Shorter menstrual cycle length predicts more severe menopause symptoms
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Findings from a study published in Menopause suggested that the length of menstrual cycles during reproductive years may predict the severity of menopause symptoms.
“We observed that women with self-reported menstrual cycles for 25 days or less had more somatic and psychological menopausal symptoms, as well as reached menopause earlier than women with menstrual cycles between 26 and 34 days,” the authors wrote. “These results, if confirmed, add to the existing epidemiologic literature on menstrual cycle length and women’s health.”
Lidia Mínguez-Alarcón, PhD, MPH, a senior research scientist at Harvard Medical School and Brigham and Women’s Hospital, and colleagues examined the relationship between cycle length and menopausal symptoms in a study of 634 women enrolled in Project Viva — a longitudinal prebirth cohort of mother-offspring pairs in eastern Massachusetts. Women self-reported menstrual cycle length at enrollment, which occurred during early pregnancy, and then reported total and specific menopausal symptoms at midlife using the Menopause Rating Scale (MRS), as well as their age at natural menopause. The median age at enrollment of the participants was 33.3 years, and the median prepregnancy BMI was 23.3 kg/m2.
Results indicated that cycle length was associated with menopausal symptoms after adjustment for age, prepregnancy BMI, race/ethnicity, education and parity. Compared with women with a normal menstrual cycle length of 26 to 34 days, women with short cycles had significantly higher total MRS scores at midlife. This association was driven by somatic and psychological symptoms, researchers said.
Specifically, the authors wrote that women with short menstrual cycles had increased odds of reporting any sleep problem (OR = 1.92; 95% CI, 1.1-3.37), heart discomfort (OR = 1.68; 95% CI, 1.03-2.73) and depressive mood symptoms (OR = 1.85; 95% CI, 1.16-2.96) at midlife compared with women with a normal menstrual cycle length of 26 to 34 days.
The researchers then confirmed the relationship between menstrual cycle length and depressive symptoms based on the Patient Health Questionnaire-9, which women completed at their midlife visit, and the findings remained significant even after they adjusted their analysis for history of depression. They said no association was evident for women with long menstrual cycles, even after making the same adjustment.
The researchers also found that among women who had reached menopause by the midlife visit, those with short cycles had an earlier age at natural menopause than women with either normal or long cycles (HR = 1.67; 95% CI, 1.11-2.51).
“Using the menstrual cycle as an additional vital sign adds a powerful tool to the assessment of physical and mental health,” the authors wrote. “Because of the limited epidemiologic literature on this topic, further studies are warranted, and in particular large studies that can evaluate separately women with usual cycle length less than 21 days, to confirm these results and further explore potential underlying mechanisms.”
Perspective
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In a new paper in Menopause, Dr. Mínguez-Alarcón and associates at Harvard revisited a former study group of pregnant women studied as a cohort in Massachusetts, recruited 18 years previously. From this group, they had collected data on their (self-reported, prepregnant) menstrual history. Eighteen years later, they followed them up to investigate their menopausal status.
What they discovered was that the women who had a history of short menstrual cycles had undergone an earlier menopause than the rest of the group. The earlier menopausal group also had more menopausal symptomatology. They believed that one explanation for these symptoms would be that these women intrinsically had lower estrogen levels, consistent with their histories of short cycles.
They suggested that collecting information on cycle length could give practitioners a better handle on age at menopause, which sounds plausible. They also suggested collecting more data on this subject. But they did accrue some very interesting data in a noninvasive manner.
Predicting ages at menopause has remained difficult and this bit of history gives one easy marker to keep in mind.
Perspective
Back to TopChrisanda Shufelt, MD, MS, FACP, NCMP
This observational cohort study provides support that the menstrual cycle is a reproductive vital sign that can give insight not only into hormonal imbalance and fertility but serves as a marker of future health. The authors found that shorter menstrual cycles (less than 25 days) during the reproductive years were associated with worse menopause related symptoms, including sleep disturbance and depressive symptoms. Since variation in menstrual cycle length can result from both physical and mental health, including stress, diet, body weight and exercise patterns, it will be important to understand the underlying cause for the shorter cycles that might predict symptoms later in life. For example, is there a role of elevated cortisol in women with shorter menstrual cycles at a young age and worse symptoms in midlife?
Furthermore, while the menstrual cycle is synonymous with estrogen and progesterone fluctuations required for ovulation, it should be recognized that this is a complex process involving both positive and negative feedback along the hypothalamic-pituitary-ovarian pathway that changes over a woman’s lifespan. While more studies are needed, these similar pathways that result in ovulation and menstruation during reproductive years shift to play a key role in thermoregulatory perception and depression after menopause. Overall, this study highlights an opportunity to ask about the menstrual cycle, not just about when your last menstrual cycle was, but whether they are regular and how often you have them.
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