"Not feeling like myself" in perimenopause - what does it mean? Observations from the Women Living Better survey.

OBJECTIVE: This study aimed to understand the meaning of the phrase "not feeling like myself" (NFLM) when used by those on the path to menopause by exploring the relationship of symptoms reported to ratings of NFLM. METHODS: Participants responded to the item "Many women report just not feeling like themselves during this phase of life. How often was this true for you over the past 3 months?" choosing from "none of the time" to "all of the time." They rated bother associated with 61 symptoms and provided demographic information. Individual symptoms and the symptom bother scale scores were correlated with NFLM. Symptom scale scores were then entered in a two-stage multiple regression model to identify symptoms associated significantly with NFLM. RESULTS: Sixty-three percent (63.3%) of participants reported NFLM 50% of the time or more over the previous 3 months. Individual symptom ratings correlated with NFLM ( r > 0.300) included the following: fatigue ( r = 0.491); feeling overwhelmed/less able to cope ( r = 0.463); low feelings ( r = 0.440); anxiety, more nervousness ( r = 0.398); being irritable ( r = 0.380); harder time concentrating ( r = 0.378); difficulty making decisions ( r = 0.357); feeling like "I can't calm down on the inside" ( r = 0.333); being more forgetful ( r = 0.332); tearfulness/crying ( r = 0.306); and worrying more ( r = 0.302). A two-stage regression analysis revealed less education completed and greater overall stress ratings as significant predictors in stage 1. In stage 2, five symptom groups met the P < 0.001 criterion: anxiety/vigilance, fatigue/pain, brain fog, sexual symptoms, and volatile mood symptoms. CONCLUSIONS: NFLM was associated with anxiety/vigilance, fatigue/pain, brain fog, sexual symptoms, and volatile mood symptoms. Recognizing symptoms associated with NFLM may allow for more accurate expectations and improve perimenopause care.

Seeking Health Care for Perimenopausal Symptoms: Observations from The Women Living Better Survey.

Background: The perimenopausal health care interaction can be challenging both for those seeking care and health care professionals (HCPs). We explore the factors that contribute to making these health care interactions either satisfying or unsatisfying for a midlife person with ovaries who consults an HCP about bothersome symptoms. Materials and Methods: Respondents to the Women Living Better (WLB) survey were asked about 61 symptoms often associated with the menopausal transition. They were then asked whether they sought health care for their most bothersome one. Of the 1024 participants who consulted an HCP, 964 provided a response to the open-ended question "how did that go?" We used conventional content analysis to code the responses and identify themes. Results: We identified six codes reflecting positive health care interactions which we then grouped into five themes suggesting satisfaction with these health care interactions. These included: validating experiences; having matching explanatory models; being supported by a team; engaging in shared decision-making; and having symptoms addressed. We identified 13 codes reflecting negative health care interactions which we then group into 4 themes suggesting dissatisfaction. These included: invalidating experiences, a mismatch in expectations between care recipients and HCP, barriers to treatment, and not feeling helped. Conclusions: Those seeking health care for bothersome symptoms on the path to menopause responded with both positive and negative comments about health care interactions in the WLB survey. Studying these comments identifies opportunities to improve midlife care.

Symptom experience during the late reproductive stage versus the menopausal transition in the Spanish-language Women Living Better survey.

OBJECTIVES: The aim of this study was to characterize and compare the symptoms women self-report during the late reproductive stage and the menopausal transition. METHODS: This cross-sectional analysis used data from the Spanish-language Women Living Better survey. Women aged 35 to 55 years completed an 82-item online survey to assess menstrual cycle patterns, changes, and 61 symptoms sometimes associated with menopause. Women's menstrual patterns were classified as late reproductive stage or menopausal transition using the Stages of Reproductive Aging Workshop. Demographic and health-related data were collected, including age, country of residence, race/ethnicity, education, parity, smoking, and alcohol use. Descriptive statistics characterized reported symptoms, and logistic regression models examined associations between reproductive stage and symptoms. RESULTS: Of 853 respondents, 358 women were included in the sample analyzed. Participants were on average 40 ± 4.1 years old, 46% reported difficulty paying for basics, 34% lived in Spain, and 20% lived in Mexico. A similar proportion of women in the late reproductive stage and menopausal transition reported 8 of 18 symptom groups. Women in the late reproductive stage had a lower age-adjusted odds of musculoskeletal pain (odds ratio, 0.35; 95% CI, 0.19-0.66) and lower odds of decreased interest in sex (odds ratio, 0.49; 95% CI, 0.25-0.92). Both groups of women reported a similar interference with personal relationships. CONCLUSIONS: Late-reproductive-stage women experience multiple symptoms often associated with menopause. A better understanding of symptoms experienced among Spanish-speaking women may lead to more personalized health care and facilitate anticipatory guidance about menopause. Future cross-cultural studies focusing on symptoms during the late reproductive stage are necessary.

Effects of bothersome symptoms during the late reproductive stage and menopausal transition: observations from the Women Living Better Survey.

OBJECTIVE: Bothersome symptoms during the late reproductive stage and menopausal transition sometimes interfere with women's activities of daily living and relationships, yet little is known about the specific effects of different groups of symptoms. Aims of these analyses were to examine the effects of bother related to 5 symptom groups on participant's assessment of 4 outcomes: interference with everyday activities, interference with relationships, "not feeling like myself," and self-ratings of health. METHODS: Participants (N = 1,539 meeting eligibility and inclusion criteria) aged 35 to 60 years responded to the online Women Living Better Survey during March to August of 2020. In addition to rating 61 symptoms as bothersome on a scale from not at all bothered (0) to extremely bothered (6), they also indicated the degree to which their symptoms interfered with their activities and relationships indicating not at all (0) to a great deal (4). They indicated the extent to which they did not "feel like myself" choosing none of the time (0) to all of the time (4) and rated their health from poor (1) to excellent (5). Symptoms were grouped using results of principal components analysis. Five symptom groups with the highest bother ratings were analyzed for this report, including the following: brain fog, volatile mood, fatigue/pain, vasomotor symptoms (VMS)/sleep onset, and anxiety/vigilance symptoms. Two-stage hierarchical regression analysis was used to examine personal characteristics of the participants such as education, menopause-related factors, roles and stressors (stage 1), and effects of 5 symptom group bother ratings on interference with daily activities and relationships, "not feeling like myself," and health ratings (stage 2). RESULTS: Interference with daily activities was related to difficulty paying for basic items and bother associated with the brain fog, anxiety/vigilance, fatigue/pain, and VMS/sleep onset symptom groups. Interference with relationships was correlated with being in a committed relationship and bother related to all 5 symptom groups. "Not feeling like myself" was related to having completed less education, reporting greater overall stress, brain fog, anxiety/vigilance, volatile mood, and fatigue/pain symptoms. More positive health ratings were related to having completed more education, having responsibility for children or dependents, experiencing greater satisfaction with roles, and less fatigue/pain symptom bother. Bother related to all 5 symptom groups was associated with increased interference with relationships, but bother related to interference with daily activities was related to only 4 of the 5 symptom groups, but not volatile mood symptoms. The phrase "not feeling like myself" was related to more bothersome anxiety/vigilance, volatile mood, brain fog, and fatigue/pain symptoms. Of interest was that VMS/sleep symptoms, often attributed to the menopausal transition, were not related to either "not feeling like myself" or to self-ratings of health. Moreover, self-rated health was related only to fatigue/pain symptom bother. CONCLUSIONS: These findings suggest that the experience of symptoms typically attributed to a developmental event, in this case perimenopause, may be viewed as unrelated to one's health. Further clarification of which symptoms can be attributed to perimenopause rather than other factors, such as aging, will improve anticipatory guidance about perimenopause. Similarly, additional investigation of the meaning of the phrase "not feeling like myself" could help clarify why bothersome symptoms, such as mood, fatigue, and cognitive symptoms, but not vasomotor/insomnia symptoms, are associated with this descriptor. Setting accurate expectations about what is typical can influence anticipations, understanding the spectrum of experiences, and attributions of symptoms. Further investigation on these fronts will contribute to timely, accurate anticipatory guidance and strategic symptom management for patients and providers.

Perimenopause meets life: observations from the Women Living Better Survey.

OBJECTIVE: The purpose of these analyses was to test a predictive quantitative model relating personal characteristics, reproductive aging stages, health behaviors, roles, stressors, and satisfaction with life roles to bothersome symptoms experienced during the late reproductive stage and the menopausal transition (MT). METHODS: Participants (N = 2,406) aged 35 to 55 years completed the Women Living Better Survey online between March to August 2020, and 1,529 met the inclusion criteria and provided menstrual cycle data for staging reproductive aging. They were recruited from the Women Living Better newsletter and from other online groups of midlife women. Hierarchical regression analysis using a two-stage model tested the effect of several factors on each of five bothersome symptom groups: brain fog, volatile mood, fatigue/pain, vasomotor/sleep disruption, and anxiety/vigilance symptoms. In stage I, personal characteristics, reproductive aging stage, and health behaviors were examined, and in stage II roles (ie, caregiver, partner, employment-related), satisfaction with life roles and stressors associated with roles were added. RESULTS: More bothersome brain fog symptoms were associated with less education, MT (vs late reproductive stage), low satisfaction with life roles, and greater health-related and overcommitment stress (all P < 0.005). More bothersome volatile mood symptoms were associated with health-related, partner relationship, and other relationship stress. More bothersome fatigue/pain symptoms were associated with less education and greater difficulty paying for basics and health-related and other relationship stress. Vasomotor/sleep-onset symptoms were associated with less education, MT, and health-related and work stress. More bothersome anxiety/vigilance symptoms were associated with less education, more difficulty paying for basics, and health and work stress. CONCLUSIONS: Recognizing that midlife stress comes from many role- and relationship-related sources and that several of these stressors are associated with greater symptom bother supports the importance of proactive identification and management of sources of stress.

Symptom experience during the late reproductive stage and the menopausal transition: observations from the Women Living Better survey.

OBJECTIVE: The aim of this study was to examine the occurrence of a variety of symptoms, their frequency, bother, burden, and interference in the lives of women in the late reproductive stage (LRS) and compare their experiences to that of women in the menopausal transition (MT) stage. METHODS: Women ages 35 to 55 years responded to an 82-question online survey offered by Women Living Better. Participants reported current menstrual patterns, recent changes and symptom frequency, bother, and interference. Women's cycles were classified as LRS or MT using Stages of Reproductive Aging Workshop +10 criteria. RESULTS: Of 2,406 respondents, 946 met criteria for LRS and 583 for MT. Participants included 30% from outside the United States, 31% from diverse racial/ethnic groups, and 18% reported having difficulty paying for basics. A similar proportion of women in the LRS and MT+ groups reported each of the symptoms: there was a less than 10% difference for 54 of the 61 symptoms. Of mean bother ratings for all symptoms, only hot flashes differed significantly between the LRS and MT groups. LRS women experienced similar levels of symptom-related interference with personal relationships and daily living to those in the MT stage but did not anticipate these symptoms occurring until they were 50 years old. CONCLUSIONS: Women in the LRS experience symptoms strikingly similar to those often associated with the MT. Women do not expect these changes until the age of 50 years or later and are surprised by such symptoms before cycle irregularity. Research about the epidemiology and management of LRS symptoms, anticipatory guidance for women, and education for clinicians who care for them warrant increased attention.

Transitioning to the menopausal transition: a scoping review of research on the late reproductive stage in reproductive aging.

IMPORTANCE AND OBJECTIVE: In 2001 Staging Reproductive Aging Workshop conferees described the late reproductive stage (LRS) of reproductive aging as preceding the onset of the menopausal transition, yet there has been little attention to this aspect of reproductive aging. The aim of this scoping review was to examine scientific publications characterizing the LRS to map what is known about this stage with particular focus on reproductive endocrine patterns, menstrual cycle changes, and symptoms. METHODS: The initial search strategy included PubMed and CINAHL searches for the phrase LRS and "human." Given a low yield of research articles, a second stage used "late reproductive age" (LRA) as a search term. These strategies yielded 9 and 26 research articles, respectively. Publications meeting inclusion criteria (data-based research studies, focus on LRS or LRA and hormonal patterns, menstrual characteristics, and symptoms) published in English were reviewed by coinvestigators. Excluded studies were related to specific diseases, such as cardiovascular disease, and treatment studies. Data were summarized using qualitative methods. To ensure adequate coverage of published research we expanded our review to a third phase in which we identified longitudinal studies of the menopausal transition. DISCUSSION AND CONCLUSIONS: Studies of the LRS focused on: symptoms (anxiety and mood symptoms, bladder symptoms, urinary incontinence, urinary frequency, and nocturia) and associated factors, such as endocrine levels and gene polymorphisms; symptom clusters women experienced during the LRS; cognitive function testing results; changing patterns of physiology such as cytokines and chemokines, lipids, hormone patterns/levels; and association of lifestyle factors such as smoking with hormone levels and symptoms. The LRA search yielded a preponderance of studies of reproductive hormones (such as anti-Mullerian hormone) and menstrual cycle patterns. Remaining studies focused on symptoms, gene variants, health-related behaviors and approaches to classifying menstrual cycles. Longitudinal studies revealed reports of symptoms as well as attempts to classify the progression from the reproductive years to the menopausal transition. Study of the LRS has not been systematic and the limited number and scope of completed studies have yet to contribute a clear and complete picture of the LRS. In some, LRS provided a comparison stage against which to evaluate menopausal transition hormonal and cycle patterns and symptoms. Harmonizing the results of studies of the LRS and LRA is essential to understand more completely women's experiences of the LRS and to allow clinicians to provide better support for women during this time. The LRS also represents an ideal inflection point to promote lifestyle choices that could alter the trajectories of chronic diseases that arise in the fifth, sixth, and seventh decades of women's lives.

Video Summary:http://links.lww.com/MENO/A694.

Alternatives to hormone therapy for hot flashes: many choices but science is lacking.

CLINICAL SCENARIO: A 51-year-old postmenopausal third-grade teacher requests help for her hot flashes. She finds them especially troubling as she stands in front of her class and starts sweating. Although one student offers her tissues, others make fun of her--disrupting the class. Her sleep is interrupted several times a night. She refuses to use any form of estrogen because her mother died of breast cancer at the age of 60 years. Perhaps alternative therapies can help her.