Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study

Sexual desire during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study

AIMS

To describe levels of sexual desire across the menopausal transition (MT) and early postmenopause (PM), including effects of age, MT-related factors, health, stress, symptoms (hot flash, sleep, mood), and social opportunity factors.

METHODS

A subset of Seattle Midlife Women's Health Study (SMWHS) participants who provided data during the early reproductive, early and late menopausal transition stages, or postmenopause (n = 286), including menstrual calendars for staging the MT, annual health reports between 1990 and 2005, and morning urine samples assayed for estrone glucuronide (E(1)G), testosterone (T), and follicle-stimulating hormone (FSH) was included. Multilevel modeling using the R program was used to test factors related to sexual desire.

RESULTS

Women experienced a significant decrease in sexual desire during the late MT stage (p < 0.01) and early PM (p < 0.0001). Those with higher urinary E(1)G and T reported significantly higher levels of sexual desire, whereas those with higher FSH levels reported significantly lower sexual desire (p < 0.0001, 0.06, and 0.0002, respectively). Women using hormone therapy also reported higher sexual desire (p = 0.02). Those reporting higher perceived stress reported lower sexual desire (p < 0.0001), but history of sexual abuse did not have a significant effect. Those most troubled by symptoms of hot flashes, fatigue, depressed mood, anxiety, difficulty getting to sleep, early morning awakening, and awakening during the night also reported significantly lower sexual desire (p range from <0.03 to 0.0001), but there was no effect of vaginal dryness. Women with better perceived health reported higher sexual desire (p < 0.0001), and those reporting more exercise and more alcohol intake also reported greater sexual desire (p < 0.0001). Having a partner was associated with lower sexual desire.

CONCLUSIONS

Clinicians working with women traversing the MT should be aware that promoting healthy sexual functioning among midlife women requires consideration of their changing biology as well as ongoing life challenges.

Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation

Vasomotor symptoms (VMS), or hot flashes and night sweats, are often considered the cardinal symptoms of menopause. SWAN, one of the largest and most ethnically diverse longitudinal studies of the menopausal transition, has allowed unique insights into VMS. Specifically, SWAN has helped yield important information about the prevalence of, racial/ethnic differences in, risk factors for, and implications of VMS for midlife women's mental and physical health. We have reviewed the literature on VMS, emphasizing findings that have emerged from SWAN and new areas of inquiry in the area of VMS.

Perimenopause and cognition

The impact of perimenopause on cognition seems to be characterized by an absence of improved scores rather than a decline. In the SWAN, the perimenopausal decrement in cognitive performance was not accounted for; however, increases in anxiety and depressive symptoms had independent, unfavorable effects on performance. Estradiol has been found to protect against changes resulting from serotonin withdrawal and defend against changes from cholinergic depletion. There is support for the critical timing hypothesis--that estrogen benefits cognitive function when instituted early, but not later. The menopausal transition may affect cognitive function in older age owing to worsened cardiovascular risk factors.

Sex differences of salivary cortisol secretion in patients with major depression

Depression is associated with increased cortisol secretion and occurs more often in women than in men. Thus, it has been hypothesized that differences in cortisol secretion might, in part, be responsible for the greater risk of developing depression in women. However, only few studies have examined sex differences in baseline cortisol secretion in depressed patients and healthy controls. We examined sex effects on cortisol secretion in 52 medication-free patients with major depression (37 women, 15 men, mean ± SD age 35 ± 11 years, Hamilton Depression Scale mean score 27 ± 5) and 50 healthy age- and sex-matched control subjects. Salivary cortisol concentrations were measured at 8:00, 12:00, 16:00, and 22:00 h. Repeated measures analysis of covariance revealed a group × sex interaction (p = 0.05). Post hoc tests revealed higher cortisol concentrations in depressed compared to healthy men [F(1;29) = 7.5, p = 0.01]. No differences were found between depressed and non-depressed women. Our results do not support the hypothesis that differences in cortisol secretion between depressed and non-depressed subjects are more pronounced in women than in men. Study characteristics and methods as well as sex-specific confounding variables such as menstrual cycle, menopause and the use of oral contraceptives may account for inconclusive results across studies.

Symptom interference with work and relationships during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study

OBJECTIVE

The aim of this study was to describe the changes in symptom interference during the menopausal transition (MT) stages and early postmenopause (PM), including the effects of age, MT-related factors (estrone, follicle-stimulating hormone, testosterone, MT stages), symptoms (hot flashes, depressed mood, awakening during the night, anxiety, backache, joint pain, forgetfulness, and difficulty concentrating), health-related factors (perceived health), and stress-related factors (perceived stress, cortisol).

METHODS

A subset of Seattle Midlife Women's Health Study participants provided data during the late reproductive, early and late MT stages, or early PM (n = 184), including menstrual calendars for staging the MT; annual health reports completed between 1990 and 2008; morning urine samples assayed for estrone glucuronide, follicle-stimulating hormone, and cortisol; and symptom diary ratings several times each year. Interference was rated in the diary along with symptoms, perceived health, and stress. Multilevel modeling with an R program was used to test the patterns of symptom interference related to age, MT-related factors, symptoms, and health- and stress-related factors, with as many as 5,656 observations. Median age was 47.4 years.

RESULTS

Interference with work was significantly associated with individual covariates such as perceived health, stress, hot flashes, depressed mood, anxiety, difficulty getting to sleep, awakening during the night, early morning awakening, backache, joint pain, forgetfulness, and difficulty concentrating (for hot flashes, P = 0.01; all others, P < 0.001). A final multivariate model included perceived health, stress, depressed mood, and difficulty concentrating. Interference with relationships was significantly associated with age and individual covariates such as perceived health, estrone, perceived stress, depressed mood, anxiety, sleep symptoms, backache, joint pain, forgetfulness, and difficulty concentrating (for estrone, P = 0.03; all others, P < 0.001). A final multivariate model included perceived health, stress, depressed mood, anxiety, difficulty concentrating, and awakening during the night.

CONCLUSIONS

Women's reports of how much the way they felt interfered with work and relationships were influenced by both their perceived health and stress levels. Interference was also influenced by depressed mood and difficulty concentrating, suggesting that these two symptoms may be most important to address, to enhance functioning during the MT and early PM.

The reproductive endocrinology of the menopausal transition

The menopause transition is a dynamic process that begins with the first appearance of menstrual irregularity and ends with a woman's final menstrual period. As ovarian follicle numbers dwindle, the hypothalamic-pituitary-ovarian axis enters a state of compensated failure. In this state, elevated FSH is capable of maintaining relatively regular folliculogenesis and ovulation, but fertility is reduced. Eventually, this state of compensated failure cannot be sustained, and the ovary becomes unable to produce functioning follicles. Recent multicenter studies from several countries have addressed the pattern of change in hormones and a model form reproductive aging has been developed that helps explain the changes in hormone patterns and fertility that accompany menopause. Perhaps more important, the hormonal changes of the menopausal transition may be predictive of future disease risk. This review will undertake an explanation of the current literature on this topic.

Pain symptoms during the menopausal transition and early postmenopause

AIM

The aim of this study was to describe changes in levels of back pain and joint pain during the stages of menopausal transition stages and early postmenopause, including the effects of age, menopausal transition-related factors (estrone, follicle stimulating hormone (FSH), testosterone), menopausal transition stages, symptoms (hot flush, sleep, mood, cognitive), health-related factors (body mass index, alcohol use, smoking, well-being), stress-related factors (perceived stress, history of sexual abuse, cortisol, catecholamines) and social factors (partner and parenting status, education).

METHODS

A subset was studied of the participants in the Seattle Midlife Women's Health Study who provided data during the late reproductive, early and late menopausal transition stages or postmenopause (n = 292) including menstrual calendars for staging the menopausal transition, annual health reports completed between 1990 and 2006, and morning urine samples assayed for estrone glucuronide (E(1)G), testosterone, FSH, cortisol and catecholamines, and symptom diary ratings several times each year. Multilevel modeling with an R program was used to test patterns of pain symptoms related to age, menopausal transition-related factors, symptoms, health-related, stress-related and social factors, with as many as 6812 observations. Age was centered at 47.4 years.

RESULTS

Women experienced a slight, non-significant rise in back pain with age and a significant increase in back pain during the early (p = 0.003) and late menopausal transition stages (p = 0.002) and early postmenopause (p = 0.02), but urinary E(1)G, FSH and testosterone levels were unrelated. Of the stress-related factors, perceived stress (p = 0.01) and lower overnight urinary cortisol levels were associated with more severe back pain (p = 0.03); history of sexual abuse and catecholamines did not have a significant effect. Those most troubled by symptoms of hot flushes, depressed mood, anxiety, night-time awakening, and difficulty concentrating reported significantly greater back pain (all p < 0.0001). Of the health-related factors, having worse perceived health (p < 0.0001), exercising more (p = 0.005), using analgesics (p < 0.0001), and having a higher body mass index (p < 0.0001) were associated with more back pain, but alcohol use and smoking did not have significant effects. Of the social factors, only having a more formal education (p = 0.004) was associated with less back pain; parenting, having a partner, and employment were not significant. Factors associated with joint pain included age (p < 0.0001), but not menopausal transition-related factors. Symptoms of hot flushes, night-time awakening, depressed mood, and difficulty concentrating were each significantly associated with joint pain (p < 0.0001). Poorer perceived health, more exercise, higher body mass index, and greater analgesic use were all associated similarly with joint pain. History of sexual abuse was the only stress-related factor significantly related to joint pain severity (p = 0.024).

IMPLICATIONS

Clinicians working with women traversing the menopausal transition should be aware that managing back and joint pain symptoms among mid-life women requires consideration of their changing biology as well as their ongoing life challenges and health-related behaviors.

Psychometric evaluation of the Midlife Women's Symptom Index in multiethnic groups

The Midlife Women's Symptom Index (MSI) was designed to measure menopausal symptoms specifically in a multiethnic sample of midlife women. This study involved a psychometric property test to evaluate MSI among 512 multiethnic groups of midlife women (White, Hispanic, African American, and Asian American). Across the ethnic groups, the MSI had an adequate internal consistency in all subdomains except psychosomatic symptoms. The item-total correlation coefficients of lost weight and nosebleeds were lower than .20 among all ethnic groups. The discriminant validity was confirmed among all ethnic groups except Asian Americans. Overall, the MSI may work better for Whites compared with other ethnic groups. Additional studies with diverse groups of multiethnic midlife women are needed, however, to confirm the psychometric properties of the MSI because the samples tended to be a select group.