The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN)

Abstract

Objective: Our initial understanding of the menopause transition (MT) has been framed by clinical samples of women seeking treatment rather than by population-based studies. The Study of Women's Health Across the Nation (SWAN) initiated in 1996 with an overall goal to define the MT, to characterize its biological and psychosocial antecedents and sequelae in an ethnically and racially diverse sample of midlife women.

Methods: This review summarizes the central findings of SWAN to date that can inform women and their healthcare providers about the impact of the MT and midlife aging on overall health and well-being.

Results: SWAN characterized changes in reproductive axis and menstrual cycle patterns that informed the development of the reproductive aging staging system Staging of Reproductive Aging Workshop+10; MT-related symptoms and mental health (vasomotor symptoms, sleep complaints, psychological symptoms, cognitive performance, and urogenital and sexual health); and physiological systems and functions (cardiovascular and cardiometabolic health, bone health, physical function performance) that are influenced by the MT. SWAN demonstrated substantial interrelations among these changes and significant racial/ethnic differences in the rate and magnitude of change in multiple health indictors in midlife women. The findings point to midlife as a critical stage for adopting healthy behavior and preventive strategies.

Conclusions: Over the past 23 years, SWAN has advanced our understanding of the impact of the MT and midlife aging on health and well-being in women. SWAN will be instrumental to determine whether MT-related changes during midlife are related to unfavorable health and well-being in early old age.

Box 1

Take-home messages: the reproductive axis, menstrual cycle patterns, and stages of the menopause transition

Box 2

Take-home messages: symptoms and mental health

Box 3

Take-home messages: physiological systems and functions

FIG. 1

Central Illustration Figure. The Contribution of the Menopause Transition and Midlife Aging to Women's Health and Well-being: What Have We Learned from the Study of Women's Health Across the Nation (SWAN)?; SWAN contributed to our understanding of the impacts of the menopause transition versus midlife aging on women's health and well-being in different domains. The figure lists changes occurring during the menopause transition that were reviewed in this paper, and differentiates whether these changes were more driven by the menopause transition or midlife aging using different color schemes. Light orange bars depict changes that were mostly driven by the menopause transition, whereas blue bars depict changes that were mostly driven by midlife aging. Transient changes are identified when applicable by fading color bars and listing the word “Transient” at the end of relevant bars. SWAN has identified midlife as a critical stage for adopting healthy behavior and preventive strategies.