Pain Severity in Relation to the Final Menstrual Period in a Prospective Multiethnic Observational Cohort: Results From the Study of Women's Health Across the Nation

Abstract

The development of pain is common in midlife, resulting in increased health care utilization and costs. The aim of this study was to determine the longitudinal trajectory of overall bodily pain among women during the transition between the reproductive years and menopause. We conducted analyses on a community-based, longitudinal cohort of women enrolled in the Study of Women's Health Across the Nation. One thousand four hundred ninety-five women met inclusion criteria, including: 1) defined date of the final menstrual period (FMP), and 2) complete data on Short Form-36 bodily pain. The primary exposure was time to/from the FMP. The primary outcome was the rate of change in Short Form-36 bodily pain, measured on a scale of 0 to 100 with 100 being the most severe pain. We performed within-person trajectory analyses using piecewise regression following nonparametric modeling of functional forms. Mean bodily pain score at the time of the FMP was 29. Mean bodily pain increased at a rate of .26 per year during the transmenopause (the interval spanning 4.5 years before the FMP through .5 years after the FMP), and decreased at a rate of .23 per year after that. Depression and sleep problems were associated with greater increases in pain during the late reproductive years, whereas abdominal cramps at baseline predicted greater decreases in pain during the late reproductive years.

Perspective: This article shows that bodily pain increases during the transmenopause and then diminishes during postmenopause. These differences may reflect differences in underlying mechanisms of pain in the 2 periods. Although mean changes were small and unlikely to be clinically meaningful, the magnitude of change varied across subgroups of women.

Keywords: Pain; aging; female; menopause; perimenopause.

Figure 1

Flow diagram showing the numbers of women excluded from the study and the reasons for exclusion.

Figure 2

The longitudinal trajectory of Short Form-36 (SF-36) pain scores in relation to the amount of time before (negative numbers) and after (positive numbers) the final menstrual period (FMP). The slopes represent the rate of change in SF-36 bodily pain during: 1) the late reproductive years: 8.8 years before the FMP to 4.5 years before the FMP, 2) transmenopause: 4.5 years before the FMP to 0.5 years after the FMP and 3) postmenopause: 0.55 to 8.4 years after the FMP.