Influence of the Perimenopause on Cardiovascular Risk Factors and Symptoms of Middle-aged Healthy Women

doi:10.1001/archinte.1994.00420200105011

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Vol. 154 No. 20, 24 October 1994

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Influence of the Perimenopause on Cardiovascular Risk Factors and Symptoms of Middle-aged Healthy Women

Karen A. Matthews, PhD; Rena R. Wing, PhD; Lewis H. Kuller, MD, DrPH; Elaine N. Meilahn, DrPH; Pam Plantinga, MS

Arch Intern Med. 1994;154(20):2349-2355.

Abstract

Objective
To determine the changes in cardiovascular risk factors andpsychological and physical symptoms that occur during the perimenopause.

Design
Cohort study of 541 healthy middle-aged premenopausal womenfollowed up through the menopause.

Setting
General community.

Participants
After a baseline evaluation taken at study entry, 152 womenceased menstruating for 3 months (not due to surgery) and werenot using hormone replacement therapy, and were reevaluatedin a similar protocol (perimenopausal examination); 105 of the152 were evaluated a third time when they had ceased menstruatingfor 12 months and were not using hormone replacement therapy(postmenopausal examination). One hundred nine premenopausalwomen who were repeatedly tested constituted a comparison group.

Main Outcome Measures
Levels of lipids and lipoproteins, triglycerides, fasting glucoseand insulin, blood pressure, weight, height, and standardizedmeasures of psychological symptoms.

Results
Women who became perimenopausal showed increased levels of cardiovascularrisk factors, which were similar in magnitude to those experiencedby the comparison group of premenopausal women. Perimenopausalwomen reported a greater number of symptoms, especially hotflashes, cold sweats, joint pain, aches in the skull and/orneck, and being forgetful; reports of hot flashes at the perimenopausalexamination were associated with low concentrations of serumestrogens. Menopausal status was not associated with depressivesymptoms. Perimenopausal women who became postmenopausal showeda decline in the level of high-density lipoprotein-2 cholesterol(means, 0.53 to 0.43 mmol/L [20.6 to 16.7 mg/dL]) and a gradualincrease in the level of low-density lipoprotein cholesterol(means, 3.14 to 3.33 mmol/L [121.3 to 128.8 mg/dL]), whereassymptom reporting declined.

Conclusions
During mid-life, women experience adverse changes in cardiovascularrisk factors and a temporary increase in total number of reportedsymptoms, with no change in depression. Preventive efforts toreduce the menopause-induced increase in cardiovascular riskfactors should begin early in the menopausal transition.

(Arch Intern Med. 1994;154:2349-2355)

Author Affiliations

From the School of Medicine (Drs Matthews and Wing) and Graduate School of Public Health (Drs Matthews, Wing, Kuller, and Meilahn, and Ms Plantinga), University of Pittsburgh (Pa).

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