Self-defined menopausal status in a multi-ethnic sample of midlife women

Objectives: This study aimed to identify factors associated with women's perceived menopausal status and to evaluate agreement between women's self-designation and a menstrually-based classification in a multi-ethnic sample of women. Methods: A cross-sectional survey was conducted as part of a large, seven-site, multi-ethnic study, the Study of Women's Health Across the Nation (SWAN). All variables were assessed by self-report in 13 952 women aged 40-55 years. Multiple linear regression was used to assess determinants of self-defined menopausal status, stratifying by race/ethnicity within three anatomical/hormone use strata. Kappa statistics were used to evaluate agreement between the self-defined and menstrually-based classifications. Results: For women with an intact uterus, at least one ovary and not using hormones, menstrual patterns explained about half the variance in self-defined menopause status with older women classifying themselves later in the transition. Disagreement between menstrually based and self-defined menopausal status was 39, 38, 36, 32 and 29% for Hispanic, African-American, Japanese, Caucasian, and Chinese women, respectively (kappa statistics=0.46, 0.41, 0.40, 0.53 and 0.58). Women with vasomotor symptoms tended to self-designate themselves as being in transition regardless of their menstrual patterns. Age and 12 months of amenorrhea explained about 40% of the variance in self-categorization among women using hormones with an intact uterus. Bilateral oophorectomy, age and time since surgery explained about 20% of the variance among post-surgical women. Conclusions: Menstrual characteristics are strong predictors of women's self-perceived menopausal status. However, additional factors, including Symptoms and cultural differences in the meaning of specific bleeding patterns, are also relevant and require further investigation. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.