Is the menopausal transition stressful? Observations of perceived stress from the Seattle Midlife Women's Health Study

Objective: To describe changes in the levels of perceived stress in relation to menopausal transition (MT)-related factors (MT stage, hot flash severity, urinary estrone glucuronide, urinary follicle-stimulating hormone, lion-none therapy), aging and age-related changes, and psychosocial factors (income adequacy, role burden, social support, parenting, employment, history of sexual abuse, depressed mood). Design: A Subset of participants (N = 418) in the longitudinal Seattle Midlife Women's Health Study provided data during the late reproductive and early and late MT stages or early postmenopause (PM) from 1990 to 2005, including menstrual calendars for staging the MT, annual health reports, and first morning urine specimens (assayed for estrone and follicle-stimulating hormone). Multilevel modeling was used to test patterns of perceived stress related to MT-related and aging-related factors and psychosocial factors with as many as 1,814 observations from 418 women per factor. Age was centered at 47.9 years. Results: The effects of the MT-related factors were not significant, although the stress ratings decreased during PM by 0.11 units (P = 0.06). In analyses with age as a covariate and with each covariate added separately, employment was associated with significantly higher levels of stress ( 0. 14, P < 0.0001), as was history of sexual abuse (P = 0. 11, P = 0.03) and depressed mood (P = 0.02, P < 0.000 1). Improvement in each of the factors of role burden, social support, and income adequacy was associated with significantly lower perceived stress (0 = -0.19, -0.13, and -0.10, respectively; P < 0.0001 for all). Negative appraisal of aging changes and perceived poorer health were both associated with significantly higher stress levels (P = 0.08, P < 0.0001 for both) and depressed mood (P = -0.02, P < 0.0001). A multivariate model included significant effects of employment, perceived health, and depressed mood (P = 0.24, -0.04, and 0.02, respectively; P < 0.0001 for all). Conclusions: Being employed, experiencing depressed mood, and perceiving one's health as poor were more important in women's evaluation of their daily stress than severity of hot flashes, MT-related factors, or other social factors. Clinicians working with women going through the MT should remain vigilant to the impact of social circumstances of women's lives, especially employment, as well as focusing on the psychosocial and endocrine features of this transition.