Islam Rakibul M, Bond Molly, Ghalebeigi Aida, Wang Yuanyuan, Walker-Bone Karen, Davis Susan R
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Roy Morgan, Melbourne, VIC, Australia.
Lancet Diabetes Endocrinol. 2025 Sep;13(9):765-776. doi: 10.1016/S2213-8587(25)00138-X. Epub 2025 Jul 25.
The premenopause-to-perimenopause transition is defined by the Stages of Reproductive Aging Workshop +10 (STRAW+10) criteria according to changed menstrual cycle frequency. However, this approach is unhelpful for women and gender-diverse people with oligomenorrhoea or amenorrhoea, and also because a range of diverse symptoms have been ascribed to menopause. We investigated the prevalence and severity of symptoms from the late reproductive stage to late postmenopause, identifying those which might best differentiate menopause onset.
The Australian Women's Midlife Years (AMY) Study was a nationally representative cross-sectional study of women aged 40-69 years who were recruited via a non-probability panel using online and offline sources between Oct 27, 2023, and March 19, 2024. To be eligible, participants needed to be able to complete a questionnaire in English. Menopausal symptoms were assessed using the Menopause-specific Quality of Life (MENQOL) questionnaire. Symptom prevalence and severity over the previous 4 weeks was calculated with 95% CIs, with prevalence ratios adjusted for age, BMI, and other demographic variables.
8096 women were recruited: 5509 women were classified using STRAW+10 as premenopausal (n=1250), early perimenopausal (n=344), late perimenopausal (n=271), and postmenopausal (n=3644). Among moderately-to-severely bothersome symptoms, hot flushes showed the greatest change in prevalence from premenopause (8·8% [95% CI 7·2-10·4]) to late perimenopause (37·3% [31·5-43·0]; adjusted prevalence ratio 4·74 [95% CI 3·64-6·19]). Less variation was apparent for other symptoms, including poor memory and low mood. Vaginal dryness was the most discriminative sexual symptom from premenopause to late perimenopause (adjusted prevalence ratio 2·54 [95% CI 1·78-3·61]). Women with vasomotor symptoms and changed menstrual flow had more prevalent moderately-to-severely bothersome symptoms compared with women without vasomotor symptoms. Compared with premenopausal women with vasomotor symptoms and changed menstrual flow, early perimenopausal women with vasomotor symptoms reported a higher prevalence of poor memory (adjusted prevalence ratio 1·36 [95% CI 1·06-1·75]).
Our findings suggest that moderately-to-severely bothersome vasomotor symptoms can reliably indicate the onset of perimenopause in women with oligomenorrhoea or amenorrhoea. Although other symptoms might be caused or exacerbated by menopause, other factors contributing to their occurrence need to be considered and included in management and care. Additionally, treatment options and care pathways are crucial to improve wellbeing during the perimenopause.
National Health and Medical Research Council.
For the Chinese and Spanish translations of the abstract see Supplementary Materials section.
绝经前到围绝经期的转变是根据生殖衰老阶段研讨会+10（STRAW+10）标准，依据月经周期频率的变化来定义的。然而，这种方法对月经过少或闭经的女性及性别多样化人群并无帮助，而且因为一系列不同的症状都被归因于更年期。我们调查了从生殖后期到绝经后期症状的患病率和严重程度，确定那些最能区分更年期开始的症状。
澳大利亚女性中年期（AMY）研究是一项具有全国代表性的横断面研究，研究对象为年龄在40 - 69岁的女性，于2023年10月27日至2024年3月19日通过非概率抽样小组，利用线上和线下渠道招募。要符合条件，参与者需能够用英语完成问卷。使用更年期特异性生活质量（MENQOL）问卷评估更年期症状。计算前4周症状的患病率和严重程度，并给出95%置信区间，患病率比根据年龄、体重指数和其他人口统计学变量进行调整。
共招募了8096名女性：5509名女性根据STRAW+10被分类为绝经前（n = 1250）、围绝经期早期（n = 344）、围绝经期晚期（n = 271）和绝经后（n = 3644）。在中度至重度困扰症状中，潮热从绝经前（8.8% [95%置信区间7.2 - 10.4]）到围绝经期晚期（37.3% [31.5 - 43.0]；调整后的患病率比4.74 [95%置信区间3.64 - 6.19]）的患病率变化最大。其他症状，包括记忆力差和情绪低落，变化不太明显。从绝经前到围绝经期晚期，阴道干燥是最具鉴别性的性症状（调整后的患病率比2.54 [95%置信区间1.78 - 3.61]）。与没有血管舒缩症状的女性相比，有血管舒缩症状且月经流量改变的女性中度至重度困扰症状更为普遍。与有血管舒缩症状且月经流量改变的绝经前女性相比，有血管舒缩症状的围绝经期早期女性记忆力差的患病率更高（调整后的患病率比1.36 [95%置信区间1.06 - 1.75]）。
我们的研究结果表明，中度至重度困扰的血管舒缩症状能够可靠地表明月经过少或闭经女性围绝经期的开始。尽管其他症状可能由更年期引起或加重，但需要考虑导致其出现的其他因素，并将其纳入管理和护理中。此外，治疗选择和护理途径对于改善围绝经期的健康状况至关重要。
国家卫生与医学研究委员会。
摘要的中文和西班牙文翻译见补充材料部分。
