Helping midlife women predict the onset of the final menses: SWAN, the Study of Women's Health Across the Nation
Department of Medicine, Division of Preventive and Behavioral Medicine
Adult; African Continental Ancestry Group; Age Factors; Asian Continental Ancestry Group; Cohort Studies; Confidence Intervals; Cultural Characteristics; Ethnic Groups; European Continental Ancestry Group; Female; Health Behavior; Hispanic Americans; Humans; Longitudinal Studies; Menopause; Menstrual Cycle; Middle Aged; Odds Ratio; Proportional Hazards Models; United States; Women's Health
Life Sciences | Medicine and Health Sciences | Women's Studies
OBJECTIVE: Women approaching menopause often ask their doctors, "When are my periods going to end?" The objective of this study was to predict time to the final menstrual period (FMP).
DESIGN: This multiethnic, observational cohort study, the Study of Women's Health Across the Nation, has been ongoing since 1996. Data collected from seven annual study visits were used. The community-based cohort from seven national sites included 3,302 white, African American, Hispanic, Chinese, and Japanese women aged 42 to 52 years at baseline with a uterus and at least one ovary, who were not pregnant or taking reproductive hormones, and had at least one menstrual period within the past 3 months at baseline. The time to the FMP was defined retrospectively after 12 months of amenorrhea. Uni- and multivariable Cox proportional hazard models, hazard ratios (HRs), and 95% CIs were computed for variables of interest.
RESULTS: A total of 2,662 women, of whom 706 had an observed FMP, were included. Age, menstrual cycles that had become farther apart (HR = 2.56, 95% CI = 1.94-3.39) or more variable (HR = 1.79, 95% CI = 1.45-2.21), and current smoking (HR = 1.68, 95% CI = 1.35-2.08) were all associated with shorter time to the FMP. Higher (log) follicle-stimulating hormone (HR = 2.32, 95% CI = 2.02-2.67) was related to a shorter time to the FMP, but the highest estradiol category (>or=100 pg/mL [367 pmol/L]) was associated with an earlier onset of the FMP (HR = 2.16, 95% CI = 1.63-2.89). The number of vasomotor symptoms was related to an earlier FMP, whereas higher physical activity and educational levels were associated with a later FMP.
CONCLUSIONS: Age, menstrual cycle recall, smoking status, and hormone measurements can be used to estimate when the FMP will occur, allowing for more precise estimates for older midlife women: in the most extreme cases, ie, age 54, high estradiol level, current smoking, and high follicle-stimulating hormone level, the FMP can be estimated to within 1 year.
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Citation: Menopause. 2007 May-Jun;14(3 Pt 1):415-24. Link to article on publisher's site
Santoro, Nanette; Brockwell, Sarah; Johnston, Janet M.; Crawford, Sybil L.; Gold, Ellen B.; Harlow, Sioban D.; Matthews, Karen A.; and Sutton-Tyrrell, Kim, "Helping midlife women predict the onset of the final menses: SWAN, the Study of Women's Health Across the Nation" (2007). Women’s Health Research Faculty Publications. 480.