Elsevier

Maturitas

Volume 70, Issue 4, December 2011, Pages 383-390
Maturitas

Symptom prevalence during menopause and factors associated with symptoms and menopausal age. Results from the Norwegian Hordaland Women's Cohort study

https://doi.org/10.1016/j.maturitas.2011.09.011Get rights and content

Abstract

Objectives

To describe symptoms during the menopausal transition and age at menopause in a representative Norwegian female cohort over a ten year period, to analyze factors associated with frequency and burden of symptoms and influence on self-rated health.

Study design

2229 women aged 40–44 years at inclusion, randomly selected from a national health survey in Hordaland County, Norway, and followed with seven postal questionnaires from 1997 throughout 2009. Data for 2002 women (90%) were eligible for analyses.

Results

In a longitudinal analysis, 36% of the women reported daily hot flushes in one or more questionnaires, whereas 29% did not experience hot flushes at all. The prevalence of daily hot flushes increased from 2% at age 41–42 to 22% at age 53–54, decreasing to 20% at age 55–57. The odds ratio for reporting daily hot flushes vs. never/seldom for daily smokers was 1.6 (1.24–2.10). Women in the lowest education group had an OR = 1.8 (1.21–2.56) for reporting daily hot flushes compared to women with a university degree. There was no relation between the symptom burden and degree of physical exercise, overall feeling of health, BMI, family income, parity or menarche age as recorded at baseline. The mean age for final menstruation period (FMP) in the cohort was 51.1 (50.9–51.3) years. Smokers had a mean age of FMP 0.9 years earlier compared to the non-smokers.

Conclusions

Daily smoking and educational level were independent risk factors for experiencing daily menopausal symptoms. Degree of physical exercise, BMI, parity or menarche age did not have significant influence.

Section snippets

Background

Symptoms most consistently connected to changes in hormonal status during the menopause are the vasomotor symptoms (hot flushes and sweats/nights sweats) and vaginal dryness, and to some extent sleep disturbances [1], [2], [3], [4]. Studies published the last decade substantiating side effects of hormone therapy (HT) have profoundly changed the attitudes to HT during and after the menopause [5], [6], [7]. Since 2002 the Norwegian volume of purchased HT has been more than halved [8]. Because

Study population

The Hordaland County Health Survey (HUSK) was a joint epidemiological research project carried out by the National Health Screening System of Norway (now: Norwegian Institute of Public Health) and the University of Bergen. It consists of a baseline registration obtained in 1997–1999, including all inhabitants in the county born 1953–57. Baseline measurements from HUSK included body height and weight, and blood pressure. A non-fasting blood sample was also collected. The self-administrated

Frequency and burden of symptoms: hot flushes, cold sweats/night sweats, vaginal soreness/dryness

When the women went through the midlife age, the prevalence of hot flushes showed a gradual increase both in terms of frequency and symptom burden (Table 2, Fig. 1, Fig. 2). The proportion of women who experienced daily hot flushes increased from 2% in the 41–42 years age group, to 22% in the 53–54 years age group, with a slight decrease to 20% in age group 55–57 years. The prevalence of cold sweats/night sweats followed a similar pattern, whereas the proportion of women who reported daily

Sample size

The Hordaland Women's Cohort (HWC) is community based, includes a large number of randomly selected participants, and the attrition rate was low, all factors strengthening the external validity of the study results. Compared to the US SWAN study, the women in the Cohort had a lower prevalence of surgically induced menopause. In SWAN, the overall incidence of surgically induced menopause (bilateral oopherectomy and/or hysterectomy) was 20.8% as compared to 8% in our population [1]. This probably

Conclusion

Our study shows that about one third of Norwegian women report frequent and bothersome vasomotor symptoms during the menopausal transition, while a somewhat lower proportion do not experience any (or very few) symptoms at all. Smoking is significantly associated with more symptoms and an earlier menopausal age, while other life style factors, like BMI or physical activity before menopause, have no significant correlation with the prevalence or the burden of menopausal symptoms.

Contributors

Bjørn Gjelsvik declares that he has written the first draft of the text and has done the main part of the statistical analyses.

Elin O. Rosvold declares that he has participated in the data analysis, interpretation and discussion of results, and discussion and revision of the paper, and has seen and approved the final version.

Jørund Straand declares that he has participated in the data analysis, interpretation and discussion of results, and discussion and revision of the paper, and has seen and

Competing interests

Authors declare no conflict of interest.

Funding

The Hordaland Women's Cohort as a sub-study of the Hordaland Health Study was performed in collaboration with the Norwegian National Health Screening Service and the University of Bergen. The Cohort was partly funded by the Norwegian Research Council. Funding for the present substudy was obtained from Norwegian Medical Association's Funds for Research in General Practice, and the University of Oslo.

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