Pitfalls and Strategies for Measuring Menopausal Stage in Eating Disorder Studies of Women in Midlife

Researchers are increasingly interested in exploring the role of the menopausal transition in eating disorder risk. We recently embarked on studies of this critical life phase and encountered significant challenges in assessing menopausal status that limited our ability to test study hypotheses. This Research Forum describes these challenges and presents descriptive data on staging accuracy as well as recommendations for improving assessments that can advance research in this critical area of women's health.

Data come from 207 women (ages 40-58) assessed in an ongoing study from the MSU Twin Registry. Menopausal status (premenopause, perimenopause, postmenopause) was measured with the Perimenopause Evaluation Questionnaire assessing women's self-identified stage as well as the regularity of menstrual cycles and medical history. Staging accuracy was evaluated by comparing the self-identified stage with results from individual case analyses of questionnaire responses.

Many more women self-identified as premenopausal (62%), perimenopausal (27%), and postmenopausal (11%) than we identified in case analyses (20%, 7%, 8%, respectively). These discrepancies appeared to be due to women failing to account for medications or medical conditions that would cause premature cessation of menses and/or insufficient questionnaire items and information for staging women with complicated reproductive histories.

Findings highlight significant limitations of self-identified status or questionnaire responses alone in determining menopausal status. We provide recommendations for improving stage assessments, drawn from the challenges and lessons learned in our own studies, thereby allowing others to better explore this critical stage and advance women's health in our field.