 Abstract | Psychogenic symptoms (trouble sleeping, lack of energy, difficulty in
concentration, nervous tension, feelings of sadness/ downheartedness) are
among the most frequently reported symptoms of menopausal transition, as
are nocturnal hot flushes/sweats. Few studies have combined psychosocial
and biomedical models to seek an explanation as to why menopausal
symptoms such as these are problematic for some but not all women during
menopausal transitional. In Study 1, 71 transitional women (mean age:
50.02 years, SD: 3.52 years) completed questionnaires examining the
predictive value of a number of psychosocial factors in terms of the impact of
menopausal symptoms on the ability to maintain a normal lifestyle during
transition. Participants included women undergoing natural transition and
those using hormone replacement therapy (HRT). A sub-set of participants
(N=22) with the highest and lowest psychogenic symptom frequency scores
took part in Study 2. Their evening on-set salivary melatonin secretion levels
were compared, as was their exposure to natural light at 500, 3,000 and
10,000 lux levels, their subjective and objective (wrist actigraph) sleep quality
and their nocturnal peripheral body temperatures (PBT). Results from Study
1 indicated that, while the quality and availability of health care was of most
concern to all participants, domestic environment, including quality of
relationships and communications, was the main predictor of successful
transition when assessed as the ability to maintain a normal lifestyle during
transition. No significant differences were found between natural or HRTassisted
transition in terms of the impact of symptom severity, or the
predictive value of psychosocial factors. Participants with low psychogenic
frequency scores (less frequent symptoms) showed a trend towards higher
evening on-set melatonin secretion levels, and had significantly greater
exposure to natural light than their high psychogenic frequency counterparts.
These results were consistent regardless of transitional status (natural or
HRT-assisted). No significant differences between the high and low
psychogenic symptom groups were found in either subjective or objective
sleep quality. However, women with high psychogenic frequencies spent
significantly more hours with higher peripheral body temperatures (35º -
36ºC) and reported significantly more nocturnal hot flush/sweat episodes
than their low psychogenic frequency counterparts. These results show that,
in terms of overall menopausal transition, domestic environment plays a
major role in the way in which transitional women are able to deal with the
impact of menopausal symptoms during transition. They also suggest a
permissive link between melatonin evening on-set of rhythms and
psychogenic symptoms that may be mediated by exposure to natural light.
However, these results should not be viewed in isolation from each other, but
in combination with each other. It could be argued that a healthy domestic
environment may affect the perception of symptom severity. This could result
in greater involvement in domestic and social activities outside the home,
increasing exposure to natural light, and thus better entrained melatonin
secretion on-set rhythms. However, any inference of causation (rather than
association) requires experimental verification, preferably in research designs
where key factors, such as exposure to natural light, can be experimentally
manipulated. |
