Health perceptions, aging, and reproductive aging: observations from the Seattle Midlife Women's Health Study

Despite increased attention to symptoms experienced by women during the menopausal transition and early postmenopause and risk for disease development, for example, cardiovascular disease and dementia, few investigators have examined women's self-ratings of their health during this part of the lifespan. Despite recent surges in interest in the menopausal transition, understanding how women experience their health during this period remains limited. Our aim was to identify the relationship of chronological aging and reproductive aging to midlife women's health perceptions using the multidimensional Health Perceptions Questionnaire (HPQ) administered on multiple occasions in the Seattle Midlife Women's Health Study (SMWHS).

Participants from the population-based longitudinal SMWHS completed annual health questionnaires and menstrual calendars between 1990 and 2005 (N=261, 957 observations). Women's ages ranged from a mean of 41.6 (SD=4.3) to 53.1 (SD=3.1) years at baseline. Participants rated their health using the HPQ on 6 occasions: baseline (1990-1992), 12 and 24 months later, and in 1995, 2001, and 2005. Mean scale scores were calculated for current health, past health, health outlook, health concern/worry, and resistance to illness (possible range was 1-5). Reproductive aging stages were assessed using menstrual calendar and questionnaire data, applying Mitchell's (2000) criteria for reproductive aging and Staging Reproductive Aging (STRAW) criteria (2001, 2010). Multilevel modeling using mixed models analysis of linear models (SPSS 28) was employed to examine relationships of age and reproductive aging stages to repeated measures of health perceptions, including current health, past health, health outlook, health concern/worry, and resistance to illness.

Means for each of the health perceptions scales were above 3.0, the midpoint of the scales, indicating more positive than negative ratings of health. Aging was not significantly related to women's ratings of current health, past health, health outlook, health concern/worry, or resistance to illness. Reproductive aging was significantly related only to current health: women's ratings were significantly higher during the late reproductive stages (LRS1 mean=3.72, SD=0.10, and LRS2, mean=3.60, SD=0.05, P=0.013 and 0.035, respectively) and the early menopausal transition stage (mean=3.64, SD=0.05, P=0.006) than the late transition stage (mean=3.44, SD=0.09) or early postmenopause (mean=3.35, SD=0.10).

SMWHS participants eligible for this study perceived their health as positive, regardless of age. Reproductive aging was influential only with respect to current health ratings: women rated their health significantly better during the late reproductive stages and early menopausal transition stages of reproductive aging than during the late menopausal transition stage and early postmenopause, stages when SMWHS participants reported the most severe symptoms related to menopause in our prior studies.