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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 and psychological and physical symptoms that occur during the perimenopause.

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

Setting
General community.

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

Main Outcome Measures
Levels of lipids and lipoproteins, triglycerides, fasting glucose and insulin, blood pressure, weight, height, and standardized measures of psychological symptoms.

Results
Women who became perimenopausal showed increased levels of cardiovascular risk factors, which were similar in magnitude to those experienced by the comparison group of premenopausal women. Perimenopausal women reported a greater number of symptoms, especially hot flashes, cold sweats, joint pain, aches in the skull and/or neck, and being forgetful; reports of hot flashes at the perimenopausal examination were associated with low concentrations of serum estrogens. Menopausal status was not associated with depressive symptoms. Perimenopausal women who became postmenopausal showed a 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 gradual increase in the level of low-density lipoprotein cholesterol (means, 3.14 to 3.33 mmol/L [121.3 to 128.8 mg/dL]), whereas symptom reporting declined.

Conclusions
During mid-life, women experience adverse changes in cardiovascular risk factors and a temporary increase in total number of reported symptoms, with no change in depression. Preventive efforts to reduce the menopause-induced increase in cardiovascular risk factors 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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