Abdominal pain during the menopause transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study

Abstract

Objective To assess the relationship between abdominal pain severity during the menopausal transition (MT) and age, MT stage, reproductive biomarkers, stress biomarkers, and stress perceptions. Methods Women ages 35–55 were recruited from multiethnic neighborhoods in the greater Seattle area from 1990 to 1992, for an original study cohort of 508. From 1990 to 2013, a subset of this cohort consented to ongoing annual data collection by annual health questionnaire, health diary, and daily menstrual calendar. Beginning in 1997, a portion of these women also provided a first morning voided urine specimen to be assayed for levels of estrone glucuronide (E 1 G), follicle stimulating hormone (FSH), testosterone, cortisol, norepinephrine, and epinephrine. To identify how changes in abdominal pain severity changed over time in relation to age, MT stage, reproductive biomarkers, stress-related biomarkers, and stress-related perceptions, mixed effects modeling was used. Results In a univariate model, E 1 G ( p = 0.02) and testosterone (p = 0.02) were significantly and negatively related to abdominal pain severity, while perceived stress ( p = 0.06), tension ( p < 0.001), and anxiety (p < 0.001) were significantly and positively associated. In a multivariate model, increasing age ( p = 0.001) and E 1 G ( p = 0.04) were negatively associated with abdominal pain severity, and anxiety (p = 0.00) positively associated. Testosterone did not improve the fit to the final model, nor did tension or perceived stress. Conclusions These results suggest that age, anxiety, and E 1 G each show a significant association with abdominal pain severity in the MT. In contrast, stress perception, tension, testosterone, stress biomarkers, and MT stage do not. These factors should be evaluated further in research on abdominal pain experienced during the MT and early postmenopause years.

Chronic Pain in the Elderly: Mechanisms and Perspectives

“…For instance, increasing age has been negatively associated with abdominal pain severity in a sample of women aging from 35 to 55 years. The authors attributed this effect to decreased estrogen levels as women move from late reproductive to post menopause stages ( Callan et al, 2019 ). In addition, menopause also contributes to a reduction of headache and cervical/lumbar pain symptoms ( Meriggiola et al, 2012 ).…”

From Menopause to Neurodegeneration—Molecular Basis and Potential Therapy

“…The gut microbiota is essential in maintaining homeostasis, and changes in the gut microbiota can also lead to alteration of behavior and cognition [96]. During menopause transition and the early menopausal period, abdominal irritation was found and negatively related to estrone glucuronide levels [97]. In postmenopausal women, the urinary estrogen level is associated with fecal microbiota [98].…”

Irritable bowel syndrome in midlife women: a narrative review

“…Multivariable analyses revealed that neither menopause transition stages (late reproductive, early menopause, late menopause) nor selected sex hormones (estrogen, follicle stimulating hormone and testosterone) were associated with changes in bowel pattern symptom severity over time; however, higher self-reported tension predicted both increases in the severity of constipation and diarrhea, a lower cortisol level predicted an increase in the severity of constipation, and younger age predicted an increase in the severity of diarrhea over time. Recently, Callan et al [ 6 ] assessed abdominal pain from the same dataset. Multivariable analyses showed that younger age, lower estrogen levels and higher anxiety were predictive of an increase in severity of abdominal pain over time, while other sex hormones and menopause transition stages were not.…”

“…While both boys and girls with IBS report predominantly constipation, adult women report more constipation and men more diarrhea symptoms. For many women with and without IBS, gastrointestinal symptom severity fluctuates with the menstrual cycle and continues through the menopause transition and into the postmenopausal period [ 6 , 7 , 12 ]. For the most part, little is known about the experience of IBS during the midlife period and/or the menopausal transition.…”

“…For the most part, little is known about the experience of IBS during the midlife period and/or the menopausal transition. Among women with IBS, cross-sectional studies show either an increase in gastrointestinal symptom severity [ 4 ] or no difference when premenopausal women are compared with postmenopausal women [ 6 , 7 , 12 ]. One cross-sectional study reported less severe gastrointestinal symptoms but lower IBS-specific quality of life among midlife and older women with IBS compared to younger individuals [ 13 ].…”