Symptom experience during the late reproductive stage versus the menopausal transition in the Spanish-language Women Living Better survey
Another research paper from the Women Living Better Survey has been accepted by Menopause, the peer-reviewed journal of the North American Menopause Society. The lead author for this paper is Yamnia Cortés, an assistant professor at UNC Chapel Hill, School of Nursing. It is available online ahead of print now and will be published in the March 2023 Issue. At that time, it will be open access.
Research Question
Does the symptom experience of those who completed the Spanish-language survey differ depending on whether they are still getting a monthly period with subtle menstrual cycle changes (in the late reproductive stage) OR have more noticeable menstrual cycle changes (in the menopausal transition)?
Definitions
The Late Reproductive Stage (LRS): Participants in this study that were in the late reproductive stage were still getting a monthly period but noticed changes to their cycle length, the number of days of bleeding during their periods or the amount of bleeding during their periods. They had 3 or 4 periods in the past 4 months.
The Menopausal Transition (MT): Participants in this study that were in the menopausal transition had more significant changes to their menstrual cycles. They had 2 or fewer periods in the past 3 months.
What we found
The rate of reporting 8 of the 18 symptom groups was similar between groups. Participants — whether before or after significant menstrual cycle irregularity — reported similar rates of feeling anxious/worried/ nervous, sad/blue/depressed, breast soreness, difficulty concentrating, headache/migraine, discomfort or pain with sex, and urinary frequency and urgency.
Some symptoms were more likely to be reported for those experiencing more significant menstrual cycle changes (in the MT) than for those with only subtle menstrual cycle changes (in the LRS). Those in the MT were more likely to report sleep disturbances, vasomotor symptoms (hot flashes, night sweats), heart palpitations, mood swings/irritability, musculoskeletal pain, vaginal dryness, urinary leakage, and low libido.
Sleep disturbance was the most reported symptom: 70% of those in the LRS (before significant menstrual cycle changes) and 80% of those in the MT (after noticeable menstrual cycle changes) reported some sleep-related complaints (e.g., hard time falling asleep, waking up in the middle of the night).
Interference with daily activities and relationships: nearly 75% of participants in both groups reported that these symptoms interfered with daily activities, and 15% reported that these symptoms interfered “a lot” with relationships.
Not feeling like myself: 36% of those in the LRS (before significant menstrual cycle changes) and 80% of those in the MT (after significant menstrual cycle changes) reported “not feeling like themselves” in the past 3 months.
What this means for those on the path to menopause
These findings support the idea that for some people on the path to menopause, symptoms begin before significant menstrual cycle changes.
So, if you are in your late 30/early 40s and notice changes to your sleep, start feeling anxious/worried/ nervous, sad/blue/depressed, have new or a return of breast soreness, have difficulty concentrating, new or more headaches/migraines, discomfort or pain with sex, and urinary frequency and urgency, it could be hormonally related and beginning of the path to menopause, your final menstrual period.
You are not alone. And these things are not in your head. They are real.
What you can do
- You can track your periods and cycle lengths to see if they are changing if you are not using hormonal birth control. Are your periods lasting fewer or more days? Is your flow heavier or lighter? Are your cycles shortening (i.e., periods starting to come closer together)?
- If you are using oral contraceptives, you can pay attention to whether you get symptoms during the placebo week.
- Talk to your peers. You may find that they too are having similar experiences. You will both benefit from sharing your experience.
- Keep in mind that midlife is a time when many of us are juggling many roles and responsibilities that add stress to our lives. We often think of ourselves last with respect to self-care or stress management. Our recent research showed some types of life stress were associated with more bothersome symptoms during the path to menopause.
- If any of these changes interfere with your daily activities or relationships, talk to your health care provider.
If you do seek healthcare
Keep in mind that many health care providers are not well trained in perimenopause and may not see a connection between your new symptoms, subtle menstrual cycle changes, and the path to menopause particularly if you are still getting a monthly period.
If your health care provider doesn’t see this connection, here are some things you can try:
- If you are tracking your cycles and symptoms, share that information. This tool can help you organize your information.
- You can print this paper from the Spanish language survey or this paper from the English language survey that had more participants and share it with your provider. They will both support the idea that symptoms start before significant cycle changes.
Other things to know about this study
- The sample size was 358 people: 276 participants had only experienced subtle changes to their menstrual cycle (LRS group) and 82 had experienced more significant changes to their menstrual cycle (MT group).
- The small number of MT participants limited how many comparisons could be made between the groups.
- While this survey was created in the US, 34% of participants were from Spain and 29% from Mexico.
Broader implications
- This study highlights the importance of creating multilingual, multicultural toolkits to support health care provider-led education.
- More studies on the epidemiology, physiology, experiences and management of LRS symptoms are warranted in diverse populations.
Other Coverage of this Research
The North American Menopause Society’s Press Release
You can read it here.
From Healio
Healio covered this research with Perspective provided by Stephanie Faubion, MD, MBA, Women’s Health & OB/GYN Peer Perspective Board Member, Director, Mayo Clinic Center for Women’s Health
“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.”
