Modeling women's health during the menopausal transition: a longitudinal analysis

Objective: There has been controversy about the relative effects on various health outcomes of hormonal, psychosocial, and lifestyle changes during the menopausal transition. In previous studies the risk factors for one particular health endpoint have been analyzed separately. Separate analyses do not provide an overall view of the relationships between all the variables or the relative importance of different factors. Thus, the objective of this study was to provide an overall analysis of the influence of hormonal changes during the menopausal transition on a range of health outcomes while simultaneously considering all the available predictors and all the endpoints and to test the hypothesis that prior health status predicts current health status. Design: This was a 9-year prospective observational study of 438 Australian-born women, who at baseline were aged 45 to 55 years and had menstruated in the prior 3 months. Interviews were conducted and fasting blood and physical measurements were performed annually. Results: Main outcome measures were hormone levels, sociodemographic variables, attitudes and lifestyle variables, self-rated health and well-being, bothersome symptoms, coronary heart disease risk, bone mineral density, and sexuality. Data from 336 women, 77% of the original sample, were analyzed. Statistical modeling using structural equations showed that for all health endpoints, the prior level of that variable was the most important predictor. Declining levels of estradiol during the menopausal transition affected certain health outcomes: bone mineral density, coronary heart disease risk, vasomotor symptoms, vaginal dryness, and sexual response. Well-being is negatively affected by symptoms, hassles, and stress. Exercise has beneficial effects on hot flushes, well-being, body mass index, and coronary heart disease risk. Relationship factors and mood affect sexual response. Conclusions: This observational study provides a conceptual data-based framework for understanding changes in women's health during the natural menopausal transition.