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Objective: To examine how symptoms at midlife grouped together by factor analyses in four different countries and to examine whether life changes were associated with symptom frequencies., Design: The Decisions at Menopause Study was a multisite study of women aged 45 to 55 drawn from the general population in the United States, Spain, Lebanon, and Morocco. Semistructured questionnaires collected demographic, reproductive, and lifestyle information, along with 4-week recalls of 25 symptoms. Factor analyses were performed using symptom frequency data from each country. Symptoms frequencies were examined by chi analysis in relation to job, home, and life changes. Regression scores for individual factors were examined as dependent variables in relation to menopause status and life change while controlling for demographic and reproductive variables., Results: The intercorrelation among symptoms differed in country-specific ways, eg, hot flashes grouped with vaginal dryness and sexual symptoms in Spain, with general somatic symptoms in Morocco, and did not cluster with other symptoms in the United States or Lebanon. In chi2 analyses, household change, not job change, was associated with increased symptomatology in Spain. Job change was a significant predictor of the first symptom cluster in the United States (mental symptoms) and Spain (emotional symptoms). Home change was a significant predictor of the third (mental) symptom cluster in Spain. Life change was a significant predictor of symptom clusters in Spain and Morocco., Conclusions: Cross-population comparisons demonstrate variation in symptom clusters. Regression analyses showed how the variables that predict symptom groupings (eg, job change, marital status, menopause status, or level of education) also differed in country-specific ways.

Objective: To investigate reported frequencies of menopausal symptoms among women in four countries, namely Lebanon, Morocco, Spain, and the United States, and to assess the relative role of menopause status, country of residence, and other factors in explaining differences in symptomatology., Design: Surveys of representative samples of approximately 300 women aged 45 to 55 years in each site were conducted, using an instrument that includes demographic, health, and menopausal variables, in addition to perceptions and attitudes toward menopause. Statistical and textual analyses are used to examine differentials and the factors that influence them., Results: The burden of symptoms and the frequencies of symptoms differ across sites, but hot flashes are reported everywhere by just under one half of the respondents. The most frequent symptoms are joint pain, fatigue, impatience/nervousness, sleep disturbances, memory loss, and one or more emotional symptoms. Menopause status is significantly associated with hot flashes and vasomotor symptoms and to a lesser extent with emotional and sexual symptoms. Smoking, schooling, employment, and age are also associated with the frequency of selected symptoms. Country of residence influences reported symptoms over and above other factors., Conclusions: Similarities among core symptoms and differences in the expression of symptoms were found across sites. Both biological (menopause status) and cultural (country of residence) variables influence symptomatology.