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PubMed2005

Determinants of ovarian volume in pre-, menopausal transition, and post-menopausal women: a population-based study.

OBJECTIVE: To verify the association of smoking, parity, body mass index, use of oral contraceptives, and hormone therapy with ovarian volume in pre-, menopausal transition, and post-menopausal women from southern Brazil. METHODS: Cross-sectional study with 273 women aged 36-62 years, representative of the urban population of Passo Fundo, southern Brazil. Participants completed an in-home interview and had their anthropometric measurements and ultrasound exams performed at a clinical center, using a standardized method. The right and left ovaries were measured by ultrasound. Mean ovarian volume was calculated according to age, menopausal status, smoking habit, parity, body mass index (BMI), use of oral contraceptives (OC), and hormone therapy (HT). RESULTS: Ovarian volume decreased after the age of 44 years when adjusted for menopausal status and OC use (p = 0.010). The mean ovarian volume decreased with menopausal status adjusted for age (p = 0.001) and with current OC use, adjusted for age (p = 0.001). There was a positive association between ovarian volume and BMI>or=30 in every woman adjusted for menopausal status and age (p = 0.005). On the other hand, there was no association with smoking, past OC use, and HT. In a linear regression model, post-menopause, menopausal transition, age, and BMI were significantly and independently associated with ovarian volume. CONCLUSION: Ovarian volume decreases with menopausal transition and even more in post-menopause. The reduction of ovarian volume also occurred with aging and OC use. Ovarian volume, however, is positively associated with obesity. Smoking, parity, and hormone treatment do not affect ovarian volume in pre-, menopausal transition, and post-menopausal women.

Adult↗

PubMed1992

Psychologic distress during the menopausal years in women attending a menopause clinic.

OBJECTIVE: This study measures psychologic distress in women attending a menopause clinic to determine if significant differences exist between peri-menopausal and menopausal women. METHOD: Consecutive women attending a university hospital menopause clinic were administered the Brief Symptom Inventory (BSI) and a study questionnaire to determine menopausal symptoms, menstrual cycle status, and use of hormone replacement therapy (HRT). The BSI results were compared between menopausal and perimenopausal women, and to a normative sample of middle-aged women who were nonpatients. RESULTS: Two hundred and fifty-nine menopause clinic women completed the questionnaire: 113 perimenopausal and 146 menopausal women. There was significantly greater psychologic distress on the BSI among perimenopausal as compared to menopausal women on the global severity index, and each of the anxiety, hostility, somatization, depression, paranoid, and psychoticism subscales. Perimenopausal women met BSI caseness severity criteria significantly more often than did menopausal women on the global severity index, and on the subscales for depression, anxiety, and psychoticism. On the BSI, menopausal women showed results similar to those of a normative sample of nonpatient middle-aged women. CONCLUSIONS: Perimenopausal women attending menopause clinics have significantly higher levels of psychologic distress meeting case severity criteria on the BSI. Further research is warranted to define the subgroups of perimenopausal women who are at increased risk, in the hopes of developing effective interventions.

Adaptation, Psychological↗

PubMed2003

Psychosocial factors associated with perceived psychological health, perception of menopause and sexual satisfaction in menopausal women and controls.

OBJECTIVES: The study investigated factors associated with attitude towards sex-role, self-image and marital satisfaction on psychological health status, perception of menopause and sexual satisfaction in climacteric women in Ibadan, Nigeria. SUBJECTS AND METHODS: 45 female participants were randomly selected from Ibadan. The mean age was 51.42 +/- 8.05 years (range = 36 - 70 years). The mean age for the 13 non-menopausal women was 42.79 +/- 3. 91 years (range = 42 - 47 years) while the mean age for the 32 menopausal women was 5.16 +/- 6.08 years (range = 47 - 70 years). The mean age of the children of the participants was 16.05 +/- 8.09 years (range = 1 - 36 years). A questionnaire having several subsections (consisting of the psychological health status of women in the climacteric, attitude towards sex role, perception of menopause, social support, marital satisfaction, self-image and sexuality scales was used for the assessment. RESULTS: Post-Menopausal women reported better psychological health compared to the pre-menopausal women (t = 1.86, p < .05) but no significant differences in their attitude to sex role. Post menopausal women had more positive attitude to sex (t = 3.15, p < .01) and were more knowledgeable about menopause (t = 2.15, p < .03). Women with conservative/reactionary preference for traditional sex roles reported negative perception of menopause compared to those with liberal attitude toward sex role (t = 1.82, p < 0.05). Menopausal Status, Educational level and social support predicted positive attitude to sex, (F = 3.62, P < .01). Age, self-image and attitude to sex domain of the marital satisfaction scale predicted better psychological health, and marital cordiality predicted better psychological health as measured by GIIQ (R2 = 25, beta = -43, t = -2.38, P < .02). Marital satisfaction significantly predicted better sexuality, (F = 5.47, R square = 0.11, p <0.05). Sources of information on menopause included health institutions, books, doctors, and books/health workers. CONCLUSION: The study highlights the need for sensitizing menopausal Nigerian women on how to improve their self-image, marital satisfaction, and sexual satisfaction. Conventional treatment options emphasizing hormone replacement therapy, need for nutritional supplement, dietary changes, marital and sex therapy are emphasized.

Adolescent↗

PubMed2004

Elevated subclinical atherosclerosis associated with oophorectomy is related to time since menopause rather than type of menopause.

OBJECTIVE: To compare common carotid artery intima-media thickness (IMT) between women who had natural menopause with those who had surgical menopause and to correlate IMT with time since menopause. DESIGN: Cross-sectional study. SETTING: University-based research clinic. PATIENT(S): One hundred eighty-nine healthy postmenopausal women who were not on hormone therapy (HT), age 46 to 81 (n = 132, women who did not have a prior hysterectomy or oophorectomy; n = 57, women who had undergone hysterectomy with bilateral oophorectomy). INTERVENTION(S): B-mode ultrasonography of the carotid artery, standardized questionnaires, and fasting blood samples were completed to evaluate the relationship between type of menopause, time since menopause, and subclinical atherosclerosis. MAIN OUTCOME MEASURE(S): Carotid artery IMT. RESULT(S): Mean (SEM) carotid artery IMT measurements were 0.74 (0.01) mm among women experiencing natural menopause and 0.81 (0.02) mm among women having bilateral oophorectomy (P=.02). After adjusting for years since menopause, the mean IMT did not differ between the two groups (0.77 [0.01] mm among natural menopause and 0.76 [0.02] mm among bilateral oophorectomy groups). The age-adjusted carotid IMT was significantly positively associated with years since menopause (P=.02). CONCLUSION(S): Earlier menopause is associated with elevated subclinical atherosclerosis. Because they have on average far earlier menopause, women with bilateral oophorectomy have elevated subclinical atherosclerosis compared with women of similar age who had natural menopause.

Aged↗

PubMed2001

Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups.

In recent years, research on menopausal symptomalogy has focused on identifying symptom groupings experienced by women as they progress from premenopausal to postmenopausal status. However, most of these studies have been conducted among Caucasian women from western cultures. This leaves open the question of whether the findings from these studies can be extended to women of other racial/ethnic groups or cultures. Furthermore, many of the previous studies have been conducted on relatively small samples. This paper addresses the diversity of the menopause experience by comparing symptom reporting in a large cross-sectional survey of women aged 40-55 years among racial/ethnic groups of women in the United States (Caucasian, African-American, Chinese, Japanese, and Hispanic). Evaluation of the extent to which symptoms group together and consistently relate to menopausal status across these five samples provides evidence for or against a universal menopausal syndrome. The specific research questions addressed in this paper are: (1) How does the factor structure of symptoms among mid-aged women compare across racial/ethnic groups? (2) Is symptom reporting related to race/ethnicity or menopausal status? and (3) Does the relation between menopausal status and symptoms vary across racial/ethnic groups? Analyses are based on 14,906 women who participated in the multi-ethnic, multi-race, multi-site study of mid-aged women called the Study of Women's Health Across the Nation (SWAN). Study participants completed a 15-min telephone or in-person interview that contained questions on a variety of health-related topics. Items of interest for these analyses include symptoms, menstrual history (to assess menopausal status), health status, and sociodemographics. Factor analysis results showed that across all five racial/ethnic groups, two consistent factors emerged; one consisting of clearly menopausal symptoms -- hot flashes and night sweats -- and the other consisting of psychological and psychosomatic symptoms. Results of regression analyses showed racial/ethnic differences in symptom reporting, as well as differences by menopausal status. Controlling for age, education, health, and economic strain, Caucasian women reported significantly more psychosomatic symptoms than other racial/ethnic groups. African-American women reported significantly more vasomotor symptoms. Perimenopausal women, hormone users, and women who had a surgical menopause reported significantly more vasomotor symptoms. All of these groups, plus postmenopausal women, reported significantly more vasomotor symptoms than premenopausal women. The pattern of results argues against a universal menopausal syndrome consisting of a variety of vasomotor and psychological symptoms.

Black or African American↗

PubMed2004

Factors associated with total cholesterol levels in women around menopause attending menopause clinics in Italy.

OBJECTIVE: To obtain data on correlates of total cholesterol (TC) levels in women around menopause attending menopause clinics in Italy. METHODS: Since 1997, a large cross-sectional study has been conducted concerning the characteristics of women around the time of the menopause attending a network of first-level menopause out-patient clinics in Italy for general counselling about the menopause or treatment of menopausal symptoms. Women observed consecutively at the participating centers were eligible for the study. Up to March 2000, TC was measured in 23 018 cases, which are considered in this analysis. RESULTS: The adjusted mean level of TC rose with age, from 216 mg/dl in women aged < 50 years to 234 mg/dl in those aged > 57 years. Mean TC increased with body mass index (BMI, kg/m2), being 224 mg/dl in women with BMI < 24, 227 mg/dl in those with BMI 24-26 and 228 mg/dl in those with BMI > 26. Considering menopausal status, the crude mean TC level was 216 mg/dl in premenopausal women, 227 mg/dl in women reporting a surgical menopause and 229 mg/dl in women reporting a natural menopause. These differences were still present when the analysis took into account the effect of age and other potential covariates, the adjusted values being 221, 225 and 227, respectively. Similar findings emerged when we considered the distribution of study subjects according to selected levels of TC (< 210, 210-250, 251-290, < 290). For example, the odds ratio of TC 210-250 mg/dl and > 250 mg/dl vs. < 210 mg/dl was, respectively, 1.8 and 2.8 in women aged > 57 years in comparison with women aged < 50 years. The corresponding odds ratio values for women with a BMI > 26 vs. < 24, and for women in spontaneous menopause vs. premenopause, were all 1.2 (all statistically significant). CONCLUSIONS: This analysis, based on a large data set, confirms the role of overweight as a determinant of TC in postmenopausal women, and indicates the role of the menopause as a determinant of TC level in women aged 50-60 years.

Age Factors↗

PubMed2005

Differences between the pre-menopausal and post-menopausal uterine fibroid vasculature.

OBJECTIVES: To quantitatively examine differences in microvascular density between fibroid and myometrial tissue from fibroid uteri removed at hysterectomy, both before and after the menopause, and with hormone replacement therapy. METHODS: Factor VIII immunostaining of formalin fixed tissues was used to identify blood vessels, and the vessels counted by an investigator blinded to tissue type or menopausal status. RESULTS: The mean myometrial: fibroid MVD ratio was 2.38 higher in the post-menopausal group (95% CI: 0.12, 4.65, p=0.0474) than in the pre-menopausal group, with the hormone therapy (HT)-using post-menopausal group lying in between. An increase in microvascular density in the myometrium after the menopause was responsible for most of the change in ratios seen between the pre and post-menopausal pairs. There was a trend to increasing myometrial MVD with increasing number of years post-menopause. CONCLUSIONS: Myometrial microvascular density increases markedly after the menopause, while fibroid microvascular density does not alter. Thus, the difference between myometrial and fibroid vasculature becomes greater after the menopause. The implications of this for the treatment of fibroids in post-menopausal women is discussed.

Analysis of Variance↗

PubMed2004

A new statistical approach demonstrated menstrual patterns during the menopausal transition did not vary by age at menopause.

OBJECTIVE: To describe population mean, variance, and correlation of cycle length across the life span and by age at menopause and age at menarche using a new statistical approach. STUDY DESIGN AND SETTING: Data from the Tremin Trust (n=997), a prospective menstrual diary study, was analyzed. Marginal models with generalized estimating equations were used to describe changes in menstrual parameters across the reproductive life span. RESULTS: During the menopausal transition, the increase in standard deviation preceded that in mean by 2 to 6 years. Although beginning earlier in women with earlier menopause, increases in mean and variance for women with different ages at menopause were parallel. Women with later menopause had longer cycles throughout life and longer, more variable cycles during the transition. CONCLUSION: The transition from late reproductive life to early menopausal transition appears to begin in the late thirties when variability of cycle length increases. Patterns of change in menstrual function during the menopausal transition do not differ by age at menopause; thus, differences in age at menopause are likely to reflect changes in the timing and not changes in the process of ovarian senescence, at least for the normative ages of menopause.

Adolescent↗

PubMed2003

Menopausal status, hormone replacement therapy use and risk of self-reported physician-diagnosed osteoarthritis in women attending menopause clinics in Italy.

OBJECTIVE: In order to offer data on the association between menopausal status, hormone replacement therapy use and risk of self-reported physician-diagnosed osteoarthritis (OA) in women around menopause, we analyzed information collected in the framework of a large epidemiological study conducted in Italy. METHODS: Since 1997, a large cross sectional study has been conducting on the characteristics of women around menopause attending a network of first level outpatients menopause clinics in Italy for general counseling about menopause or treatment of menopausal symptoms. Eligible for the study were women consecutively observed at the participating centers. Up to March 2000, a total of 42464 women (mean age 53 years) were observed. Women were asked, using the same questionnaire, about their general characteristics and habits, and if they suffer of OA diagnosed by a physician requiring medical or surgical treatment. RESULTS: A total of 12521 women reported OA. The risk of OA increased with body mass index (BMI), the odds ratio, OR, being for BMI>or equal to 27 versus <24, 1.56 (95%CI 1.47-1.64). The risk increased with a history of osteoporosis/osteopenia (OR 1.65, 95%CI 1.57-1.74) and was lower in more educated women (OR high school/university degree vs. primary school degree 0.79, 95%CI 0.75-0.84). Considering menopausal status, women in spontaneous or surgical menopause were, at increased risk of OA (OR 1.13, 95%CI 1.07-1.21, and 1.18, 95%CI 1.08-1.28, respectively, in women in surgical and spontaneous menopause). No clear relationship, however, emerged with age at menopause. Ever hormonal replacement therapy users were at decreased risk of OA, the OR being for ever users in comparison with never 0.73 (95%CI 0.69-0.78). CONCLUSION: This analysis gives some epidemiological support to the hypothesis that estrogen deficiency may increased the risk of OA.

Body Mass Index↗

PubMed2000

Blood pressure and metabolic profile after surgical menopause: comparison with fertile and naturally-menopausal women.

In 1978 a random sample (367 men and 568 women aged 18-65 years) taken from the general population of a north-eastern Italian town was screened for cardiovascular risk; 16 years later, the women were invited to a second screening. Three groups were identified at the initial screening (fertile, naturally menopausal and surgically menopausal) and four in the longitudinal study (137 remained fertile during the whole study, 205 became naturally menopausal, 56 were ovariectomised and 127 were already going through the menopause). The protocol included a questionnaire, blood pressure (BP) measurement, and blood exams. Continuous variables were adjusted for confounders. Systolic BP, prevalence of hypertension, cholesterol, glycaemia and uricaemia were similar, whereas diastolic and triglycerides (TG) were lower in surgically-menopausal than in fertile women (P < 0.001). No significant difference in 16 years' variation from baseline was observed between the four groups, although women who remained fertile showed the smallest increases. In particular, neither systolic or diastolic BP increases differed between the women who were oophorectimised and those who remained fertile. 'Fertile status' was rejected from the logistic equation of incidence of hypertension, and 'age of menopause' was also rejected when this analysis was repeated in ovariectomised women. New coronary artery disease (angina pectoris or myocardial infarction) was observed in one ovariectomised woman, in three naturally menopausal, and in 13 already menopausal women which seemed to reflect the age trend. No new cases were observed in women who remained fertile. In conclusion, in Italian women surgical menopause, similarly to natural menopause, is devoid of any negative prognostic effect. Journal of Human Hypertension (2000) 14, 799-805

Adolescent↗

PubMed1998

Somatotropic axis and body weight in pre-menopausal and post-menopausal women: evidence for a neuroendocrine derangement, in absence of changes of insulin-like growth factor binding protein concentrations.

The altered function of the somatotropic axis observed in perimenopause may underlie the changes in body weight and fat distribution. The aim of the present study was to evaluate, in pre-menopausal and post-menopausal women with body mass index (BMI) > or = or <25, the basal plasma levels of growth hormone (GH), insulin-like growth factor (IGF)-I and -II, IGF binding protein (IGFBP)-1 and -3, and the response of GH and IGFBP-1 and -3 to GH releasing hormone (GHRH) and GHRH plus arginine tests. GH and IGF-I basal concentrations were significantly higher in pre-menopausal than in post-menopausal women, while IGF-II, IGFBP-1 and IGFBP-3 concentrations did not vary significantly. IGFBP-1, but not IGFBP-3, concentrations were higher in lean than in obese patients. Insulin concentrations were significantly higher in obese patients, while no differences were observed between pre-menopausal and post-menopausal women. In all subjects, GH concentrations increased significantly during GHRH test; pre-menopausal and lean women showed a higher response compared to post-menopausal and obese women. The GHRH plus arginine test stimulated GH response in all women, irrespective of age and BMI. IGFBP-1 and -3 concentrations did not vary in response to GHRH or GHRH plus arginine tests. The somatotropic axis undergoes modifications in post-menopausal women, apparently not involving IGFBP-1 and -3. Arginine infusion restores the response of GH to GHRH, in both post-menopausal and obese subjects. A somatostatinergic hyperactivity at the climateric period may underlie the changes both in body weight and somatotropic axis.

Arginine↗

PubMed2004

Menopause transition: Annual changes in serum hormonal patterns over the menstrual cycle in women during a nine-year period prior to menopause.

To examine the hormonal characteristics of menstrual cycles in healthy women approaching menopause, serum hormone profiles were investigated annually in this longitudinal study of 13 healthy women between 4 and 9 yr before menopause and the year of the menopause. Serum FSH, LH, estradiol, progesterone, total inhibin, inhibins A and B, and prolactin were determined in blood samples collected annually three times weekly for 4 wk beginning with the onset of menses. Menstrual bleeding diaries covering this 4- to 9-yr period were also collected allowing the prospective identification of the final menstrual period. A change in serum hormone patterns was observed in cycles approaching menopause, exemplified by an increasing number of cycles of prolonged length with a prolonged follicular phase resulting in a failure to detect a luteal phase rise in serum progesterone within the 4-wk collection period. These prolonged cycles (designated B cycles based on a previous work) were analyzed separately and compared with the remaining ovulatory (D) cycles. No B cycles were identified in any women earlier than 27 cycles from menopause. The proportion of B cycles increased as menopause approached, reaching 62% in the last 10 cycles. The proportion of D cycles decreased accordingly. The B cycles during the initial 4-wk collection period were characterized by elevated FSH, LH, FSH/inhibin A and FSH/inhibin B ratios, and longer duration, although cycle length/subject was not significantly different presumably due to the small number of B cycles. The D cycles showed no changes in hormonal profiles over the 4- to 9-yr time period. These data indicate that there is a time-related change in the character of menstrual cycles as menopause approaches, with an increasing proportion of cycles observed with prolonged follicular phases that may either be delayed ovulatory cycles or anovulatory cycles. The increase in the proportion of B cycles with elevated early follicular phase FSH levels and low inhibin/FSH ratios toward menopause provides a basis for the apparent early increase in serum FSH and decrease in serum inhibins observed previously in studies of the menopause transition based on sampling confined to the follicular phase only. The data amplify and clarify current concepts of the endocrine basis of the menopause transition.

Estradiol↗

PubMed2000

Clinical outcomes of post-operative locoregional radiotherapy in pre-menopausal and post-menopausal Chinese women with breast cancer.

BACKGROUND AND PURPOSES: Recent randomized studies from the West show that post-operative locoregional radiotherapy improves survival in lymph node (LN) positive pre-menopausal women with breast cancer but this benefit has not been established in the Chinese population. There is no published study on clinical outcomes (locoregional recurrence, survival and toxicities) of post-operative locoregional radiotherapy in Chinese women with breast cancer. MATERIALS AND METHODS: We conducted a retrospective study of 399 female Chinese patients with breast cancer who had received post-mastectomy locoregional radiotherapy in our center between 1984 and 1990. The patients were stratified according to tumor size, menopausal and LN status. We analyzed the incidence and pattern of locoregional recurrence, distant recurrence, survival rates and toxicity related to radiotherapy. RESULTS: Of the 399 patients 216 were pre-menopausal and 183 were post-menopausal. The mean age was 49.3 years (23-83). Distribution of tumor size and LN status of the two groups was similar. Median follow-up was 71.9 months. Locoregional recurrence occurred in 57 (14.3%) patients (pre-menopausal 24 (11.1%); post-menopausal 33 (18.3%) P=0.489). Recurrence was more common in LN positive patients (18.2%) than LN negative patients (9.2%). The pattern of locoregional recurrence was: chest wall 24, axilla LN 12, supraclavicular LN 10, chest plus LN 11. The distant recurrence rate was 39.6% for all patients and 75.4% for patients with locoregional recurrences. The overall 10-year survival rate for all patients was 54%. For LN positive patients the 10-year survival rate of pre-menopausal and post-menopausal women was 38 and 51%, respectively (P=0.207), and for LN negative patients the rate was 73 and 70%, respectively (P=0.603). Acute skin toxicity included redness (30.8%), dry desquamation (12.8%), and wet desquamation (6. 8%). Long-term toxicities included skin atrophy (0.3%), telangectasia (3.3%), pneumonitis (2.8%) and brachial plexus palsy (1.3%). CONCLUSIONS: In our series Chinese patients with node-positive breast cancer have a relatively high locoregional recurrence rate in spite of mastectomy and post-operative radiotherapy. Limited use of adjuvant system chemotherapy may account, at least in part, for this finding. Clinical outcomes of post-operative radiotherapy in pre-menopausal and post-menopausal breast cancer patients are similar.

Adult↗

PubMedDate not supplied

Activity of autonomic nervous system is related to body weight in pre-menopausal, but not in post-menopausal women.

This study analyzed vegetative modulation, expressed as heart rate variability (HRV) power spectral analysis, in lean and obese women at pre-menopausal or post-menopausal age to reveal possible differences in menopause-related autonomic activity in lean and obese subjects. Sedentary women (n = 40) were divided in four groups: pre-menopausal lean and obese women, post-menopausal lean and obese subjects. The HRV-power spectrum was evaluated on a 5-min long ECG recording. The absolute values of the spectrum were summed in the following frequencies: a low-frequency (0.04-0.15 Hz; LF) and high-frequency (0.15-0.40; HF) range. LF and HF were values used to estimate the sympathetic and parasympathetic activity. LF and HF values of pre-menopausal obese women are lower than values of lean women. The menopause induced a same decrease in LF and HF values in lean and obese subjects, so that no difference was found in post-menopausal groups. This experiment indicates that modifications of autonomic modulation can be included among factors related to obesity in pre-menopausal, but not post-menopausal women.

Adult↗

PubMed2005

The menopausal transition was associated in a prospective study with decreased health functioning in women who report menopausal symptoms.

OBJECTIVE: To examine change in health functioning as women progress through the menopausal transition. STUDY DESIGN AND SETTING: Prospective study of 2,489 women followed through four phases of the Whitehall II study. Health functioning was assessed with the eight subscales of the SF-36. RESULTS: Compared with peri- and postmenopausal women who did not experience menopausal symptoms, women who reported vasomotor symptoms or menopausal depression experienced large and significant declines on most scales of the SF-36. Women who reported the greatest symptom severity experienced the largest declines in functioning. For example, decline in physical functioning for perimenopausal women experiencing severe vasomotor symptoms was 3.3 (standard error SE=1.1) greater than those who experienced no vasomotor symptoms. Decline in role limitation-emotional for perimenopausal women experiencing severe menopause-associated depression was 18.4 (SE=2.3), compared with those who did not experience these symptoms. Vasomotor symptom reporting was predicted by low socioeconomic position, high body mass index, and limiting long-term illness at baseline. Menopause-associated depression was additionally predicted by smoking and depression. CONCLUSION: The menopausal transition is associated with decreased health functioning in women who report menopausal symptoms. Menopausal symptoms are strongly related to all aspects of health functioning assessed by the SF-36. Socioeconomic and behavioral risk factors for menopausal symptoms and associated declines in health functioning have been identified.

Adult↗

PubMed2005

Defining menopause status: creation of a new definition to identify the early changes of the menopausal transition.

OBJECTIVE: Several menopausal staging definitions are currently being used in ongoing studies designed to identify changes occurring during menopause. The objective of this study was to determine which definition captures the earliest hormonal changes in the menopausal transition. DESIGN: In this prospective cohort study, women aged 35 to 47 years were followed for 5 years. Women were classified as premenopausal, early transition, late transition, and postmenopausal by 2 different menopausal staging systems defined by bleeding patterns. Definitions from the Study of Women Health Across the Nation (SWAN) and Stages of Reproductive Aging Workshop (STRAW) were compared. A new menopausal staging system (PENN-5) was also developed with five groups rather than four to distinguish among women with more subtle changes in cycle length. For each staging system, a linear regression model was created comparing mean hormone values (inhibin B, FSH, LH, E2) and menopausal stages at each assessment. Race, body mass index, cycle day, smoking, and follow-up time were included in the model. RESULTS: Statistically significant differences in mean inhibin B and FSH levels, but not estradiol levels, were detected between the earliest menopausal stages of each definition. Significant differences in LH values were detected among the earliest stages of the SWAN and STRAW definitions, but not the PENN-5 definition. CONCLUSIONS: Subtle changes in menstrual cycle length reflect significant changes in inhibin B and FSH levels during the menopausal transition. Therefore, it appears that subtle changes in bleeding pattern may be helpful in identifying the earliest hormonal changes during menopausal transition.

Adult↗

PubMedDate not supplied

Menopausal transition: predicting time to menopause for women 44 years or older from simple questions on menstrual variability.

OBJECTIVE: To assess whether menstrual variability predicts time to menopause. DESIGN: Analyses drew on 326 menstruating women, aged 44 to 56, who were followed until they reached menopause or the study ended. The women provided data on their menstrual characteristics at intake. We evaluated the utility of six definitions of menstrual variability for predicting time to ascertained menopause (final menstrual period + 12 months): (1) more than 90 days since the most recent menstrual period (n = 20); (2) 60 or more days of amenorrhea during the previous year (n = 71); (3) cycle lengths that varied by 19 or more days (n = 106); (4) cycle lengths too variable to report a usual length (n = 29); (5) cycles less regular than they had been at age 40 (n = 107); and (6) change in the duration or heaviness of menstrual flow compared with age 40 (n = 255). In addition, we evaluated hot flashes or night sweats during the previous week (n = 50) and age 50 or more years (n = 60) as predictors. RESULTS: Definitions 1 to 5 predicted time to menopause; definition 6 did not. Definition 1 had the highest positive predictive value for ascertained menopause within 2 years and within 4 years; definitions 2 and 4 had low to moderate positive predictive values for ascertained menopause within 2 years but good positive predictive values for ascertained menopause within 4 years. For ascertained menopause within 2 years, definition 2 showed the best balance of sensitivity (94%) and specificity (91%). CONCLUSION: Simple questions about menstrual variability elicit information that is informative about proximity to menopause.

Adult↗

PubMedDate not supplied

Age at natural menopause and factors associated with menopause state among Puerto Rican women aged 40-59 years, living in Puerto Rico.

OBJECTIVE: The timing of menopause is associated with multiple health outcomes in female populations including all-cause mortality, heart disease, breast cancer, and osteoporosis. Although research suggests that age at menopause varies in different ethnic groups, data on age at menopause among Hispanic women are limited. DESIGN: The present cross-sectional study estimates age at natural menopause among a sample of 1,272 Puerto Rican women aged 40 to 59 years who participated in health fairs held in 22 municipalities of Puerto Rico between May 2000 and November 2001. Cox proportional hazard regression analysis was used to characterize age at natural menopause and its association with relevant covariates. RESULTS: The overall adjusted median age at natural menopause was 51.3 years. Current employment (hazard ratio = 0.75, 95% CI: 0.59-0.95) and parity of two or three children as compared with having no children or one child (hazard ratio = 0.73, 95% CI: 0.54-0.98) were associated with a later menopause. CONCLUSIONS: This study provides a robust estimate of age at menopause for Puerto Rican women, which is similar to overall estimates previously reported for US populations, but higher than estimates for other Hispanic populations. Our results confirm attributes associated with age at menopause and provide information relevant to understanding the potential chronic disease burden of Puerto Rican women as they age.

Adult↗