HEALTH STATUS AND UTILIZATION BEHAVIOR ASSOCIATED WITH MENOPAUSE

Since menopause is increasingly implicated in the etiology of some major age-related diseases in women, such as cancer, cardiovascular disease, osteoporosis, and depression, there is a need to understand the epidemiology of this physiologic event which is universal for women. To date, knowledge of menopause is based on a small proportion of self-selecting, predominantly ill women. A stereotype has emerged of the “typical” menopausal woman, who presents a broad range of diffuse symptoms and is a higher utilizer of health care. This prevailing view is contradicted by prospective data gathered over 27 months on a cohort of approximately 2,500 women who are representative of women aged 45–55 years in Massachusetts. It is demonstrated that 1) menopause itself does not cause poorer health status (either physical or psychologic); 2) menopause itself does not cause an increase in utilization behavior; 3) occurrence of a surgical menopause is the primary menopause-related change associated with subsequent perceived health status and utilization behavior, and then only minimally; and 4) almost all the explained variability in health status and utilization behavior outcomes is attributable to the prior health status of the respondents and, to a lesser extent, to utilization behavior. These findings underscore the importance of two methodological requirements for future work: 1) representative samples of apparently healthy women; and 2) prospective data which elucidate cause-effect relations.