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Health symptoms during midlife in relation to menopausal transition: British prospective cohort study

BMJ 2012; 344 doi: (Published 08 February 2012) Cite this as: BMJ 2012;344:e402
  1. Gita D Mishra, honorary senior research scientist and professor12,
  2. Diana Kuh, professor and director1
  1. 1MRC Unit for Lifelong Health and Ageing, University College and Royal Free Medical School, London, UK
  2. 2School of Population Health, University of Queensland, Herston, QLD 4006, Australia
  1. Correspondence to: G D Mishra g.mishra{at}
  • Accepted 15 November 2011


Objective To characterise symptoms experienced by women during the transition into natural menopause, to classify women into distinct symptom profiles or trajectories, and to relate these profiles to sociodemographic factors and health behaviours.

Design Nationally representative cohort study.

Setting England, Scotland, and Wales.

Participants 695 women followed-up since birth in 1946 and annually from age 47 to 54 who experienced natural menopause and reported on 20 common health symptoms.

Main outcome measure Longitudinal profiles for reported bothersome symptoms.

Results Of 20 individual symptoms, 18 formed into four stable symptom groups: psychological, somatic, vasomotor, and sexual discomfort. Using latent class analyses, all except the somatic group of symptoms showed a clear relation with the timing of menopause for some women. A small proportion of women (10%, n=63) had a severe psychological symptom profile that peaked at or in the year after menopause. For vasomotor symptoms, 14% of women (n=83) had the early severe profile that also peaked around early postmenopause and then declined noticeably; 11% (n=67) had the late severe profile of bothersome symptoms that increased rapidly in perimenopause and remained high for four years or more after menopause. Women were less likely to have a profile for severe vasomotor symptoms if they were from a non-manual social class (odds ratio 0.79, 95% confidence interval 0.57 to 1.01) or had degree level qualifications (0.37, 0.18 to 0.77). The 14% of women (n=85) who had the late severe profile for sexual discomfort showed a similar increase in symptoms until menopause, with symptoms persisting after menopause. Married women were more likely to have the late severe or late moderate profile than women of other marital status (2.40, 1.30 to 4.41). Four profiles each were identified for somatic symptoms (mild, moderate, severe, and very severe), although these did not vary by chronological age or age at menopause.

Conclusion Profiles for psychological, vasomotor, and sexual discomfort symptoms relative to age at menopause could help health professionals to tailor their advice for women with natural menopause.


  • Contributors: GDM carried out the statistical analysis, interpreted the data, and drafted the manuscript. DK contributed to the study design, interpreted the data, and critically revised the manuscript. Both authors made a significant contribution to the research and the development of the manuscript, approved the final version, and are the guarantors.

  • Funding: The Medical Research Council provided funding for the National Survey of Health and Development and financial support for DK and GDM. GDM also received funding from the Australian National Health and Medical Research Council.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the North Thames multicentre research ethics committee.

  • Data sharing: No additional data available.

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