Discussing menopause in general practice

The dual objective is, first, to determine if menopausal women discuss the menopause with a doctor, and if so to which extent; second, to ascertain potential differences between those who do and those who do not. METHODS: A postal questionnaire was sent to 1251 Danish women randomly selected among all 51-year-old women born and living in Denmark. Completed questionnaires were returned by 972 (77%) women. RESULTS AND CONCLUSIONS: More than two thirds (71.8%) of the peri and postmenopausal women had discussed the menopause with a doctor; either with the general practitioner (GP) or with another doctor. There were significant differences between women who had discussed the menopause with a doctor and those who had not. The more problematic the symptoms the greater the likelihood that the woman would have discussed the menopause. Women who had not discussed the menopause with a doctor, had fewer symptoms and were more critical of hormone replacement therapy (HRT). Menopausal symptoms do not necessarily create problems for women in their daily lives. For example almost all women reported hot flushes (87.2%), but few felt very bothered by this symptom (13.8%). Doctors most often listen to menopausal women with severe symptoms. This "bias" may direct the focus upon the negative aspects of menopause. It is suggested that active intervention among women who have not consulted a doctor about menopause is inappropriate, partly because they apparently have chosen non-medical solutions and partly because they have so few symptoms that the use of resources in this way could be considered wasteful.     

Attitudes toward menopause among middle-aged women: a community survey in an island of Taiwan

OBJECTIVES: The purpose of this report is to explore the attitudes toward menopause of middle-aged women in Taiwan as well as to examine related factors. METHODS: A large community-based sample of Taiwanese women aged 40-54 years who are living on the islet of Kinmen were recruited for this study. Attitudes toward menopause were collected with a self-administered questionnaire. RESULTS: Of a targeted population of 1429 individuals, 1113 (78%) participated in the study. The mean age was 48.5+/-4.0 years (range, 43-57 years) and 434 women (39%) were premenopausal. The rate of current hormone use was 13.5%. Compared to premenopausal women, fewer postmenopausal women agreed that menopause depressed them, and that interests distracted their attention from menopause (p<0.01, Mann-Whitney test). Postmenopausal women did not believe that menopause would change their lives, and not having periods made women feel regretful. Compared with the illiterate women, higher educated women were more regretful about menopause (p<0.05, Mann-Whitney test). Women who experienced vasomotor symptoms within 2 weeks of the study expressed a more negative attitude regarding menopause. CONCLUSIONS: Women in Taiwan held a more positive attitude toward menopause as compared to prior studies in other countries. They had a more positive attitude when they actually faced menopause. Education and vasomotor symptoms had a significantly negative impact on menopausal perceptions. This report provides more insight on the perception of menopause in Taiwanese women that will guide future public health initiatives.     

A community-based study of menopause symptoms and estrogen replacement in older women

This study examines the symptoms after a natural menopause recalled by women aged 50–89 years. We determined the frequency and clustering of symptoms, the effect of age on symptoms, and the relation of symptoms to the use of estrogen therapy in a cross-sectional, community-based study of 589 Caucasian, middle- to upper-middle-class women from Rancho Bernardo, California. At the time of menopause, 55% of the women reported that they felt life was getting better and 57% were more cheerful. The most frequently recalled symptoms were hot flushes (74%), propensity to weight gain (45%), night sweats (35%), tiredness (32%), and insomnia (28%). Irritability was reported by one-fourth depression by one-fifth. Nearly 11% reported anxiety about looking older. The recalled prevalence of hot flushes, irritability, weepiness and tiredness did not vary by current age, but younger women were significantly more likely than older women to have experienced night sweats, visible flushes, depression, anxiety about looking older and insomnia. Principal components factor analysis yielded four main independent factors: psychological symptoms (21% of the variance), vasomotor symptoms (14%), positive feelings (11%), and negative self-image (8%). The four symptom groupings suggest different causal mechanisms. Forty-two percent reported past, and 27% reported current use of estrogen therapy. Both past and current hormone users were significantly more likely to report menopause symptoms than non-users. Estrogen use was not associated with positive feelings or self-image at the time of menopause. Although three-quarters experienced symptoms, the majority of women reported positive feelings about menopause.     

Self-awareness during the menopause

OBJECTIVE: The aim of the study was to test the hypothesis that body-image and self-esteem are major contributors to the severity of menopausal symptoms, and furthermore to measure the influence of hormonal therapy and postmenopausal oestrogen level on specific complaints such as vasomotor symptoms. METHODS: For the random check 51 patients, aged 43-63 (x=53.8; s=4.4) of an independent medical institution for menopause referred to as 'Viennese ambulance' were questioned. RESULTS: It turned out, that their attitude towards menopause was of major influence on the degree of specific symptoms (e.g. depression, misery, headache etc.)-women who had a negative attitude towards the menopause suffered much more from such symptoms than women who had a positive one. Moreover, women who were satisfied with their physical appearance experienced fewer troublesome symptoms. There was a significant association between high self-esteem and fewer menopausal symptoms. The higher the self-esteem, the lower the symptoms. CONCLUSION: Women with a postmenopausal oestrogen level did not experience more menopausal symptoms than women with an average oestrogen level. Moreover, the symptoms were neither fewer nor more whether the women had undergone a hysterectomy or not whether they got hormonal treatment or not. That refutes the hypothesis, that the decrease of the oestrogen level during menopause is the main reason for the accompanying complaints.     

Menopause symptoms in HIV-infected and drug-using women

OBJECTIVE: To examine the association of HIV infection, drug use, and psychosocial stressors with type and frequency of menopause symptoms. DESIGN: In a cross-sectional study, HIV-infected and HIV-uninfected midlife women underwent standardized interviews on menopause status and symptoms, demographic characteristics, depressive symptoms, negative life events, and substance abuse. Body mass index (BMI), HIV serostatus, and CD4 count were measured. Associations between study variables and menopause symptoms were assessed using generalized estimating equations. RESULTS: Of 536 women not on hormone therapy, 48% were black, 42% were Hispanic, 54% were HIV positive, and 30% recently had used illicit drugs. The mean age was 45 +/- 5 years; 48% of the women were identified as premenopausal, and 37% were perimenopausal. Psychological symptoms were most prevalent (89%), followed by arthralgias (63%) and vasomotor symptoms (61%). Perimenopausal women reported significantly more menopause symptoms than premenopausal women (ORadj 1.34, 95% CI, 1.09-1.65). HIV-infected women were more likely to report menopause symptoms than uninfected women (ORadj 1.24, 95% CI, 1.02-1.51). Among HIV-infected women not on highly active antiretroviral therapy, symptoms decreased as the CD4 count declined. Increased menopause symptoms were significantly associated with depressive symptoms (ie, Center for Epidemiologic Studies Depression scale score > 23, ORadj1.82, 95% CI, 1.46-2.28), and with experiencing more than three negative life events (ORadj 2.08, 95% CI, 1.54-2.81). Increasing BMI (per kg/m) was also associated with more menopause symptoms (ORadj 1.03, 95% CI, 1.02-1.05). CONCLUSION: HIV-infected women reported more menopause symptoms than HIV-uninfected women, but symptoms were less frequent in women with more advanced HIV disease. Depressive symptoms and negative life events were also highly associated with symptoms. Further study of menopause symptoms and HIV-related factors is warranted. Mental health interventions may also have a role in ameliorating menopause symptoms.     

Depressive symptoms, menopausal status, and climacteric symptoms in women at midlife

OBJECTIVE: Previous studies have found increased rates of depression in women aged 45 to 54 years, but the factors that influence these rates are not understood. It was assessed whether higher rates of depressive symptoms were associated with menopausal status, climacteric symptoms, and use of hormone replacement therapy. DESIGN: Cross-sectional survey. SETTING: Community sample. METHODS: Data are from 581 women ages 45 to 54 years who were interviewed by telephone between October 1998 and February 1999. MEASURES: Depression was measured with the abbreviated CES-D, a depressive symptoms screening measure. Women's reported perception of menopausal stage, frequency of periods in the preceding 12 months, and history of oophorectomy were used to classify their menopausal status into four categories: (1) no indication of menopause; (2) close to menopause; (3) had begun menopause; and (4) had completed menopause. RESULTS: There were 168 women (28.9%) who reported a high level (> or = 10) of depressive symptoms when the abbreviated CES-D was used. In a logistic-regression analysis, significant factors associated with increased depressive symptoms included physical inactivity, inadequate income, use of estrogen/progesterone combination, and presence of climacteric symptoms (trouble sleeping, mood swings, or memory problems). Menopausal status was not associated with depressive symptoms. CONCLUSIONS: In this sample of women age 45 to 54 years, climacteric symptoms but not menopausal status were associated with higher rates of depressive symptoms.     

Breast electrical impedance and estrogen use in postmenopausal women.

OBJECTIVES: To examine the potential for using electrical impedance measurements on the breast as an indicator of estrogen activity in breast tissue. METHODS: Eighty-six postmenopausal women were examined with TS2000, a device that measures electrical capacitance and conductance on the breast. Seventy women had undergone natural menopause (NM) and 16 had had a hysterectomy/ovarectomy. Twenty-one women were using estrogen replacement therapy (ERT). Each woman had electrical impedance measured over several frequencies on the nipple sector of both breasts. We analyzed capacitance and conductance at 200 and 1100 Hz and the slopes and intercepts of regression lines relating capacitance and conductance to the natural log of frequency. RESULTS: Type of menopause (natural or induced) was not statistically related to any measured variable. The number of years since the start of menopause was statistically related to all measured variables. Overall, levels of capacitance and conductance decreased as the number of years since the start of menopause increased. Women who used ERT had a statistically higher level of nipple conductance at 200 Hz than did women who did not use ERT. CONCLUSIONS: The pattern of electrical measurements on the nipple (and in particular conductance at 200 Hz) is correlated with the pattern of estrogen changes after menopause. These data indicate that electrical measurements might be a useful, non-invasive assay of estrogen activity in breast tissue.     

Stress,psychological distress,psychosocial factors,menopause symptoms and physical health in women

Objectives

Relatively few studies have evaluated relationships between stress, psychological distress, psychosocial factors and menopause symptoms, and none have evaluated emotional intelligence (EI) in relation to menopause. In this study, direct and indirect relationships were evaluated between stress, psychological distress, psychosocial factors (e.g. social support, coping, EI), menopause symptom severity and physical health in middle-aged women.

Methods

One hundred and sixteen women aged 45–55 years were recruited through women's health centres and community organizations. They completed a short questionnaire asking about stress, psychological distress (i.e. anxiety, depression), EI, attitude to menopause, menopause symptoms and physical health.

Results

Low emotional intelligence was found to be related to worse menopause symptoms and physical health, and these associations were partly mediated by high stress, anxiety and depression, a negative attitude to menopause and low proactive coping.

Conclusions

Women with high EI appear to hold more positive attitudes to menopause and experience less severe stress, psychological distress and menopause symptoms and better physical health. These results suggest that women who expect menopause to be a negative experience or are highly stressed or distressed may be more likely to experience a more negative menopause.     

Depressive symptoms in the transition to menopause: the roles of irritability,personality vulnerability,and self-regulation

Although the transition to menopause represents a period of risk for depressive symptoms, there is little research into personality or trait-like factors that may confer vulnerability to depression during the transition to menopause. This study investigated whether the personality trait of self-criticism moderated the effects of irritability on depressive symptoms in women transitioning to menopause and whether these effects were mediated by lower levels of emotional regulation. Participants were 376 women, of whom 157 had entered the transition phase to menopause. These women in the transition phase completed measures of self-criticism, irritable mood, emotional regulation, and depressive symptoms. All analyses controlled for attitudes toward menopause and somatic symptoms. Moderated mediation regression analyses showed that higher levels of irritability were associated with poorer emotional regulation in highly self-critical women, but not in less self-critical women, and poorer emotional regulation was, in turn, related to higher levels depressive symptoms. Findings suggest that the transition to menopause may represent an especially vulnerable period for women with high levels of self-criticism. Although irritability is transitory for most women, for women who are highly self-critical, irritability may tax their ability to self-regulate and lead to more encompassing symptoms of depression.     

Low-dose transdermal estradiol for symptomatic perimenopause

OBJECTIVE: To determine whether low-dose transdermal estrogen therapy is associated with a reduction in vasomotor symptoms in women who continue to have menstrual cycles. DESIGN: An open-label, observational evaluation conducted over 12 months in 22 consecutive perimenopausal women with vasomotor symptoms. RESULTS: Improvement in vasomotor symptoms was reported by 16 (73%) of women evaluated. Of responders, 11 characterized symptom relief as complete and 6 as moderate. Fifteen (68%) of the women remained on transdermal estrogen at 12 months. No adverse health-related events were attributed to estrogen therapy. CONCLUSION: Low-dose transdermal estrogen is well tolerated and was associated with a reduction in complaints of vasomotor symptoms before menopause. The steady-state pharmacokinetics of transdermal delivery of unopposed estrogen may be advantageous in a population sensitive to fluctuations in circulating hormone levels.     

Menopause,local biologies,and cultures of aging

Menopause marks the end of menstruation, once generally accepted as the closure of women's reproductive lives. The current medical view of menopause, however, is as a pathological event with its own distinct set of symptoms and diseases. Researchers have described women as facing a dramatic increase in the risk of heart disease, osteoporosis, stroke, and Alzheimer's, all as the result of the impact of changing hormone levels, particularly the decline in estrogen. The clinical literature has interpreted these findings in terms of the absolute necessity of replacing these lost hormones for all women who are menopausal regardless of any other physiological, social, or cultural characteristic they might possess. Using research done in Japan, Canada, and the United States, this paper challenges the notion of a universal menopause by showing that both the symptoms reported at menopause and the post‐menopause disease profiles vary from one study population to the next. For most of the symptoms commonly associated with menopause in the medical literature, rates are much lower for Japanese women than for women in the United States and Canada, although they are comparable to rates reported from studies in Thailand and China. Mortality and morbidity data from these same societies are used to show that post‐menopausal women are also not equally at risk for heart disease, breast cancer, or osteoporosis. Rather than universality, the paper suggests that it is important to think in terms of “local biologies”, which reflect the very different social and physical conditions of women's lives from one society to another. Am. J. Hum. Biol. 13:494–504, 2001. © 2001 Wiley‐Liss, Inc.     

Consciousness about climacteric and menopausal symptoms affects the mental health of middle-aged women

Consciousness about climacteric and menopausal symptoms in relationship to menopausal stage and mental health was investigated. Midlife women (N = 407, 40-60 years old) were asked about their menstrual status, consciousness of climacteric and menopausal symptoms, self-esteem and depression. Based on their menstrual status, 222 participants were divided into three groups (pre-menopause, peri-menopause, and post-menopause). The main results are as follows. Women who were pre-menopausal had a negative consciousness about menopause, which contributed negatively to their self-esteem. Women who were perimenopausal or post-menopausal had more symptoms, which contributed negatively to their mental health. These results indicate that middle-aged women should be provided with interventions focusing on their menopausal status.     

Sex steroids to maintain cognitive function in women after the menopause: A meta-analyses of treatment trials

It is still debated whether estrogen treatment after the menopause could result in improved cognitive function in women. This debate is based on many animal and cell culture data showing that estrogens can positively affect the aging brain. Observational data also show a halved risk of dementia in women who took estrogens around the age of menopause. However, large treatment trials have shown negative effects of long-term treatment with estrogens in older women. The present meta-analyses included 36 randomised treatment trials and tested various hypotheses which have been developed to attempt to explain discrepant data. Results indicated that, contrary to expectations, age of women and duration of time elapsed when treatment was initiated since menopause (‘window of opportunity’ hypothesis) did not significantly affect treatment outcome, nor did it matter whether women were symptomatic or not. It was not clear whether bilateral oophorectomy affected the outcome, as this effect was based on only a few studies from the same group and some observational studies show negative effects on cognition in surgical menopausal women treated with hormones for more than 10 years. Duration of treatment overall significantly affected outcome. More negative effects were seen in longer studies, where positive effects were mainly seen in short term studies (<4 months). Treatment with combined estrogens and progestagens also negatively affected the outcome. Whether women with symptoms should be treated for a couple of months or using other (intermittent) modes of treatment and whether this could have long-term positive consequences remains to be investigated.     

Changes in psychological well-being during postmenopause as a result of estrogen therapy

A study of the effects of a conjugated estrogen (Femipren) upon various climacteric symptoms, depression and anxiety scores and psycho-social factors in 120 women around the menopause, was carried out in a Menopause Clinic.

In order to participate in this study, the women had to meet very strict criteria. A climacteric symptom list, the MMPI and a psycho-social questionnaire were used for assessment, and were employed before, during and at the end of 1 yr of hormone replacement therapy.

Typical vasomotor and psychic symptoms changed significantly as did such factors as self-image, optimism, perception of the future and satisfaction with personal appearance, in those patients who received hormonal replacement therapy for 1 yr. As the psychological factors changed only in those patients who received long-term estrogen therapy, a tentative hypothesis of direct psychotropic effect of estrogen was formulated.     

Depressive disorders and the menopause transition

Aim

Depressive disorders and symptoms are common among middle-aged women. The effects of hormones on depression remain unclear. This review aims to clarify the nature of depressive disorders during the menopause transition as well as their links with climacteric syndrome, sexuality, cardiovascular risk and cognitive function.

Material and methods

The recent literature on depressive disorders and menopause is reviewed.

Results and conclusions

Women are more vulnerable than men to depressive disorders. Endocrine influences have been postulated but differences in, for example, coping style and response to stress may also contribute to the gender difference in the prevalence of depressive disorders. Gender differences in socialization may lead to higher rates of depression in women. There are data top suggest that menopause and depression are associated, although there is not a common clear causative factor. Women with climacteric symptoms (hot flushes, night sweats, vaginal dryness and dyspareunia) are more likely to report anxiety and/or depressive symptoms. Bothersome vasomotor symptoms could be associated with sleep disturbances, which in turn can increase reports of anxiety and depressive symptoms. Biopsychosocial and partner factors have a significant influence on middle-aged women's sexuality and depressive disorders, and most antidepressants can have a negative effect on sexual response. Lastly, studies have consistently shown that women with high levels of depressive symptoms are at greater cardiovascular risk and have poorer cognitive function than non-depressed women. At present, a direct relationship between psychiatric symptoms and hormonal changes such as estrogen decrease has not been clearly found. Stress, educational level, ethnicity, socioeconomic factors and partner status may influence the prevalence and clinical course of both menopause symptoms and depressive disorders. Since in many cases depression is a lifelong condition, and is associated with severe comorbid conditions, further studies are needed to improve the early diagnosis of depression; it may be advisable to monitor a woman's mental health during the menopause transition to prevent a depressive disorder having long-term negative consequences.     

Pregnancy and birth history influence women's experience of menopause

OBJECTIVE: The determinants of experiencing menopausal symptoms are complex, representing biological, psychological, and social factors. We report the impact of one such factor, fertility, on the experience of menopausal symptoms. We hypothesize that nulliparous women will have more dissatisfaction with childbearing choices and more negative attitudes toward menopause but will experience fewer menopausal symptoms. DESIGN: Women aged 40 to 65 years were recruited from a single internal medicine practice to participate in a 5-year longitudinal study of the impact of menopause on health-related quality of life. Women completed questionnaires including the RAND-36, attitudes toward menopause, menopausal symptoms, and fertility and childbearing. Based on self-reported pregnancy and birth history, we categorized women as parous (one or more live births), nulligravida (no pregnancies or births), and nulliparous (one or more pregnancies and no live births). Categorical variables were analyzed using univariable and multivariable ordered logistic and logistic regression. Continuous variables were analyzed using Student's t test and multivariable linear regression techniques. RESULTS: The 728 participants were, on average, 50.8 years old with 2.4 pregnancies and 1.7 live births. Compared with parous women, nulligravida and nulliparous women were more likely to report being very dissatisfied with childbearing choices (odds ratio [OR] [95% CI]: 3.3 [2.3-4.6] and 4.0 [2.5-6.4], respectively). Nulliparous, but not nulligravida, women expressed more negative attitudes toward menopause compared with parous women (P<0.001). Nulligravida and nulliparous women were half as likely to report hot flashes as parous women (OR [95% CI]: 0.6 [0.4-0.9] and 0.5 [0.3-0.9], respectively). Compared with parous women, nulligravida women were less likely to report vaginal dryness (OR [95% CI]: 0.5 [0.3-0.7]). CONCLUSIONS: Our study examined the impact of pregnancy and birth history on menopausal symptoms, and the findings support the hypothesis that women who experience infertility may find menopause to be a time of normalcy and experience fewer hot flashes. Both physiologic and psychosocial mechanisms deserve further study.     

Myths and realities of the menopause.

Menopause is a reproductive milestone in a woman's life around which many different myths have developed. We reviewed three sets of myths that middle-aged premenopausal women hold and evaluated those myths according to scientific data from our own work and that of others. First, middle-aged women expect to experience depression, irritability, and vasomotor symptoms during the menopause. It appears that the vast majority of postmenopausal women do not experience depression, but do experience vasomotor symptoms that are uncomfortable and may have secondary effects on psychological well being, especially during the perimenopause. Second, middle-aged women believe that holding negative expectations about the menopause affects the quality of the menopausal experience. Indeed, that appears to be the case, perhaps because myths can function as self-fulfilling prophecy. The third myth is that there are no important changes that occur during the menopause. That is incorrect. Estrogen deficiency during the menopause sets the stage for substantial changes in risk for CHD, which becomes clinically apparent later in life. We discussed how estrogen deficiency may influence both lipids and lipoprotein levels and the magnitude of neuroendocrine and cardiovascular respond to mental stress. That latter pathway is of particular interest because middle-aged women may be exposed more often to interpersonal stress and may respond more emotionally to it, relative to men, suggesting a potential interactive effect of the decline in reproductive hormones and co-occurring social and psychological changes during the menopausal period. This discussion of the myths and realities of the menopause has deliberately not been exhaustive.(ABSTRACT TRUNCATED AT 250 WORDS)     

Menopause across cultures: a review of the evidence

OBJECTIVE: To review the cross-cultural evidence on menopausal symptoms to assess the extent of variability in symptomatology and the relative weight of hormonal and social factors. DESIGN: Literature review and critical summaries of available studies. RESULTS: Symptoms related to menopause are found in all regions of the world, although everywhere large proportions of women go through menopause uneventfully. The evidence does not support that women in developing countries report fewer symptoms than in industrialized countries. There is a great diversity in symptom frequencies across countries, and the association of symptoms with menopausal status is weak. A number of symptoms thought to be part of menopause are in fact not specific to it, although the evidence does support the narrow estrogen hypothesis of a core of symptoms associated with estrogen decline, namely vasomotor and vaginal symptoms. CONCLUSIONS: The association between hormonal changes and menopause symptomatology is complex and mediated by sociocultural factors.     

A population-based study of depressed mood in middle-aged, Australian-born women

OBJECTIVE: There has been controversy about the relationship between menopause and depression. This study utilizes a unique prospective population-based data set of middle-aged, Australian-born women to identify determinants of depressed mood. DESIGN: The Melbourne Women's Midlife Health Project sample consisted of 438 women aged 45 to 55 at baseline; they were followed annually for 11 years. Of this group, 314 (72%) completed the Center for Epidemiologic Studies Depression Scale (CES-D) scale in year 11 to measure depressed mood. Variables measured at baseline and annually included negative mood (measured with Affectometer) and psychosocial, hormonal, health, and lifestyle factors. RESULTS: Women who had the highest CES-D scores were those who by year 11 were still in the menopause transition stage (had not reached final menstrual period) or had experienced surgical menopause. CES-D correlated with negative mood measured concurrently (r = 0.63) and baseline negative mood (r = 0.37). There was a significant reduction in negative mood for all menopause status groups, but those who experienced surgical menopause showed less reduction than other women. Ever-use or number of years of use of hormone therapy made no difference to CES-D outcome. CES-D was associated with baseline negative attitudes toward aging, mood, and premenstrual complaint experience and annual mood, poor self-rated health, number of bothersome symptoms, and daily hassles. CONCLUSIONS: Women most likely to have higher depressed mood in the age group 57 to 67 are those who have undergone surgical menopause or have menstruated within the last 12 months. Prior negative mood, history of premenstrual complaints, negative attitudes toward aging or menopause, poor health, and daily hassles predict depressed mood.     

The prevalence of symptoms possibly related to the climacteric in pre- and postmenopausal women in Linköping,Sweden

BACKGROUND: Some extragenital symptoms have been suggested to be associated with the menopause and thus to be affected by estrogen status. In such case extragenital symptoms may be more frequent in postmenopausal women without hormone replacement therapy (HRT) than in premenopausal women or women using HRT. OBJECTIVE: To assess if the prevalence of a number of extragenital symptoms is higher in postmenopausal women without than with HRT, or in premenopausal women of the same age. MATERIAL AND METHODS: All women aged 53 and 54 years in the community of Link?ping (n=1760) were sent a validated questionnaire about use of HRT, time since last menstruation and about different extragenital symptoms. RESULTS: 1298 (73.8%) women answered the questionnaire and answers from 1180 (67%) women were possible to analyze. Postmenopausal women woke up significantly more often during night than premenopausal, and those without HRT often due to hot flushes and sweating. Women with HRT reported more muscular pain than the others. We found no other significant difference in prevalence of extragenital symptoms between the three groups of women. CONCLUSIONS: Sleeping disorders, arthralgia, xerophthalmia, xerostomia and dry skin are not more prevalent in 53 and 54 years old postmenopausal women without HRT than in women with HRT or in premenopausal women of the same age. It may still be that some of these symptoms are related to estrogen deficiency, but do not develop until some years after menopause. It may also be that women with the most severe symptoms decided to use HRT and thereby decreased symptoms to the same level as in non-users.