Associations of loneliness and social isolation with menopausal symptom burden: findings from the CLIMATERE population-based cohort.

Background

Menopausal symptoms are influenced by hormonal as well as psychosocial factors. Social isolation and loneliness are related but distinct constructs, and their specific associations with menopausal symptom burden remain unclear. We examined their associations with scores on the Greene Climacteric Scale (GCS) and severe symptomatology in women from the CLIMATERE population survey.

Methods

This cross-sectional analysis included 4124 women with an available GCS score from the nationwide web-based CLIMATERE cohort. Social isolation and loneliness were combined into four mutually exclusive categories. The GCS was analysed continuously, in sample-specific quartiles, and as severe symptom burden (GCS ≥31) using multivariable linear, proportional-odds ordinal, and binary logistic regression. Age was modelled with a restricted cubic spline; heteroscedasticity-robust standard errors were used for the linear model.

Results

The GCS median was 17 (interquartile range 12-24). In fully adjusted analyses, loneliness alone was associated with a higher continuous GCS score (B = 2.91, 95% CI 1.61 to 4.22), with greater odds of belonging to a higher GCS quartile (OR = 1.77, 95% CI 1.36 to 2.30), and with having severe symptom burden (OR = 1.68, 95% CI 1.13 to 2.50). Co-occurring loneliness and social isolation was associated with the continuous and ordinal outcomes but not significantly with GCS ≥31. Social isolation alone was inversely associated in the prespecified continuous and ordinal models, but this finding changed direction or disappeared when alternative isolation thresholds or the full isolation score were used.

Conclusion

Loneliness was consistently associated with greater menopausal symptom burden across complementary outcome definitions. The association with objective social isolation was threshold-dependent and should not be interpreted as protective.