Physical functioning and menopause in middle aged women

Aim: It has been reported that women in their midlife were more likely to have worse physical functioning (PF) limitations than men of a similar age. Since PF limitations are significant predictors for disability, healthcare utility, healthcare cost, and mortality in the elderly, the higher prevalence of PF limitations reported in middle-aged women is considered a public health issue. Given that the accelerated decline of PF is coincident with the menopausal transition, whether the menopausal transition, rather than normal aging, is related to lower levels of physical functioning in middle aged women remains uncertain. The primary aim of this work was to review systematically the literature that evaluates the associations between menopausal status and measures of PF. Related literature addressing the associations between sex hormones and PF were also reviewed. Methods: Published articles between March 24, 1999 and March 24, 2014 were retrieved from the Pubmed database using selective keywords in the “Title/Abstract”. Only English non-review articles in Humans that evaluated PF measures as outcome variables and menopausal status or sex hormones as independent variables were included in this literature review. Results: Nineteen articles were reviewed. In summary, the natural transition through the menopause was associated with declines in PF independent of the effect of aging. However, few studies used performance-based measurements to evaluate PF declines. Additionally, women undergoing surgical menopause were more likely to experience lower levels of PF compared to premenopausal women. These studies, however, did not evaluate comprehensively the impact of underlying medical conditions leading to surgical menopause on the levels of PF. Finally, the association between sex hormones and PF was still not clear. Conclusion: First, further studies that use performance-based measures of PF, are needed to support the findings that natural menopause is associated with lower level of PF as reported in studies used self-reported measures. Second, underlying medical conditions of surgical menopause should be considered in future studies evaluating surgical menopause and PF. Lastly, the role of the dynamic changes of sex hormones during the menopausal transition in the corresponding changes of PF needs to be explored further