Life Satisfaction, Symptoms, and the Menopausal Transition

Lorraine Dennerstein, AO, MBBS, PhD, FRANZCP, DPM; Emma Dudley, BSc, Grad Dip Epidemiol; Janet Guthrie, MSc, PhD, Dip Ed; and Elizabeth Barrett-Connor, MD

Disclosures
In This Article

Methods

The study was approved by the Human Research Ethics Committee of the University of Melbourne, and the procedures followed were in accordance with the ethical standards of the National Health & Medical Research Council. All subjects provided written informed consent for their participation in the study.

The recruitment strategy and baseline characteristics of the Melbourne Women's Midlife Health Project have been described in detail.[8,9] Briefly, an initial sample of 2001 Australian-born women, ages 45-55 years and resident in the Melbourne metropolitan region, were recruited by random-digit telephone dialing. Those women who had menstruated in the last 3 months and were not taking hormone replacement therapy (HRT) or the oral contraceptive pill were invited to take part in a longitudinal study, which entailed an annual interview and blood sample. Of those eligible, 56% agreed to participate (n = 438). Volunteers for the longitudinal study were significantly more likely than nonparticipants to report better self-rated health, paid employment, more than 12 years of education, having ever had a Pap smear, exercising at least once a week, and having undergone dilatation and curettage.[9] Retention at the sixth year of the study was 90% (n = 395).

Two life satisfaction scales were administered in year 6 and form the basis of this report. The Life Satisfaction Index Scale (LSI-A) is a measure of the individual's own evaluation of her present or past life, her satisfaction, and happiness, originally developed for the assessment of older persons.[5] The Life Satisfaction Index-Z scale (LSI-Z) version used in the current analysis was adapted from the LSI-A by item analysis; an alternative scoring designed to increase the validity and reliability coefficients was also developed.[10] The participants were asked if they "agree," "disagree," or are "uncertain" with the statements listed in Table 1. The LSI-Z is calculated as the sum of the items and scored as follows: 2 points are scored for agreement with the positive statements and disagreement with the negative statements. Uncertain responses are scored 1 point. The range of possible scores is 0-26. The Satisfaction With Life Scale (SWLS) is a single-factor, multi-item measure of global life satisfaction designed to focus specifically on the cognitive-judgmental process of assessing life overall and does not include an affective component. It was designed to be usable for a wide range of age groups, from young adults to geriatric populations. Validation studies have shown good internal consistency and reliability.[11] The SWLS consists of the 5 statements listed in Table 2.[1,11] Agreement or disagreement is measured using a 7-point Likert scale: strongly disagree (1), disagree (2), slightly disagree (3), neither agree nor disagree (4), slightly agree (5), agree (6), and strongly agree (7). The SWLS is calculated as the sum of the 5 items and ranges from 5-35.

There were 2 types of data: prospective, or predictor, variables collected at baseline or before year 6 of follow-up; and associated, or explanatory, variables, collected at year 6 of follow-up.

Predictor variables included baseline data of parity, years of education, occupation, premenstrual complaints, and social support. Attitudes toward menopause[12] were collected in year 2, and attitudes toward aging[13] were collected in year 5.

Explanatory variables from year 6 included the following:

  • age

  • body mass index (BMI)

  • well-being (including positive and negative mood subscales -- sets of questions that measure positive and negative feelings[3,14])

  • satisfaction with job and day-to-day activities

  • self-rated health

  • number of symptoms

  • specific symptoms grouped according to the factor analysis of baseline data (dysphoric, vasomotor, cardiopulmonary, skeletal, digestive, respiratory, and general somatic)[8]

  • interpersonal stress

  • major life events (death of someone close, divorce, separation)

  • secondary life events (someone close has been demanding, caused worry, or been seriously ill)

  • operation in past year

  • current treatment for chronic condition

  • number of daily hassles[15,16]

  • indices of sexual health (arousal, interest, frequency, and total sex score [sum of means of these items])

  • health behaviors (exercise, smoking, alcohol)

  • marital status

  • presence of a sexual partner

  • feelings for partner

  • children at home

Menopausal status was determined on the basis of the woman's perceived changes in menstruation. Women were asked to compare the regularity of their current menstrual cycles with that experienced in the 12 months prior.

[17]

Premenopausal status was assigned to women who reported no change in menstrual frequency. Early perimenopausal status was assigned to women who reported change in menstrual frequency but had menstruated in the last 3 months. Late perimenopausal status was assigned to women who had experienced amenorrhea for 3 to 11 months.

[17]

Women were assigned to postmenopausal status when they had been amenorrheic for at least 12 months. The occurrences of late perimenopause and postmenopause were verified by fieldworkers who viewed women's prospectively kept menstrual calendars. Women who were on HRT in year 6 were considered to be a separate menopausal status group as were those who had induced or surgical menopause.

Hormones. Blood samples were taken between days 4 and 8 of the menstrual cycle for those still cycling or after 3 months of amenorrhea. Follicle-stimulating hormone (FSH) and estradiol (E2) were measured by radioimmunoassays as described previously.[9]

External validity of the LSI-Z and SWLS scales were assessed through correlations with other psychosocial data collected at year 6 using the Affectometer-2 scale[3,14] (well-being, positive and negative mood subscales), and satisfaction questions for employment and day-to-day activities. Linear regression analysis modeled LSI-Z as a function of explanatory variables described above. Those variables significant in the univariate analyses were then entered into a multivariate model using the stepwise linear regression technique in SPSS. Analysis was repeated with SWLS as the outcome variable.

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