Classifying menopause stage by menstrual calendars and annual interviews: need for improved questionnaires

This study aims to assess the agreement between the menopausal transition stages defined by annual interviews or annual follicle-stimulating hormone levels and the menopausal transition stages defined by monthly menstrual calendars, as well as factors associated with discordance.

These analyses used daily self-recorded menstrual calendar data from 1996 to 2006, annual interviews, and annual follicle-stimulating hormone levels. Participants were recruited from four study sites of the Study of Women's Health Across the Nation (Boston, southeastern Michigan, Oakland, and Los Angeles) and four racial/ethnic groups (African American, white, Chinese, and Japanese). Women who had a defined final menstrual period and who never had hormone therapy were included (n = 379). Cohen's κ statistics for 2 × 2 tables were calculated for two definitions of agreement. Logistic regression was used to identify factors associated with discordance.

Poor agreement between annual interview and menstrual calendar data was found for early menopausal transition (κ = -0.13; 95% CI, -0.25 to -0.02) and late menopausal transition (κ = -0.18; 95% CI, -0.26 to -0.11). For late stage, Chinese women (odds ratio [OR], 2.16; 95% CI, 1.08 to 4.30), African-American women (OR, 2.39; 95% CI, 1.00 to 5.71), and women with high school education or less (OR, 2.16; 95% CI, 1.08 to 4.30) were more likely to be discordant. Poor agreement between annual follicle-stimulating hormone levels and menstrual calendars was also found for early menopausal transition (κ = -0.44; 95% CI, -0.57 to -0.30) and late menopausal transition (κ = -0.32; 95% CI, -0.42 to -0.23).

New questions need to be developed to accurately identify the start of the menopausal transition and should be evaluated in a multiethnic population with varying educational backgrounds.