Abstract and Introduction
Abstract
Objective: The aim of this study was to determine whether postmenopause status is associated with self-reported limitations in physical function.
Methods: The Study of Women's Health Across the Nation is a multisite, multiethnic, longitudinal study of midlife women. Women aged 45 to 57 years (N = 2,566) completed the physical function scale of the Medical Outcomes Study Short-Form 36 on visit 4 (2000-2001). Scores created a three-category variable of physical function limitations: none (86-100), moderate (51-85), and substantial (0-50). In the Study of Women's Health Across the Nation, menopause status is a five-category list variable based on menstrual bleeding patterns and gynecological surgery. Premenopausal and perimenopausal women using hormones (n = 284) or missing physical function scores (n = 46) were excluded. Multinomial logistic regression was used to relate physical function and menopause status after adjustment for age, ethnicity, site, education, body mass index (BMI), and self-reported diabetes, hypertension, arthritis, depressive symptoms, smoking, and hormone use among postmenopausal women.
Results: Of 2,236 women, 8% were premenopausal, 51% were early perimenopausal, 12% were late perimenopausal, 24% were naturally postmenopausal, and 5% were surgically postmenopausal. In the full model, substantial limitations in physical function were higher in postmenopausal women, whether naturally postmenopausal (odds ratio, 3.82; 95% CI, 1.46-10.0) or surgically postmenopausal (odds ratio, 3.54; 95% CI, 1.15-10.84), than in pre-menopausal women. These associations were attenuated by higher BMI and depressive symptoms but remained significant. Moderate limitations in physical function were not significantly related to menopause status.
Conclusions: Women experiencing surgical or naturally occurring postmenopause report greater limitations in physical function compared with premenopausal women, independent of age and only partly explained by higher BMI and depressive symptoms. This suggests that physiological changes in menopause could contribute directly to limitations in physical function.
Introduction
Health-related quality of life is an important mediator of and surrogate marker for future disease, disability, and mortality. Physical function, a component of health-related quality of life, can be an indicator of the aging process and can be used as a surrogate marker to measure the overall impact of disease and the environment. An estimated 54.4 million (18.7%) people living in the United States have some level of disability, and 35 million (12%) have severe disability. The impact of limitations in physical function has been extensively studied in adults 65 years or older.
Among women 70 years or older, 42% report one physical function limitation and 20% report four or more limitations. Although physical function limitations in older women are common, these limitations may first present in midlife rather than in later life. Even at midlife, more women than men report functional limitations. In the Study of Women’s Health Across the Nation (SWAN) telephone survey, approximately 20% of women aged 40 to 55 years perceived themselves as having physical function limitations.
Menopausal factors and related health factors may be associated with the increased prevalence of physical function limitations among women compared with men, independent of aging. The aim of this article was to explore the association between menopause status and limitations in physical function.