estimates ranged from 28% to 29%; for those who had completed menopause, the prevalence of depressed mood symptoms ranged from 24.5% to 29% (late reproductive) to 23% to 28% (late MT) to 23% to 34% (postmenopause)4Matthews K.A. Wing R.R. Kuller L.H. et al.Influences of natural menopause on psychological characteristics and symptoms of middle-aged healthy women.J Consult Clin Psychol. 1990; 58: 345-351Crossref PubMed Scopus (215) Google Scholar, 21Dennerstein L. Guthrie J.R. Clark M. et al.A population-based study of depressed mood in middle-aged, Australian-born women.Menopause. 2004; 11: 563-568Crossref PubMed Scopus (113) Google Scholar, 22Avis N.E. Crawford S. Stellato R. et al.Longitudinal study of hormone levels and depression among women transitioning through menopause.Climacteric. 2001; 4: 243-249PubMed Google Scholar, 23Avis N.E. Brambilla D. McKinlay S.M. Vass K. A longitudinal analysis of the association between menopause and depression results from the Massachusetts Women’s Health Study.Ann Epidemiol. 1994; 4: 214-220Abstract Full Text PDF PubMed Scopus (378) Google Scholar, 24McKinlay J.B. McKinlay S.M. Brambilla D. The relative contributions of endocrine changes and social circumstances to depression in mid-aged women.J Health Social Behav. 1987; 28: 345-363Crossref PubMed Scopus (261) Google Scholar, 25Woods N.F. Mariella A. Mitchell E. Patterns of depressed mood across the MT approaches to studying patterns in longitudinal data.Acta Obstet Gynecol Scand. 2002; 81: 623-632Crossref PubMed Scopus (51) Google Scholar, 26Woods N.F. Mitchell E.S. Patterns of depressed mood in midlife women observations from the Seattle Midlife Women’s Health Study.Res Nurs Health. 1996; 19: 111-123Crossref PubMed Scopus (60) Google Scholar, 27Bromberger J.T. Assmann S.F. Avis N.E. et al.Persistent mood symptoms in multiethnic community cohort of pre- and perimenopausal women.Am J Epidemiol. 2003; 158: 347-356Crossref PubMed Scopus (177) Google Scholar (Table 24Matthews K.A. Wing R.R. Kuller L.H. et al.Influences of natural menopause on psychological characteristics and symptoms of middle-aged healthy women.J Consult Clin Psychol. 1990; 58: 345-351Crossref PubMed Scopus (215) Google Scholar, 5Kaufert P.A. Gilbert P. Tate R. The Manitoba Project a re-examination of the link between menopause and depression.Maturitas. 1992; 14: 143-155Abstract Full Text PDF PubMed Scopus (268) Google Scholar, 19Lock M. Culture and the menopause.in: Aso T. Yanaihara T. Fujimoto S. The Menopause at the Millennium: The Proceedings of the 9th International Menopause Society World Congress on the Menopause: Yokohama, Japan, October 17–21, 1999. Parthenon, New York2000: 29-35Google Scholar, 22Avis N.E. Crawford S. Stellato R. et al.Longitudinal study of hormone levels and depression among women transitioning through menopause.Climacteric. 2001; 4: 243-249PubMed Google Scholar, 23Avis N.E. Brambilla D. McKinlay S.M. Vass K. A longitudinal analysis of the association between menopause and depression results from the Massachusetts Women’s Health Study.Ann Epidemiol. 1994; 4: 214-220Abstract Full Text PDF PubMed Scopus (378) Google Scholar, 24McKinlay J.B. McKinlay S.M. Brambilla D. The relative contributions of endocrine changes and social circumstances to depression in mid-aged women.J Health Social Behav. 1987; 28: 345-363Crossref PubMed Scopus (261) Google Scholar, 28Busch C. Zonderman A. Costa P. MT and psychological distress in a nationally representative sample is menopause associated with psychological distress?.J Aging Health. 1994; : 6209-6228Google Scholar, 29Lock M. Kaufert P. Gilbert P. Cultural construction of the menopausal syndrome the Japanese case.Maturitas. 1988; 10: 317-332Abstract Full Text PDF PubMed Scopus (122) Google Scholar, 30Bromberger J. Harlow S. Avis N. et al.Racial/ethnic differences in the prevalence of depressive symptoms among middle-aged women the Study of Women’s Health Across the Nation (SWAN).Am J Public Health. 2004; 94: 1378-1385Crossref PubMed Scopus (172) Google Scholar, 31Bromberger J. Meyer P. Kravitz H. et al.Psychologic distress and natural menopause a multiethnic community study.Am J Public Health. 2001; 92: 1435-1442Crossref Scopus (222) Google Scholar, 32Freeman E.W. Sammel M.D. Liu L. et al.Hormones and menopausal status as predictors of depression in women in transition to menopause.Arch Gen Psychiatry. 2004; 61: 62-70Crossref PubMed Scopus (466) Google Scholar).Table 2Prevalence of depressed mood symptoms from selected longitudinal studiesStudyStudy PopulationMeasuresSTRAW MT StageLate ReproductiveEarly MTLate MTPostmenopauseMassachusetts Women’s Health Study22Avis N.E. Crawford S. Stellato R. et al.Longitudinal study of hormone levels and depression among women transitioning through menopause.Climacteric. 2001; 4: 243-249PubMed Google Scholar, 23Avis N.E. Brambilla D. McKinlay S.M. Vass K. A longitudinal analysis of the association between menopause and depression results from the Massachusetts Women’s Health Study.Ann Epidemiol. 1994; 4: 214-220Abstract Full Text PDF PubMed Scopus (378) Google Scholar, 24McKinlay J.B. McKinlay S.M. Brambilla D. The relative contributions of endocrine changes and social circumstances to depression in mid-aged women.J Health Social Behav. 1987; 28: 345-363Crossref PubMed Scopus (261) Google Scholar2,352 white women, aged 45–55 yr, randomly selected from from Massachusetts state census listsAsked if sad or blue/depressed over past 2 wk (symptom checklist)29.1%NA28.1%33.8%Healthy Women Study4Matthews K.A. Wing R.R. Kuller L.H. et al.Influences of natural menopause on psychological characteristics and symptoms of middle-aged healthy women.J Consult Clin Psychol. 1990; 58: 345-351Crossref PubMed Scopus (215) Google Scholar460 women, aged 42–50 yr (19 black and 183 white), randomly selected from drivers’ licenses and census listsBeck Depression Inventory 4.5%NANA5.9%National Health Examination Follow-up Study28Busch C. Zonderman A. Costa P. MT and psychological distress in a nationally representative sample is menopause associated with psychological distress?.J Aging Health. 1994; : 6209-6228Google Scholar394 women, aged 40–58 yr, selected using stratified probability sample of adult, noninstitutionalized civilian populationCES-D measures repeated 10 yr apart; cut point, >1613%NA19%17%Manitoba Project on Women and Their Health in the Middle Years5Kaufert P.A. Gilbert P. Tate R. The Manitoba Project a re-examination of the link between menopause and depression.Maturitas. 1992; 14: 143-155Abstract Full Text PDF PubMed Scopus (268) Google Scholar, 19Lock M. Culture and the menopause.in: Aso T. Yanaihara T. Fujimoto S. The Menopause at the Millennium: The Proceedings of the 9th International Menopause Society World Congress on the Menopause: Yokohama, Japan, October 17–21, 1999. Parthenon, New York2000: 29-35Google Scholar, 29Lock M. Kaufert P. Gilbert P. Cultural construction of the menopausal syndrome the Japanese case.Maturitas. 1988; 10: 317-332Abstract Full Text PDF PubMed Scopus (122) Google Scholar469 women, aged 45–55 yr, selected from nonrandom mail survey, 145 with hysterectomyQuestionnaire asking whether depressed or blue24.5%NA23.2%23.0%SWAN30Bromberger J. Harlow S. Avis N. et al.Racial/ethnic differences in the prevalence of depressive symptoms among middle-aged women the Study of Women’s Health Across the Nation (SWAN).Am J Public Health. 2004; 94: 1378-1385Crossref PubMed Scopus (172) Google Scholar, 31Bromberger J. Meyer P. Kravitz H. et al.Psychologic distress and natural menopause a multiethnic community study.Am J Public Health. 2001; 92: 1435-1442Crossref Scopus (222) Google Scholar3,015 of 3,302 women selected from 7 sitesPersistent mood symptoms included dysphoric mood, feeling blue or depressed, irritable or grouchy, tense or nervous, and frequent mood changes >6 days/wk8%–12%14.9%–18.4%NANA16,065 women, aged 40–55 yrPsychologic distress (feeling tense, depressed, and irritable in the previous week)20.9%NA28.9%22%Penn Ovarian Aging Study32Freeman E.W. Sammel M.D. Liu L. et al.Hormones and menopausal status as predictors of depression in women in transition to menopause.Arch Gen Psychiatry. 2004; 61: 62-70Crossref PubMed Scopus (466) Google ScholarWomen, aged 35–47 yr, randomly selected from community (African Americans = 219, European Americans = 217)Interviews using CES-D conducted at baseline and 4 yr laterCES-D >16 12%–15%1.4%–7.8%13.1%–18.3%1%–13.8%Interviews to identify MDDMDD 10%–13%1%–4%<1%<1%CES-D = Center for Epidemiologic Studies Depression Scale; MDD = major depressive disorder; MT = menopausal transitron; NA = estimate not available from published literature; STRAW = Staging Reproductive Aging Workshop; SWAN = Study of Women’s Health Across the Nation. Open table in a new tab CES-D = Center for Epidemiologic Studies Depression Scale; MDD = major depressive disorder; MT = menopausal transitron; NA = estimate not available from published literature; STRAW = Staging Reproductive Aging Workshop; SWAN = Study of Women’s Health Across the Nation. Several investigators have used the Center for Epidemiologic Studies Depression Scale (CES-D) to obtain estimates of depressed mood. Using a cut point of 16 to identify women with scores resembling those of patients with major depressive disorders, investigators estimated that the prevalence of depressed mood for women in the reproductive stage ranged from 11.6% to 15%.28Busch C. Zonderman A. Costa P. MT and psychological distress in a nationally representative sample is menopause associated with psychological distress?.J Aging Health. 1994; : 6209-6228Google Scholar, 32Freeman E.W. Sammel M.D. Liu L. et al.Hormones and menopausal status as predictors of depression in women in transition to menopause.Arch Gen Psychiatry. 2004; 61: 62-70Crossref PubMed Scopus (466) Google Scholar Estimates ranged from 1% to 19% for women in the early menopausal transition stage, from 13% to 18% for those who were in the late menopausal transition stage, and from 1% to 17% for those who were postmenopausal.5Kaufert P.A. Gilbert P. Tate R. The Manitoba Project a re-examination of the link between menopause and depression.Maturitas. 1992; 14: 143-155Abstract Full Text PDF PubMed Scopu
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