First findings from the Australian Women's Midlife Years (AMY) Study

We are excited to share the first findings from the Australian Women's Midlife Years (AMY) Study.

This study has provided much needed documentation as to how women experience menopause today. We have investigated the criteria traditionally used to determine when perimenopause begins, which menopausal symptoms are most bothersome and when, and clarified the impact of the menopause transition on testosterone blood levels and sexual function.

This work is unique in that it is underpinned by the recruitment of a large nationally, geographically representative sample of over 8,000 Australia women aged 40-69 years – a special thanks to all our study participants.

Women’s symptoms and symptom severity were documented by validated questionnaires.

• We could clearly determine the menopausal stage for 5,509 participants, and when we analysed their information we took into account multiple factors that might influence symptom reporting (many previously not considered (e.g. LBGTQIA+ and experience of abuse).
• Sex hormones were measured, and women with any identifiable factors that might influence endogenous sex steroid levels were excluded from analysis to determine sex steroid physiology.

The overarching novel findings so far are that:

1. Changed flow (heavier or lighter periods) combined with hot flushes or night sweats (vasomotor symptoms, VMS) appears to signal the earliest phase of perimenopause, prompting the need for the definition of perimenopause to be reviewed.
2. Change in flow without VMS is not a reliable indicator of entering the menopause transition.
3. Most perimenopausal symptoms track with flushes and sweats.
4. Many of the symptoms associated with menopause peak in severity and prevalence during the late perimenopause such that that guidelines for the care of perimenopausal women are urgently needed.
5. Menopausal hormone therapy (MHT) use has not substantially increased in the last decade and most symptomatic postmenopausal women remain untreated.
6. The likelihood of a woman experiencing desire, arousal, or sexual self-image dysfunction doubles between premenopause and the early perimenopause, with little variation in prevalence thereafter.
7. Testosterone blood levels decline between the ages of 40 and 59 years but do not vary by menopausal stage. Therefore, changes in testosterone do not appear to explain the increase in sexual dysfunction observed between premenopause and perimenopause.