Premenstrual Symptoms Linked to Quality of Life in Menopause

Veronica Hackethal, MD

May 27, 2014

Women with a history of premenstrual symptoms are more likely to report quality-of-life issues in menopausal women, such as depressed mood, memory problems, and feeling less attractive, according to a new study. However, the study, published online May 12 in Menopause, did not find a link between premenstrual symptoms and hot flashes.

The study is the first to link a history of premenstrual symptoms to impaired quality of life during menopause, according to Hanna Hautamäki, MD, from the Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland, and colleagues.

Women with premenstrual symptoms commonly worry that they are at increased risk for symptoms during menopause, the authors note. Yet associations between premenstrual and later menopausal symptoms remain unclear.

One hundred fifty healthy women enrolled in the prospective study. The participants had recently gone through menopause and had not used hormone therapy. The women recorded the severity of their hot flashes in diaries over the course of 2 weeks, with symptoms ranging from none to severe. The researchers assessed quality of life, using the validated Women's Health Questionnaire. In addition, women self-reported premenstrual symptoms on questionnaires, during interviews with a trained research nurse, and using the validated Premenstrual Symptoms Screening Tool.

Most women (n = 107; 89.2%) experienced premenstrual symptoms. Of those, 43.3% (n = 52) reported moderate or severe premenstrual symptoms and 53.3% (n = 64) experienced symptoms severe enough to affect work, relationships, or social life.

Women reported similar premenstrual symptoms, regardless of the severity of their hot flashes (P = .10). The severity of postmenopausal hot flashes also failed to correlate with premenstrual symptom severity (P = .35).

However, premenstrual symptoms did appear to be linked to impaired memory and concentration (P < .001), depression (P = .02), difficulty sleeping (P = .01), and feeling less attractive (P = .02) during menopause.

Limitations of the study included the retrospective nature of the data on premenstrual symptoms, which raises the possibility of recall bias. In addition, the study sample was too small to look at clinical diagnoses of premenstrual syndrome or premenstrual dysphoric disorder, which include women with more severe symptoms. Finally, the researchers recruited voluntary participants using newspaper advertisements, which could have resulted in selection bias and a study population not representative of women in the general population.

The similarity between premenstrual and menopausal quality-of-life symptoms raises the question of whether they share common mechanisms. These could include abnormalities in central nervous system neurotransmitters, changes in the regulation of the autonomic nervous system, and underlying genetic susceptibilities, according to the authors, all of which remain topics for future research.

In a press release about the study, Margery Gass, MD, executive director of the North American Menopause Society, commented, "Women who are troubled by PMS can be reassured that it doesn't mean bothersome hot flashes are inevitable later."

The authors have disclosed no relevant financial relationships.

Menopause. Published online May 12, 2014. Abstract


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