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Premenstrual Syndrome as a Predictor of Menopausal Symptoms

E W. Freeman, PhD^*, M D. Sammel, ScD, P J. Rinaudo, MD^* and L Sheng, PhD

From the *Departments of Obstetrics/Gynecology, Psychiatry, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia; and Department of Mathematics, Drexel University, Philadelphia, Pennsylvania.

Address reprint requests to: Ellen W. Freeman, PhD, Department of Obstetrics/Gynecology, Mudd Suite, 3701 Market Street, Suite #820, Philadelphia, PA 19104–5509; e-mail: freemane{at}mail.med.upenn.edu.

OBJECTIVE: To estimate whether premenstrual syndrome (PMS) predicts common menopausal symptoms assessed longitudinally for 5 years among women in the transition to menopause.

METHODS: Data were obtained from a structured interview questionnaire, daily symptom ratings, and standard measures of depressive symptoms and sleep quality at 7 assessment periods in a population-based cohort of 436 women. Menstrual status was determined by menstrual bleeding dates. Hormones were measured in the early follicular phase, with a maximum of 14 measures per subject. Multivariate logistic regression models for repeated measures were used to estimate the effects of study variables.

RESULTS: Premenstrual syndrome significantly decreased with age (P < .001) and with changes in menstrual bleeding status (P = .003). Women with PMS at enrollment were more likely over the 5-year period to report menopausal hot flushes (odds ratio [OR] 2.09; confidence interval [CI] 1.42, 3.08; P < .001); depressed mood (OR 2.34; CI 1.60. 3.43; P < .001); poor sleep (OR 1.72; CI 1.16, 2.53; P = .007), and decreased libido (OR 1.54; CI 1.06, 2.24; P = .024) after adjusting for age, race, diagnosis of major depression, and estradiol. Subjects’ fluctuations in estradiol were significantly associated with hot flushes, depressive symptoms, and poor sleep.

CONCLUSION: Premenstrual syndrome decreased in the transition to menopause. Women who reported PMS at baseline were at greater risk of menopausal hot flushes, depressed mood, poor sleep, and decreased libido. Further studies of the associations of symptoms and changes in ovarian function are needed to elucidate the underlying symptom physiology and aid in the development of effective treatments for women during the menopausal transition.

LEVEL OF EVIDENCE: II-2

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