Menopausal Transition: Psychosocial Aspects and the Role of Melatonin in Psychogenic Symptoms

Psychogenic symptoms (trouble sleeping, lack of energy, difficulty in concentration, nervous tension, feelings of sadness/ downheartedness) are among the most frequently reported symptoms of menopausal transition, as are nocturnal hot flushes/sweats. Few studies have combined psychosocial and biomedical models to seek an explanation as to why menopausal symptoms such as these are problematic for some but not all women during menopausal transitional. In Study 1, 71 transitional women (mean age: 50.02 years, SD: 3.52 years) completed questionnaires examining the predictive value of a number of psychosocial factors in terms of the impact of menopausal symptoms on the ability to maintain a normal lifestyle during transition. Participants included women undergoing natural transition and those using hormone replacement therapy (HRT). A sub-set of participants (N=22) with the highest and lowest psychogenic symptom frequency scores took part in Study 2. Their evening on-set salivary melatonin secretion levels were compared, as was their exposure to natural light at 500, 3,000 and 10,000 lux levels, their subjective and objective (wrist actigraph) sleep quality and their nocturnal peripheral body temperatures (PBT). Results from Study 1 indicated that, while the quality and availability of health care was of most concern to all participants, domestic environment, including quality of relationships and communications, was the main predictor of successful transition when assessed as the ability to maintain a normal lifestyle during transition. No significant differences were found between natural or HRTassisted transition in terms of the impact of symptom severity, or the predictive value of psychosocial factors. Participants with low psychogenic frequency scores (less frequent symptoms) showed a trend towards higher evening on-set melatonin secretion levels, and had significantly greater exposure to natural light than their high psychogenic frequency counterparts. These results were consistent regardless of transitional status (natural or HRT-assisted). No significant differences between the high and low psychogenic symptom groups were found in either subjective or objective sleep quality. However, women with high psychogenic frequencies spent significantly more hours with higher peripheral body temperatures and reported significantly more nocturnal hot flush/sweat episodes than their low psychogenic frequency counterparts. These results show that, in terms of overall menopausal transition, domestic environment plays a major role in the way in which transitional women are able to deal with the impact of menopausal symptoms during transition. They also suggest a permissive link between melatonin evening on-set of rhythms and psychogenic symptoms that may be mediated by exposure to natural light. However, these results should not be viewed in isolation from each other, but in combination with each other. It could be argued that a healthy domestic environment may affect the perception of symptom severity. This could result in greater involvement in domestic and social activities outside the home, increasing exposure to natural light, and thus better entrained melatonin secretion on-set rhythms. However, any inference of causation (rather than association) requires experimental verification, preferably in research designs where key factors, such as exposure to natural light, can be experimentally manipulated.