Menopause symptoms may arise in late reproductive stage
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Spanish-speaking women in the late reproductive stage reported eight menopause symptoms at the same frequency as those already transitioning through menopause, according to a cross-sectional analysis published in Menopause.
“The late reproductive stage marks the time when fecundability begins to decline and hormonal patterns begin to change,” Yamnia I. Cortés, PhD, MPH, FNP-BC, an assistant professor at the University of North Carolina at Chapel Hill School of Nursing, and colleagues wrote. “Recent studies suggest that, during the late reproductive stage, women may experience symptoms typically associated with the menopausal transition such as hot flashes, sleep disturbances, mood changes, joint pain and fatigue. Despite evidence of sociocultural differences in symptom reporting during the menopausal transition, most of the research on symptoms during the late reproductive stage has been conducted in English among non-Hispanic white women.”
Cortés and colleagues evaluated the menstrual patterns and symptoms self-reported by 358 women aged 35 to 55 years who completed the 82-item online Spanish language Women Living Better survey between March 3 and Aug. 3, 2020.
There were 276 women who met the Stages of Reproductive Aging Workshop (STRAW) criteria for the late reproductive stage, which were menstruating three or more times in the past 3 months and experiencing changes in cycle length, flow or number of days of flow. The remaining 82 women met the STRAW criterion for the menopausal transition, which was menstruating fewer than three times in the past 3 months.
The largest proportions of participants lived in Spain (34%), Mexico (29%) or South America (19%), identified as Hispanic or Latina (50.8%) and had completed some college education (59.6%).
There were no significant differences between late reproductive stage and menopausal women in the reporting of several symptoms:
- feeling anxious/worried/nervous (41.7% vs. 47.6%);
- feeling sad/blue/depressed (34.4% vs. 36.6%);
- breast soreness (47.8% vs. 50%);
- difficulty concentrating (50% vs. 57.3%);
- headache/migraine (44.6% vs. 56.1%);
- discomfort or pain with sex (29% vs. 29.8%); and
- urinary frequency (17.4% vs. 25.6%) and urgency (9.4% vs. 14.6%).
Women in both groups reported similarly high rates of symptom interference in daily activities and relationships, but menopausal women more commonly reported “not feeling like myself in the past 3 months.”
In age-adjusted analyses, women in the late reproductive stage less commonly reported musculoskeletal pain (adjusted OR = 0.35; 95% CI, 0.19-0.66) and decreased libido (aOR = 0.49; 95% CI, 0.26-0.92) compared with menopausal women.
With further adjustment for parity and caring for dependents, only findings for musculoskeletal pain remained significant.
“This study highlights the importance of generating multilingual, multicultural toolkits to personalize clinician-led education,” Cortés and colleagues wrote. “Studies on the epidemiology, physiology, experiences and management of late reproductive stage symptoms are warranted. Finally, findings suggest the need for further consideration to the late reproductive stage in the STRAW framework.”
Perspective
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This study involving 358 women (mean age, 40 years) who participated in the Spanish-language Women Living Better Survey and who were in the late reproductive stage (still menstruating regularly with little or no change in menstrual cycle length) or menopause transition (experiencing more irregular menstrual cycles with up to 60 days of amenorrhea) found that women in the late reproductive stage experienced multiple symptoms often associated with menopause. Indeed, over 40% of women from both the late reproductive stage and menopause transition groups reported symptoms, such as sleep disturbances, mood swings/irritability, feeling anxious/worried/nervous, headache or migraine, breast soreness, difficulty concentrating or forgetfulness, and musculoskeletal pain. Similar percentages of women in each group reported that these symptoms interfered with their daily activities and with their relationships.
These study results are similar to those reported by Nina Coslov, MBA, and colleagues in 2021, which was conducted among English-speaking women, also from the Women Living Better Survey, and highlight that women in the late reproductive stage are experiencing menopause-related symptoms even without significant variation in menstrual cycle length. Women may not anticipate or expect menopause symptoms prior to the mean age of menopause (age 52 years in the U.S.) and may be surprised and caught off-guard when they do occur.
These findings highlight an opportunity for health care professionals to educate their patients about the menopause transition and to provide anticipatory guidance to women as early as their mid-30s. In addition, better understanding of racial and ethnic differences in the experience of menopause will help inform creation of culturally and linguistically appropriate, individualized education and recommendations for symptom management.
Reference:
Coslov N, et al. Menopause. 2021.doi:10.1097/GME.0000000000001805.
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