Association Between Stress Hormones and Menopausal Symptoms in Iraqi Postmenopausal Women

There is increasing evidence that dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis may play a role in the etiology and severity of symptoms of menopause but the data are scarce regarding stress hormones in postmenopausal women with limited data from Middle Eastern population. The aim of this study was to examine serum levels of cortisol, ACTH, and DHEA and their associations with menopausal symptoms in postmenopausal women in Iraq. We used a cross-sectional comparative design including 68 postmenopausal women and 42 age-matched premenopausal controls. The information regarding menopausal symptoms was obtained via structured questionnaires, meanwhile, serum cortisol, ACTH, and DHEA concentrations were measured by enzyme-linked immuno-sorbent assay (ELISA). Cortisol in postmenopausal women had significantly higher concentrations of cortisol (18.6 ± 4.2 µg/dL vs. 13.9 ± 3.6 µg/dL, P < 0.02) and ACTH (46.3 ± 10.8 pg/mL vs. 38.1 ± 9.4 pg/mL, P < 0.03), along with significantly lower concentrations of DHEA (88.21 ± 12.3 µg/dL vs. 95.4 ± 18.9 µg/dL, P < 0.017), compared with premenopausal women. Postmenopausal participants experienced significantly higher prevalence of menopausal symptoms, especially hot flashes (78.0%), sleep disturbances (69.1%), and mood disturbances (64.7%). Hot flashes (P=0.02; P=0.01), sleep disturbance (P=0.03; P=0.04), and mood disturbances (P=0.04; P=0.02) were significantly associated with elevated cortisol and ACTH levels, respectively. By contrast, lower DHEA was independently associated with lack of libido (P = 0.001) and vaginal dryness (P = 0.03). Such stress hormone imbalance is associated with menopausal symptomatology, which suggests that stress-related hormonal assessment should be included to the bedside evaluation of postmenopausal women.