Predictors of declining self-rated health during the transition to menopause
Introduction
There has been much concern about the effect of the menopausal transition on quality of life. An important component of quality of life is undoubtedly health status. Self-rating of health, a global assessment by an individual, has been shown to be a significant predictor of the use of health services [1] and of mortality [2]. Self-rated health is a complex construct which is affected by both medical and socio-cultural factors. Utilising an assessment question anchored to the health of one's peers, we have previously shown that health perceived worse than one's peers was largely a reflection of the physical experience of ill-health, whereas better self-rated health was a more complex construct incorporating social factors, as well as absence of ill-health [3]. That analysis utilised the baseline data of a prospective population-based study of women's experience of health during midlife. As such, the study was able to identify factors correlated with different categories of self-rated health but suffered from the disadvantages present in cross-sectional studies. Cross-sectional studies can neither identify the direction of causality nor take into account the often powerful effect of baseline levels of determinants [4]. Such studies are not able to disentangle the effect of age from that of changes in menopausal status, which reflect underlying hormonal changes. These studies are less satisfactory than longitudinal studies in which the same women are being followed over time with the same instruments so that what is being observed is change in the same population with time. Longitudinal cohort designs facilitate the identification of those associations most likely to reflect a cause–effect relationship and can potentially separate the effects of aging from those of menopause [5]. Longitudinal collection of data reduces reliance on memory for long recall periods, which can lead to further inaccuracy of data. This is not only true for the studied endpoints, but also for possible covariates at the time of occurrence. In longitudinal studies, there is the opportunity for measures to be made prospectively (such as menstrual diaries) rather than relying on self-recall, which may be substantially less accurate. When change over time is the key concern, a prospective design is mandatory [6].
The aim of the present study was to determine the factors associated with declining self-rated health as measured annually for 8 years in the Melbourne Women's Midlife Health Project, a prospective population-based cohort of middle-aged Australian-born women. A major focus of the analysis was to investigate the potential role of the menopausal transition in changing self-rated health.
Section snippets
Subjects
The study began in 1991 using random telephone digital dialing to obtain a baseline interview from 2001 Australian-born women aged between 45 and 55 years and residing in Melbourne (71% response rate) [7]. All women at baseline who had experienced menses in the prior 3 months, and who were not taking the oral contraceptive pill or hormone therapy, were invited to participate in a longitudinal study. Of those eligible, 438 (56%) chose to do so. Volunteers for the longitudinal study were more
Results
The average (S.D.) age at baseline of the 262 women was 48.8 (2.4) years, range 45–55; 81% were married or living with a partner, 37% had more than 12 years of education, and 72% were in paid employment.
Fig. 1 shows the percentage distribution of self-rated health by study year. The percentage of women reporting their health to be “better than most” decreased from 51.2% at Year 1 to 41.3% at Year 8, representing a decline of −9.9% (95% CI=18.7% to −1.1%, P<.05), or −1.2% per annum. The
Discussion
This study found a small and continuing decline in perception of health with increasing age. When self-rated health was centred on first reporting of prolonged amenorrhoea (late menopausal transition status), there appeared to be a small association. However, when the study group of women who passed through the menopausal transition were compared with the two smaller subgroups derived from the same population sample whose menopausal status remained the same, no statistically significant effect
Conclusions
This prospective study found a continuing small decline in self-rated health with aging but no significant effect of the menopausal transition. The study confirms our earlier findings that different factors relate to differing self-rated health groupings. Changing psychosocial factors have more impact on those women who at baseline self-rated their health as better than most, whereas those whose health was rated at baseline as the same as others were more negatively impacted by the physical
Acknowledgements
This study was supported by grants from the Victorian Health Promotion Foundation and the Public Health Research and Development Committee of the Australian National Health and Medical Research Council. In 2001, grant-in-aids were received from Pharmacia and Upjohn and ANZ Trustees. We thank Mr. Nick Balazs and the staff of the Department of Biochemistry at Monash Medical Centre for the hormone assays.
References (24)
- et al.
The Tromso study: predictors of self-evaluated health—has society adopted the expanded health concept?
Soc Sci Med
(1991) - et al.
Self-rated health: biological continuum or social discontinuity?
Soc Sci Med
(1994) - et al.
A longitudinal analysis of the association between menopause and depression: results from the Massachusetts women's health study
Ann Epidemiol
(1994) - et al.
Symptom reporting at the menopause
Soc Sci Med
(1981) - et al.
A prospective population based study of menopausal symptoms
Obstet Gynaecol
(2000) - et al.
Executive summary: Stages of Reproductive Aging Workshop (STRAW)
Fertil Steril
(2001) - et al.
Psychological well-being, mid-life and the menopause
Maturitas
(1994) - et al.
Is incontinence associated with the menopause
Obstet Gynecol
(2001) - et al.
Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups
Soc Sci Med
(2001) - et al.
Perceived health and mortality: a nine-year follow up of the Human Population Laboratory cohort
Am J Epidemiol
(1988)
Factors contributing to positive mood during the menopausal transition
J Nerv Ment Dis
The Massachusetts Women's Health Study: an epidemiologic investigation of the menopause
J Am Med Women's Assoc
Cited by (33)
Hot flashes severity, complementary and alternative medicine use, and self-rated health in women with breast cancer
2014, Explore: The Journal of Science and HealingCitation Excerpt :In the current study, more severe HF were reported by those who had poorer SRH during treatment and at six-month follow-up. This is different from the observation of no significant association of SRH with menopausal symptoms or menopausal transition from two prospective studies in healthy women undergoing menopausal transition.22,52 However, in these studies, a different measure was used; SRH was rated relative to their peers on a 3-point scale—worse than most, about the same as others, or better than most women their age—in contrast to the 5-point scale used in the current study.
Menopausal symptoms: Do life events predict severity of symptoms in peri- and post-menopause?
2012, MaturitasCitation Excerpt :A higher BMI was also a significant predictor for several physical symptoms; hence women with a more elevated body weight would present more severe complaints in terms of aches and pain, numbness, urinary symptoms and body shape changes. It has been evidenced elsewhere that the menopausal status does not have an impact in self-rated health; however, modifications in BMI can predict a change in the perceived health status [34]. This data is relevant as an increase in weight can be reported around the menopause transition [35], and weight gain prevention should be targeted in order to prevent its impact not only in the body shape perception, but also in the perceived health status and specific physical symptoms that are, as demonstrated by our results, worsened with higher body weight.
Well-Being During the Menopausal Transition and Early Postmenopause. A Within-Stage Analysis
2008, Women's Health IssuesManaging Menopausal Symptoms
2006, Handbook of Models for Human AgingDoes the menopausal transition affect health-related quality of life?
2005, American Journal of MedicineCitation Excerpt :The results of longitudinal studies before and after surgery, including 1 randomized clinical trial, do suggest that hysterectomy leads to improvement in QOL (Table 3).29-31 In 3 longitudinal studies, primarily in women of European ancestry, investigators report effects of the perimenopause on HRQOL other than the effects of emotional and vasomotor symptoms (Table 4).32-36 Despite their limited population base, these studies can be particularly informative because they take into account women’s well-being when premenopausal in evaluating changes due to menopausal transition.