Objective: The objective of this study was to determine the relationships among perceived stressors, neuroendocrine indicators of stress arousal, and well-being among women during the transition to menopause. Design: Participants enrolled in the longitudinal Seattle Midlife Women’s Health Study since 1990 (N=205) provided monthly first morning voided urine specimens analyzed for estrone, FSH, cortisol and catecholamines for 4 years (1997-2000), rated their symptoms and stress levels on three consecutive days each month in a monthly health diary, and completed an annual health update following an interview in their homes. Methods: Women enrolled in the study were interviewed in person at inception of the study, provided urine specimens and diary records to an interview at a site near their homes or workplaces, and an annual mailed health update containing standardized instruments. Interviewers maintained contact with the same women through out the study as possible. Population/Sample/Settings: A subset of women with complete assay data for 1998, symptom diaries, and health updates for the same period was selected for analyses (N=166). Concepts/Variables: Stressors recorded in daily health diaries completed three times per month included work, parenting, and relationships stress. Material stress was measured with the Income Adequacy Scale (Lobo) and role stress with the Role Burden Scale (Montgomery). Stress arousal indicators included urinary epinephrine, norepinephrine, and cortisol. E:N ratios indexed stress arousal and have been linked to hypertension in women. Menopausal transition stages were classified using the method of Mitchell, Woods and Mariella. Urinary FSH and estrone were assayed as indicators of the HPO axis function. Well-being was measured using the Positive Well-being Scale (Dupuy) and the Self Esteem Scale (Rosenberg). Findings: Ratings of stress levels, stress arousal indicators, and health indicators did not vary across groups of women in the early, middle, or late transition stage or who were postmenopausal, but women with higher FSH levels had higher cortisol (C), epinephrine (E), and norepinephrine (N) levels. Women’s ratings of stressors (family, material, work) were related to stress arousal indicators. Parenting stress was related to C and E and N and relationship stress/personal stress was related to higher E:N ratio. Improvement in role burden, income adequacy and employment were correlated with lower E:N ratio. Lower occupational status and working fewer hours per week were associated with higher E levels. Women with lower well being and lower self esteem had higher E:N ratios. Women with more stress related to physical health, personal stress, lower income adequacy, and a history of sexual abuse reported lower well- being and self esteem. Conclusions: Family, material and work stressors were were related to stress arousal and to well-being. Although menopausal transition stages were not related to stressors, stress arousal, and well-being, the relationship of FSH to cortisol, epinephrine and norepinephrine may mediate stress response as women age and complete the transition to menopause. Implications: The relationship between FSH and higher levels of E, N, and cortisol, and the relationships between E, E:N ratio and well-being warrant further investigation into the role of the HPO axis in modulating stress arousal and possible health outcomes following the menopause transition. Although the HPO axis may influence stress arousal, the social origins of stress in and its influence on stress arousal and well-being should be considered when providing health care to midlife women.
Back to Research in Health Maintenance and Promotion
Back to The Advancing Nursing Practice Excellence: State of the Science