Quality of Life, Menopausal Symptoms, Insomnia and Depression in Peri- and Post-Menopausal Women: A Cross-Sectional Study

Introduction

Menopausal transition is a distinct period in a woman’s life, characterized by profound hormonal changes that affect both physical and psychological well-being. Its symptoms cover a wide spectrum, including vasomotor disturbances (hot flashes, night sweats), sleep disorders, mood fluctuations, and cognitive difficulties [1]. Up to 63% of women in menopausal transition report sleep problems [2], with insomnia being the most common. The incidence of insomnia can vary depending on ethnicity, as well as whether a woman is in the peri- or postmenopausal stage [3]. A high prevalence of insomnia, reaching 70%, was observed in postmenopausal women with COVID-19 in Bangladesh [4]. In a Korean cohort of nearly 2500 middle-aged women, menopause remained an independent risk factor for insomnia after adjustment for age, income, and depression [5]. Sleep disorders strongly correlate with the severity of other symptoms and the risk of developing depressive disorders [6]. Recent findings confirm that sleep and mood disturbances substantially reduce women’s quality of life (QoL) [7,8].

Depression during menopause is a significant mental health concern worldwide and is associated mainly with estrogen deficiency and poor sleep quality. In a large group of almost 4000 women, Zhang et al [6] identified a U-shaped relationship between sleep duration and depressive symptoms, with sleep duration of less than or greater than 7.5 hours significantly increasing the risk of depression. Women in the early perimenopausal stage appear particularly vulnerable, experiencing higher levels of stress, depression, and anxiety than women in the premenopausal or postmenopausal stages [9]. The complex interplay of hormonal fluctuations, sleep quality, and mood underscores the multifactorial nature of menopausal health challenges.

The adverse effects of insomnia and depression during menopause extend beyond mental health, affecting physical health, social functioning, and overall QoL [6,10]. These problems are linked with higher risks of chronic diseases, reduced productivity, and greater healthcare utilization [11,12]. Psychosocial resources, such as resilience and self-efficacy, may help mitigate distress and improve adaptation during this transition [13].

Since the global population of women in menopausal transition is expected to reach 1.2 billion by 2030 [14,15], understanding the interplay between menopausal symptoms, QoL, insomnia, and depression has become increasingly important for public health and clinical practice [6,9].

There is an urgent need for comprehensive assessment and intervention approaches in this regard. Recent evidence underscores the importance of addressing sleep and mood disorders as integral components of menopausal care, to improve QoL and long-term health outcomes for women worldwide [10].

The study aimed to determine whether the severity of menopausal symptoms, insomnia, and depression is associated with decreased QoL in peri- and postmenopausal Polish women. Specifically, it was important to evaluate the extent to which these factors, independently and jointly, influence QoL. In this study, with the use of validated health scales and structured statistical analyses, we aimed to identify significant patterns and correlations within the analyzed population. Although menopausal symptoms and their effects on QoL have been widely studied in diverse populations worldwide, data from Central and Eastern Europe, particularly Poland, remain limited. The research we conducted fills this gap by focusing on a well-characterized cohort of Polish peri- and postmenopausal women, accounting for socio-demographic and cultural factors typical of this population. Such regionally specific insights may be important for developing national public health strategies to improve women’s QoL.

Material and Methods

ETHICS STATEMENT:

The study was conducted in accordance with the principles outlined in the Declaration of Helsinki. It was approved by the Ethics Committee of the Institute of Rural Medicine in Lublin (consent number 07/2015, issued on September 15, 2015).

All participants recruited for the study provided informed consent.

DATA COLLECTION AND SOURCE:

We conducted a single large cross-sectional observational study in 2021 and 2022 at the Institute of Rural Health in Lublin (Poland). The study group consisted of women living in southeastern Poland who voluntarily responded to a health promotion advertisement titled “Selected physical and psychological determinants of the quality of life of women in perimenopausal and postmenopausal periods,” posted on the institute’s website and social media.

Eligible participants were white European (Polish) women aged 45 to 60 years. Women were excluded if they were using hormone replacement therapy, had chronic diseases or cancer within the previous 5 years, had drug or alcohol dependence, or had diagnosed psychiatric disorders or cognitive impairment.

Data were collected via questionnaires, clinical examination, and laboratory testing. All variables were measured at a single time point. External databases or registries were not used.

All participants underwent a gynecological examination by the co-author of this manuscript, who is a gynecologist with many years of experience.

Blood samples were obtained to determine serum follicle-stimulating hormone concentration in a certified laboratory. Perimenopausal or postmenopausal status was classified according to the 2012 Stages of Reproductive Aging Workshop (STRAW+10) criteria [17,18], based on menstrual cycle length and regularity and early follicular phase serum follicle-stimulating hormone concentration.

Incomplete questionnaires with missing items (32 questionnaires) were excluded before analysis. No imputation or post hoc data modification was performed.

In total, 287 women (141 in the perimenopausal stage and 146 in the postmenopausal stage) were included in the study.

TWO PARTS OF THE RESULTS TO BE PUBLISHED:

During the study, data were collected simultaneously across multiple domains. The results were divided into separate analyses. Findings examining correlations between quality of life, cognitive function, and serum concentrations of vitamins D, B6, and B12 were published previously in 2024 [16]. The present study is an extension of the previous investigation, focusing on correlations between QoL and the severity of menopausal symptoms, insomnia, and depression in the same cohort. The data were derived from the same group of women as in the 2024 study [16], with no additional participants recruited.

SAMPLE SIZE CALCULATION:

Because our main goal in this study was to correlate QoL with severity of menopausal symptoms, insomnia, and depression (all variables are numerical), we estimated Pearson correlation coefficients between the variables. A minimum sample size of 84 participants was calculated to detect a Pearson correlation coefficient of −0.3 with 80% power at a significance level of 0.05. The final sample sizes, including 141 perimenopausal and 146 postmenopausal women, exceeded this requirement.

GREENE CLIMACTERIC SCALE:

The Greene Climacteric Scale was used to assess the severity of menopause symptoms. It contains 20 symptoms which fall into 3 groups: psychological (symptoms 1–11), somatic (symptoms 12–18), and vasomotor (symptoms 19,20) [19].

The psychological symptoms are as follows: (1) heart beating quickly or strongly, (2) feeling tense or nervous, (3) difficulty sleeping, (4) excitability, (5) attacks of anxiety or panic, (6) difficulty concentrating, (7) feeling tired or lacking energy, (8) loss of interest in most things, (9) feeling unhappy or depressed, (10) crying spells, and (11) irritability.

The somatic symptoms are as follows: (12) feeling dizzy or faint, (13) pressure or tightness in the head, (14) numbness in parts of the body, (15) headaches, (16) muscle and joint pain, (17) loss of feeling in the hands or feet, and (18) breathing difficulties.

The vasomotor symptoms are (19) hot flushes and (20) night sweats.

Each symptom is scored as follows: not at all=0, a little=1, quite a bit=2, and extremely=3. The psychological scale is calculated as the sum of scores for symptoms 1 to 11. The somatic scale is calculated as the sum of scores for symptoms 12 to 18. The vasomotor scale is calculated as the sum of scores for symptoms 19 and 20. Higher scores indicate greater severity of menopausal symptoms.

The mean normative data for the general population of women are 7.42 for the psychological scale, 3.25 for the somatic scale, and 1.79 for the vasomotor scale. The mean normative data for menopausal women are 12.33 for the psychological scale, 6.16 for the somatic scale, and 4.41 for the vasomotor scale [20].

ATHENS INSOMNIA SCALE:

The Athens Insomnia Scale is used to assess the severity of insomnia. It contains 8 items scored from 0 (lack of symptom) to 3 (severe symptom). Higher scores indicate a higher severity of insomnia [21]. The total score is calculated as a sum of scores for all 8 items and ranges from 0 to 24. Scores are interpreted as follows: absence of insomnia (0–5), mild insomnia (6–9), moderate insomnia (10–15), and severe insomnia (16–24).

BECK DEPRESSION INVENTORY:

The Beck Depression Inventory is used to assess the severity of depression. It contains 21 questions scored from 0 (lack of symptom) to 3 (severe symptom). Higher scores indicate a higher severity of depression [22]. The total score is calculated as a sum of scores for all 21 questions and ranges from 0 to 63. Scores are interpreted as follows: 0–9, minimal depression;10–18, mild depression; 19–29, moderate depression; and 30–63, severe depression.

WHO QUALITY OF LIFE–BREF QUESTIONNAIRE:

The shortened version of the WHO Quality of Life questionnaire was used to assess QoL in the study population [23]. This questionnaire is applicable to healthy and clinical populations. It consists of 26 questions, 24 of which are positively worded and 2 of which are negatively worded. The 24 positively worded questions are scored as follows: very poor=1, poor=2, neither poor nor good=3, good=4, and very good=5. The 2 negatively worded questions (questions 3 and 4) are reverse scored.

Question 1 refers to overall quality of life, whereas question 2 refers to general health. The remaining questions are used to calculate an arithmetic mean to obtain scores for the 4 specific domains of quality of life: physical health, psychological health, social relationships, and environment. All domain scores are positively oriented, such that higher scores indicate better QoL.

Scores on the 1-to-5 scale can be converted to a 4-to-20 scale by multiplying by 4, thereby placing them on the same scale as the full WHO Quality of Life questionnaire. These results can also be rescaled from 0 to 100 for comparative purposes.

STATISTICAL METHODS:

The data were analyzed using STATISTICA 13.3 software (StatSoft Polska Sp. z o.o., Kraków, Poland). All analyses were performed separately in 2 the groups of women: perimenopausal and postmenopausal. Absolute numbers (n) and percentages (%) of the occurrence of categories were estimated for categorical variables: level of education, place of residence, marital status, as well as intervals of insomnia and depression. Arithmetic means and standard deviations were estimated for numerical variables: age, severity of menopausal symptoms, insomnia, depression, and 6 domains of QoL in numbers from 1 to 5.

The following statistical tests were used. The chi-square test was applied to compare categorical patient characteristics (level of education, place of residence, marital status) and intervals of insomnia and depression between the perimenopausal and postmenopausal groups. The t test for 2 independent samples was used to compare age, numerical severity of menopausal symptoms, insomnia, depression, and quality of life assessments between the perimenopausal and postmenopausal groups. The Pearson correlation coefficient was used to examine correlations among the severity of menopausal symptoms, insomnia, depression, and quality of life assessments; all relationships were bidirectional. The t test for 2 independent samples was also applied to compare severity of menopausal symptoms, insomnia, depression, and quality of life assessments between women with a university degree and those with lower education, between women living in rural and those in urban areas, and between married and single women (never married, divorced, widowed, or separated); these analyses were conducted separately for the perimenopausal and postmenopausal groups.

The significance level was set at 0.05 for all statistical tests. If differences between groups or correlations were significant, we also assessed effect size using Cohen’s d for t test for 2 means in 2 unpaired samples and t test for Pearson correlation coefficient with values that were at least 0.3 or −0.3.

Results

CHARACTERISTICS OF THE STUDY GROUPS:

Table 1 presents the age, level of education, place of residence, and marital status of the women included in the study. The perimenopausal group had an average age of 50±3.1 years, while the average age of the postmenopausal group was 56±3.1 years. The women in the perimenopausal group had more education than those in the postmenopausal group (76% vs 53% completed university). Most women from the perimenopausal and postmenopausal groups lived in cities (64% vs 63%, respectively) and were married (72% vs 81%, respectively) [16].

MENOPAUSAL SYMPTOMS IN PERI- AND POSTMENOPAUSAL WOMEN:

Table 2 and Figure 1 present the severity of the 3 types of menopausal symptoms in the study participants, as assessed by the Greene Climacteric Scale. In the perimenopausal group, the mean scores were 8.7 for psychological symptoms, 4.6 for somatic symptoms, and 1.2 for vasomotor symptoms. All of these scores fell between the normative values for the general population and those reported for a menopause clinic sample.

The postmenopausal group had more severe psychological and vasomotor menopausal symptoms than the perimenopausal group (P=0.027 and P<0.001, respectively), while the severity of somatic menopausal symptoms did not differ significantly between the peri- and postmenopausal groups.

We also compared the severity of menopausal symptoms between women with a university degree and those with lower education, between women living in villages and those in urban areas (both cities and towns), and between married women and single women (never married, divorced, widowed, or separated), which were analyzed separately in the peri- and postmenopausal groups. Psychological menopausal symptoms were more severe in the perimenopausal women living in villages (11.4±6.6) than in those living in urban areas (8.2±6.4, P=0.036). Vasomotor menopausal symptoms were more severe in the postmenopausal women with a lower level of education (2.6±1.9) than in those with a university degree (1.9±2.0, P=0.036). There were no other significant differences between the groups (P>0.05).

INSOMNIA IN PERI- AND POSTMENOPAUSAL WOMEN:

Table 3 and Figure 2 present the severity of insomnia in the study participants according to the Athens Insomnia Scale. The perimenopausal group had an average insomnia score of 6.4; 51% had no insomnia, 29% had mild, 15% had moderate, and 5% had severe insomnia. The insomnia scores of the postmenopausal group did not differ significantly from those of the perimenopausal group (7.2 on average, P=0.152): 40% had no insomnia, 28% had mild, 26% had moderate, and 5% had severe insomnia.

We also compared the severity of insomnia between women with a university degree and those with lower education, between women residing in rural vs urban areas, and between women who were married and those who were single (never married, divorced, widowed, or separated); these analyses were conducted separately in the perimenopausal and postmenopausal groups. No significant differences in insomnia scores were observed between these groups (P>0.05).

DEPRESSION IN PERI- AND POSTMENOPAUSAL WOMEN:

Table 4 and Figure 3 present the severity of depression in the study participants according to the Beck Depression Inventory. The perimenopausal group had a depression score of 9.0 on average; 62% had no or minimal depression, 26% had mild, 9% had moderate, and 2% had severe depression. The postmenopausal group had a depression score of 10.5 on average; 49% had no or minimal depression, 38% had mild, 12% had moderate, and 1% had severe depression. The depression scores of the postmenopausal group did not differ significantly from those of the perimenopausal group (P=0.072).

We also compared the severity of depression between women with a university degree and those with lower education, between women living in villages and those in urban areas (both cities and towns), and between married women and single women (never married, divorced, widowed, or separated); these analyses were conducted separately in the perimenopausal and postmenopausal groups. However, we did not find any significant differences in depression score between these groups (P>0.05).

CORRELATIONS BETWEEN MENOPAUSAL SYMPTOMS, INSOMNIA, AND DEPRESSION IN PERI- AND POSTMENOPAUSAL WOMEN:

The severity of the 3 types of menopausal symptoms, as assessed by the Greene Climacteric Scale, correlated positively with each other in both the perimenopausal and postmenopausal groups. The more severe one type of menopausal symptom was, the more severe the other types were on average. In the perimenopausal group, the Pearson correlation coefficients were r=0.553 (P<0.001) between psychological and somatic symptoms, r=0.381 (P<0.001) between psychological and vasomotor symptoms, and r=0.316 (P<0.001) between somatic and vasomotor symptoms. In the postmenopausal group, the coefficients were r=0.669 (P<0.001) between psychological and somatic symptoms, r=0.436 (P<0.001) between psychological and vasomotor symptoms, and r=0.494 (P<0.001) between somatic and vasomotor symptoms.

The severity of depression according to the Beck Depression Inventory correlated positively with the severity of psychological and somatic menopausal symptoms both in the peri- and postmenopausal groups. Higher severity of psychological and somatic menopausal symptoms was associated with higher severity of depression on average. In the perimenopausal group, the Pearson correlation coefficients were r=0.561 (P<0.001) between psychological symptoms and depression, and r=0.274 (P<0.001) between somatic symptoms and depression. In the postmenopausal group, the coefficients were r=0.621 (P<0.001) between psychological symptoms and depression, and r=0.387 (P<0.001) between somatic symptoms and depression. No significant correlation was found between the severity of depression and the severity of vasomotor symptoms in either group (r=0.149, P=0.079 for the perimenopausal group and r=0.159, P=0.055 for the postmenopausal group).

We found a positive correlation between the severity of depression, as measured by the Beck Depression Inventory, and the severity of insomnia, as measured by the Athens Insomnia Scale, in both the perimenopausal and postmenopausal groups (r=0.611, P<0.001, and r=0.515, P<0.001, respectively). Higher severity of depression was associated with higher severity of insomnia on average.

QOL IN PERI- AND POSTMENOPAUSAL WOMEN:

Table 5 presents the assessment of QoL in the study population according to the WHO Quality of Life–BREF questionnaire. This questionnaire assesses overall QoL (Figure 4A) and general health (Figure 4B) as well as 4 domains of QoL: physical health, psychological health, social relationships, and environment. The 4 domains were assessed with an arithmetic mean between 3 and 4, indicating “neither poor nor good” to “good” for both the peri- and postmenopausal groups (Figure 5).

Out of the 4 domains of QoL – physical health, psychological health, social relationships, and environment – the best scores were for physical health, and the lowest scores were for psychological health in both the peri-and postmenopausal groups.

The postmenopausal group reported overall significantly lower QoL, physical health, and social relationships, compared with that of the perimenopausal group. Assessments of general health, psychological health, and environment did not differ significantly between the peri- and postmenopausal groups (P>0.05).

The assessment of overall QoL and general health, as well as the 4 domains of physical health, psychological health, social relationships, and environment, correlated positively with each other, both in the peri- and postmenopausal groups. The higher the assessment of one domain among women, the higher the average evaluation of all other domains (r>0, P<0.05).

We also compared the QoL between women with a university degree and those with lower education, between women living in villages and those in urban areas (both cities and towns), between married women and single women (never married, divorced, widowed, or separated), which was analyzed separately in the peri- and postmenopausal groups. QoL did not differ significantly between women in rural and urban areas (P>0.05) in either the peri- or postmenopausal groups. Perimenopausal women with a university degree reported significantly higher psychological health and environment scores than those with lower education (psychological health: 3.2±0.4 vs 3.0±0.5, P=0.021; environment: 3.5±0.5 vs 3.3±0.4, P=0.025). These differences were not observed in the postmenopausal group.

Married perimenopausal women rated their social relationships significantly higher than those living alone (3.8±0.6 vs 3.4±0.7, P<0.001). In the postmenopausal group, married women assessed their physical and psychological health, as well as social relationships, significantly higher than those living alone (physical health: 3.8±0.5 vs 3.5±0.7, P=0.034; psychological health: 3.1±0.5 vs 2.9±0.5, P=0.014; social relationships: 3.6±0.6 vs 3.0±0.7, P<0.001).

CORRELATIONS BETWEEN MENOPAUSAL SYMPTOMS AND QOL IN PERI- AND POSTMENOPAUSAL WOMEN:

Table 5 and Figure 6 present correlations between the severity of menopausal symptoms and the assessment of overall QoL and general health, as well as the 4 domains of physical health, psychological health, social relationships, and environment. The severity of psychological menopausal symptoms correlated negatively with the assessment of all 4 domains of QoL, both in the peri- and postmenopausal groups (r<0, P<0.05). Higher severity of psychological menopausal symptoms was associated with lower self-reported QoL on average.

The severity of somatic menopausal symptoms correlated negatively with the assessment of all of the domains of QoL except for psychological health in the perimenopausal group and overall QoL and social relationships in the postmenopausal group. The severity of vasomotor menopausal symptoms correlated negatively with the assessment of general health, physical health, social relationships, and environment in the perimenopausal group, while only with physical health in the postmenopausal group.

CORRELATIONS BETWEEN INSOMNIA AND QOL IN PERI- AND POSTMENOPAUSAL WOMEN:

Table 6 and Figure 7 present correlations between the severity of insomnia and the assessment of overall QoL and general health, as well as the 4 domains: physical health, psychological health, social relationships, and environment. The severity of insomnia correlated negatively with the assessment of all 4 domains of QoL, both in the peri- and postmenopausal groups (r<0, P<0.05). On average, higher severity of insomnia was associated with lower self-reported QoL.

CORRELATIONS BETWEEN DEPRESSION AND QOL IN PERI- AND POSTMENOPAUSAL WOMEN:

Table 7 and Figure 8 present correlations between the severity of depression and the assessment of overall QoL and general health, as well as the 4 domains: physical health, psychological health, social relationships, and environment. The severity of depression correlated negatively with the assessment of all 4 domains of QoL, both in the peri- and postmenopausal groups (r<0, P<0.05). On average, higher severity of depression was associated with lower self-reported QoL.

Discussion

In the present study, menopausal symptoms, analyzed in a group of Polish women aged 45 to 60 years, were associated with lower QoL. Higher severity of psychological and vasomotor symptoms was observed in postmenopausal women than in perimenopausal women, whereas somatic (physical) symptoms did not differ between the 2 groups. In the analyzed population, both insomnia and depression were significant, interrelated problems in the peri- and postmenopausal groups. Insomnia affected 49% of perimenopausal women (29% mild, 15% moderate, and 5% severe) and 60% of postmenopausal women (28% mild, 26% moderate, and 5% severe). Thus, the same percentage (5%) of perimenopausal and postmenopausal participants experienced severe insomnia. Athens Insomnia Scale scores did not differ significantly between the 2 groups (mean 6.4 in the perimenopausal group vs 7.2 in the postmenopausal group). Similarly, the distribution of mild, moderate, and severe depression and the mean Beck Depression Inventory scores were comparable between the peri- and postmenopausal groups.

The lack of significant differences in the severity of insomnia between peri- and postmenopausal groups that we observed in our study is consistent with other data [24,25]. The results of meta-analysis on sleep disorders in menopausal women, based on a large number of cases (from 41 studies), demonstrate that insomnia occurred in almost the same percentage of peri- and postmenopausal women (37.6% vs 37.4%, respectively) [25].

On the other hand, sleep problems (such as difficulty falling asleep and frequent wakening) and depression are common and impactful during menopausal transition [26,27]. Sleep duration below or above normal (approximately 7.5 hours) significantly increases depression risk; the perimenopausal stage is consistently identified as the highest risk for new-onset depressive syndrome worldwide [6].

In our study group, depression scores did not significantly differ between the peri- and postmenopausal groups (9.0 vs 10.5, respectively). Similarly, the postmenopausal group did not have a higher risk of depression than the premenopausal group when a pooled analysis was made in a recent meta-analysis [28]. In contrast, this meta-analysis found a significantly higher risk of depression symptoms and diagnoses in perimenopausal women, compared with premenopausal women (OR=1.40). Our previously published data reported higher depressive symptoms in postmenopausal participants living in rural areas compared with those in urban areas, and the severity of depressive symptoms correlated negatively with age in urban postmenopausal participants, but not in rural participants [29].

Psychological symptoms, as well as insomnia and depression, showed negative correlations with all domains of QoL in both the peri- and postmenopausal groups. In general, the more severe the symptoms, the lower the women rated their QoL. However, somatic and vasomotor symptoms showed domain-specific patterns that differed slightly between the peri- and postmenopausal groups. However, these findings should be interpreted with caution. The analyzed symptoms are known to be highly intercorrelated and may be mutually reinforcing rather than operating as independent predictors of QoL. The observed associations likely reflect complex, bidirectional relationships among symptom domains rather than distinct, isolated effects.

Data from other studies showed that psychological symptoms (depression, anxiety), vasomotor symptoms (hot flushes, night sweats), and joint and muscle pains consistently worsen QoL during menopause [30,31]. This effect was observed regardless of the women’s country of origin. There is also data showing no difference in QoL between peri- and postmenopausal women, as well as a lack of, or a weak effect of, sociodemographic variables on QoL.

Consistent with our results, AlDughaither et al [32] demonstrated that mean somatic subscale scores did not differ between pre-, peri-, and postmenopausal women. However, the authors used different scales to measure these symptoms, such as the Menopausal Rating Scale instead of the Green Climacteric Scale, which was used in our study. These tools measure menopausal symptom burden in similar ways, but due to differences in item content, domains, and scaling, they should be treated separately and compared qualitatively. In addition, the authors observed that the mean total QoL score and subscale scores for psychological and urogenital factors did not differ among the groups of women [32]. In their Saudi Arabian study group, smoking status had no effect on QoL scores. The authors also demonstrated that exercising fewer than 3 times per week or greater than 5 times per week was associated with improved QoL scores compared with exercising 3 to 5 times per week; however, the differences were not significant [32]. In the study by Ozkan et al [33], there was no difference in physical, psychological, social relationships, and environmental QoL scores between pre- and postmenopausal women. In postmenopausal women, the authors also did not observe an effect of hormone replacement therapy on QoL between groups [33].

QoL scores in the present study were rated from “neither poor nor good” to “good”, with physical health being highest and psychological well-being being the lowest. Recent data showed that almost 25% of menopausal working women had a low QoL, and there was a significant positive correlation between menopausal symptoms and QoL (r=0.71) [34]. Self-efficacy moderates the relationship between the severity of menopausal symptoms and life satisfaction in menopausal women. At low levels of self-efficacy, increased symptom severity is associated with reduced life satisfaction, whereas at moderate and high levels of self-efficacy, symptom severity does not affect life satisfaction [35]. The 2013 US National Health and Wellness Survey found that women with menopausal symptoms had significantly lower health-related QoL and higher work impairment and healthcare use [36]. Depression, anxiety, and joint stiffness had the most potent effects on health outcomes [36]. Workplace studies show menopausal symptoms impair productivity and confidence, with more severe symptoms linked to greater work impairment. In a cross-sectional survey of hospital workers, menopausal symptoms, such as fatigue, poor concentration, and memory problems, significantly reduced work performance and attendance, with severity correlating to worse work outcomes [37]. There are also well-documented links between declining health-related QoL and psychosocial deficits, especially in women with untreated depression or sleep disorders [38,39]. Women with a history of depression and anxiety show markedly lower health-related QoL during midlife, partly explained by sleep disturbance and menopause-related symptoms [38]. In a study by Lucena et al [39], based on groups of women with and without insomnia symptoms, they were associated with higher levels of fatigue, anxiety, and depression. The women with insomnia symptoms also reported a lower perceived QoL, regardless of the season [39]. Given these data, social and family support appear important for improving women’s QoL. A study by Wang et al [40] indicated that psychological stress in women during menopausal transition may be influenced jointly by mental resilience and family support. When these 2 parameters were in agreement, the combined effect on psychological stress in women during menopausal transition had a negative correlation. On the other hand, when mental resilience and family support were in disagreement, psychological stress increased [40].

The present study has certain limitations. Most notably, it was conducted as a cross-sectional rather than a longitudinal analysis, and due to this design, the observed associations cannot establish causal relationships between menopausal symptoms, depression, insomnia, and QoL. The study was conducted at a single center; therefore, the results cannot be generalized broadly to diverse populations or settings. This aspect also affects the risk of selection bias, due to a narrower patient pool and smaller sample size. Multicenter studies would address this issue by recruiting a larger number of participants from different locations to ensure stronger external validity. In addition, the psychological scales used in the study share overlapping items, which can increase the values of correlation coefficients. Also, the study did not include women younger or older than those in the perimenopausal and postmenopausal periods; therefore, it was not possible to demonstrate a correlation between QoL and menopausal problems with age. Additional limitations include the cultural specificity of the measurement tools and potential biases resulting from handling missing data. Addressing these issues in future longitudinal and multicenter studies will improve the validity and practical significance of the findings.

Despite these limitations, our study may have value for future research and public health initiatives. Identifying factors that reduce the QoL of women in menopausal transition may be helpful in developing effective strategies to support their long-term well-being.

Conclusions

Postmenopausal women assessed their overall QoL, physical health, and social relationships lower than did perimenopausal women. However, these 2 groups of women did not differ significantly in their assessments of general and psychological health, or of their environment. The assessment of QoL did not correlate with place of residence, whereas lower levels of education and single marital status were associated with a lower QoL evaluation.

A substantial association between menopausal symptoms, depression, insomnia, and reduced QoL may negatively affect daily functioning. This highlights the need for integrative screening and management strategies in peri- and postmenopausal populations, as well as the benefit of multidisciplinary support within healthcare and workplace settings. However, the findings are not directly translatable into clinical decision-making.