Pain symptoms during the menopausal transition and early postmenopause

The aim of this study was to describe changes in levels of back pain and joint pain during the stages of menopausal transition stages and early postmenopause, including the effects of age, menopausal transition-related factors (estrone, follicle stimulating hormone (FSH), testosterone), menopausal transition stages, symptoms (hot flush, sleep, mood, cognitive), health-related factors (body mass index, alcohol use, smoking, well-being), stress-related factors (perceived stress, history of sexual abuse, cortisol, catecholamines) and social factors (partner and parenting status, education).

A subset was studied of the participants in the Seattle Midlife Women's Health Study who provided data during the late reproductive, early and late menopausal transition stages or postmenopause (n = 292) including menstrual calendars for staging the menopausal transition, annual health reports completed between 1990 and 2006, and morning urine samples assayed for estrone glucuronide (E(1)G), testosterone, FSH, cortisol and catecholamines, and symptom diary ratings several times each year. Multilevel modeling with an R program was used to test patterns of pain symptoms related to age, menopausal transition-related factors, symptoms, health-related, stress-related and social factors, with as many as 6812 observations. Age was centered at 47.4 years.

Women experienced a slight, non-significant rise in back pain with age and a significant increase in back pain during the early (p = 0.003) and late menopausal transition stages (p = 0.002) and early postmenopause (p = 0.02), but urinary E(1)G, FSH and testosterone levels were unrelated. Of the stress-related factors, perceived stress (p = 0.01) and lower overnight urinary cortisol levels were associated with more severe back pain (p = 0.03); history of sexual abuse and catecholamines did not have a significant effect. Those most troubled by symptoms of hot flushes, depressed mood, anxiety, night-time awakening, and difficulty concentrating reported significantly greater back pain (all p < 0.0001). Of the health-related factors, having worse perceived health (p < 0.0001), exercising more (p = 0.005), using analgesics (p < 0.0001), and having a higher body mass index (p < 0.0001) were associated with more back pain, but alcohol use and smoking did not have significant effects. Of the social factors, only having a more formal education (p = 0.004) was associated with less back pain; parenting, having a partner, and employment were not significant. Factors associated with joint pain included age (p < 0.0001), but not menopausal transition-related factors. Symptoms of hot flushes, night-time awakening, depressed mood, and difficulty concentrating were each significantly associated with joint pain (p < 0.0001). Poorer perceived health, more exercise, higher body mass index, and greater analgesic use were all associated similarly with joint pain. History of sexual abuse was the only stress-related factor significantly related to joint pain severity (p = 0.024).

Clinicians working with women traversing the menopausal transition should be aware that managing back and joint pain symptoms among mid-life women requires consideration of their changing biology as well as their ongoing life challenges and health-related behaviors.