Late reproductive stage and menopausal transition share similar symptoms

Women in the late reproductive stage of life may be surprised when they begin experiencing symptoms similar to those associated with menopausal transition before cycle irregularity has begun, according to a study published by Menopause.

“One of the authors’ personal experiences led to the creation of womenlivingbetter.org, which has opportunities for others to submit and share their experience on the path to menopause,” Nina Coslov, MBA, founder of Women Living Better, told Healio. “We heard from so many who also had symptoms before significant changes to cycle length.”

Coslov said this also resonated with a clinician on her research team.

Nina Coslov

“She frequently heard from women about new symptoms with still monthly periods. And the women’s health researcher on our team noted that previous work she’d done also showed this,” she said.

The researchers invited women between the ages of 35 and 55 years to complete an 82-question online survey of their menstrual patterns, symptoms, how these symptoms interfere with their lives, overall health and demographics.

Respondents included 945 women in the late reproductive stage (LRS), which is associated with subtle changes to menstrual flow and cycle length, and 491 women in menopausal transition (MT), experiencing consecutive menstrual cycles varying by more than 7 days. To allow for the possibility of some women in the MT group having recently entered early postmenopause, the study used the designation MT+ for this group.

The women in the LRS group had a mean age of 46.1 years, whereas those in the MT+ group had a mean age of 49.8 years. Overall, 87% of the women tracked their menstrual cycles, which varied between the groups.

For example, women in the LRS group were most likely to report cycles ranging from 25 to 28 days (n = 442; 47%) or 29 to 31 days (n = 182; 20%), whereas women in the MT+ group were most likely to report cycles that exceeded 35 days (n = 86; 27%).

Respondents also were asked to rate how they experienced 61 different symptoms in terms of occurrence, frequency and bother over the previous 3 months.

The researchers said the experiences of the two groups for most symptoms were “strikingly similar.” In fact, the groups differed by 10% or more in percentage reporting for only eight of the 61 symptoms surveyed. Only hot flashes were significantly different between the groups in terms of mean bother ratings.

Symptoms most commonly reported by women in both groups included being more forgetful (n = 904; 63%), feeling irritable (n = 802; 56%), feeling less interest in sexual activities (n = 799; 56%), having a hard time concentrating (n = 778; 54%), feeling fatigue (n = 745; 52%), feeling anxious (n = 713; 50%), having drier skin (n = 695; 48%), having sore breasts (n = 655; 46%), having night or cold sweats (n = 628; 44%), and experiencing urinary leakage when coughing or sneezing (n = 619; 43%).

Both groups named fatigue and difficulty concentrating as the most burdensome symptoms overall. Joint and muscle pain as well as forgetfulness also were among the most burdensome symptoms shared by both groups.

According to the survey, 46% of women in both groups indicated that their symptoms somewhat interfered with daily activities, and 40% said they interfered in their relationships with family and friends.

The researchers explained that women do not expect these changes until the age of 50 years or even later, and they are surprised to experience these symptoms before the onset of cycle irregularity. The survey asked women to think back to when they were 30 years old and remember when they thought they would experience changes related to menopause. Most commonly, 59% of respondents said they expected changes at the age of 50 years or older, 28% anticipated changes between the ages of 45 to 49 years, 9% thought they would happen between 40 and 44 years, and 2% said they would occur between 35 and 39 years. There were no significant differences in responses between the two groups.

Coslov said they received positive feedback about the survey, which provided validation to some women.

The researchers said they were unable to collect hormonal data to align with staging or symptoms, although information available to most clinicians was included in the survey. Other limitations included the study’s cross-sectional design, the impact of the COVID-19 pandemic on anxiety levels, and the difficulty distinguishing between aging and reproductive aging effects with regard to symptom experiences.

Still, the researchers concluded that the LRS and MT groups experience similar symptoms in terms of type, frequency, bother and burden, and that the symptoms similarly interfere in their lives.

Also, the researchers said that health care providers should be alerted to the likelihood that the symptoms may occur among younger patients.

Coslov encouraged health care providers to validate the experience of patients who are still getting monthly periods.

“Encourage them to track their cycles so they notice slight changes in length and changes to pattern of menstrual flow: more/fewer days of the cycle, or heavier/lighter bleeding,” she said.

Providers also should normalize the experience and use the opportunity to discuss the wide range of symptoms that can happen and offer support if any symptoms interfere with activities or relationships, Coslov said.

Meanwhile, women can use the information to better understand what to expect and that it is more than hot flashes, Coslov continued, adding that shifting hormonal patterns affect mood, sleep and cognition, among other aspects of health.

“They should know what is normal but also seek help if symptoms interfere with their lives,” she said. “They should find a health care provider that validates their experience and not work with one that doesn’t.”

Coslov further called for more research to better understand the lived experience of this transition in more diverse populations, as well as research that links symptoms to underlying hormonal changes.

This research should “develop new ways to help women anticipate changes related to menopause and how they affect everyday living by providing education earlier, before changes in their menstrual cycles occur,” she said.