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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

Published:November 08, 2016DOI:https://doi.org/10.1016/j.jpain.2016.10.012

      Highlights

      • Bodily pain increases during transmenopause and decreases during postmenopause.
      • In the overall population, mean changes in bodily pain were small.
      • Women with a history of abdominal cramps had the largest declines in bodily pain.
      • Women with depression and sleep problems had the largest increases in bodily pain.

      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.

      Key words

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      References

        • Angst F.
        • Aeschlimann A.
        • Stucki G.
        Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities.
        Arthritis Rheum. 2001; 45: 384-391
        • Berecki-Gisolf J.
        • Begum N.
        • Dobson A.J.
        Symptoms reported by women in midlife: Menopausal transition or aging?.
        Menopause. 2009; 16: 1021-1029
      1. Boggero IA, Rojas-Ramirez MV, Carlson CR: All fatigue is not created equal: The association of fatigue and its subtypes on pain interference in orofacial pain. Clin J Pain June 2, 2016; [Epub ahead of print]

        • Chlebowski R.T.
        • Cirillo D.J.
        • Eaton C.B.
        • Stefanick M.L.
        • Pettinger M.
        • Carbone L.D.
        • Johnson K.C.
        • Simon M.S.
        • Woods N.F.
        • Wactawski-Wende J.
        Estrogen alone and joint symptoms in the Women’s Health Initiative randomized trial.
        Menopause. 2013; 20: 600-608
        • Comstock G.W.
        • Helsing K.J.
        Symptoms of depression in two communities.
        Psychol Med. 1976; 6: 551-563
        • de Leon-Casasola O.A.
        Opioids for chronic pain: New evidence, new strategies, safe prescribing.
        Am J Med. 2013; 126: S3-S11
        • Dugan S.A.
        • Powell L.H.
        • Kravitz H.M.
        • Everson Rose S.A.
        • Karavolos K.
        • Luborsky J.
        Musculoskeletal pain and menopausal status.
        Clin J Pain. 2006; 22: 325-331
        • Ford K.
        • Sowers M.
        • Crutchfield M.
        • Wilson A.
        • Jannausch M.
        A longitudinal study of the predictors of prevalence and severity of symptoms commonly associated with menopause.
        Menopause. 2005; 12: 308-317
        • Freeman E.W.
        • Sammel M.D.
        • Lin H.
        • Gracia C.R.
        • Pien G.W.
        • Nelson D.B.
        • Sheng L.
        Symptoms associated with menopausal transition and reproductive hormones in midlife women.
        Obstet Gynecol. 2007; 110: 230-240
        • Gao H.L.
        • Lin S.Q.
        • Wei Y.
        • Chen Y.
        • Wu Z.L.
        The effect of age and menopausal status on musculoskeletal symptoms in Chinese women aged 35–64 years.
        Climacteric. 2013; 16: 639-645
      2. Generaal E, Vogelzangs N, Penninx BW, Dekker J: Insomnia, sleep duration, depressive symptoms and the onset of chronic multi-site musculoskeletal pain. Sleep September 9, 2016; [Epub ahead of print]

        • Gibson C.J.
        • Thurston R.C.
        • El Khoudary S.R.
        • Sutton-Tyrrell K.
        • Matthews K.A.
        Body mass index following natural menopause and hysterectomy with and without bilateral oophorectomy.
        Int J Obes (Lond). 2013; 37: 809-813
        • Gold E.B.
        • Crawford S.L.
        • Avis N.E.
        • Crandall C.J.
        • Matthews K.A.
        • Waetjen L.E.
        • Lee J.S.
        • Thurston R.
        • Vuga M.
        • Harlow S.D.
        Factors related to age at natural menopause: Longitudinal analyses from SWAN.
        Am J Epidemiol. 2013; 178: 70-83
        • Greendale G.A.
        • Sowers M.
        • Han W.
        • Huang M.H.
        • Finkelstein J.S.
        • Crandall C.J.
        • Lee J.S.
        • Karlamangla A.S.
        Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: Results from the Study of Women’s Health Across the Nation (SWAN).
        J Bone Miner Res. 2012; 27: 111-118
        • Institute of Medicine
        Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research.
        National Academy of Sciences, Washington, DC2011
        • Jensen M.P.
        • Dworkin R.H.
        • Gammaitoni A.R.
        • Olaleye D.O.
        • Oleka N.
        • Galer B.S.
        Do pain qualities and spatial characteristics make independent contributions to interference with physical and emotional functioning?.
        J Pain. 2006; 7: 644-653
        • Jensen M.P.
        • Hoffman A.J.
        • Cardenas D.D.
        Chronic pain in individuals with spinal cord injury: A survey and longitudinal study.
        Spinal Cord. 2005; 43: 704-712
        • Ju H.
        • Jones M.
        • Mishra G.
        The prevalence and risk factors of dysmenorrhea.
        Epidemiol Rev. 2014; 36: 104-113
        • Karli N.
        • Baykan B.
        • Ertas M.
        • Zarifoglu M.
        • Siva A.
        • Saip S.
        • Ozkaya G.
        • Onal A.E.
        Impact of sex hormonal changes on tension-type headache and migraine: A cross-sectional population-based survey in 2,600 women.
        J Headache Pain. 2012; 13: 557-565
        • Kosinski M.
        • Zhao S.Z.
        • Dedhiya S.
        • Osterhaus J.T.
        • Ware Jr., J.E.
        Determining minimally important changes in generic and disease-specific health-related quality of life questionnaires in clinical trials of rheumatoid arthritis.
        Arthritis Rheum. 2000; 43: 1478-1487
        • Lerman S.F.
        • Rudich Z.
        • Brill S.
        • Shalev H.
        • Shahar G.
        Longitudinal associations between depression, anxiety, pain, and pain-related disability in chronic pain patients.
        Psychosom Med. 2015; 77: 333-341
        • Meana M.
        • Cho R.
        • DesMeules M.
        Chronic pain: The extra burden on Canadian women.
        BMC Womens Health. 2004; 4: S17
        • Meriggiola M.C.
        • Nanni M.
        • Bachiocco V.
        • Vodo S.
        • Aloisi A.M.
        Menopause affects pain depending on pain type and characteristics.
        Menopause. 2012; 19: 517-523
        • Mishra G.D.
        • Brown W.J.
        • Dobson A.J.
        Physical and mental health: Changes during menopause transition.
        Qual Life Res. 2003; 12: 405-412
        • Mitchell E.S.
        • Woods N.F.
        Pain symptoms during the menopausal transition and early postmenopause.
        Climacteric. 2010; 13: 467-478
        • Moilanen J.
        • Aalto A.M.
        • Hemminki E.
        • Aro A.R.
        • Raitanen J.
        • Luoto R.
        Prevalence of menopause symptoms and their association with lifestyle among Finnish middle-aged women.
        Maturitas. 2010; 67: 368-374
        • Prieto-Alhambra D.
        • Judge A.
        • Javaid M.K.
        • Cooper C.
        • Diez-Perez A.
        • Arden N.K.
        Incidence and risk factors for clinically diagnosed knee, hip and hand osteoarthritis: Influences of age, gender and osteoarthritis affecting other joints.
        Ann Rheum Dis. 2014; 73: 1659-1664
        • Prior J.C.
        • Hitchcock C.L.
        The endocrinology of perimenopause: Need for a paradigm shift.
        Front Biosci (Schol Ed). 2011; 3: 474-486
        • Randolph Jr., J.F.
        • Sowers M.
        • Bondarenko I.V.
        • Harlow S.D.
        • Luborsky J.L.
        • Little R.J.
        Change in estradiol and follicle-stimulating hormone across the early menopausal transition: Effects of ethnicity and age.
        J Clin Endocrinol Metab. 2004; 89: 1555-1561
        • Randolph Jr., J.F.
        • Zheng H.
        • Sowers M.R.
        • Crandall C.
        • Crawford S.
        • Gold E.B.
        • Vuga M.
        Change in follicle-stimulating hormone and estradiol across the menopausal transition: Effect of age at the final menstrual period.
        J Clin Endocrinol Metab. 2011; 96: 746-754
        • Reitsma M.
        • Tranmer J.E.
        • Buchanan D.M.
        • VanDenKerkhof E.G.
        The epidemiology of chronic pain in Canadian men and women between 1994 and 2007: Longitudinal results of the National Population Health Survey.
        Pain Res Manag. 2012; 17: 166-172
        • Riley 3rd, J.L.
        • Robinson M.E.
        • Wise E.A.
        • Price D.D.
        A meta-analytic review of pain perception across the menstrual cycle.
        Pain. 1999; 81: 225-235
        • Ryan S.
        • McGuire B.
        Psychological predictors of pain severity, pain interference, depression, and anxiety in rheumatoid arthritis patients with chronic pain.
        Br J Health Psychol. 2016; 21: 336-350
        • Santoro N.
        The menopausal transition.
        Am J Med. 2005; 118: 8-13
        • Sivertsen B.
        • Lallukka T.
        • Petrie K.J.
        • Steingrimsdottir O.A.
        • Stubhaug A.
        • Nielsen C.S.
        Sleep and pain sensitivity in adults.
        Pain. 2015; 156: 1433-1439
        • Smith M.T.
        • Klick B.
        • Kozachik S.
        • Edwards R.E.
        • Holavanahalli R.
        • Wiechman S.
        • Blakeney P.
        • Lezotte D.
        • Fauerbach J.A.
        Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain.
        Pain. 2008; 138: 497-506
        • Stening K.D.
        • Eriksson O.
        • Henriksson K.G.
        • Brynhildsen J.
        • Lindh-Astrand L.
        • Berg G.
        • Hammar M.
        • Amandusson A.
        • Blomqvist A.
        Hormonal replacement therapy does not affect self-estimated pain or experimental pain responses in post-menopausal women suffering from fibromyalgia: A double-blind, randomized, placebo-controlled trial.
        Rheumatology (Oxford). 2011; 50: 544-551
        • Stubbs D.
        • Krebs E.
        • Bair M.
        • Damush T.
        • Wu J.
        • Sutherland J.
        • Kroenke K.
        Sex differences in pain and pain-related disability among primary care patients with chronic musculoskeletal pain.
        Pain Med. 2010; 11: 232-239
        • Szoeke C.E.
        • Cicuttini F.M.
        • Guthrie J.R.
        • Dennerstein L.
        The relationship of reports of aches and joint pains to the menopausal transition: A longitudinal study.
        Climacteric. 2008; 11: 55-62
      3. Thomas JG, Pavlovic J, Lipton RB, Roth J, Rathier L, O'Leary KC, Buse DC, Evans EW, Bond DS: Ecological momentary assessment of the relationship between headache pain intensity and pain interference in women with migraine and obesity. Cephalalgia January 6, 2016; [Epub ahead of print]

        • Vincent K.
        • Warnaby C.
        • Stagg C.J.
        • Moore J.
        • Kennedy S.
        • Tracey I.
        Brain imaging reveals that engagement of descending inhibitory pain pathways in healthy women in a low endogenous estradiol state varies with testosterone.
        Pain. 2013; 154: 515-524
        • Volkman J.E.
        • DeRycke E.C.
        • Driscoll M.A.
        • Becker W.C.
        • Brandt C.A.
        • Mattocks K.M.
        • Haskell S.G.
        • Bathulapalli H.
        • Goulet J.L.
        • Bastian L.A.
        Smoking status and pain intensity among OEF/OIF/OND veterans.
        Pain Med. 2015; 16: 1690-1696
        • Wang S.J.
        • Fuh J.L.
        • Lu S.R.
        • Juang K.D.
        • Wang P.H.
        Migraine prevalence during menopausal transition.
        Headache. 2003; 43: 470-478
        • Ware Jr., J.E.
        • Sherbourne C.D.
        The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • Ware J.E.
        • Snow K.K.
        • Kosinski M.
        • Gandeck B.
        SF-36 Health Survey Manual and Interpretation Guide.
        The Health Institute, New England Medical Center, Boston, MA1993
        • Warren M.P.
        • Fried J.L.
        Temporomandibular disorders and hormones in women.
        Cells Tissues Organs. 2001; 169: 187-192
        • Weissman M.M.
        • Sholomskas D.
        • Pottenger M.
        • Prusoff B.A.
        • Locke B.Z.
        Assessing depressive symptoms in five psychiatric populations: A validation study.
        Am J Epidemiol. 1977; 106: 203-214
        • Woods N.F.
        • Mitchell E.S.
        Symptom interference with work and relationships during the menopausal transition and early postmenopause: Observations from the Seattle Midlife Women’s Health Study.
        Menopause. 2011; 18: 654-661
        • Yoo J.J.
        • Cho N.H.
        • Lim S.H.
        • Kim H.A.
        Relationships between body mass index, fat mass, muscle mass, and musculoskeletal pain in community residents.
        Arthritis Rheumatol. 2014; 66: 3511-3520
        • Zheng H.
        • Sowers M.
        • Karvonen-Gutierrez C.
        • Jacobson J.A.
        • Randolph Jr., J.F.
        • Harlow S.D.
        Semiparametric mixed effect model with application to the longitudinal knee osteoarthritis (OAK) data.
        J Syst Cybern Inf. 2012; 10: 87-93