Menopausal symptom severity, perceived stress, and autonomic stress response: insights from the cross-sectional Frauenherzen study

Objectives Menopause marks a major life transition. Menopausal symptoms may act as stressors, while stress may exacerbate symptom burden. This study examined the associations between menopausal symptom severity and both perceived and autonomic stress, and evaluated whether stress levels differed across reproductive stages among midlife women. Study design This cross-sectional study included 253 apparently healthy women aged 40–68 years ( M = 52.14, SD = 6.84) recruited in Switzerland. Autonomic stress was measured continuously over seven days using a wearable device (a smartwatch that captured physiological data). Main outcome measures Menopausal symptoms were assessed using the Menopause Rating Scale II, perceived stress was assessed with the Perceived Stress Scale 10, and a wearable-derived stress score was calculated using an algorithm based on heart rate variability that reflects autonomic nervous system activity. Results Pearson correlations revealed a significant positive association between menopausal symptom severity and perceived stress ( r = 0.42, p < 0.001), with the strongest association observed for psychological symptoms. No significant association was found between symptom severity and the wearable-derived stress score. Analyses of covariance showed that perceived stress and wearable-derived stress scores did not differ significantly across reproductive stages. Conclusions Perceived stress was associated with menopausal symptom severity, whereas stress levels did not differ significantly across reproductive stages. Interventions focusing on symptom management and coping strategies may be helpful to support women in relation to perceived stress and quality of life during menopause.