Menopausal symptom network differences between women with and without waist-to-height ratio-defined abdominal obesity

To compare the structure of menopausal symptom networks between women with and without abdominal obesity (AO), defined as waist-to-height ratio (WHtR).

This cross-sectional analysis included 1,150 women from visit 6 of the study of Women's Health Across the Nation (SWAN). AO was defined as a WHtR of ≥ 0.5. We adjusted for demographic and clinical differences by regressing each symptom score on covariates, and subsequently using the residualized symptom scores for network estimation. We used centrality indices and community structure analysis to characterize the networks, and applied the Network Comparison Test (NCT) to evaluate differences in network structure and global strength.

Women with AO reported higher prevalence and greater severity of several symptoms. Network density was marginally higher in the AO group (0.59; 46 of 78 edges) than in the non-AO group (0.55; 43 of 78 edges). The NCT revealed significant differences in network structure, whereas global strength remained comparable. Core symptoms differed by AO status: in the AO network, forgetfulness, irritability, and night sweats exhibited the highest centrality, whereas in the non-AO network, night sweats, palpitations, and depression demonstrated the highest centrality. In addition, symptom clusters also differed between the groups.

Women with AO exhibit both a higher prevalence and greater severity of symptoms, as well as a distinct symptom network structure. These findings highlight distinct symptom network profiles in women with AO, which may reflect different patterns of symptom interaction or underlying biological processes that warrant further investigation. Assessment of AO using WHtR may help stratify women who are likely to benefit from targeted, network-based interventions over isolated symptom management.