THE MENOPAUSAL TRANSITION - A DYNAMIC APPROACH TO THE PATHOGENESIS OFNEUROVEGETATIVE COMPLAINTS

In our cross-sectional study we investigated the separate influence of three main factors, namely menopausal and estrogen status, and chrono logical age, on ten neurovegetative climacteric complaints reported in the scale of Kupperman et al. A multivariate statistical analysis was performed by a multivariate statistical approach on 1161 untreated wo men seen at the Menopause Center of the Ferrara University Hospital. N inety women (age range, 41-54 years) were premenopausal; 492 women (ag e range, 38-55 years) were perimenopausal with irregular periods or am enorrhea for less than 12 months; 468 women (age range, 41-69 years) h ad a spontaneous menopause (age range, 37-66 years); 111 had had hyste rectomy with bilateral ovariectomy while still regularly menstruating. Serum estrone was used as the indicator of the patients' estrogen sta tus. A clear positive trend was demonstrated between menopausal status and the prevalence of depression, hot flushes, insomnia and joint pai n. However, only the prevalence of hot flushes amongst these four symp toms was significantly related with the climacteric estrogen decline ( beta = -0.006, P = 0.001). Moreover, menopausal status appeared to inf luence the intensity of fatigue, hot flushes, insomnia and paresthesia . Age was found to significantly (P = 0.053) co-vary only with the int ensity of the hot flushes, with a positive relation (beta = 0.092, r = 0.104, P = 0.003), whereas estrone values did not significantly co-va ry with any symptom. Furthermore, while neurovegetative symptoms are l argely present also in the absence of hot flushes, when these latter a re present, they exacerbate both the intensity and the prevalence of a ll the-other symptoms. We conclude that hot flushes seem to act on all of the other neurovegetative symptoms in two fashions. First, they el icit complaints already sub-clinically present; second, they worsen ne urovegetative complaints clinically present. Menopausal status, on the other hand, appears to significantly influence both the prevalence an d the intensity of hot flushes, whereas estrogen decline significantly influences the prevalence but not the intensity of this symptom, whic h appears to be related only to age.