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A symptomatic approach to understanding women's health experiences: a cross-cultural comparison of women aged 20 to 70 years

Dennerstein, Lorraine AO, DPM, PhD, MBBS, FRANZCP1; Lehert, Philippe DrEg, PhD1,2; Koochaki, Patricia E. PhD, BA3; Graziottin, Alessandra MD4; Leiblum, Sandra PhD5; Alexander, Jeanne Leventhal MD, FABPN, FRCPC, FAPA, FACPsych6

doi: 10.1097/gme.0b013e31802dabf0
Articles from the Workshop on "Cross-cultural Comparisons of Midlife and Aging"

Objectives: To determine patterns of symptoms across age groups, identify symptom groups associated with ovarian hormonal depletion or other variables, and develop a prediction model for each symptom.

Design: This was a cross-sectional survey of 4,517 women ages 20 to 70 years recruited from market research panels in the United States, United Kingdom, Germany, France, and Italy using a self-report questionnaire that included general health information and a checklist of 36 symptoms. Stepwise regression was used to determine for each symptom how prevalence varied with age, indicators of menopausal hormonal changes, and the effects of other explanatory variables, including body mass index, morbidity, and country. Hierarchical clustering was used to group symptoms.

Results: Six groups of symptoms were found, of which two groups, with seven symptoms in total, were related to markers of menopausal hormonal change: a group consisting of hot flashes and night sweats and a second group including poor memory; difficulty sleeping; aches in the neck, head, and shoulders; vaginal dryness; and difficulty with sexual arousal. Physical and mental morbidity affected estimates of the prevalence of all symptoms. Psychological symptoms declined with age from a maximum prevalence before age 40. Certain physical symptoms increased with age and body mass index. Clustering identified three country groups: (1) US and UK women; (2) French and Italian women; and (3) German women. There were marked differences in prevalence between countries for certain physical and psychological symptoms.

Conclusions: The seven symptoms most linked to menopausal hormonal change should form part of any future menopause symptom list. Physical and mental morbidity affect symptom prevalence and should be measured.

Seven symptoms were linked to indicators of ovarian hormonal depletion: hot flashes; night sweats; poor memory; difficulty sleeping; aches in the neck, head, or shoulders; vaginal dryness; and difficulty with sexual arousal.

From the 1Office for Gender and Health, Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia; 2Statistics Department, Faculty of Economics, FUCAM, Louvain Academy, Louvain, Belgium; 3Procter and Gamble Pharmaceuticals, Mason, OH; 4Center of Gynecology and Medical Sexology, H. San Raffaele Resnati, Milan, Italy; 5University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, NJ; and 6Kaiser Permanente Medical Group, Oakland, CA.

Received September 10, 2006; revised and accepted November 1, 2006.

Financial disclosure: None reported.

Address correspondence to: Lorraine Dennerstein, AO, MBBS, PhD, DPM, FRANZCP, Office for Gender and Health, Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia 3050. E-mail: ldenn@unimelb.edu.au.

©2007The North American Menopause Society