The soon-to-be-published research, presented at the Menopause Society Conference in Philadelphia on Sept. 28, found that caregiving for 15 or more hours a week—often for both an older parent or spouse and younger children— significantly increases the odds of having more intense physical, psychological, or urogenital symptoms (such as burning and irritation) compared with non-caregivers.

Caregiving burden and stress

About one in five adults 18 or older say they’re currently caring for an ill or disabled family member, according to AARP. Across the United States, about six in 10 caregivers are female, at an average age of 49.4. That’s prime time for perimenopause symptoms, says lead study author Dr. Mariam Saadedine, a postdoctoral fellow at the Mayo Clinic Women’s Health Center in Jacksonville, Florida. However, this is the first study of its kind to directly identify an association between caregiving hours and menopause symptom burden.

With the expected increase in the demand for caregiving on midlife women as the population ages, there is a critical need to improve menopause care and to provide support for women in this transition, according to Saadedine.

“We thought there would be a connection between these two, but that it wouldn’t be as strong once we factored in things like stress, socioeconomics, and mental health. To our surprise, there was still a strong association,” Saadedine says. 

Caregiving is not part of what’s known as social determinants of health—factors like race, education, and income—but it clearly plays a role when it comes to the health of midlife women experiencing menopausal symptoms.

How the study was conducted

Data was collected through the Hormones and ExpeRiences of Aging (HERA) study, which used questionnaires from 4,295 women aged 45–60, who were receiving primary care at one of four Mayo Clinic locations between March and June 2021. Participants were asked about caregiving status, their care recipients and conditions, time spent providing care, and their daily stress levels. Among those who responded, 19.7% were currently caring for an older, ill, or disabled family member. Most caregivers were white (96.6%), partnered (77.9%), educated (93.5% with at least some college), and employed (91.6%).

Menopause symptoms were evaluated using the Menopause Rating Scale (MRS) which includes 11 items, including physical, psychological, and urogenital issues. Each item was scored for severity. Scores of eight or higher for physical and psychological, and six or higher for urogenital symptoms, were considered moderate or greater.

More caregiving, worse symptoms

Nearly two in five women (37.6%) reported moderate or greater physical, psychological, and/or urogenital symptoms. Among this group, the intensity or frequency of symptoms worsened as the number of caregiving hours increased.

Many women are happily providing caregiving for their beloved ones, even if it’s long hours, according to Saadedine: “On the other hand, sometimes you’re giving care for a few hours a week and you perceive this as a huge burden.”

As expected, daily stress levels were strong predictors of worse menopause systems. However, after adjusting for all these factors, “our theory is that caregiving might actually act as its own independent predictor of more severe menopause symptoms,” Saadedine says.

The demand for family caregivers is only expected to grow, according to the U.S. Centers for Disease Control and Prevention (CDC). Currently, there are seven potential family caregivers per older adult. By 2030, they estimate, there will be only four per older adult. Saadedine suggests women with menopause symptoms be assessed for potential contributing factors, including the stress brought on by caregiving, so that they can receive appropriate counseling, treatment, and support. Additionally, employers need to become more aware of the health and family needs of midlife employees, so they can provide appropriate caregiver-friendly and menopause-friendly workplace policies.

Since this study only looked at women who received care at Mayo Clinic facilities, who tended to be white and have higher incomes, “we are leaving out those who might actually have worse living conditions. Caregiving may actually be threatening the economic stability of these women,” says Saadedine.

There is a critical need for efforts to improve menopause care and to provide support for women during this time of life, researchers concluded. Additionally, they recommended that physicians treating women with menopausal symptoms ask about possible contributing factors, including the stress brought on by caregiving, so women can receive appropriate counseling, treatment, and support.