Premenstrual disorders increase early menopause and vasomotor symptom risks

Premenstrual disorders increase early menopause and vasomotor symptom risks | Image Credit: © highwaystarz - © highwaystarz - stock.adobe.com.

According to a recent study published in JAMA Network Open, premenstrual disorders (PMDs) are associated with increased risks of early menopause and moderate to severe menopause-related vasomotor symptoms (VMS).

PMDs are recurrent affective and physical symptoms which occur prior to menstruation. While PMDs are associated with a decreased quality of life, there is little data on long-term adverse effects. 

During menopause transition, patients often experience VMS which impacts quality of life. Similar risk factors have been reported for PMDs, early menopause, and VMS, indicating they share certain etiologies. However, the association between PMDs and early menopause has not been evaluated.

Investigators conducted a study to determine the association of PMDs with early menopause and VMS, including participants from the Nurses’ Health Study II (NHSII). The NHSII included 116,429 female nurses aged between 25 and 42 years in 1989, with follow-up occurring until 2017. The study had a cumulative response rate of 88%.

In the matched cohort study of NHSII, there were 4077 women with PMDs and 3202 without PMDs. PMD was determined by NHSII questionnaires from 1989 to 2005. Women with menopause or unknown menopause status, oophorectomy, hysterectomy, or cancer were excluded from the study.

Participants reported if they had permanent cessation of menstrual periods during each biennial cycle. Those who reported yes were asked to report the cause of menopause and their age when periods ceased. 

Menopause was determined by 12 consecutive months of amenorrhea, Early menopause was determined by being aged under 45 years at onset, normal menopause 45 to 54 years, and late menopause 55 years or older.

The presence of hot flashes or night sweats in the previous 4 weeks was reported by participants in 2009, 2013, and 2017. Patients experiencing these symptoms were asked to report if they were mild, moderate, or severe.

VMS was determined by a report of VMS in the past 4 weeks or in the first postmenopausal cycle. VMS duration was categorized as less than 5 years or 5 or more years using self-reported data. Covariates included age at menarche, race and ethnicity, experiences of childhood abuse, and maternal education level.

There were 1220 women with PMDs and 2415 without PMDs included in the final analysis, aged a median 40.7 and 41.7 years respectively. Patients with PMDs were more often younger, had a lower education level, obese, used oral contraceptives, and experienced childhood abuse, depression, and anxiety.

Patients with PMDs were aged a mean 51.4 years at menopause onset, while those without PMDs were aged a mean 51.8 years. While the timing of natural menopause overall was similar between both groups, women with PMDs had an increased risk of early menopause. PMDs were also positively associated with VMS, with an odds ratio of 1.43.

These results indicated increased risks of early menopause and VMS in women with PMDs. Investigators recommended further research on health risks after menopause in patients with PMDs.

Reference

Yang Y, Valdimarsdóttir UA, Manson JE, et al. Premenstrual disorders, timing of menopause, and severity of vasomotor symptoms. JAMA Netw Open. 2023;6(9):e2334545. doi:10.1001/jamanetworkopen.2023.34545