Institutional members access full text with Ovid®

Classifying menopause stage by menstrual calendars and annual interviews: need for improved questionnaires

Paramsothy, Pangaja PhD, MPH1; Harlow, Siobán D. PhD1; Elliott, Michael R. PhD2; Lisabeth, Lynda D. PhD, MPH1; Crawford, Sybil L. PhD3; Randolph, John F. Jr MD1,4

doi: 10.1097/GME.0b013e3182825ff2
Original Articles
Editorial

Objective: This study aims to assess the agreement between the menopausal transition stages defined by annual interviews or annual follicle-stimulating hormone levels and the menopausal transition stages defined by monthly menstrual calendars, as well as factors associated with discordance.

Methods: These analyses used daily self-recorded menstrual calendar data from 1996 to 2006, annual interviews, and annual follicle-stimulating hormone levels. Participants were recruited from four study sites of the Study of Women’s Health Across the Nation (Boston, southeastern Michigan, Oakland, and Los Angeles) and four racial/ethnic groups (African American, white, Chinese, and Japanese). Women who had a defined final menstrual period and who never had hormone therapy were included (n = 379). Cohen’s κ statistics for 2 × 2 tables were calculated for two definitions of agreement. Logistic regression was used to identify factors associated with discordance.

Results: Poor agreement between annual interview and menstrual calendar data was found for early menopausal transition (κ = −0.13; 95% CI, −0.25 to −0.02) and late menopausal transition (κ = −0.18; 95% CI, −0.26 to −0.11). For late stage, Chinese women (odds ratio [OR], 2.16; 95% CI, 1.08 to 4.30), African-American women (OR, 2.39; 95% CI, 1.00 to 5.71), and women with high school education or less (OR, 2.16; 95% CI, 1.08 to 4.30) were more likely to be discordant. Poor agreement between annual follicle-stimulating hormone levels and menstrual calendars was also found for early menopausal transition (κ = −0.44; 95% CI, −0.57 to −0.30) and late menopausal transition (κ = −0.32; 95% CI, −0.42 to −0.23).

Conclusions: New questions need to be developed to accurately identify the start of the menopausal transition and should be evaluated in a multiethnic population with varying educational backgrounds.

From the Departments of 1Epidemiology and 2Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI; 3Division of Preventive and Behavioral Medicine, University of Massachusetts School of Medicine, Worcester, MA; and 4Division of Reproductive Endocrinology and Infertility, University of Michigan Health System, Ann Arbor, MI.

Received September 26, 2012; revised and accepted December 10, 2012.

Funding/support: The Study of Women’s Health Across the Nation received grant support from the NIH, Department of Health and Human Services, through the NIA, National Institute of Nursing Research, and NIH Office of Research on Women’s Health (grants NR004061, AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, and AG012495). P.P. was also supported by ReSTAGE Collaboration, which received grant support from the NIA (grant AG 021543) and the University of Michigan Rackham Graduate School.

Financial disclosure/conflicts of interest: None reported.

The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH), National Institute on Aging (NIA), National Institute of Nursing Research, and NIH Office of Research on Women’s Health.

Address correspondence to: Pangaja Paramsothy, PhD, MPH, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109. E-mail: pparams@umich.edu

© 2013 by The North American Menopause Society.