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Symptom clusters during the late reproductive stage through the early postmenopause: observations from the Seattle Midlife Women’s Health Study

Cray, Lori A. PhD, RN1; Woods, Nancy Fugate RN, PhD, FAAN2; Herting, Jerald R. PhD2; Mitchell, Ellen Sullivan PhD2

doi: 10.1097/gme.0b013e31824790a6
Original Articles

Objective The aim of this study was to identify symptom clusters that characterize women’s experiences through the late reproductive stage, the menopausal transition, and early postmenopause and to explore the influence of the menopausal transition stages and early postmenopause, compared with that of the late reproductive stage, on the clusters of symptoms women experience.

Methods Participants from the Seattle Midlife Women’s Health Study whose symptom calendars were staged for the menopausal transition provided data for a total of 6,857 occasions. Multilevel latent class analysis was used to identify classes using scores for hot flashes and symptom factors (sleep, cognitive, mood, pain, tension).

Results Class 1 included observations of low severity levels for all symptoms, whereas class 2 included low-severity hot flashes and moderate-severity levels for all other symptom factors. Class 3 included high severity hot flashes with lower severity levels of all other symptom factors. During the early and late menopausal transition stages and early postmenopause, the likelihood of being in class 3 was significantly greater than being in class 1 relative to the late reproductive stage. There were no significant effects of the menopausal transition stages on the likelihood of being in class 2.

Conclusions This effort is the first to examine the latent classes or clusters of symptoms during the prolonged period from late reproductive stage to early postmenopause. As such, the data contribute to the understanding of symptom experiences beyond our early efforts to characterize the late menopausal transition stage.

From the 1College of Nursing, Seattle University, Seattle, WA; and 2School of Nursing, University of Washington, Seattle, WA.

Received October 20, 2011; revised and accepted December 20, 2011.

Funding/support: This work was supported by grants from the National Institute of Nursing Research (NINR 1R21NR012218-01 Menopause Symptom Clusters: Refocusing Therapeutics; NR 04141 Menopausal Transition: Biobehavioral Dimensions; P30 NR 04001, P50-NR02323—Center for Women’s Health and Gender Research).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Lori A. Cray, PhD, RN, 5628 Admiral Way SW, Seattle, WA, 98116. E-mail:

©2012The North American Menopause Society