The relationship between diurnal cortisol secretion and climacteric-related symptoms.

OBJECTIVES: Chronic stress, also associated with climacteric-related symptoms, may influence cortisol secretion. We studied cortisol metabolism in peri- and postmenopausal women with diverse climacteric-related symptoms. STUDY DESIGN AND MAIN OUTCOME MEASURES: The study population was 35 women, aged 45-70 years. Plasma cortisol levels were measured from blood samples collected every 20 min over 24 h. Urinary cortisol was analysed from 24-hour urine collections. Climacteric-related symptoms (vasomotor, sleep, depressive, anxiety, cognitive, sexual, menstrual, and somatic) were evaluated with the Women's Health Questionnaire (WHQ). Associations between cortisol variables (24-hour, night, day, maximum, minimum, morning baseline, cortisol awakening response (CAR), area under the curve, slope, and 24-hour urinary cortisol) and the symptoms were first examined with a correlation analysis. Then, the women were divided into two groups according to their climacteric symptomatology, and differences in cortisol variables between the groups were investigated. Diurnal cortisol curves by symptomatology were also analyzed visually. RESULTS: In the correlation analysis, more frequent vasomotor symptoms were associated with a higher CAR (rs = 0.37, p = 0.039) and lower 24-hour urinary cortisol excretion (rs= -0.45, p = 0.012), and more frequent depressive symptoms were associated with a higher minimum cortisol level (rs = 0.33, p = 0.0498). When the women were divided into two groups, women with more frequent vasomotor (p = 0.012) or somatic symptoms (p = 0.021) had a lower 24-hour urinary cortisol excretion than less symptomatic women. CONCLUSIONS: Although previous studies have reported associations between climacteric-related symptoms and cortisol secretion, these two factors were not substantially interrelated in our study.

Climacteric-related symptoms in menopause transition and beyond: a prospective 19-year follow-up study on previously hysterectomized women.

OBJECTIVE: Only a few extended follow-up studies have investigated the natural progress of climacteric-related symptoms. The results have been conflicting. Thus, our aim was to evaluate, through a 19-year longitudinal study, whether these symptoms decrease or disappear as time elapses after menopause. METHODS: Our study was a prospective follow-up survey of 65 hysterectomized peri or postmenopausal women. The women were interviewed at the baseline, and at 6 and 19 years thereafter. Changes in various climacteric-related symptoms were evaluated by repeated-measures analysis of variance with time as the independent variable. The analyses were adjusted for baseline age, body mass index, employment, and use of hormone therapy. Climacteric-related symptoms were evaluated with the Women's Health Questionnaire, of which we included seven symptom domains (vasomotor, sleep, depressive, anxiety/fears, cognitive, sexual, and somatic). RESULTS: Vasomotor symptoms decreased remarkably during the follow-up period. In addition, a statistically significant decrease was found in sleep problems and cognitive difficulties. However, the decrease was minor, and thus probably clinically insignificant. CONCLUSIONS: The only symptom with notable decrease was vasomotor symptoms. The etiology of other symptoms, commonly connected to menopause transition, is probably multifactorial and not substantially dependent on the climacteric.

Psychometric properties of the Finnish version of the Women's Health Questionnaire.

OBJECTIVE: The Women's Health Questionnaire (WHQ) is a validated and commonly used instrument for measuring climacteric-related symptoms. A revised version was previously developed. However, validation in a Finnish population is lacking. As it is important to use qualified instruments, we performed a validation study of the WHQ in a Finnish population. METHODS: In all, 3,421 women, aged 41 to 54 years, formed the study population. In the original 36-item WHQ, the items were rated on a 1 to 4 scale and on a binary scale (0-1). The scaling of the revised 23-item WHQ was 0 to 100. We evaluated the psychometric properties (internal consistency, correlations between the symptom domains, factor structure, and sampling adequacy) in all three versions. RESULTS: For the 1 to 4 scale and on the revised version of the WHQ, the internal consistency was acceptable (the Cronbach's α coefficients >0.70) for most of the domains. On the binary scale, the majority of the coefficient values were below the acceptable level. The original symptom domains, especially those on the revised version, were recognizable from the factors in the exploratory factor analysis, but there were some limitations. The Kaiser-Meyer-Olkin values were high. CONCLUSIONS: The WHQ is a valid instrument for measuring climacteric-related symptoms in Finnish middle-aged women. The psychometric properties of the revised 23-item WHQ were as good or even better than those of the original 36-item WHQ. Thus, we encourage use of the revised version.

Climacteric symptoms in middle-aged women with chronic somatic diseases.

OBJECTIVES: Chronic diseases may aggravate or simulate climacteric symptoms. Although acknowledged in clinical practice, there is a lack of research systematically analysing the association between chronic diseases and climacteric symptoms. STUDY DESIGN AND MAIN OUTCOME MEASURES: Our study was a cross-sectional population-based study, which included 3421 women, aged 41-54 years. Climacteric symptoms were evaluated using the Women's Health Questionnaire (WHQ), of which we included seven symptom domains (vasomotor, sleep, depressive, anxiety/fears, cognitive, sexual, and menstrual) and a question concerning whether the women were worried about growing old. The occurrence of various diseases (cardiovascular, neurological, sensory organ, bronchopulmonary, musculoskeletal, gastrointestinal, urological, dermatological, and thyroid disease, diabetes, and cancer) was recorded. The associations between the diseases and symptoms were defined with multivariable analyses, adjusting for various confounding factors. RESULTS: The women with the diseases had more symptoms. Vasomotor symptoms and sleep problems were associated only with gastrointestinal diseases, and lower sexual functioning only with diabetes. The remaining symptoms were associated with several diseases, except being worried about growing old, which was not associated with any. CONCLUSIONS: Many symptoms connected to the climacteric may manifest also due to chronic diseases. Thus, health-care professionals should consider the origin of the symptoms when treating middle-aged women with chronic diseases.

A population-based survey of quality of life in middle-aged Finnish women.

OBJECTIVE: Factors that cause a decrease in quality of life (QoL) among middle-aged women are contradictory. Given that previous studies have been presumably performed in ethnically heterogeneous populations, we evaluated the impact of socioeconomic and lifestyle factors on QoL in Finnish women because the Finnish population is ethnically homogenous. METHODS: A total of 6,408 women (aged 41-54 y) who were called for municipal screening mammography received a postal survey concerning their health-related issues. A total of 3,421 women returned the questionnaire. QoL was evaluated with the Women's Health Questionnaire, from which we included eight symptom clusters (somatic symptoms, depressive symptoms, cognitive difficulties, anxiety/fears, sexual functioning, vasomotor symptoms, sleep problems, and menstrual symptoms). The effects of variables on QoL were defined with multivariate analysis. RESULTS: Older women had more symptoms. Lower educational level was associated with lower QoL. Retired women had more symptoms than working or unemployed women, and unemployed women had more symptoms than employed women. Increasing body mass index was associated with lower QoL. Women who consumed alcohol occasionally had fewer symptoms, and women who consumed alcohol weekly had more symptoms than abstainers. Women who smoked had more symptoms than nonsmokers. Current hormone therapy users had more symptoms than nonusers, and former hormone therapy users had more symptoms than nonusers or current hormone therapy users. CONCLUSIONS: Higher socioeconomic status and healthier lifestyle are beneficial for good QoL in middle-aged women. Thus, women should be encouraged to continue employment and to avoid behavioral health risks.