Present situation and analysis of factors affecting perimenopausal syndrome among clinical nurses—a cross-sectional survey
Original Article

Present situation and analysis of factors affecting perimenopausal syndrome among clinical nurses—a cross-sectional survey

Li Ding1, Li-Ling Xie2, Huixin Zhang3, Jinhua Ding1, Juan Li1, Shujun Wang1, Jiayi Mao4, Qin Zhou1

1Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; 2Department of Nursing, The First Branch of The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; 3Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; 4School of Nursing, Chongqing Medical University, Chongqing, China

Contributions: (I) Conception and design: L Ding, LL Xie; (II) Administrative support: LL Xie; (III) Provision of study materials or patients: LL Xie; (IV) Collection and assembly of data: J Ding, J Li, S Wang; (V) Data analysis and interpretation: L Ding, J Mao, H Zhang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Li-Ling Xie. Department of Nursing, The First Branch of The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Email:

Background: The quality of life of women is seriously affected by perimenopausal symptoms and related diseases. Clinical nurses often suffer from job burnout due to high pressure and intensity of work and life, which is easy to induce and aggravate perimenopausal syndrome. Nursing occupational environment varies greatly in different economic regions, but relevant studies are limited to northern cities, and are often confined to the second and third grade hospitals or a hospital in a certain region, lacking multi-center studies on hospitals of different grades. Therefore, it is necessary to understand the occurrence of perimenopausal syndrome in clinical nurses in Chongqing and its influencing factors, so as to provide reference for managers to take targeted intervention measures.

Methods: The investigation was conducted using the method of stratified random cluster sampling. A questionnaire survey was conducted among 933 clinical nurses aged from 40 to 55 in primary, secondary and tertiary hospitals. Kupperman’s total symptom score ranged from 0 to 63, while a score of ≥7 can determine the existence of perimenopausal syndrome.

Results: Among the 933 clinical nurses surveyed, 662 (70.95%) had perimenopausal syndrome, the results of the multivariate unconditional logistic regression analysis showed that The age ranges from 51 to 55 (OR =2.035, 95% CI: 1.070–3.872), the presence of chronic diseases (OR =1.659, 95% CI: 1.095–2.512), menopause (OR =1.989, 95% CI: 1.198–3.303), moderate family function impairment (OR =1.940, 95% CI: 1.356–2.776), severe family dysfunction weekly (OR =2.309, 95% CI: 1.178–4.524), never participation in sports (OR =3.328, 95% CI: 1.657–6.684) and exercising 1–5 times per week (OR =2.689, 95% CI: 1.516–4.768) were risk factors for perimenopausal syndrome in clinical nurses, basic security (OR =0.939, 95% CI: 0.887–0.994), and sufficient manpower (OR =0.915, 95% CI: 0.855–0.979) were protective factors for perimenopausal syndrome in clinical nurses.

Conclusions: The incidence of perimenopausal syndrome in clinical nurses at all levels of hospitals situated in Chongqing is relatively high. It is suggested that nursing managers should attach great importance to the physical and mental condition of this population and timely take targeted intervention measures to prevent or alleviate the occurrence and development of perimenopausal syndrome in clinical nurses.

Keywords: Clinical nurses; influencing factors; middle-aged nurses; perimenopausal syndrome

Submitted Apr 20, 2022. Accepted for publication Jul 07, 2022.

doi: 10.21037/apm-22-563


There is a trend towards an aging population, and in addition, women tend to live longer than men and develop more diseases (1). Perimenopause is defined as the permanent cessation of menstruation and a decrease in the levels of ovarian steroid hormones (i.e., estrogen and progesterone) due to the loss of ovarian follicular function (2). The perimenopausal phase generally refers to women aged between 40–55 years and indicates that women are entering a period of physiological change related to reproductive aging (3). Perimenopausal syndrome is characterized by a range of specific symptoms due to dynamic changes in sex hormones and reproductive function (4), such as hot flushes, vaginal dryness, sleep disturbances, and joint pains (5-7). It has been reported that there are approximately 167 million women in the perimenopausal phase in China at present, and that the incidence of perimenopausal syndrome is 68.1% (8). To a certain extent, the occurrence of perimenopausal syndrome is related to the population aging (9). Thus, the proportion of perimenopausal females will continue to rise as the global population ages.

It has been shown that at least 30% of menopausal women suffer from perimenopausal symptoms that are both frequent and bothersome (10). Menopausal symptoms are influenced by many factors, including psychological status, hormonal status, lifestyle, and social and psychosocial factors. Women with perimenopausal symptoms are prone to develop a variety of physiological, psychological, and societal problems that greatly affect their quality of life (11). Further, it has been shown that the occurrence and severity of perimenopausal is closely related to women’s occupation (12).

Clinical nurses, as a specific group, may experience job burnout due to their high-pressure work and life, which may aggravate their perimenopausal symptoms (13). Clinical nurses with high seniority, rich clinical experience and theoretical knowledge, and proficient skills play a leading role in hospitals. However, perimenopausal symptoms have negative effects on clinical nurses, which makes their work ability decline sharply, and increases their work pressure, which in turn may damage their physical and mental health tremendously (14-16). The physical and mental health of nurses is closely related to patient safety (11). Thus, it is necessary to attach importance to the physical and mental health of nurses. It is imperative that we identify the factors influencing perimenopausal syndrome among clinical nurses and implement effective preventive measures.

A study has analyzed the prevalence of perimenopausal symptoms in Chinese middle-aged women and identified their healthcare needs to improve their quality of life (17). However, to date, very few studies have focused on clinical nurses. In this study, we sought to investigate the prevalence and severity of perimenopausal syndrome and analyze the influencing factors among clinical nurses, and thus provide a reference for nursing managers to implement effective preventive measures. We present the following article in accordance with the SURGE reporting checklist (available at


Study design and participants

This investigation was conducted using the method of stratified random cluster sampling. A survey was administered from August to December 2020 in Chongqing, China. According to 2018 figures from the Chongqing Municipal Bureau of Health, there were 26,751 registered nurses in tertiary hospitals, secondary hospitals with 25,497 registered nurses and primary hospitals with 4,788 registered nurses. we set parameters of incidence at 50%, accuracy at 0.05, and bilateral confidence interval at 95%. Thus, the estimated sample size was 876. According to the proportion of nurses aged 40–55 in each level of hospital, 384 patients were selected from tertiary hospitals, 417 from secondary hospitals and 75 from primary hospitals. Final inclusion: A total of 933 clinical nurses, comprising 86 nurses from 1st-level hospitals, 418 from 2nd-level hospitals, and 429 from 3rd-level hospitals, aged 40–55 years, participated in this study. To be eligible to participate in the study, participants had to meet the following inclusion criteria: (I) be a clinical nurse aged 40–55 years who volunteered to complete the survey; and (II) have no history of hysterectomy or ovariectomy. Participants were excluded from the study if they met any of the following exclusion criteria: (I) had irregular menstruation or abnormal anatomical structures of the uterus and ovary; (II) were pregnant; (III) had mental or cognitive dysfunction; (IV) had communication difficulties; and/or (V) had an unstable chronic disease.

Survey tools

The general information survey

The general information survey was designed by the authors of this study. It included questions related to age, education level, marital status, nursing age, position, title, shift work, annual income, and current menstrual status.

Kupperman self-rating scale

The modified Kupperman menopausal symptoms self-rating scale (the Kupperman self-rating scale) (18) was used to diagnose and classify perimenopausal syndrome, including headaches, dizziness, heart palpitations, insomnia, hot flushes, sweating, fatigue, muscle and bone joint pain, mood swings, depression, paresthesia, formication, decreased quality of sexual life, urinary tract infection, and 13 other assessment criteria According to its severity, each symptom, was divided into the following 4 grades: none, mild, moderate, and severe based on a score of 0 to 3, respectively. A higher score indicated more severe, and the total score ranged from 0 to 63. The specific criteria of symptom degree score are: a score of ≤6 is normal, while a score of ≥7 can determine the existence of perimenopausal syndrome. According to Kupperman’s total score, the severity of symptoms was classified as follows: (I) 0–6: asymptomatic; (II) 7–15: mild; (III)16–30: moderate, and (IV) >30: severe.


The Social Support Scale (SSRS) was used to measure the 3 dimensions of individual social relations; that is, objective support, subjective support, and the utilization of support (19). The SRSS comprises 10 items and had a test-retest reliability of 0.92 and a consistency for each item of 0.89–0.94; thus, its reliability and validity were acceptable. The highest possible total score is 66, and a total score of ≤22 indicates low-level support, 23–44 indicates medium-level support, and 45–66 indicates high-level support.


The Family Care Index Survey (APGAR) was designed by Good et al. (20), and is a universal self-evaluation scale for the subjective and quantitative evaluation of one’s own family functions. The scale contains the following 5 items: adaptation, partnership, growth, affection, and resolve. They are all positive entries and contain the following 3 options: 0= almost rarely, 1= sometimes, and 2= always. A total score of 7–10 indicates good family functioning, a total score of 4–6 indicates moderate family dysfunction, and a total score of 0–3 indicates severe family dysfunction. The test-retest reliability coefficient of the survey was 0.80–0.83.

Nursing Work Environment Scale

This scale was designed by Lake (21) and contains the following 7 dimensions: career development, leadership and management, medical-nursing relationship, recognition atmosphere, professional autonomy, basic security, and sufficient manpower, with a total of 26 criteria. A Likert 6-level scoring was used to evaluate each item. The Cronbach’s α of this survey was 0.97, and the Cronbach’s α coefficient of the subscale was between 0.77 and 0.97.

Data collection

The surveys were completed by the participants online via a mobile application named “WeChat”. An IP address could only be used once to avoid repeat answers. A total of 968 surveys were collected, of which 933 were valid, with an effective rate of 96.4%.

Statistical analysis

The data were analyzed using SPSS statistical software (version 23.0). In this study, 2 independent samples tests were used for the measurement data, and the χ2 test was used for the count data for the single-factor analysis. If the data did not satisfy the χ2 test analysis condition, the Fisher exact probability method was used. Variables with a P value <0.05 in the univariate analysis were included in the multivariate logistic regression analysis, and the forward method was used to screen the variables. The outcome of logistic regression was the binary level of perimenopausal syndrome. P<0.5 means the difference is statistically significant.

Ethical approvals

The study was approved by the Ethics Committee of The First Affiliated Hospital of Chongqing Medical University (No. 2019-241) and performed in accordance with the principles of the Declaration of Helsinki (as revised in 2013). Informed consent was obtained from all the participants included in our study.


Perimenopausal syndrome status among clinical nurses

Among the 933 clinical nurses, 662 (70.95%) showed perimenopausal symptoms, and of these 439 nurses (66.31%) had mild symptoms, 208 (31.42%) had moderate symptoms, and 15 (2.27%) had severe symptoms. The incidence of each symptom is shown in Table 1.

Table 1

The occurrence of perimenopausal syndrome symptoms in clinical nurses

Symptoms Number of cases Percentage (%)
Tired 731 78.35
Mood swings 727 77.92
Insomnia 649 69.56
Headache 563 60.34
Bone and joint pain 547 58.63
Dizziness 470 50.38
Palpitations 453 48.55
Depression and suspicion 448 48.02
Urinary tract infection 437 46.84
Sensory disturbance 251 26.90
Hot flashes and sweating 244 26.15
Sexual life status 190 20.36
Formication 160 17.15

Single-factor analysis of the influencing factors

The mean and standard deviation were used to statistically describe the scores of the samples. There were statistically significant differences (P<0.05) between the symptomatic and asymptomatic patients in relation to age, education, working hours, the presence or absence of chronic diseases, spousal health, major negative events, weekly participation in sports, menopause, different levels of social support, and family care. There were also statistically significant differences between the symptomatic and asymptomatic participants in relation to the medical-care relationship, leadership and management, basic security, career development, professional autonomy, recognition atmosphere, and sufficient manpower. Thus, these factors appeared to differ between the groups (see Table 2).

Table 2

General data of the research objects and the results of the single-factor analysis of the influencing factors

Variable N Sick or not χ2/t P
No (n, %) Yes (n, %)
Age, years 15.262 <0.001
   40–50 803 252 (31.38) 551(68.62)
   51–55 130 19 (14.62) 111 (85.38)
Education 8.728 0.032
   Technical secondary school 63 9 (14.30) 54 (85.70)
   Junior college 360 109 (30.30) 251 (69.70)
   Undergraduate 502 149 (29.70) 353 (70.30)
   Master’s degree and above (including master and doctoral students) 8 4 (50.00) 4 (50.00)
Technical titles 2.750 0.601
   Primary 184 46 (25.00) 138 (75.00)
   Intermediate 551 168 (30.50) 383 (69.50)
   Advanced 198 57 (28.80) 141 (71.20)
Hospital level 0.071 0.965
   1st-level 93 26 (28.00) 67 (72.00)
   2nd-level 383 111 (29.00) 272 (71.00)
   3rd-level 457 134 (29.30) 322 (70.70)
Time of participation in work 11.987 0.002
   11–20 years 165 59 (35.80) 106 (64.20)
   21–30 years 592 178 (30.10) 414 (69.90)
   >30 years 176 34 (19.30) 142 (80.70)
Number of night shifts per month 0.840 0.840
   No 691 199 (28.80) 492 (71.20)
   <5 164 49 (29.90) 115 (70.10)
   5–9 53 14 (26.40) 39 (73.60)
   ≥10 25 9 (36.00) 16 (64.00)
Suffers from chronic disease 199 36 (18.10) 163 (81.90) 14.732 <0.001
Marital status 0.615*
   Married 826 241 (29.20) 585 (70.80)
   Unmarried 3 2 (66.70) 1 (33.30)
   Divorced 70 18 (25.70) 52 (74.30)
   Widowed 6 2 (33.30) 4 (66.70)
   Remarried 28 8 (28.60) 20 (71.40)
Spouse’s health 7.953 0.019
   Enjoys good health 714 223 (31.20) 491 (68.80)
   Suffers from chronic disease 146 29 (19.90) 117 (80.10)
   Not involved 73 19 (26.00) 54 (74.00)
Major negative event 5.203 0.023
   No 863 259 (30.00) 604 (70.00)
   Yes (mainly refers to medical disputes, house demolition, traffic accidents, the death of family members, etc.) 70 12 (17.10) 58 (82.90)
Participates in sports weekly 18.549 0.001
   Never 134 29 (21.64) 105 (78.36)
   1–6 day/week 739 211 (28.55) 528 (71.45)
   ≥6 day/week 60 31 (51.67) 29 (48.33)
Weekly drinking 0.142*
   Never 619 187 (30.20) 432 (69.80)
   <1 day/week 259 66 (25.50) 193 (74.50)
   1 day/week 35 10 (28.60) 25 (71.40)
   2–3 day/week 16 6 (37.50) 10 (62.50)
   4–6 day/week 2 0 (0.00) 2 (100.00)
   Daily 2 2 (100.00) 0 (0.00)
Menopause 22.21 <0.001
   No 730 239 (32.74) 491(67.26)
   Yes 203 32 (15.80) 171 (84.20)
Social support 22.451 <0.001
   Low level 9 2 (22.20) 7 (77.80)
   Medium level 523 120 (22.90) 403 (77.10)
   High level 401 149 (37.20) 252 (62.80)
Family care 32.059 <0.001
   Severe family dysfunction 76 12 (15.80) 64 (84.20)
   Moderate family function impairment 282 54 (19.10) 228 (80.90)
   Good family function 575 205 (35.70) 370 (64.30)
Medical-care relationship 19.24±2.73 18.40±2.80 4.140 <0.001
Leadership and management 17.68±3.94 16.67±3.81 3.648 <0.001
Basic guarantee (compensation, vacation time, benefits) 12.42±3.23 11.02±3.42 5.721 <0.001
Career development 22.24±4.42 21.05±4.51 3.701 <0.001
Professional autonomy 19.41±2.65 18.68±2.64 3.801 <0.001
Recognition atmosphere 14.79±1.96 14.3±12.04 3.379 0.001
Sufficient manpower 13.24±2.74 12.10±3.00 5.573 <0.001

The mean and standard deviation were used to statistically describe the scores of the samples. *, indicates Fisher’s exact probability method. Major negative events refer to traffic accidents or death of family members, medical disputes, etc.

Multi-factor analysis of the influencing factors

The presence or absence of perimenopausal syndrome was used as the dependent variable (0= No, 1= Yes), and the statistically significant influencing factors in the univariate analysis were used as the independent variables in the regression analysis. The standard for inclusion in the equation was 0.05, and the standard for rejection was 0.1. The independent variables were assigned in accordance with the requirements of the logistic forward stepwise regression analysis (see Table S1). The data indicated that the presence or absence of chronic diseases, menopause, family care, weekly participation in sports, basic security, and sufficient manpower were the main influencing factors of perimenopausal syndrome (see Table 3).

Table 3

Results of the multi-factor unconditional logistic regression analysis

Factors β SE Wald P value OR value 95% CI
   40–50 years old (reference)
   51–55 years old 0.711 0.328 4.694 0.030 2.035 1.070–3.872
Chronic disease
   No (reference)
   Yes 0.506 0.212 5.708 0.017 1.659 1.095–2.512
   No (reference)
   Yes 0.688 0.259 7.062 0.008 1.989 1.198–3.303
Family care
   Good family function (reference)
   Moderate family function impairment 0.663 0.183 13.134 <0.001 1.940 1.356–2.776
   Severe family dysfunction 0.837 0.343 5.943 0.015 2.309 1.178–4.524
Participates in sports weekly
   ≥6 (reference)
   Never 1.202 0.356 11.42 0.001 3.328 1.657–6.684
   1–5 0.989 0.292 11.457 0.001 2.689 1.516–4.768
Basic guarantee (compensation, vacation time, benefits) −0.063 0.029 4.669 0.031 0.939 0.887–0.994
Sufficient manpower −0.089 0.034 6.651 0.010 0.915 0.855–0.979

SE, standard error; OR, odds ratio; CI, confidence interval.


In this study, the incidence of perimenopausal syndrome among clinical nurses in Chongqing was 70.95%, which is higher than that in Beijing 37.83% (22). This may be related to the city’s economic level, hospital management mode, or work intensity. The top 5 reported symptoms were fatigue, mood swings, insomnia, headaches, and bone and joint pain. Notably, fatigue was particularly prominent, which may be related to the high intensity of clinical work, which places clinical nurses under pressure for long periods. The perimenopausal symptoms affected the majority of nurses in terms of their physical and mental health, life, and work, and to some extent, also affected the quality of nursing care and patient safety. Thus, nursing managers are encouraged to pay attention to the physical and mental health of senior nurses, especially those >40 years of age.

Studies have shown that menopause is closely related to the severity of perimenopausal syndrome (23). This is because women after menopause, estrogen deficiency will lead to a series of serious harm to the quality of life health events, Menopausal hormone therapy (MHT) is the only comprehensive solution to menopausal-related symptoms and disorders (24). However, medical staff are not aware of the long-term dangers of menopause and lack objective understanding of hormone therapy (25). In this study, we found that the risk of perimenopausal syndrome in menopausal nurses was 1.989 times that of non-menopausal nurses, which was consistent with the findings of previous study (26). Therefore, for menopausal nurses, hospitals should strengthen the publicity of knowledge related to menopause, At the same time, more training courses and seminars on menopause health care have been established to further raise the awareness of health workers to benefit from MHT.

In this study, nurses with chronic diseases had a higher risk of perimenopausal syndrome than those with non-chronic diseases (1.659 times), and chronic disease was an independent risk factor for perimenopausal syndrome. This may be due to the fact that chronic diseases generally require the long-term use of pharmaceuticals, which can lead to various complications (27), and may affect nurses’ daily work and life. Additionally, this can create economic and mental burdens, which in turn can aggravate nurses’ perimenopausal symptoms. Consequently, nursing managers should increase their focus on perimenopausal nurses with chronic diseases and implement measures to help them address any issues that may arise in routine work.

This study indicated that the more severe the degree of family dysfunction, the higher the risk of perimenopausal syndrome. Due to the irregular nature of work and work schedule of clinical nurses, there are conflicts between work and family care, and they are in a state of mental tension for a long time, so they need more support and understanding from families (28). Further, nurses may feel disappointed, or even hopeless, without their family members’ understanding, support, and encouragement. Such factors directly affect their emotions and physical condition, which can lead to severe perimenopausal symptoms. It is thus necessary for nurses’ family members to provide effective support in a timely manner, which in turn is conducive in relieving perimenopausal syndrome among middle-aged nurses.

In recent years, exercise therapy has gradually been implemented in clinical practice due to its low costs. Long-term regular physical exercise can help control the emotional disorders and physical symptoms of perimenopausal women, enhance women’s ability to resist the stress of negative events, and prevent perimenopausal syndrome to some extent (29). However, it is difficult for clinical nurses to form good exercise habits due to busy and irregular work schedules; It is suggested that perimenopausal nurses should do physical exercise every day after work as much as possible, and hospitals with conditions can establish staff activity rooms, which can help prevent the occurrence of perimenopausal syndrome. Tai Chi may be recommended as an effective and safe adjunct treatment for patients with perimenopausal syndrome (30). Therefore, Tai Chi is a very core exercise program that should be considered and applied to clinical nurses to alleviate perimenopausal symptoms.

Previous research has focused on the risk factors for perimenopausal syndrome related to the work environment, such as loud noise, frequent contact with patients’ body fluids, and frequent or occasional death at work (31). However, few studies have examined the effects of the social environment on nurses’ perimenopausal syndrome. In the present study, basic guarantees (i.e., salary, vacation time, and benefits at work) were considered protective factors. This may be because salary and benefits provide the most intuitive return for nurses’ work, ensure that their basic living needs are met, and provide a foundation for pursuing a higher quality of life. Nurses entering the perimenopausal period often have aging parents, live with many diseases and expend large sums on their children’s education. Their satisfaction with salary and benefits will directly affect the perception of their own health, albeit this is subjective (32).

Sufficient manpower can prevent or decrease the occurrence of perimenopausal syndrome. Work overload is a risk factor in nurses developing menstrual disorders, which lead to an increased risk of perimenopausal syndrome (33). Nurses’ workloads have increased due to the shortage of nurses in China, and current workloads exceed the work intensity that nurses can bear. Middle-aged nurses have decreased physical function and a lack of energy, resulting in long-term fatigue (15). Additionally, the insufficient allocation of nurses will increase the incidence of adverse nursing events (34). Middle-aged women often lead teaching or nursing teams. When an adverse event occurs, they believe that they have an inescapable responsibility, which may lead to negative feelings, such as self-blame, regret, depression, and fear, that can last for months or years (35). Some nurses can never overcome this, which places greater psychological pressure on them, thereby increasing their risk of perimenopausal syndrome. Thus, nursing managers should optimize the allocation of human resources. Additionally, increasing salaries or benefits may help enhance job wellbeing, improve job satisfaction, and reduce the occurrence of perimenopausal syndrome.


This cross-sectional survey analyzed the factors influencing perimenopausal syndrome from the following 3 aspects: (I) the work environment; (II) personal; and (III) family social support. However, variations in the influencing factors of different degrees of perimenopausal syndrome were not considered; thus, these need to be further refined in future research. As this was a cross-sectional study, recall bias and report bias could not be completely avoided, especially in relation to the approximate onset time of symptoms. However, the bias may have occurred evenly among the participants, and thus may have had little effect on the results. Additionally, some items in the survey related to personal and private issues, such as nurses’ sexual life, and participants may not have felt comfortable answering these questions. Thus, the morbidity and severity of menopausal symptoms could have been underestimated to some extent.


This study showed that the incidence of perimenopausal syndrome in clinical nurses at all levels of hospitals in Chongqing was not ideal and was affected by personal, family, and working-environment factors. Living with an illness or poor family support aggravates the occurrence of perimenopausal syndrome among middle-aged nurses. Regular exercise, basic security at work, and sufficient manpower have a direct effect on perimenopausal symptoms. Thus, nursing managers should identify and improve controllable adverse environmental factors in a timely manner to prevent perimenopausal syndrome in middle-aged nurses.


Funding: This work was supported by the In-hospital Nursing Research Fund Project of the First Affiliated Hospital of Chongqing Medical University in 2018 (grant number HLJJ2018-19), and the Technology Promotion Project of the Chongqing Health Commission (No. 2019jstg030).


Reporting Checklist: The authors have completed the SURGE reporting checklist. Available at

Data Sharing Statement: Available at

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was approved by the Ethics Committee of The First Affiliated Hospital of Chongqing Medical University (No. 2019-241) and performed in accordance with the principles of the Declaration of Helsinki (as revised in 2013). Informed consent was obtained from all the participants included in our study.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See:


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(English Language Editor: L. Huleatt)

Cite this article as: Ding L, Xie LL, Zhang H, Ding J, Li J, Wang S, Mao J, Zhou Q. Present situation and analysis of factors affecting perimenopausal syndrome among clinical nurses—a cross-sectional survey. Ann Palliat Med 2022;11(7):2432-2442. doi: 10.21037/apm-22-563

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