From the Massachusetts General Hospital, Boston, MA.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
Menopause. 2023 Sep 1;30(9):913-919. doi: 10.1097/GME.0000000000002229. Epub 2023 Aug 1.
The aim of the study is to examine longitudinal associations of history of infertility with menopausal symptoms in midlife.
Six hundred ninety-five midlife women (≥45 y old or reporting ≥12 mo of amenorrhea at the midlife visit) in Project Viva, a prospective cohort enrolled 1999-2002 during pregnancy and followed for 18 years after enrollment ("midlife visit"). Exposure was history of infertility defined as time to pregnancy ≥12 months (≥6 mo if ≥35 y), use of medical treatment to conceive, or infertility consultation or treatment in the 6-month preceding enrollment. The primary outcome was score below or above the median on the Menopause Rating Scale (MRS). Secondary outcomes included individual symptom score on the MRS and self-reported age of menopause.
A total of 36.6% had a history of infertility in their lifetime. At the time of MRS completion, the women with prior infertility were older (53.4 [SD, 3.8] vs 51.2 [SD, 3.7] y) than those without infertility and a larger proportion had reached menopause (62% vs 40%). Women with prior infertility were more likely to score above the median on the MRS (Adjusted Odds Ratio [aOR], 1.45; 95% confidence interval [CI], 1.04-2.01) and had higher odds for reporting any depressive mood (aOR, 1.56; 95% CI, 1.12-2.16) and irritability (aOR, 1.57; 95% CI, 1.13-2.19). There was a trend toward greater severity of sleep problems among women with prior infertility. There was no association of prior infertility with report of other menopausal symptoms or age of menopause.
Our findings suggest that women with prior infertility are more likely to have an MRS score above the median and experience depressive mood, irritability, and sleep problems during midlife than women without infertility. These findings have implications for mental health screening among midlife women.
本研究旨在探讨中年女性不孕史与绝经症状的纵向关联。
本研究纳入了参加 1999-2002 年孕期项目 Viva 的 695 名中年女性（年龄≥45 岁或在中年访视时报告≥12 个月闭经），并随访了 18 年（“中年访视”）。不孕史的暴露定义为妊娠时间≥12 个月（≥35 岁时为≥6 个月）、使用医疗手段受孕，或在入组前 6 个月内进行不孕咨询或治疗。主要结局是绝经评定量表（MRS）评分低于或高于中位数。次要结局包括 MRS 各单项症状评分和自我报告的绝经年龄。
共有 36.6%的女性一生中曾有不孕史。在 MRS 完成时，有不孕史的女性年龄较大（53.4 [标准差，3.8]岁 vs 51.2 [标准差，3.7]岁），且更多的人已经绝经（62% vs 40%）。有不孕史的女性更有可能 MRS 评分高于中位数（调整后的优势比 [aOR]，1.45；95%置信区间 [CI]，1.04-2.01），且报告抑郁情绪（aOR，1.56；95% CI，1.12-2.16）和易怒（aOR，1.57；95% CI，1.13-2.19）的可能性更高。有不孕史的女性睡眠问题更严重。不孕史与报告的其他绝经症状或绝经年龄无关联。
我们的发现表明，与无不孕史的女性相比，有不孕史的女性更有可能 MRS 评分高于中位数，且在中年时更容易出现抑郁情绪、易怒和睡眠问题。这些发现对中年女性的心理健康筛查具有启示意义。
