Does the menopausal transition affect health-related quality of life?
2005; Elsevier BV; Volume: 118; Issue: 12 Linguagem: Inglês
10.1016/j.amjmed.2005.09.032
ISSN1555-7162
AutoresKaren A. Matthews, Joyce T. Bromberger,
Tópico(s)Cancer survivorship and care
ResumoWe address whether the menopausal transition affects health-related quality of life (HRQOL). To do this, we review how HRQOL is defined and measured, present HRQOL findings from the large, population-based studies of menopause, and identify key gaps in knowledge. HRQOL is defined as the value assigned to duration of life as modified by impairments, functional states, perceptions, and social opportunities that are influenced by disease, injury, treatment, or policy. The specific domains of HRQOL include resilience or the capacity to respond to stress, health perceptions, physical functioning, and symptoms. The majority of menopause studies have operationalized HRQOL as frequency and severity of symptoms. Taken together, the findings from 12 cross-sectional reports and 3 longitudinal studies suggest that the perimenopause is associated with higher levels of somatic symptoms. It is unclear whether the perimenopause is related to other domains of HRQOL. Only 1 longitudinal study reported an association between reduced physical functioning and perimenopause. Studies typically compare premenopausal women with women of other menopausal transition status separately, thereby not addressing the question of further change in HRQOL after the cessation of menses. There is a clear need for understanding the effects of the menopause beyond the domain of symptoms and to consider whether some domains of HRQOL may improve. We address whether the menopausal transition affects health-related quality of life (HRQOL). To do this, we review how HRQOL is defined and measured, present HRQOL findings from the large, population-based studies of menopause, and identify key gaps in knowledge. HRQOL is defined as the value assigned to duration of life as modified by impairments, functional states, perceptions, and social opportunities that are influenced by disease, injury, treatment, or policy. The specific domains of HRQOL include resilience or the capacity to respond to stress, health perceptions, physical functioning, and symptoms. The majority of menopause studies have operationalized HRQOL as frequency and severity of symptoms. Taken together, the findings from 12 cross-sectional reports and 3 longitudinal studies suggest that the perimenopause is associated with higher levels of somatic symptoms. It is unclear whether the perimenopause is related to other domains of HRQOL. Only 1 longitudinal study reported an association between reduced physical functioning and perimenopause. Studies typically compare premenopausal women with women of other menopausal transition status separately, thereby not addressing the question of further change in HRQOL after the cessation of menses. There is a clear need for understanding the effects of the menopause beyond the domain of symptoms and to consider whether some domains of HRQOL may improve. Most women care not only about living long lives but also about living healthy lives free of disability, disease, and unpleasant symptoms that prevent the enjoyment of and involvement in meaningful relationships, work, and recreation. The characteristics of a healthy life are the essence of what is meant by health-related quality of life (HRQOL). The focus of this article is to examine whether the menopausal transition affects HRQOL. Herein, we define HRQOL, describe the measures of quality of life (QOL) that have been used in studies of the menopausal transition, evaluate the effects of the menopausal transition on QOL, and identify key gaps in our knowledge about the effects of menopause on HRQOL. The theoretical basis of HRQOL is a multidimensional perspective of health stemming from the often-cited World Health Organization (WHO) definition of health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."1World Health OrganizationConstitution of the World Health Organization. World Health Organization, Geneva, Switzerland1948Google Scholar HRQOL is defined "as the value assigned to duration of life as modified by impairments, functional states, perceptions, and social opportunities that are influenced by disease, injury, treatment or policy."2Patrick D.L. Erickson P. Health Status and Health Policy. Oxford University Press, New York1993Google Scholar The specific domains of HRQOL, in addition to its length, include resilience or the capacity to respond to stress, health perceptions, physical functioning, and symptoms. These domains do not necessarily covary within an individual. Consider someone like the actor Michael J. Fox, who has decreasing physical functioning caused by Parkinson disease but who maintains the capacity to be resilient, or a professional athlete who has many aches and pains but remains able to maintain a high level of physical function despite his or her symptoms. Many in the science and practice of healthcare acknowledge that HRQOL is important to take into account in conducting clinical practice, in evaluating the effectiveness of treatments, and in developing health policies. Understanding the impact of the menopausal transition on HRQOL is as key to good medicine as understanding that menopause is a universal phenomenon. Such awareness may affect the conduct of clinical practice and effectiveness of treatments in women at mid life. Given the breadth of the concepts captured by HRQOL, it is not surprising that many types of measurement tools are available. Some tools measure each of the major domains of HRQOL separately, some attempt to combine scales into an overall HRQOL score weighting patient preferences for health outcomes, and some construct a profile of health status based on scores of interrelated components of health as an alternative to an aggregate index. Many studies of menopause operationalize QOL as frequency and severity of symptoms (Table 1).3Freeman E.W. Sammel M.D. Liu L. Martin P. Psychometric properties of a menopausal symptom list.Menopause. 2003; 10: 258-265Crossref PubMed Scopus (54) Google Scholar, 4Greene J.G. Constructing a standard climacteric scale.Maturitas. 1998; 29: 25-31Abstract Full Text Full Text PDF PubMed Scopus (462) Google Scholar, 5Heinemann K, Ruebig A, Potthoff P, et al. The Menopause Rating Scale (MRS) scale: a methodological review. Health Qual Life Outcomes [serial online]. 2004;2:45. Available at: http://www.hqlo.com/content/2/1/45. Accessed September 21, 2005Google Scholar, 6Hilditch J.R. Lewis J. Peter A. et al.A menopause-specific quality of life questionnaire development and psychometric properties.Maturitas. 1996; 24: 161-175Abstract Full Text PDF PubMed Scopus (497) Google Scholar, 7Hunter M. The Women's Health Questionnaire (WHQ) the development, standardization and application of a measure of mid-aged women's emotional and physical health.Qual Life Res. 2000; 9: 733-738Crossref Google Scholar, 8Wiklund I. Methods of assessing the impact of climacteric complaints on quality of life.Maturitas. 1998; 29: 41-50Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 9Perz J.M. Development of the menopause symptom list a factor analytic study of menopause associated symptoms.Women Health. 1997; 25: 53-69Crossref PubMed Scopus (63) Google Scholar, 10Utian W.H. Janata J.W. Kingsberg S.A. Schluchter M. Hamilton J.C. The Utian Quality of Life (UQOL) scale development and validation of an instrument to quantify quality of life through and beyond menopause.Menopause. 2002; 9: 402-410Crossref PubMed Scopus (134) Google Scholar, 11Andrews F.M. Withey S.B. Social Indicators of Wellbeing. Springer, New York1976Crossref Google Scholar, 12Ferrans C.E. Powers M.J. Psychometric assessment of the quality of life.Res Nurs Health. 1992; 15: 29-38Crossref PubMed Scopus (558) Google Scholar, 13Hunt S.M. McKenna S.P. McEwen J. Backett E.M. Williams J. Papp E. A quantitative approach to perceived health status a validation study.J Epidemiol Community Health. 1980; 64: 281-286Crossref Scopus (724) Google Scholar, 14Kammann R. Flett R. Affectometer 2 a scale to measure current level of general happiness.Austr J Psychol. 1983; 35: 259-265Crossref Scopus (285) Google Scholar, 15Ware Jr, J.E. Sherbourne C.D. The MOS 36-item short-form health survey (SF-36).Med Care. 1992; 30;: 473-481Crossref PubMed Scopus (29283) Google Scholar Investigators have developed psychometrically sound menopause-specific measures of QOL, including the Toronto Menopause-Specific Quality of Life Questionnaire (MENQOL)6Hilditch J.R. Lewis J. Peter A. et al.A menopause-specific quality of life questionnaire development and psychometric properties.Maturitas. 1996; 24: 161-175Abstract Full Text PDF PubMed Scopus (497) Google Scholar; the Greene Climacteric Scale4Greene J.G. Constructing a standard climacteric scale.Maturitas. 1998; 29: 25-31Abstract Full Text Full Text PDF PubMed Scopus (462) Google Scholar; the Women's Health Questionnaire (WHQ)7Hunter M. The Women's Health Questionnaire (WHQ) the development, standardization and application of a measure of mid-aged women's emotional and physical health.Qual Life Res. 2000; 9: 733-738Crossref Google Scholar; 2 scales both labeled the Menopause Symptom List (MSL), MSLa3Freeman E.W. Sammel M.D. Liu L. Martin P. Psychometric properties of a menopausal symptom list.Menopause. 2003; 10: 258-265Crossref PubMed Scopus (54) Google Scholar and MSLb9Perz J.M. Development of the menopause symptom list a factor analytic study of menopause associated symptoms.Women Health. 1997; 25: 53-69Crossref PubMed Scopus (63) Google Scholar; the Menopause Rating Scale (MRS)5Heinemann K, Ruebig A, Potthoff P, et al. The Menopause Rating Scale (MRS) scale: a methodological review. Health Qual Life Outcomes [serial online]. 2004;2:45. Available at: http://www.hqlo.com/content/2/1/45. Accessed September 21, 2005Google Scholar; and the Utian Menopause Quality of Life (UQOL) score.10Utian W.H. Janata J.W. Kingsberg S.A. Schluchter M. Hamilton J.C. The Utian Quality of Life (UQOL) scale development and validation of an instrument to quantify quality of life through and beyond menopause.Menopause. 2002; 9: 402-410Crossref PubMed Scopus (134) Google Scholar All yield factor-derived subscales analytically determined. With the exception of the UQOL scale, all measure symptoms. For example, the Greene Climacteric Scale yields scores for vasomotor and somatic symptoms as well as anxiety and depression. The UQOL scale yields subscales reflecting perceptions of well-being or functioning in 4 domains (occupational, health, emotional, and sexual). It is unique among the menopause-specific measures because it does not strictly assess symptoms. Rather, the items ask women how they view themselves within each domain, for example, "I feel challenged by my work"or "I am unhappy with my appearance." The scale items also reflect certain personality characteristics, such as optimism or trait anxiety.Table 1Measures of quality of life (QOL) used in menopause studies (continued on page 28S)StudyScaleDescriptionReliabilityValidityCommentsMenopause-Specific Scales Freeman et al (2003)3Freeman E.W. Sammel M.D. Liu L. Martin P. Psychometric properties of a menopausal symptom list.Menopause. 2003; 10: 258-265Crossref PubMed Scopus (54) Google ScholarMSLa12 symptoms rated on 4-point scale of severity over past month from 0 (none) to 3 (severe); 3 factors: psychological, somatic, vasomotorInternal consistency, α = 0.77 for total scale; α = 0.87–0.88 for each factorTotal and factor scores correlated with mood measureDeveloped on ∼350 community women, aged 38–52 yr, who menstruated in last year Greene (1998)4Greene J.G. Constructing a standard climacteric scale.Maturitas. 1998; 29: 25-31Abstract Full Text Full Text PDF PubMed Scopus (462) Google ScholarGreene Climacteric Scale21 symptoms rated on 4-point scale of severity from not at all (0) to extremely (3); 4 factors: depression, anxiety, somatic, vasomotorNANABased on other factor analytic studies of symptoms Heinemann et al (2004)5Heinemann K, Ruebig A, Potthoff P, et al. The Menopause Rating Scale (MRS) scale: a methodological review. Health Qual Life Outcomes [serial online]. 2004;2:45. Available at: http://www.hqlo.com/content/2/1/45. Accessed September 21, 2005Google ScholarMRS11 symptoms rated on 5-point scale of severity from 0 (none) to 4 (severe); 3 factors: somatovegetative, psychological, urogenital Structure same across regions/countries. Sleep overlap with somatic and psychological factors in some countriesInternal consistency, α = 0.6–0.9 across countries for total scores and subscales; test-retest reliability over 2 wk for total and subscales, r = 0.50–0.97Total correlated with SF-36 somatic and psychological subscales, r = 0.48 and 0.73Scale developed to measure change over time and across cultures in HRQOL Hilditch et al (1996)6Hilditch J.R. Lewis J. Peter A. et al.A menopause-specific quality of life questionnaire development and psychometric properties.Maturitas. 1996; 24: 161-175Abstract Full Text PDF PubMed Scopus (497) Google ScholarToronto MENQOL29 symptoms/problems rated on 7-point scale, how much bothered by each in past month from 0 (not at all) to 6 (extremely); a priori domains: physical, vasomotor, psychological, sexualTest-retest reliability over 7 mo: vasomotor, r = 0.37; others, r = 0.70–0.81. Internal consistency of each, α = 0.81–0.87Face validity high; domains validated against other relevant instrumentsDeveloped in women, aged 47–62 yr, without menses for 2–7 yr, no HT in previous 6 mo, no hysterectomy Hunter (2000)7Hunter M. The Women's Health Questionnaire (WHQ) the development, standardization and application of a measure of mid-aged women's emotional and physical health.Qual Life Res. 2000; 9: 733-738Crossref Google Scholar Wiklund (1998)8Wiklund I. Methods of assessing the impact of climacteric complaints on quality of life.Maturitas. 1998; 29: 41-50Abstract Full Text Full Text PDF PubMed Scopus (53) Google ScholarWHQ36 physical and emotional symptoms rated on 4-point scale: definitely, sometimes, not much, not at all; 9 factorsTest-retest reliability across 2 wk, r = 0.78–0.96. Internal consistency, α = 0.59–0.84Subscale scores differentiated between clinic attendees and nonattendees. WHQ depressed subscale correlated highly with SF-36 mental health and vitality scalesDeveloped in women, aged 45–65 yr, to evaluate change in symptoms in response to interventions. Translated into 8 European languages Perz (1997)9Perz J.M. Development of the menopause symptom list a factor analytic study of menopause associated symptoms.Women Health. 1997; 25: 53-69Crossref PubMed Scopus (63) Google ScholarMSLb25 symptoms rated for frequency of occurrence in past 3 mo on 6-point scale from 0 (never) to 6 (almost daily); 3 factors: psychological, vasosomatic, general somatic. Severity also rated, but results of reliability similar to frequency ratingsTest-retest reliability across a month range, 0.73–0.92 for factors and total scoreCorrelates with Greene symptom scale; range, 0.71–0.89 for psychological and vasomotor factors and total scores, and 0.40 for somatic factorDesigned to address methodologic problems of early studies of menopause symptoms in clinical settings Utian et al (2002)10Utian W.H. Janata J.W. Kingsberg S.A. Schluchter M. Hamilton J.C. The Utian Quality of Life (UQOL) scale development and validation of an instrument to quantify quality of life through and beyond menopause.Menopause. 2002; 9: 402-410Crossref PubMed Scopus (134) Google ScholarUQOL23 items rated on 5-point scale from 1 (not true of me) to 5 (very true of me); items reflect perception of well-being or functioning. 4 factors: occupational, health, emotional, sexualTest-retest reliability across 3–7 days, r = 0.75–0.92. Internal consistency, α = 0.83 for total and α = 0.63–0.88 for factorsHealth and emotional factors, r = 0.55 and 0.57, with relevant SF-36 subscales. Occupational and sexual had low correlationsDeveloped in 2 large samples, aged 45–60 yr; focus group feedback was used in final scale. Authors recommend using UQOL with a symptom inventoryGeneral QOL scales Andrews and Withey (1976)11Andrews F.M. Withey S.B. Social Indicators of Wellbeing. Springer, New York1976Crossref Google ScholarLadder Scale1 question asking about QOL rated on 10-point scale from "best life I could have" to "worst life I could have"Test-retest reliability in same interview, r = 0.7; across 2 yr, r = 0.41Self-rated health and life events are strong predictors of overall life satisfaction Ferrans and Powers (1992)12Ferrans C.E. Powers M.J. Psychometric assessment of the quality of life.Res Nurs Health. 1992; 15: 29-38Crossref PubMed Scopus (558) Google ScholarQOL Index2 sections, each includes 35 items, rated on 6-point scale. 1 section measures satisfaction and 1 measures the importance of each of 4 domains: health and functioning, socioeconomic status functioning, psychological/spiritual, familyInternal consistency in patients and students, α = 0.66–0.93 for subscales. Test-retest reliability after 2 wk, r = 0.88 (students)Correlates, r = 0.65–0.80 with a life satisfaction scaleLack of normative data Hunt et al (1980)13Hunt S.M. McKenna S.P. McEwen J. Backett E.M. Williams J. Papp E. A quantitative approach to perceived health status a validation study.J Epidemiol Community Health. 1980; 64: 281-286Crossref Scopus (724) Google ScholarNottingham Health ProfilePart 1. 38 yes/no statements/problems with daily life grouped into 6 sections: physical abilities, pain, sleep, social isolation, emotional reactions, energy levelPart 2. yes/no effect of health problems on 7 areas: occupation, household tasks, social life, sex life, interests/hobbies, holidays, home lifePart 1. Test-retest reliability across 4 wk in patients, r = 0.75–0.88.Part 2. r = 0.44–0.86Concurrent and discriminant validity adequate to high; good sensitivity to changeConcern about floor effects; does not discriminate as well as SF-36 in those with minor ailments Kamman and Flett (1983)14Kammann R. Flett R. Affectometer 2 a scale to measure current level of general happiness.Austr J Psychol. 1983; 35: 259-265Crossref Scopus (285) Google ScholarAffectometer 220 adjectives/10 negative, 10 positive. Frequency of feeling, each on 4-point scale: not at all to all the time. Creates positive and negative affect scales. Well-being score = difference between 2 scoresInternal reliability = 0.95Highly correlated with scales measuring constructs of well-beingPsychometric data based on earlier 96-item version (Affectometer 1) and mutual reliability on Affectometer 2 Ware and Sherbourne (1992)11Andrews F.M. Withey S.B. Social Indicators of Wellbeing. Springer, New York1976Crossref Google Scholar, 15Ware Jr, J.E. Sherbourne C.D. The MOS 36-item short-form health survey (SF-36).Med Care. 1992; 30;: 473-481Crossref PubMed Scopus (29283) Google ScholarSF-36Multi-item scales that measure 8 dimensions: physical functioning, role limitations due to physical problems, role limitations due to emotional problems, bodily pain, social functioning, vitality, general mental health, general health perceptionsInternal consistency of scales from many studies high to very high. Test-retest reliability across 2 wk, >0.8 for all except social functions, which was 0.6Association comparisons with ability to work and symptoms. Correlated with other illness scales for specific health conditions. Sensitive to change due to treatmentDesigned as generic indicator for use in general population and in patients with chronic medical or psychiatric illness. Norms available for general US population and 13 medical conditionsHRQOL = health-related QOL; HT = hormone therapy; MENQOL = Menopause-Specific QOL questionnaire; MSL = Menopause Symptom List (a and b); MRS = Menopause Rating Scale; NA = not available; SF-36 = Medical Outcomes Study 36-item short form; UQOL = Utian Quality of Life; WHQ = Women's Health Questionnaire. Open table in a new tab HRQOL = health-related QOL; HT = hormone therapy; MENQOL = Menopause-Specific QOL questionnaire; MSL = Menopause Symptom List (a and b); MRS = Menopause Rating Scale; NA = not available; SF-36 = Medical Outcomes Study 36-item short form; UQOL = Utian Quality of Life; WHQ = Women's Health Questionnaire. Other menopause studies have used profile HRQOL measures that are not specific to menopause but that are often used in diverse patient samples such as the Ladder Scale.11Andrews F.M. Withey S.B. Social Indicators of Wellbeing. Springer, New York1976Crossref Google Scholar Widely used are the Medical Outcomes Study 36-item short form (SF-36)15Ware Jr, J.E. Sherbourne C.D. The MOS 36-item short-form health survey (SF-36).Med Care. 1992; 30;: 473-481Crossref PubMed Scopus (29283) Google Scholar and the Nottingham Health Profile.13Hunt S.M. McKenna S.P. McEwen J. Backett E.M. Williams J. Papp E. A quantitative approach to perceived health status a validation study.J Epidemiol Community Health. 1980; 64: 281-286Crossref Scopus (724) Google Scholar The SF-36 yields scores of general health perceptions, physical functioning, general mental health, vitality, bodily pain, role limitations due to physical or emotional health, and social functioning. Scoring for the latter 3 scales is based on how individuals perceive the effect of their physical or mental health or both on each type of functioning. However, the physical limitations subscale of the SF-36 asks respondents to provide behavioral information on the effects of health. The Nottingham Profile part 1 includes items in the following domains: pain, physical mobility, sleep, emotional reactions, energy, and social isolation. There are several methodologic issues associated with HRQOL measurement. First, the HRQOL measures have very different meanings, although they may have the same labels. Thus, care must be taken to examine the measures being used and to be precise in interpretation of study findings. Second, a number of menopause-specific measures that have been assessed for their validity are limited; some of these have been used in only homogeneous small samples, and none has examined the association of the same construct assessed with different methods (e.g., self-report versus interview), which would be useful in both scientific and clinical settings. Third, domains of HRQOL include inherently subjective elements (e.g., feelings of pain or vitality), which can be highly influenced by personality and social circumstances.16Muldoon M.F. Barger S.D. Flory F.D. Manuck S.B. What are quality of life measurements measuring?.BMJ. 1998; 316: 542-545Crossref PubMed Scopus (367) Google Scholar Clinicians and researchers need to be cognizant of the multiple determinants, besides the menopausal transition itself, that may account for the results. Fourth, domains of HRQOL that are less subjective (e.g., degree to which health limits physical function) are based on self-report and may be affected by personality and social circumstances. Observed performance tests (e.g., ability to walk) have rarely been used and are of considerable advantage here. We reviewed the HRQOL results from cross-sectional population-based studies that had >450 women and that were not based on samples of women seeking treatment, and from population-based longitudinal studies in which women were initially premenopausal or perimenopausal and were followed through the transition. Few studies directly measured ovarian aging, which is the physiologic basis for changes in menstruation. Note that the cross-sectional studies only provided information comparing different menopausal groups at 1 point in time, whereas longitudinal studies assessed QOL as it changed over time and as menopausal status changed. These studies classified women on the basis of retrospective histories of menses in the recent past (e.g., annual reports of menses in the last year), except for the Healthy Women Study and the Study of Women's Health Across the Nation (SWAN), which collected monthly records of menses. Categorization of women into menopausal transition status was somewhat similar across studies (i.e., premenopause = having menses in the last 3 months; perimenopause = having irregular menses in the last year and/or no menses in the last 3 to 11 months; and postmenopause = not having menses for ≥1 year). Some of the studies also required a comparison of regularity and frequency of menses in the current year with the prior year to differentiate premenopausal from perimenopausal status or to subdivide perimenopausal status into early and late phases. The 2 exceptions are analyses that compared premenopausal women with women categorized as postmenopausal on the basis of 6 months of amenorrhea21Collins A. Landgren B.M. Reproductive health, use of estrogen and experience of symptoms in perimenopausal women a population-based study.Maturitas. 1994; 20: 101-111Abstract Full Text PDF PubMed Scopus (130) Google Scholar or that compared menstruating and nonmenstruating women.25Ledésert B. Ringa V. Bréart G. Menopause and perceived health status among the women of the French GAZEL cohort.Maturitas. 1994; 20;: 113-120Abstract Full Text PDF PubMed Scopus (76) Google Scholar Studies of women seeking treatment for "menopausal" symptoms were not included. We also included selected studies that examine the changes in QOL in women who had elective hysterectomy (although their ovaries may have been conserved) because of concern that surgical menopause has an adverse effect on QOL. (Other articles in this supplement to The American Journal of Medicine review in detail the effects of the menopausal transition on vasomotor symptoms, depression, and sexual function, so these are not included unless they are part of a report on other domains of QOL.) It is beyond the scope of this article to review the data on menopause-induced risk for specific diseases or on the impact of hormone therapy (HT) in randomized clinical trials on HRQOL. In 12 cross-sectional reports (Table 2),17Avis N.E. Ory M. Matthews K.A. Schocken M. Bromberger J. Colvin A. Health-related quality of life in a multiethnic sample of middle-aged women.Med Care. 2003; 41: 1262-1276Crossref PubMed Scopus (140) Google Scholar, 18Avis N.E. Assmann S.F. Kravitz H.M. Ganz P.A. Ory M. Quality of life in diverse groups of midlife women assessing the influence of menopause, health status and psychosocial and demographic factors.Qual Life Res. 2004; 13: 933-946Crossref PubMed Scopus (119) Google Scholar, 19Barentsen R. Peter H.M. Weijer V.D. Gend S.V. Foekema H. Climacteric symptoms in a representative Dutch population sample as measure with the Green Climacteric Scale.Maturitas. 2001; 38: 123-128Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar, 20Blumel J.E. Castelo-Branco A. Binfa L. et al.Quality of life after the menopause a population study.Maturitas. 2000; 34: 17-23Abstract Full Text Full Text PDF PubMed Scopus (240) Google Scholar, 21Collins A. Landgren B.M. Reproductive health, use of estrogen and experience of symptoms in perimenopausal women a population-based study.Maturitas. 1994; 20: 101-111Abstract Full Text PDF PubMed Scopus (130) Google Scholar, 22Fuh J.L. Wang S.J. Lee S.J. Lu S.R. Juang K.D. Quality of life and menopausal transition for middle-aged women on Kinmen Island.Qual Life Res. 2003; 12: 53-61Crossref PubMed Scopus (68) Google Scholar, 23Ho S.C. Chan S.G. Yip Y.B. Cheng A. Yi Q. Chan C. Menopausal symptoms and symptom clustering in Chinese women.Maturitas. 1999; 33: 219-227Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar, 24Kuh D.L. Wadsworth M. Hardy R. Women's health in midlife the influence of the menopause, social factors and health in earlier life.Br J Obstet Gynaecol. 1997; 104: 923-933Crossref PubMed Scopus (262) Google Scholar, 25Ledésert B. Ringa V. Bréart G. Menopause and perceived health status among the women of the French GAZEL cohort.Maturitas. 1994; 20;: 113-120Abstract Full Text PDF PubMed Scopus (76) Google Scholar, 26Li C. Wilawan K. Samsioe G. Lidfeldt J. Agardh C.D. Nerbrand C. Health profile of middle-aged women the Women's Health in the Lund Area (WHILA) study.Hum Reprod. 2002; 17: 1379-1385Crossref PubMed Scopus (42) Google Scholar, 27Maartens L.W. Leusink G.L. Knottnerus J.A. Smeets C.G. Pop V.J. Climacteric complaints in the community.Fam Pract. 2001; 18: 189-194Crossref PubMed Scopus (56) Google Scholar, 28Sowers M.F. Pope S. Welch G. Sternfeld B. Albrecht G. The association of menopause and physical functioning in women at midlife.J Am Geriatr Soc. 2001; 49: 1485-1492Crossref PubMed Scopus (65) Google Scholar perimenopausal women reported greater bodily pain and role limitations due to physical health or emotional problems, poorer perceived health, and more physical or somatic symptoms than did premenopausal women. These studies were based on diverse populations, including women from England, Holland, Taiwan, Chile, France, Sweden, and the United States, where women of Japanese, Chinese, Hispanic, African, and European ancestry participated. The results of several studies24Kuh D.L. Wadsworth M. Hardy R. Women's health in midlife the influence of the menopause, social factors and health in earlier life.Br J Obstet Gynaecol. 1997; 104: 923-933Crossref PubMed Scopus (262) Google Scholar, 26Li C. Wilawan K. Samsioe G. Lidfeldt J. Agardh C.D. Nerbrand C. Health profile of middle-aged women the Women's Health in the Lund Area (WHILA) study.Hum Reprod. 2002; 17: 1379-1385Crossref PubMed Scopus (42) Google Scholar also suggest that women who choose to use HT have poor HRQOL, perhaps because these women seek out treatment for symptoms. Usually the analyses compare premenopausal women with women in each of the other menopausal transition states. Thus, it is not clear whether the transition from perimenopause to postme
Referência(s)