Lori Cray, PhD, RNNancy Fugate Woods, PhD, RN, FAAN

Ellen Sullivan Mitchell, PhDJerald R. Herting, PhD

SYMPTOM CLUSTERS AND WELL-BEING DURING THE MENOPAUSAL

TRANSITION AND EARLY POSTMENOPAUSE

Funding SupportNINR 1R21NR012218-01 Menopause

Symptom Clusters: Refocusing Therapeutics

NINR R01-NR 04141 Menopausal Transition: Biobehavioral Dimensions

NINR P30 NR 04001, P50-NR02323 – Center for Women’s Health and Gender Research

BackgroundSeattle Midlife

Women’s Health Study (SMWHS) participants report multiple symptoms during the menopausal transition

hot flashessleep disturbancepainmood changescognitive difficulties

Previous analyses of SMWHS data revealed 4 clusters of symptoms women experienced during the late menopausal transition stage

Current analyses expand our research across the menopausal transition stages and early postmenopause

Hypothesized Model

PurposesDetermine effects

of socio-behavioral risk factors on latent class membershipSmokingStressAgeEducationBMI

Determine overall effect of latent class membership on positive well-being

Sample & DesignSample consisted of women from the

SMWHS who: provided diary data on at least one occasion

between 1990 and 2010 were in the late reproductive stage, the early

or late menopausal transition stages or early postmenopause

yielded 6857 observations

Measures - Symptoms3-day health diary

Measures – Socio-behavioral Risk FactorsStress

Education

Age

Smoking status

Body mass index (BMI)

“How stressful was your day?” Scale: 0 (not at all) to 6 (extremely) Continuous variable assessed as number of years of education Continuous variable entered in years Defined by a yes/no response on annual health questionnaireCalculated according to the formula kg/m2 based on self reported height and weight collected annually in the health questionnaire

Measures –Perceived Well-being

Healthy

Rested

Happy

Interest

“How healthy did you feel today?”

“How rested did you feel today?”

“How happy did you feel today?”

“How much interest did you have today in work, school, home, friends, hobbies?”

Constructed from 4 items from 3-day health diaryRated 0 (not at all) to 6(extremely)

Multilevel LatentClass Analysis(MLCA)

Data AnalysisC

Sleep PainHotFlash Mood Cog-

nitiveTensio

n

Latent class variable(i.e. symptom severity profile)

Latent class indicators (i.e. symptom clusters)

• Diff. getting to sleep• Night time awakening• Early AM awakening

• Backache• Joint ache• Headache

• Depressed• Mood changes• Crying• Irritable

• Problem concentrating• Forgetful• Irritable

• Panic• Nervous• Tension

Data Analysis

Model No of free parameters

BIC BLRT (p) Entropy

1 class 12 72669.4 NA NA 2 class 19 62670.9 .000 .924 3 class 32 57879.0 .000 .944 4 class 33 56368.3 .000 .936 5 class 40 54877.2 .000 .941 6 class 47 53360 .9 .000 .948

Selection of best fitting model (optimal # of latent classes)

Goodness-of-fit measures:• Bayesian information criterion (BIC)• Bootstrap likelihood ratio test (BLRT)

Logical interpretation of the resulting classes

0

0.5

1

1.5

2

2.5

HotflashSleepPainMoodCognitveTense

Results

12% 16% 72%

High HF Low HF/mod other sx’s All Low

ResultsEffects of Socio-behavioral Risk Factors on Latent Class Membership      

Class 1 (n=839) Class 2 (n=1070)

High HF Low HF/mod

other sx’sb (SE) Wald(1) OR b (SE) Wald(1) OR

 

Model  

Intercept 13.931 2.281 -6.108 NA -0.342 1.668 -0.205 NA

Stress 0.285 0.079 3.595* 1.33 0.287 0.072 3.966* 1.333

Smoking -1.060 0.697 -1.521 0.346 -0.673 0.387 -1.74 0.51

Age 0.247 0.031 7.906* 1.281 0.022 0.024 0.92 1.023

Education -0.637 0.756 -0.842 0.529 -1.805 0.695 -2.598† 0.164

BMI 0.142 0.277 0.512 1.152 -0.013 0.270 -0.047 0.987

Low symptomatic group (class 3) was used as the referent (n=4948)

*p < .001; †p<.01

Results

Effects of Latent Class Membership on Perceived Well-being      

Class 1 High HF

(n=839)

Class 2 Low HF/mod

other sx’s(n=1070)

b (SE) Wald(1) p b (SE) Wald(1) p

 

 

Poswb -0.231 0.111 -2.081 .037 -0.366 0.113 -3.233 .001

                 Low symptomatic group (class 3) was used as the referent (n=4948)

ConclusionFirst effort to examine latent classes or clusters

of symptoms over the prolonged period from late reproductive stage through early postmenopause

Women experience multiple symptomsSymptoms tend to cluster togetherWe identified 3 classes of symptom episodes

Differed by symptom severity of individual symptom clusters

Age, education, stress play significant role in class membership

Perceived well-being likely to be significantly lower for women with higher symptomatology regardless of HF severity

Next Steps

SC1=high HF SC2=lowHF, mod.other sx’sSC3=low severity

Thank you