Is it possible to investigate menopausal age? A comparative cross-sectional study of five cohorts between 1968 and 2017 from the Population Study of Women in Gothenburg, Sweden

Personality, eating behaviour, and body weight: results from the population study of women in Gothenburg 2016/17

AIMS

The aim was to investigate the cross-sectional associations between personality traits, psychogenic needs and eating behaviour, and to describe the extent to which personality influences the association between eating behaviour and weight status.

METHODS

In 2016/17, a population-based sample of 573 women in Gothenburg, Sweden aged either 38 or 50 participated in a health examination. They completed the Three-Factor Eating Questionnaire, measuring uncontrolled eating, emotional eating and cognitive restraint on a scale of zero to 100. Scores higher than 50 defined excessive eating behaviour. The Cesarec-Marke Personality Schedule was used to measure psychogenic needs, characterised by pursuits and objectives that define personality and influence actions. Extraversion and neuroticism were assessed using the Eysenck-Personality Inventory. Regression models for excessive eating behaviour and for logarithmic body mass index (BMI) as a function of standardised personality scores were adjusted for sociodemographic, lifestyle and health factors.

RESULTS

A higher need to defend one's status (DST) was positively associated with excessive uncontrolled eating, odds ratio (OR) = 1.44, 95% confidence interval = (1.11, 1.86) per standard deviation (SD) of DST. The need to defend one's status was more strongly associated with excessive emotional eating, OR = 1.61 (1.18, 2.20) than neuroticism, OR = 1.45 (1.06, 1.97), in a mutually adjusted model. Needs for achievement and autonomy were associated with excessive cognitive restraint, OR = 1.39 (1.09, 1.76) and 0.78 (0.62, 0.97), respectively. Excessive emotional eating was associated with 5.3 (1.1, 9.6) % higher values of BMI when adjusted for the need of DST, which was associated with -2.7 (-4.1, -1.3) % lower BMI per SD.

CONCLUSIONS

Psychogenic needs were more closely associated with eating behaviour than personality traits. A lower need to defend one's status and excessive emotional eating were independently associated with higher BMI, suggesting different pathways to obesity and treatment strategies.

Exploring the clinical, psychological, and social relevance of menopause for trans and gender diverse people: a qualitative study

OBJECTIVE

The aim of this study was to explore the meanings and experiences of menopause for trans and gender diverse (TGD) people and how menopause affects clinical practice.

METHODS

For this qualitative study in 2021-2022, a scoping literature review informed interview schedule development. Following email invitations, online semi-structured interviews were conducted in March-April 2021 in Australia with three prominent TGD community leaders (trans male, trans female, nonbinary person) and three experienced medical practitioners (general practitioner, endocrinologist, psychiatrist), which were audio-recorded and transcribed. Inductive, iterative thematic analysis of transcripts was conducted. A further literature search was completed in 2024.

RESULTS

Themes identified included the following: (1) no consensus on the definition of menopause for TGD individuals; (2) diverse menopause experiences existing in the TGD community; (3) large variations present regarding perimenopausal hormone therapy for older TGD patients: maintain dose, taper to low dose, or cease hormones; and (4) minimal support for TGD people to discuss menopause and concerns around aging. Saturation was not reached with the sample size.

CONCLUSIONS

There is a paucity of relevant research and no consensus on definitions, management, or impacts of menopause for TGD people. Therefore, current management approaches should be individually tailored and guided by clinical expertise. To formulate practical and realistic recommendations for clinical practice, future research could include the following: (1) a broader literature review into varied gender-affirming hormone treatment (GAHT) regimens among aging TGD people; (2) utilizing the Delphi technique to achieve expert consensus regarding GAHT in older TGD individuals; and (3) a prospective study design of TGD participants on different GAHT regimens over time.

Exploring the impact of mental and work-related stress on sick leave among middle-aged women: observations from the population study of women in Gothenburg, Sweden

OBJECTIVE

To investigate whether mental and work-related stress predicts a one-year incidence of sick leave in a cohort of middle-aged working women.

DESIGN

The 2016/17 survey was part of the Population Study of Women in Gothenburg, Sweden, with registry data information on sick leave during one year pre- and post-baseline.

SUBJECTS

A cohort of women aged 38 and 50 in 2016/17 (n = 573; 68% participation), of which 504 women were gainfully employed and not on sick leave ± 2 weeks around baseline examination; 493 women had complete data on stress exposure.

METHODS

We studied associations between self-assessed mental and work-related stress and incident sick leave of >14 days during the year following the baseline examination. We used multiple logistic regression, adjusting for age and previous sick leave, and additionally for sleep quality, well-being, and physical activity.

RESULTS

Overall, 75 women (16%) experienced at least one period of sick leave after baseline. Permanent stress during the last five years almost tripled the risk for incident sick leave, OR = 2.8 (95% CI 1.2-6.3), independent of previous sick leave, OR = 2.3 (95% CI 1.3-4.2). Among 21 specific work-related problems, conflicts at work, OR = 2.2 (95% CI 1.3-3.6), and low decision latitude, OR = 1.7 (95% CI 1.0-2.9), were associated with incident sick leave. The association with conflicts at work remained upon further covariate adjustment.

CONCLUSION

Low decision latitude and conflicts at work are risk factors for incident sick leave among working women. The impact of conflicts at work, irrespective of own involvement, may indicate a specific vulnerability among women of interest for future interventions.

Age of menopause and dementia risk in 10,832 women from the Swedish Twin Registry

INTRODUCTION

An earlier age of menopause (AOM) is hypothesized to increase vulnerability to the neuropathological processes of dementia which begin in midlife.

METHODS

We tested this hypothesis in a sample of 10,832 women from the Swedish Twin Registry, stratified by menopause etiology. Survival models showed that a U-shaped association was present for women whose menopause occurred spontaneously. Sensitivity analyses conducted in hormone naïve, APOE ε4+ and AOM restricted subsamples showed largely analogous patterns of results.

DISCUSSION

Supporting conclusions from basic research, our results suggest that estrogens (proxied here by AOM) interact with several biological pathways mediating dementia disease processes. In line with trends in hormone research across the past century, our findings challenge the oversimplified 'more-is-better' perspective on hormone exposure. Specifically, the non-linear association we observed between AOM and dementia risk points to the involvement of distinct and interacting biological mechanisms beyond just estrogen levels.

Eating Behaviors and Adiposity Indicators - Observations from the 2016/17 Examination of the Population Study of Women in Gothenburg

Purpose

To determine the cross-sectional association between eating behavior in terms of the three-factor eating questionnaire (TFEQ) and adiposity measures.

Methods

The TFEQ-R21 was administered to 573 women aged 38 and 50 who participated in the population study of women in Gothenburg 2016/17. Three domains, emotional eating (EE), uncontrolled eating (UE), and cognitive restraint (CR) were examined as outcomes as well as predictors of adiposity outcomes. Multiple linear and logistic regression models were adjusted for age, education, lifestyle factors, and dieting behavior.

Results

All TFEQ domains were positively associated with dieting. EE and UE were associated with higher consumption of sweets and CR with lower consumption of sweets. Wellbeing was negatively associated with EE and UE. In mutually adjusted models, EE and CR but not UE were positively associated with BMI, waist circumference (WC), waist-to-hip ratio, waist-to-height ratio, and skinfold. One standard deviation higher EE was associated with obesity, BMI ≥ 30 kg/m2, OR = 1.62 (1.26, 2.10), and abdominal fatness, WC > 88 cm, OR = 1.57 (1.26, 1.95). Former and current dieting were positively associated with these outcomes, too, but UE and CR were not associated in mutually adjusted models.

Conclusion

This study shows that emotional eating behavior is associated with adiposity in a population of middle-aged women, over a large range of values for body fatness, and independent of dieting behavior. The results imply that treatment of obesity should include psychological support to restrict the risk for emotional eating in response to states of negative mood.

Trends in haemoglobin levels from 1968 to 2017 and association with hormonal contraceptives: observations from the population study of women in Gothenburg, Sweden

AIM

To investigate trends in the haemoglobin (Hb) level in middle-aged Swedish women from 1968 to 2017 and to examine the potential association between Hb and the use of hormonal contraceptives (HCs).

DESIGN

A prospective observational population study of representative 38- and 50-year-old women of Gothenburg, Sweden.

SETTING

The population study of women in Gothenburg started in 1968-1969 and has continued since then with new examinations every 12 years, including both follow-ups and new recruited cohorts. The study consists of both physical examinations and questionnaires.

SUBJECTS

Two thousand four hundred eighty-eight women aged 38 and 50 participated in the study from 1968 to 2017.

STATISTICAL METHODS

Linear regression model analyses were used to analyse linear and non-linear trends in the level of Hb. Linear and logistic regression models were used to analyse possible associations between HC and Hb and possible associations between the use of HC and anaemia, respectively.

MAIN OUTCOME MEASURES AND COVARIATES

Hb was measured in g/L. HC included any ongoing use of HC therapy. Covariates were smoking, body mass index (BMI), alcohol consumption and education.

RESULTS

A non-linear U-shaped trend in mean Hb was seen in the two age groups, 38- and 50-years old. After adjusting for covariates, a significantly higher mean Hb was seen in the 2016-2017 examination compared to 1980-1981, 1992-1993 and 2004-2005. In 38-year-olds, using HC was associated with a reduced risk of anaemia (OR 0.35, 95% CI 0.13-0.75). In both age groups, the use of HC was significantly associated with having a higher Hb.

CONCLUSIONS

Mean levels of Hb in middle-aged women of the general population seem to be increasing again after lower levels in the 1980s and 1990s. The use of HC was associated with having a higher Hb and a lower risk of anaemia in 38-year-old women.

Perception of higher frequency of daily hot flashes in 50-year-old women today: a study of trends over time during 48 years in the Population Study of Women in Gothenburg, Sweden

OBJECTIVE

The aim of this study was to examine if there are any differences in the prevalence of daily hot flashes in 50-year-old women in a longitudinal perspective (from 1968 to 2017).

METHODS

Cohort comparisons of four population-based samples of 50-year-old women born in 1918, 1930 (earlier-born cohorts), 1954, and 1966 (later-born cohorts) from the Prospective Population Study of Women in Gothenburg examined in 1968-1969, 1980-1981, 2004-2005, and 2016-2017. Questions about frequency of hot flashes have been formulated in the same way throughout all follow-up examinations. Changes between four generations of 50-year-old women were studied.

RESULTS

In the unadjusted model, we found an increased prevalence of daily hot flashes in 50-year-old women born in 1954 and 1966 compared with 50-year-old women born in 1918 and 1930 (odds ratio, 1.74; 95% confidence interval, 1.37-2.22). When considering potential predictors for daily hot flashes (smoking, perceived level of high stress, BMI, waist-to-hip ratio, hormone therapy, and hormonal contraceptives) in the adjusted model, there was a notable difference; odds ratio increases from 1.74 to 1.92 (95% confidence interval, 1.46-2.52). Smoking frequency was substantially lower in the later-born cohorts, 39% compared with 17%.

CONCLUSIONS

In this prospective longitudinal study of 50-year-old women, we found nearly twice as high odds of reporting daily hot flashes in the later-born women compared with earlier-born. When controlling for potential predictors, there was still an obvious difference, which cannot be explained in our study. These findings have not earlier been described, and there is a need for further longitudinal population studies investigating the prevalence of hot flashes over time. Moreover, additional research is required exploring the underlying mechanism of hot flashes, as well as studies that take into account potential risk factors in the environment and societal development over time, that is, impacts of endocrine-disrupting chemicals changes in lifestyle, environmental, and dietary factors, as well as working conditions.

Oophorectomy and rate of dementia: a prospective cohort study

OBJECTIVE

Globally, dementia disproportionally affects women, which is not fully explained by higher female longevity. Oophorectomy at any age leads to the permanent loss of ovarian sex steroids, potentially increasing the risk of dementia. We aimed to investigate the association between oophorectomy and dementia and whether this was conditional on age at oophorectomy, hysterectomy or use of hormone therapy (HT).

METHODS

A prospective study of 24,851 female nurses from the Danish Nurse Cohort. Nurses were followed from age 60 years or entry into the cohort, whichever came last, until date of dementia, death, emigration or end of follow-up (December 31, 2018), whichever came first. Poisson regression models with log-transformed person-years as offset were used to estimate the associations.

RESULTS

During 334,420 person-years of follow-up, 1,238 (5.0%) nurses developed dementia and 1,969 (7.9%)/ 1,016 (4.1%) contributed person-time after bilateral-/unilateral oophorectomy. In adjusted analyses, an 18% higher rate of dementia was observed following bilateral oophorectomy (aRR 1.18: 95% CI, 0.89-1.56) and 13% lower rate (aRR 0.87: 95% CI, 0.59-1.23) following unilateral oophorectomy compared to nurses who retained their ovaries. Similar effects were detected after stratification according to age at oophorectomy. No statistically significant modifying effects of hysterectomy or HT were detected (Pinteraction≥0.60).

CONCLUSIONS

Bilateral, but not unilateral, oophorectomy was associated with an increased rate of incident dementia. We were unable to establish whether this association was conditional on hysterectomy or HT use. Although an increase in dementia after bilateral oophorectomy is biologically plausible, limited statistical power hampers the precision of the estimates.

Increased use of analgesics in midlife women but no association with mental stress: observations from the Prospective Population Study of Women in Gothenburg

Background

The study is part of the ongoing Prospective Population Study of Women in Gothenburg, Sweden, initiated in 1968–1969 with the aim of characterising a total population of women who were representative of middle-aged females. The aim of the present study was to investigate the prevalence of actual analgesic use (prescribed and self-medication) and the possible association with perceived mental stress among women aged 38 and 50 years, respectively, in the Population Study of Women.

Methods

Two different cohorts of population-based samples of 38- and 50-year-old women examined in 2004–2005 and 2016–2017, respectively, were eligible participants. The women were representative for their age cohort at the time of the examinations. Use of medicines and especially analgesics, as well as perceived mental stress, was registered. Changes in medicine use among 38- and 50-year-old women between 2004 and 2005 and 38- and 50-year-old women in 2016–2017 were studied. Data were analysed using logistic regression. Use of analgesics and mental stress were analysed controlling for lifestyle factors, use of other medicines and pain.

Results

The overall sample size across the time periods was 1,073 individuals. The frequency of analgesic use in 38- and 50-year-old women was about 26% in 2004–2005 and 58% in 2016–2017. 28% of women who reported high mental stress in 2004–2005 used analgesics, compared to 60% in 2016–2017. There were no associations between self-perceived mental stress and the use of analgesics.

Conclusion

The higher use of analgesics among midlife women in 2016–2017 is in line with global findings and could be due to increased availability in Sweden of over the counter medicines. The impact of mental stress on analgesic use found previously by other researchers was not confirmed. However, medicine use as a potential coping strategy is an important public health issue that needs to be further explored.

Prognostic factors for future mental, physical and urogenital health and work ability in women, 45-55 years: a six-year prospective longitudinal cohort study

BACKGROUND

Impaired health due to stress is a common cause of long-term illness in women aged 45-55 years. It is a common cause for visits to primary health care (PHC) and may influence work-ability. The aim of this study was to investigate prognostic factors for future mental, physical and urogenital health as well as work-ability in a population of average women aged 45-55 years.

METHODS

This longitudinal cohort study initially assessed 142 women from PHC centers in southwestern Sweden. One houndred and ten accepted participation and were followed for 6 years. They were assessed using the self-reported questionnaires: the Menopause Rating Scale (MRS), the Montgomery-Asberg Depression Rating Scale (MADRS-S), the Short-Form Health Survey (SF-36). Descriptive data are presented of health, education, relationships and if they are working. Multicollinearity testing and logistic regression were used to test the explanatory variables.

RESULT

Severity of symptoms in the MRS somatic and urogenital domains decreased while they increased in the psychological and depressive domains. Having tertiary education was associated with decreased overall mental health, vitality and social role functioning. Living with a partner was associated with increased physical role functioning, social role functioning and emotional role functioning.

CONCLUSION

Quality of life seems to be enhanced by a good relationship with the partner, social support and work/life balance. Therefore, to improve women health women should early discuss ways in which these issues can be incorporated as they pursue their academic or career goals. Hence, we emphasize the importance of supporting women to gain increased awareness about a healthy life balance and to have realistic goals in work as well as in their social life.

Age at menopause onset and risk of cardiovascular disease around the world

Earlier menopause onset has been linked to a greater risk of cardiovascular disease. Both menopause onset and cardiovascular disease risk vary by geographical region, race/ethnicity and socioeconomic status. As such, it is plausible to hypothesize that these factors may influence the association of menopause onset and cardiovascular disease risk. Taking a global approach, this narrative review focuses on how geographic, racial/ethnic and socioeconomic factors might influence menopause onset, mainly natural menopause, and possibly its association with cardiovascular disease risk. The contribution of genetic factors to menopause onset variation is also summarized. A clear gap in the literature has been identified. Several meta-analyses have assessed the question of whether menopause onset is related to cardiovascular disease risk by combining large populations of diverse racial/ethnic backgrounds and socioeconomic status across wide geographical regions. None of these analyses adequately assessed how these factors might modify the association of menopause onset and cardiovascular disease risk. Testing such a question requires the study of a large group of women of diverse racial/ethnic backgrounds across different geographical locations with good documentation of their socioeconomic status, clinical and environmental factors. The increasing evidence supporting age at menopause onset as a marker of overall health calls for worldwide efforts to implement a standardized approach to define age at menopause in both the clinical and the research fields.