Health status and utilization behavior associated with menopause.

Since menopause is increasingly implicated in the etiology of some major age-related diseases in women, such as cancer, cardiovascular disease, osteoporosis, and depression, there is a need to understand the epidemiology of this physiologic event which is universal for women. To date, knowledge of menopause is based on a small proportion of self-selecting, predominantly ill women. A stereotype has emerged of the "typical" menopausal woman, who presents a broad range of diffuse symptoms and is a higher utilizer of health care. This prevailing view is contradicted by prospective data gathered over 27 months on a cohort of approximately 2,500 women who are representative of women aged 45-55 years in Massachusetts. It is demonstrated that menopause itself does not cause poorer health status (either physical or psychologic); menopause itself does not cause an increase in utilization behavior; occurrence of a surgical menopause is the primary menopause-related change associated with subsequent perceived health status and utilization behavior, and then only minimally; and almost all the explained variability in health status and utilization behavior outcomes is attributable to the prior health status of the respondents and, to a lesser extent, to utilization behavior. These findings underscore the importance of two methodological requirements for future work: representative samples of apparently healthy women; and prospective data which elucidate cause-effect relations.