Menopause and Sexual Functioning: A Review of the Population-Based Studies, The

In relatively few of the population studies of the menopausal transition have women been asked about sexual functioning. In even fewer has a validated questionnaire to assess the different aspects of sexual functioning been used. A major problem has been to disentangle the effects of aging from that of menopause. The hormonal changes of menopause take place over a variable period of time known as the menopausal transition, so that aging and menopause are inevitably confounded. In most epidemiological studies, hormonal status of the women surveyed, using menstrual status as a proxy for hormonal status, has not been directly measured. In a recent study from the Melbourne Women's Midlife Health Project, we compared reports by women based on retrospective recall of their menstrual frequency and flow over the prior year with information from prospectively recorded menstrual diaries (Taffe & Dennerstein, 2000). We found that self-report of change in menstrual frequency and flow had low sensitivity compared with measures based on the prospectively kept diaries. Yet, in most surveys of the effects of menopause on health outcomes, retrospective recall of menstrual change has been relied on in order to classify women into menopausal stages. A major advantage of longitudinal studies is that of less reliance on retrospective data, providing that the recall period enquired about is kept short. In longitudinal studies of samples derived from the general population, we are in the best position to sort out whether there is a change in sexual functioning associated with the menopausal transition and, if so, whether this reflects aging, health status, hormonal, or psychosocial factors. A major advantage of longitudinal studies is the ability to control for the effect of prior level of sexual functioning.

For longitudinal studies, the length of prospective follow-up is crucial. For example, after 9 years of follow-up of our population-based Melbourne Women's Midlife Health Project cohort of women aged 45-55 at baseline (mean age = 48 years), 8% were still menstruating, and 51% of the women had reached documented final menstrual period without medical intervention. Twenty-one percent had taken up HRT before reaching final menstruation, and 8% had undergone surgical menopause (see Figure 1) (Guthrie & Dennerstein, 2003).

Most studies of the relationship between menopause and sexual functioning were carried out before recent interest in refining classifications for both sexual dysfunction (Basson et al., 2000) and for reproductive aging (Soules et al., 2001). Important components of the classification systems for sexual dysfunction are the separation of desire, arousal, orgasmic, and pain disorders, and the requirement that the person should express distress. The majority of scales developed to measure sexual functioning prior to the consensus conference had not included any measure of distress. The international consensus classification paper does indicate that a composite score may be useful (Basson et al., 2000).