When Do Menopausal Symptoms Appear
Menopausal symptoms vary among women at each stage of the menopausal transition and also vary for each woman over time as she goes through these stages.
When do menopausal symptoms appear, how long do they persist and with what frequency and severity, and what is known about the factors that influence them?
Natural History of Menopausal Symptoms
Menopausal symptoms vary among women at each stage of the menopausal transition and also vary for each woman over time as she goes through these stages. In the United States, most women experience menopause between the ages of 40 and 58, with a median age of 52. Factors associated with earlier menopause include lower body weight, shorter menstrual cycles, and smoking. Higher body weight is associated with later onset of menopause.
Natural history concerns the symptoms which are experienced and their prevalence, severity, frequency of episodes, and duration (number of years experienced). Some women who transit menopause have no symptoms at all; but most experience some symptoms, often beginning several years before the FMP. Understanding the natural history of menopausal symptoms requires long-term data on numerous women from diverse backgrounds. To date, most longitudinal studies have followed women for 2 "8 years, which is not long enough to define the natural history of the menopausal transition. In addition, these studies have just had one or several followups and have excluded important groups of women (those with surgical menopause and those who are on hormone therapy). Other major limitations of these studies are that they have mainly studied Caucasian women and have asked about current symptoms only (potentially missing those that occur between interviews). Most analyses consider symptoms one-by-one, yet they often occur in multiples in a woman s life. Last, the age ranges of studies miss most women with premature ovarian failure. Spontaneous premature ovarian failure cannot be considered the equivalent of an early natural menopause because other disease processes may be involved that have important clinical implications.
Prevalence of Menopausal Symptoms
The following symptoms are strongly or moderately linked to menopause: hot flashes, night sweats, vaginal dryness, and sleep disturbance. Evidence about other symptoms is limited and weak (see Question 1). We state below the known symptom prevalence by menopausal stage, using ranges of estimates from prior studies. The wide ranges may reflect variability in how symptoms are measured and reported, women studied, and study quality. It is important to note that women who have had sudden menopause (e.g., surgical) are likely to have symptoms at the higher end of these ranges. Long-term assessment of symptoms into the postmenopausal period is lacking due to short followup after the FMP. Few data exist about severity, frequency, and duration of symptom episodes.
Vasomotor Symptoms (Hot Flashes and Night Sweats)
The estimates of prevalence of vasomotor symptoms varies in the premenopausal stage from 14 to 51 percent, in perimenopause from 35 to 50 percent and in postmenopause from 30 to 80 percent. Increased vasomotor symptoms are associated with high body mass index and younger age of onset of menopause. After the WHI study results were published, many women in clinical settings stopped hormone therapy. In one study, among women who discontinued hormonal therapy, 25 percent resumed it due to symptoms. This would indicate that there is a significant subgroup for which symptoms were so severe that they were willing to accept some increased risk of long-term complications.
Vaginal Dryness/Painful Intercourse
Vaginal dryness becomes increasingly more common throughout the menopausal transition. The prevalence of vaginal dryness varies in the premenopausal stage from 4 to 22 percent, in perimenopause from 7 to 39 percent, and in postmenopause from 17 to 30 percent.
Women appear to have more sleep disturbances as they progress through the menopausal stages. The prevalence of sleep disturbance varies in the premenopausal stage from 16 to 42 percent, in perimenopause from 39 to 47 percent, and in postmenopause from 35 to 60 percent. The postmenopausal stage includes women with either surgical or natural menopause in these studies.
Different studies have estimated the prevalence of mood symptoms in the premenopausal stage from 8 to 37 percent, in perimenopause from 11 to 21 percent, and in postmenopause (natural or surgical) from 8 to 38 percent. African Americans may report more mood symptoms than Caucasians during the menopausal transition, but this difference narrows greatly when socioeconomic differences are controlled for in the analysis.
Other Symptoms of Menopause
The prevalence of urinary complaints varies in the premenopausal stage from 10 to 36 percent, in perimenopause from 17 to 39 percent and in postmenopause (natural or surgical) from 15 to 36 percent.
No association appears to exist for increased physical complaints or cognitive problems during the menopausal transition.
Women in the age range of menopause demonstrate an increase in sexual dysfunction. The association between sexual dysfunction and vaginal dryness is unknown.
Overall, the natural history of menopausal symptoms may differ for race/ethnic groups and for women with surgically induced menopause. Current studies will provide information on the first issue, if adjusted socioeconomic differences. Women with surgical menopause, and some who cease hormone therapy, are clinically known to sometimes experience swift onset of symptoms that can be severe.
The source of this article release is http://www.nih.gov