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Vascular dysfunction across the stages of the menopausal transition is associated with menopausal symptoms and quality of life

Hildreth, Kerry L. MD1; Ozemek, Cemal PhD2; Kohrt, Wendy M. PhD1,3; Blatchford, Patrick J. PhD4; Moreau, Kerrie L. PhD1,3

doi: 10.1097/GME.0000000000001112
Original Articles

Objective: The menopausal transition is associated with somatic symptoms and increased rates of depression, which can impair quality of life (QOL) and increase cardiovascular disease (CVD) risk. This period is also associated with accelerated vascular aging (arterial stiffening and endothelial dysfunction), an antecedent to CVD. This secondary analysis sought to explore associations between depression, menopausal symptoms and QOL, and vascular aging across menopause stages.

Methods: Arterial stiffness (carotid artery compliance), endothelial function (brachial artery flow-mediated dilation [FMD]), menopausal symptoms (Menopausal Symptom List [MSL]), depression (Center for Epidemiologic Studies Depression Scale [CES-D]), and QOL (Utian QOL Scale [UQOL]) were measured in 138 women (19-70 years) classified as premenopausal (n = 41, 34 ± 8 years; mean ± SD), early (n = 25, 49 ± 3 years), or late perimenopausal (n = 26, 50 ± 4 years), or early (n = 22, 55 ± 4 years) or late postmenopausal (n = 24, 61 ± 5 years). Differences across menopause stages were determined using one-way analysis of variance; associations between vascular measures and MSL, CES-D, and UQOL were tested using Pearson's correlation analyses.

Results: Menopausal symptoms, depression, and QOL worsened across menopause stages, particularly in late perimenopausal women. Vasosomatic symptom frequency, and general somatic symptom frequency and severity were inversely correlated with carotid artery compliance and FMD (r = −0.27 to −0.18, all P < 0.05). Only correlations with general somatic symptoms were significant after adjusting for multiple comparisons. Total QOL was positively correlated with carotid artery compliance (r = 0.23, P = 0.01). CES-D scores were not correlated with carotid artery compliance or FMD (r = −0.08, −0.03, P = 0.35).

Conclusions: Vascular dysfunction across the stages of menopause was associated with greater frequency and severity of menopausal symptoms, and lower QOL, but not depression. Mechanisms underlying these associations (eg, inflammation, oxidative stress) should be explored.

1Department of Medicine, Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO

2Department of Physical Therapy and the Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL

3Eastern Colorado VA Geriatric Research, Education and Clinical Center, Denver, CO

4Colorado Biostatistical Consortium, Colorado School of Public Health, University of Colorado Denver, Denver, CO.

Address correspondence to: Kerrie L. Moreau, PhD, 12631 East 17th Avenue, Mail Stop B-179, Aurora, CO 80045. E-mail:

Received 3 November, 2017

Revised 8 March, 2018

Accepted 8 March, 2018

Funding/support: National Institutes of Health awards R01 AG027678, K01 AG020683, K23 AG045201, P50 HD073063, R56 HL114073, Colorado Clinical and Translational Sciences Institute UL1 TR001082, and Colorado Nutrition Obesity Research Center P30 DK048520; University of Colorado Center for Women's Health Research; Eastern Colorado VA Geriatric Research, Education and Clinical Center.

Financial disclosure/conflicts of interest: None reported.

© 2018 by The North American Menopause Society.