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Symptoms, menopause status, and country differences: a comparative analysis from DAMES

Obermeyer, Carla Makhlouf DSc1; Reher, David PhD2; Saliba, Matilda MSc3

doi: 10.1097/gme.0b013e318046eb4a
Articles from the Workshop on "Cross-cultural Comparisons of Midlife and Aging"

Objective: To investigate reported frequencies of menopausal symptoms among women in four countries, namely Lebanon, Morocco, Spain, and the United States, and to assess the relative role of menopause status, country of residence, and other factors in explaining differences in symptomatology.

Design: Surveys of representative samples of approximately 300 women aged 45 to 55 years in each site were conducted, using an instrument that includes demographic, health, and menopausal variables, in addition to perceptions and attitudes toward menopause. Statistical and textual analyses are used to examine differentials and the factors that influence them.

Results: The burden of symptoms and the frequencies of symptoms differ across sites, but hot flashes are reported everywhere by just under one half of the respondents. The most frequent symptoms are joint pain, fatigue, impatience/nervousness, sleep disturbances, memory loss, and one or more emotional symptoms. Menopause status is significantly associated with hot flashes and vasomotor symptoms and to a lesser extent with emotional and sexual symptoms. Smoking, schooling, employment, and age are also associated with the frequency of selected symptoms. Country of residence influences reported symptoms over and above other factors.

Conclusions: Similarities among core symptoms and differences in the expression of symptoms were found across sites. Both biological (menopause status) and cultural (country of residence) variables influence symptomatology.

Surveys on representative samples of women aged 45-55 in Massachusetts, Spain, Lebanon, and Morocco, show differences in reported symptom frequencies across sites, but also similarities in core symptoms including hot flashes; the article examines the determinants of these differences and similarities.

From the 1Department of Population and International Health, Harvard University, Boston, MA; 2Departamento de Sociología II, Facultad de Ciencias Políticas y Sociología, Universidad Complutense, Madrid, Spain; and 3Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon.

Received November 1, 2006; revised and accepted February 7, 2007.

Financial support: This work was supported by National Science Foundation grant SBR-9600721 and National Institutes of Health/National Institute on Aging grant 5R01 AG17578-03.

Financial disclosure: None reported.

Address correspondence to: Carla Makhlouf Obermeyer, DSc World Health Organization, 20 Avenue Appia, 1211 Geneva Switzerland. E-mail:

©2007The North American Menopause Society