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Physical Functioning and Menopause States

From the Departments of ¹Epidemiology, School of Public Health, ²Obstetrics/Gynecology, and ³Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan.

OBJECTIVE: To assess whether losses in physical functioning are related to the natural menopause, hysterectomy, or calendar time during midlife, after adjustment for body size and smoking.

METHODS: A longitudinal assessment of physical functioning was conducted from 2000/01 through 2005/06 in a population-based sample of 544 women at midlife enrolled in the Michigan Bone Health and Metabolism Study. Longitudinal mixed models were used to relate menopausal status to measures of physical functioning. Perception of physical functioning was assessed with the Medical Outcomes Study Short-Form 36 questionnaire. Eight performance-based measures of physical functioning were also included.

RESULTS: Women with hysterectomy (with or without estrogen from ovarian conservation or exogenous replacement) had reduced levels of functioning and greater rates of change in the 2-lb lift (P<.005), sit-to-stand (P<.01), timed stair climb (P<.01), timed walk (P<.01), velocity (P<.05), and perception of physical functioning (P<.01) compared with premenopausal and perimenopausal women after adjustment for time since baseline, body size, and smoking. Diminished functioning in postmenopausal women was observed in hand grip (P<.005), 2-lb lift (P<.05), sit-to-stand (P<.05), velocity (P<.05), and perceived physical functioning (P<.05). Based on regression analyses, there was greater loss in women with hysterectomy compared with natural menopause. Level of functioning among postmenopausal women with exogenous hormone replacement was similar to premenopausal women on eight of nine physical functioning measures.

CONCLUSION: Hysterectomy, even with availability of an estrogen source, seems to be a "risk" state for diminishing physical function at midlife, and this may initiate a vulnerable stage for future compromised quality of life.

LEVEL OF EVIDENCE: II