OBJECTIVE: Results of past studies of menopause and weight are inconsistent, in part because of problems in study design and analyses, such as retrospective assessment of age at menopause and failure to control for confounding factors. To address such shortcomings, we conducted multivariate analyses on longitudinal data from a large, community-based sample of initially pre- and perimenopausal women who were making the transition through menopause. DESIGN: Data were from the second phase of the Massachusetts Women's Health Study, a cohort of 418 women aged 50-60 years in 1986. We assessed the relationship between menopause transition and weight, after accounting for previous weight; age; and the behavioral factors of smoking, exercise, and annual ethanol consumption. Menopause status was defined in terms of months of amenorrhea. The association of hormone replacement therapy and weight also was examined. RESULTS: Menopause transition was not consistently associated with increased weight, and use of hormone replacement therapy was not significantly related to weight. Behavioral factors--particularly exercise and ethanol consumption--were more strongly related to weight than was menopause transition. CONCLUSIONS: These results are consistent with findings from other studies that suggest that the weight increases experienced by middle-aged women in the United States are not a result of the menopause transition.

Patterns of hormone replacement therapy (HRT) use over time and predictors of initiating or discontinuing use were examined in a longitudinal study. A cohort of 2,425 women aged 45-55 years identified from a population-based random survey in Massachusetts in 1981-1982 was followed by six telephone interviews, 9 months apart. Cohort participants were either premenopausal (66.8%) or in early perimenopause (33.2%). During the study, prevalence of use was low overall (12.3%) and was considerably higher for surgical menopause (45%) than for peri- (9.3%), natural (4.5%), or premenopause (1.5%). Predictors of HRT uptake and discontinuation (from time t - 1 to time t) were examined by repeated-measures logistic regression, stratified by surgical status. For surgical menopause, the only significant predictor of HRT uptake was recent surgery (odds ratio = 4.4; 95% confidence interval 2.73-7.22), while for nonsurgical subjects, menopausal status (primarily perimenopause), prior use of HRT, health care utilization, hot flashes, alcohol consumption, regular exercise, and leaner body mass were all significant predictors of uptake. Discontinuing HRT was inversely associated with surgical and perimenopause and positively related to prior short-term use and health care utilization. Nonsurgical HRT users had a somewhat more favorable cardiovascular risk profile than did nonusers.