Comparison of Symptoms Between Midlife Women in Perimenopause and Postmenopause Using Network Comparison Test.

The analysis is cross-sectional and secondary, so it cannot show that menopausal stage caused the symptom pattern or that any symptom caused another. Symptoms were self-reported retrospectively, so recall bias may affect the reported severity and relationships. Ordinal symptom severity scores were treated as continuous Gaussian data for network comparison, which may bias estimates of group differences. The study used several different symptom measures, including depression and anxiety scales and a SWAN questionnaire, which may overlap and not capture the same symptom constructs. Propensity score matching reduced the perimenopause group from 1719 to 898, and the matched groups still differed significantly in mean age (51.7 vs 52.7 years, P < .001). Betweenness centrality was unstable in the perimenopause network (Cs-coefficient 0), so centrality findings should rely mainly on strength and expected influence. Women with endocrine disorders such as polycystic ovary syndrome were not considered, and matching covariates were limited to available data, so relevant confounders may be missing.

The authors declared no potential conflicts of interest and received no financial support for the research, authorship, or publication.

Do not read the different core symptoms as proof that mood changes or anxiety caused other symptoms, or as evidence that treating them will improve menopause symptoms. The study is a cross-sectional self-report network comparison, not a treatment trial, and the overall networks were similar.