Longitudinal Changes in the Prevalence and Severity of Menopausal Symptoms During the Menopausal Transition

Background: Menopausal symptoms impair quality of life during the menopausal transition.However, most evidence is cross-sectional and rarely distinguishes how often symptoms occur from how severe they are.Therefore, this study examined longitudinal changes in both the simple prevalence and the moderate-to-severe bother caused by 29 menopause-specific symptoms across the transition.Methods: Data from a prospective cohort of 947 premenopausal Korean women who had completed the Menopause-Specific Quality of Life (MENQOL) questionnaire from premenopause through early menopausal transition and beyond (mean follow-up, 7.4 years) were analyzed.The timescale was aligned by defining entry into the early menopausal transition as time zero.Each of the 29 MENQOL items was classified as simple prevalence (symptom present) or moderate-to-severe bother (bother score ≥5 on a 1-8 scale).Prevalence was estimated across five time points and linear time trends were analyzed using generalized estimating equations, with absolute changes expressed as percentage points (pp).Results: The prevalence of most symptoms increased over time.For simple prevalence, the steepest increase occurred in vasomotor symptoms (excessive sweating +34.9 pp, night sweats +31.1 pp).In contrast, the largest increases in the moderate-tosevere group were concentrated in the sexual domain (sexual avoidance +24.3 pp, vaginal dryness +23.2 pp, low desire +21.7 pp).Hot flashes markedly increased in the simple prevalence group (+18.4 pp) but only modestly in the bothersome group (+5.0 pp).Memory issues and low productivity showed no significant trends in the moderate-to-severe group, whereas the remaining 27 items significantly increased (p<0.05 for trend).Conclusion: The most common symptoms differed from the most bothersome ones.Vasomotor symptoms accounted for the largest increases in the simple prevalence group, whereas increases in moderate-to-severe group were concentrated in the sexual domain.Assessing menopausal symptoms by prevalence alone may underestimate the domains with the greatest impact on quality of life, which suggests that symptom burden should be evaluated in terms of both frequency and severity.