Associations between vasomotor symptoms, sleep disturbances, and frequent mood changes individually and within symptom groups across the menopausal transition and early postmenopause: observations from the Study of Women’s Health Across the Nation

OBJECTIVE: To explore associations between vasomotor symptoms (VMS), sleep disturbances, and frequent mood changes, and predictors of each, in women transitioning menopause. METHODS: Data were analyzed from the baseline and first 10 annual follow-up visits (1996-2008) from 2,066 participants in the Study of Women's Health Across the Nation who had reached natural menopause. The visit closest to the final menstrual period (FMP) was considered as FMP 0; visits 5 years before/after were relabeled accordingly. Associations between symptoms over time were determined using generalized additive mixed models (GAMMS, for individual symptoms). Predictors of symptom groups were determined using Bayesian multinomial regression. RESULTS: Prevalence of VMS and sleep disturbances increased up to FMP+1, remaining >50% thereafter; frequent mood changes gradually decreased (47%-33%). In the GAMMs, VMS and sleep disturbances were each associated with double the odds of the other, and VMS and frequent mood changes were associated with ~50%-60% increased odds of the other. In the Bayesian models, the probability of experiencing VMS and sleep disturbances together increased with increasing age at FMP (~1.3 percentage points/year); the strongest predictors of experiencing all symptoms concurrently were high level of depression (an increase of 10 percentage points per 10-point increase in depression score) and high anxiety (46% vs. 15% probability for low anxiety). CONCLUSIONS: Our findings underscore the importance of identifying, monitoring and addressing VMS, sleep disturbances, and frequent mood changes specifically and collectively, and support a personalized approach to menopausal symptom management, with anxiety and depression being important considerations.