Methods
The Menopause Health Questionnaire (MHQ), a comprehensive survey of menopause-related health information, was administered to all women who presented to the Women’s Health Clinic at Mayo Clinic (Rochester, MN) for consultation on menopausal concerns.
The questionnaire, which assesses demographics, reproductive and gynecologic history, personal habits, and ratings of menopausal symptom presence and severity, is administered before the physician visit and subsequently entered into an electronic database. The MHQ data for all women aged 40 years or older who were seen for consultation on menopausal concerns between July 25, 2005 and July 25, 2011 and who provided a written informed consent form allowing their medical records to be used for research were included in this study.
Assessment of the presence and severity of menopausal symptoms by the MHQ consisted of a set of 33 questions, with each symptom rated from 1 to 4 for symptom bother (1, not at all; 2, a little bit; 3, quite a bit; 4, extremely) (Figure 1). For primary analysis, a vasomotor symptom bother score including hot flashes and night sweats was used. For secondary analysis, in addition to a total symptom score, items were grouped into five additional domains based on content: sleep (items 3 and 4), neurocognitive (items 5-15), bowel/bladder function (items 16-20), sexual function (items 21-30), and general symptoms/other (items 31-33) (Figure 1). Caffeine intake was assessed as present or absent (yes/no) with the question, "Do you consume drinks with caffeine (coffee, tea, soda drinks)?" Current tobacco use was assessed as present or absent (yes/no). Menopause status was assessed in the MHQ by self-report as premenopausal (before menopause; having regular periods), perimenopausal (with changes in periods but have not gone 12 consecutive months without a period), or postmenopausal (after menopause). Given the subjective nature of self-reporting for perimenopause status, the premenopausal and perimenopausal groups were combined for comparison with the more well-defined postmenopausal group. Data were summarized using mean (SD) for continuous variables and frequency percentages for nominal variables. For each symptom domain of the MHQ, a score was calculated as the mean response of the included items. Menopausal symptom bother scores were analyzed as continuous variables and compared between women who used caffeine and women who did not use caffeine, using two-sample t test. Analysis of covariance was used to assess whether caffeine use was associated with menopausal symptom bother after adjusting for smoking and menopause status. Although the vasomotor symptom domain was of primary interest, analyses were performed to assess associations between caffeine use and each domain score and the total score. In all cases, two-tailed P < 0.05 was considered statistically significant.
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Figure 1.
Menopausal symptom questions from the Menopause Health Questionnaire.