Emma C Dudley | PubMed Health

PubMed2003

Predictors of declining self-rated health during the transition to menopause.

OBJECTIVE: To determine factors associated with declining self-rated health as measured annually for 8 years in a prospective population-based cohort of middle-aged Australian-born women. In particular, to investigate the potential role of the menopausal transition in changing self-rated health. METHODS: A total of 262 women from the Melbourne Women's Midlife Health Project were asked to rate their present health compared with other women about the same age as worse than, the same as or better than most. RESULTS: Women reporting their health to be "better than most" decreased from 51.2% at Year 1 to 41.3% at Year 8. In the year prior to the late menopausal transition, women reporting their health to be 'better than most' declined by 5%. Comparing women who experienced the menopausal transition with women whose menopausal status did not change, there was no significant difference in changes in self-rated health. Change in body mass index (OR = 1.53; 95% CI = 1.13 to 2.06) and change in feelings for partner (OR = 0.38; 95% CI = 0.17 to 0.86) predicted a change in self-rated health from a baseline status of 'better than most.' Having an operation or procedure in the last year (OR = 8.63; 95% CI = 1.84 to 40.4) and an increase in the number of symptoms (OR = 1.32; 95% CI = 1.01 to 1.72) predicted a decline in self-rated health from baseline status of 'same as others.' CONCLUSION: This prospective study found a small decline in self-rated health with age but no significant effect of the menopausal transition. Different factors relate to differing self-rated health groupings. Further studies involving other ethnic groups and larger sample sizes are needed.

Cohort Studies↗

PubMed2002

Hormonal changes in the menopause transition.

The menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. It is heralded by the menopausal transition, a period when the endocrine, biological, and clinical features of approaching menopause begin. A common initial marker is the onset of menstrual irregularity. The biology underlying the transition to menopause includes central neuroendocrine changes as well as changes within the ovary, the most striking of which is a profound decline in follicle numbers. Follicle-stimulating hormone (FSH) is an established indirect marker of follicular activity. In studies of groups of women, its concentration, particularly in the early follicular phase of the menstrual cycle, begins to increase some years before there are any clinical indications of approaching menopause. The rise in FSH is the result of declining levels of inhibin B (INH-B), a dimeric protein that reflects the fall in ovarian follicle numbers, with or without any change in the ability of the lining granulosa cells to secrete INH-B. Estradiol levels remain relatively unchanged or tend to rise with age until the onset of the transition and are usually well preserved until the late perimenopause, presumably in response to the elevated FSH levels. During the transition, hormone levels frequently vary markedly - hence, measures of FSH and estradiol are unreliable guides to menopausal status. Concentrations of testosterone have been reported to fall by about 50% during reproductive life, between the ages of 20 and 40. They change little during the transition and, after menopause, may even rise. Dehydroepiandrosterone (DHEA) and DHEAS, its sulphate, on the other hand, decline with age, without any specific influence of the menopause. Symptoms of the menopause can be interpreted as resulting primarily from the profound fall in estradiol, occurring over a 3- to 4-year period around final menses, a fall that presumably contributes importantly to the beginning, in the late perimenopause, of loss of bone mineral density.

Adult↗