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PubMed2006

Age at menopause, and knowledge of and attitudes to menopause, of women in Karachi, Pakistan.

OBJECTIVES: The objectives of the study were to identify the average age at menopause in Karachi and to assess knowledge of and attitudes to the menopause among Pakistani women in different social strata. STUDY DESIGN: A population-based cross-sectional study of 960 women aged over 35 years was conducted. RESULTS: As insufficient data were available for 35 women, 925 interviews were analysed. There were 287 menopausal women, whose mean (SD) age at menopause was 47.1 (4.7) years (95% CI 46.8 to 47.6). Of these 287 women, 135 (47%) wanted their menses to continue and 235 (82%) had consulted a physician after the menopause. Of all 925 women, 58% knew the correct definition of the menopause, all had consulted a physician for various symptoms related to the menopause and 53% said that women should consult a physician premenopausally. Symptoms experienced by premenopausal women included lack of sleep (25%), fear of infertility (13%) and urinary incontinence (18%). The majority of the overall sample (52%) were sexually active. Of the sexually active women, 16% had marital problems, compared with 44% of sexually inactive women, and this difference was statistically significant (P < 0.0001). Source of knowledge about the menopause included relatives (35%), television (18%), neighbours (17%), friends (17%) and health-care providers (14%). CONCLUSIONS: Evidence-based information about the menopause should be provided for Pakistani women.

Adult↗

PubMed2001

Attitudes towards menopause in a group of women followed in a public service for menopause counseling.

This preliminary study addressed some specific attitudes towards menopause, and behavioral styles in menopausal women. The study was conducted during the period January-May 1998 at the Menopausal Service of the Magenta Hospital (Milano) in 88 women, representing almost one half of the patients followed during that period; 43 women were treated with HRT. Some traits characterizing women's life during menopause were examined, such as presence of disturbing physical symptoms, changes in interests and discovery of new interests, and feelings of loss and uselessness. We used different psychological tests in order to evaluate anxiety and depression, in particular, the STAI (State-Trait Anxiety Inventory), the SDS (Self-rating Depression Scale), and 16 cartoon-like images representing stereotypes of menopause. The answers of our subjects showed high individual variation, with negative symptoms (e.g., hot flashes, memory loss) frequently associated with positive experiences (e.g., new hobbies, new life-styles). However, even the most frequent negative symptom (memory loss) was reported only by 70%. The experience of a change represented by menopause was described both in terms of objective change (e.g., weight increase, hot flashes, memory loss), and of subjective change (e.g., character, feeling of not being attractive, new life-styles). Treatment with HRT seems to reduce the onset of hot flashes considerably. The occurrence of anxious-depressive states was comparable to that observed in other studies; it was not associated with HRT, but rather to losses (loss of desire, memory loss, insomnia). In conclusion, menopause represents a transitional moment in which physical and psychological changes are generally integrated by the persons experiencing them. In order to preserve a good quality of life in menopause, it seems relevant to check memory loss and stabilize the mood in persons who are most "at risk" of psychological disease.

Adult↗

PubMed1997

Alcohol consumption and age of maternal menopause are associated with menopause onset.

OBJECTIVES: To examine whether a number of nutritional and familial factors were associated with menopausal development. METHODS: A prospective postal survey amongst a random sample of 1227 women aged 47 to 51 who were premenopausal in a cross-sectional survey 2 years previously. Women were classed into three groups; premenopause (regular menstruation); irregular menstruation; postmenopausal (absence of menstrual cycle for at least 6 months). Proportional odds regression was used to identify those factors which were independently predictive of subsequent menopausal development. RESULTS: There was an 80% (n = 983) survey response rate. After exclusion of current HRT users (n = 178); 150 (19%) women were postmenopausal, 277 (34%) had erratic menstruation and 378 (47%) were premenopause. There were significant univariate associations between menopausal status and age (P < 0.001), age of maternal menopause (P = 0.006), alcohol consumption (P = 0.005) and social class (P = 0.03). Maternal age and alcohol consumption were significantly correlated with estradiol levels (r = 0.45, P = 0.02, and r = 0.61, P = 0.02 for maternal age and alcohol consumption, respectively). In proportional odds regression analyses, age, maternal menopausal age, alcohol consumption and smoking were independently associated with menopausal status. CONCLUSIONS: These results suggest that, (1) there is a strong familial association in menopausal age, and (2) moderate consumption of alcohol is associated with delayed menopausal development.

Age Factors↗

PubMed2006

Metabolic syndrome throughout the menopausal transition: influence of age and menopausal status.

OBJECTIVE: To assess the relationship between the main components of both the metabolic syndrome and insulin resistance and menopausal status in the menopausal transition. METHODS: A total of 124 healthy women were divided into four groups according to their menstrual status: the first group consisted of 35 women in menopausal transition with menstrual bleeding (MTM) and with cycles between 35 and 80 days; the second group was composed of 29 women in menopausal transition with 3-6 months of amenorrhea (MTA). The third group consisted of 31 postmenopausal women (PostM) and the fourth group of 29 premenopausal women (PreM) with regular cycles. The metabolic syndrome was evaluated following the ATP III criteria. Evaluation of insulin resistance was made through the HOMA, QUICKI and McAuley indices and the triglycerides/high density lipoprotein (HDL) cholesterol ratio. RESULTS: The triglycerides/HDL cholesterol ratio increased in MTM, MTA and PostM women in comparison with PreM women. A slight decrease in the QUIKI index (p = 0.06) and a decrease in the McAuley index (p < 0.001) were observed in MTM, MTA and PostM women in comparison to PreM women. The relative frequencies of metabolic syndrome in the four groups were: PreM, 0%; MTM, 20%; MTA, 21%; and PostM, 22% (p = 0.0001). The most frequent markers of the metabolic syndrome were increased waist circumference, low HDL cholesterol levels and hypertension. Linear regression between menopausal status and metabolic syndrome was lost when age was added to the model. CONCLUSIONS: The frequency of metabolic syndrome increased from the time of the menopausal transition to the postmenopause. Abdominal obesity was the most frequent feature observed. Nevertheless, aging erased the effect of the menopause on the metabolic syndrome. In order to prevent cardiovascular disease, the metabolic syndrome must be evaluated from the time of the menopausal transition.

Adult↗

PubMed2004

Current smoking at menopause rather than duration determines the onset of natural menopause.

BACKGROUND: Smoking has frequently been associated with early menopause. However, studies of this association have been inconclusive with regard to duration and intensity of smoking. A major problem in analyzing the effect of smoking duration on menopausal age is that both exposure and outcome are age-dependent. METHODS: We calculated age-specific rates for categories of smoking duration and subsequently computed the rate ratios for occurrence of menopause. We were thus able to model the effect of smoking duration on 2 time scales without assumptions of linearity. We used data from a Dutch population-based cohort comprising 5544 women age 49-70 years who had experienced natural menopause. RESULTS: The rate ratio (RR) for occurrence of menopause was increased in women who smoked in the year of menopause (RR = 1.41; 95% confidence interval = 1.32-1.50). The rate ratio of former smokers was similar to women who never smoked (0.95; 0.89-1.02). Prolonged exposure of smoking did not materially affect the risk of menopause, although the daily number of cigarettes currently smoked could increase the risk. CONCLUSION: Perimenopausal smoking is apparently more important than smoking history in explaining an earlier age of onset of menopause among women who smoke.

Aged↗

PubMed1995

The influence of demographic characteristics, menopausal status, and symptoms on women's attitudes toward menopause.

The purpose of this study was to determine the influence of demographic characteristics, including ethnicity, socioeconomic status, marital status, and number of children, as well as menopausal status, physical symptoms, and psychological symptoms on midlife women's attitudes toward menopause. A random sample of 149 women, aged 35 to 65 and stratified by occupation, age, and race, was selected from employee lists. A 20-item, 7-point semantic differential Menopause Attitude Scale was administered. Menopausal status was determined by self-report and serum hormone levels of estradiol and follicle stimulating hormone (FSH). Symptoms were assessed by a 28-item Symptom Index, the Center for Epidemiologic Studies Depression Scale (CES-D) and the Bradburn Affect Balance Scale. Overall the majority of women, regardless of ethnicity or socioeconomic status, had neutral feelings toward menopause. Postmenopausal women reported the most positive attitudes toward menopause, which may indicate that once women have gone through menopause they find it to be less troubling than they anticipated earlier in life. Negative attitudes toward menopause were related to psychological symptoms with higher scores on the depression scale, suggesting that these women may be at higher risk for a difficult midlife transition.

Adult↗

PubMed2000

Menopause and depression: a review of psychologic function and sex steroid neurobiology during the menopause(1).

The purpose of this review is threefold. The first objective is to assess from current literature the extent to which depressive symptoms may be associated with peri- and postmenopausal states. Although there have been many studies published addressing this topic, there remains much controversy as to whether there is a true positive correlation of increased depressive symptomatology with the peri- and postmenopausal periods. Second, sex steroid neurobiology will be reviewed. In recent years, improved technology has allowed for much more detail in investigations of the central mechanisms of action of the sex hormones. Ultimately, estrogen appears to play an excitatory role in the central nervous system, whereas progesterone has been shown to be inhibitory. The third objective is to determine whether sex steroids have been shown to clinically affect mood and psychologic function, and if so, how such information might relate to regimens for peri- and postmenopausal hormone replacement. Currently, only large, pharmacologic doses of estrogen have been shown to improve mood in clinically depressed patients. Estrogen has been shown to potentiate the effects of some antidepressants; therefore menopausal women with major depressive disorders may respond to lower doses of antidepressant medications when estrogen replacement is added to the treatment regimen.The psychological and physiological manifestations in depressive illnesses of the post-menopausal age period are of great complexity and not clearly understood. In view of the obscurity of the etiological factors it is important to isolate and study the effect of one such possible factor at a time.1Many symptoms and signs of various mood disturbances have been attributed to estrogen deficiency during the climacteric, yet it has been argued that there are no psychological symptoms specific to the menopause. The literature concerning psychological symptoms accompanying menopause is confusing.2Taken from studies published more than 50 years apart, these quotes describe the long-standing difficulty investigators have faced in evaluating psychologic function during the menopause. From the 1930s to the present, ongoing debate has surrounded issues of depression associated with the peri- and postmenopausal periods: whether there is an association at all and if so, what the cause might be and how might it be treated. Investigators continue to add new information to this debate, driven by the common understanding that issues relating to menopause and the postmenopausal period have become increasingly important. Not only are greater numbers of women approaching menopause, but these women are now expected to live greater than one third of their lives after menopause.3 The purpose of this review is first to assess from the literature the extent to which depressive symptoms may be associated with peri- and postmenopausal states. Second, in an attempt to explain or define causes of proposed changes in psychologic function during menopause, sex steroid neurobiology will be reviewed. The last objective is to determine from the literature whether sex steroids as used in hormone replacement therapy have been shown to clinically affect mood and psychological function and if so, how such information might relate to regimens for peri- and postmenopausal hormone replacement.

Journal Article↗

PubMed2005

Does body mass index, smoking, lipoprotein levels, surgically induced menopause, hormone replacement therapy, years since menopause, or age affect hemostasis in postmenopausal women?

BACKGROUND: Controversy still exists as to the relative importance of menopausal status and lifestyle factors for the risk of coronary heart disease in women. OBJECTIVE: The purpose of this study was to assess the influence of body mass index (BMI), smoking,lipoprotein levels, surgically induced menopause, hormone replacement therapy (HRT), years since menopause, and age on hemostasis in apparently healthy postmenopausal women. METHODS: Lipoproteins (total cholesterol [TC], low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL-C], triglycerides [TG]), and hemostatic factors (fibrinogen, von Willebrand factor antigen [vWFag], coagulation factors VIIag [FVIlag] and VIIa [FVIIa], plasminogen activator inhibitor 1 [PAI-1]) were each measured once. A forward, stepwise, multiple regression analysis was used to assess variations in hemostatic parameters. RESULTS: A group of 292 healthy Stockholm women recruited from the census register participated in the Stockholm Female Coronary Risk Study as controls. Of these women, 260 participated in the present study. BMI, smoking, lipoprotein levels, surgically induced menopause, and years since menopause (1-5 y) were found to be associated with a 31% increase in fibrinogen levels. A 7% increase in FVIIa levels was attributed to TC, BMI, and HRT. Years since menopause (1-15 y), TG, TC, BMI, and HRT were associated with an increase of up to 26% in FVIIag levels. A 9% increase in vWFag correlated with HDL-C and years since menopause (1-10, 11-14, and > or =15 y). BMI and TG explained a 21% and 3% increase, respectively, in PAI-1 levels. Neither the use of HRT nor years since menopause had any influence on hemostasis. CONCLUSION: BMI, high levels of TC and TG, and low HDL-C levels appear to be more important than hormonal status in their impact on hemostatic variables in healthy postmenopausal women.

Adult↗

PubMed2003

Morning/evening menopausal formula relieves menopausal symptoms: a pilot study.

OBJECTIVE: The purpose of the study was to determine the efficacy of a morning/evening menopause formula (morning capsule contains panax ginseng, black cohosh, soy, and green tea extracts; evening capsule contains black cohosh, soy, kava, hops, and valerian extracts) for relieving menopausal symptoms such as hot flashes and sleep disturbance. METHODS: Healthy postmenopausal women, between 45 and 65 years of age, were asked to take the menopause formula orally, one capsule of the morning formula every morning and one capsule of the evening formula every evening for 2 months. The Greene Climacteric Scale (GCS) and the Pittsburgh Sleep Quality Index (PSQI) were used to determine the efficacy. RESULTS: Morning/evening menopause formula significantly reduced the number of hot flashes. The reduction in the number of hot flashes was observed as early as at the end of the second week. At the end of the second week, the number of hot flashes was reduced by 47%. The morning/evening menopause formula also significantly reduced the GCS total and subscale scores. At the end of the eighth week, the vasomotor, anxiety, and depression scores of GCS were reduced by 50%, 56%, and 32%, respectively. Furthermore, the morning/evening menopause formula significantly reduced global PSQI score and scores in five components (sleep quality, sleep latency, sleep duration, sleep disturbance, and daytime dysfunction) by 18%-46%. CONCLUSIONS: This study suggests that the morning/evening menopausal formula is safe and effective for relieving menopausal symptoms including hot flashes and sleep disturbance.

Cimicifuga↗

PubMedDate not supplied

[Pre-menopausal simple hysterectomy and post-menopausal female bone mineral density].

This study aimed to evaluate the bone mineral density (BMD) of post-menopausal women with previous pre-menopausal hysterectomy including bilateral ovarian conservation compared to a group of non-hysterectomized women with natural menopause. Data from a cross-sectional study of 30 pre-menopausally hysterectomized women evaluated in the post-menopause were compared with 102 naturally post-menopausal women, analyzing their respective bone densitometry, measuring the femoral and lumbar spinal BMD. Multiple regression analysis of the 132 women showed that age and body mass index (BMI) were heavily associated with femoral and lumbar spinal BMD, BMI directly associated, and age inversely associated with BMD. In addition, 30 hysterectomized women were matched by age and BMI to the 30 non-hysterectomized women, and bone densitometry did not show significant differences in BMD. These findings suggest that pre-menopausal hysterectomy with bilateral ovarian conservation does not appear to cause an additional reduction in bone mass when evaluated in the post-menopausal phase.

Age Factors↗

PubMed1997

Menopause, only for women? The social construction of menopause as an exclusively female condition.

Over the last three decades the menopause has continued to interest the medical profession, the pharmaceutical industry and the mass media. Although there exist many different views on the menopause, there is one common denominator. Menopause is depicted as an exclusively female condition. The medical discourse on menopause seems to exclude men. However, a closer look at the history of the medical sciences reveals that there have been and still are, attempts to classify symptoms of ageing men as male menopause or climacterium. Despite these attempts to put men on the menopausal agenda, most attention is focused on women. How can we understand this almost exclusive focus on female bodies? Why does there exist such an emphasis on the medicalization of the third age of women rather than of men? Maybe we might be inclined to think of a male conspiracy, as has been suggested by feminists: women take the pills, while men cash the bills. We might consider the enormous profits of the pharmaceutical industry. This paper is concerned with finding an alternative explanation for the almost exclusive attention for the female menopause. Based on historical data and more recent discussions in medical journals, the paper shows that the medicalization of the female menopause and the relative silence around the male climacterium can be understood in terms of the social and cultural processes that underly the classification of health problems as specific diseases. The imbalance in medical treatment of climacteric health problems in women and men is not simply rooted in biological sex differences, but can be ascribed to men's attitudes towards health problems and organizational infrastructures of the medical institutions.

Climacteric↗

PubMed1990

Features of menopause and menopausal age in Nigerian women.

The age of menopause and the clinical features of menopause were investigated by questionnaire survey in 563 Nigerian women of Yoruba descent who have been menopausal for at least 5 years. The mean and median ages of menopause were 48.4 and 48.0 years, respectively. No relationship could be established between menopausal age and various biosocial factors such as age of menarche, social class, parity, smoking and place of residence. The commonest menopause related symptoms were joint pains and hot flush and only 42% of them still practiced sexual intercourse. These findings when compared to those from other populations indicate that there is need for more work on menopause in Nigerian women.

Age Factors↗

PubMed1986

A prospective long-term study in women from pre-menopause to post-menopause: changing profiles of gonadotrophins, oestrogens and androgens.

To permit a more detailed hormonal characterization of the peri-menopause, 30 healthy women were examined at regular intervals over a 7-yr period, starting about 3 yr before the menopause. Even though most of the subjects periodically experienced climacteric symptoms, no hormonal supplementation was given. The serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), oestradiol and oestrone that were recorded essentially confirmed previous data obtained in cross-sectional studies. Within the 6-mth period around the menopause the serum levels of testosterone and androstenedione showed small but significant decreases of 18 and 16%, respectively. These decreases continued over the following years and amounted to about 30% after 3 yr. In contrast, neither the mean level of dehydroepiandrosterone (DHA) nor the DHA/DHA sulphate (DHAS) ratio changed significantly at the menopause, but DHA and DHAS concentrations declined slowly by about 20% over the 7-yr observation period. The mean level of DHAS showed an isolated increase during the last few months before the menopause. A similar, although not significant, increase was also seen in DHA and testosterone levels. After the first post-menopausal year a significant positive correlation was found between the levels of oestrone and androstenedione. This longitudinal study of individual women appeared to lend itself well to the investigation of even subtle hormonal fluctuations during the gradual transition to an established post-menopausal pattern.

Androstenedione↗

PubMed1986

Effect of progesterone injection on progesterone receptor levels and distribution in untreated and short-term Premarin-primed pre-menopausal and post-menopausal endometrium.

Cytosolic and nuclear progesterone receptors (RPC, RPN) were measured in post-menopausal endometria, using [3H]R5020 as the radioligand, and the findings compared with those in pre-menopausal endometria. Total RP levels (RPC + RPN) in post-menopausal endometria were low, i.e. less than 2000 fmol/mg DNA. A 7-11 day course of Premarin (conjugated equine oestrogen) treatment in post-menopausal subjects resulted in RP levels in 11818 +/- 3008 fmol/mg DNA, which were higher than those in proliferative, mid-cycle and Premarin-primed pre-menopausal endometria. Progesterone injection 1-3 h before tissue collection resulted in a change in the distribution of the RP in both premenopausal and post-menopausal Premarin-primed endometria and pre-menopausal proliferative and mid-cycle endometria. Following the progesterone injection RPN levels increased to 57 +/- 9% of the total as compared with 23 +/- 8% in endometrial samples from women who received no progesterone.

Adult↗

PubMed1987

Evaluation of erythrocyte deformability in pre-menopausal and post-menopausal women.

Whole blood filterability expressed as volume of red blood cells filtered per minute (VRBC) was evaluated in 10 pre-menopausal and 10 post-menopausal women. In addition, blood concentrations of total and high-density lipoprotein (HDL), cholesterol, triglycerides, uric acid, fasting glucose and fibrinogen were measured and correlated with VRBC values. Whole blood filterability was significantly lower in the post-menopausal than in the pre-menopausal women. All the other parameters examined were higher after the menopause, except for HDL-cholesterol levels, which were found to be lower. The VRBC values correlated strongly with fibrinogen, triglyceride and HDL concentrations. These findings indicate that the higher plasma fibrinogen and triglyceride concentrations and the lower HDL-cholesterol levels observed in women after the menopause might be associated with haemorrheological changes. These might be partly responsible for the increased incidence of cardiovascular diseases in post-menopausal women.

Adult↗

PubMed2003

Associations with menopause and menopausal transition in a nationally representative US sample.

OBJECTIVES: The purpose of this study was to assess sociodemographic and behavioral factors in relation to menopausal status in a representative sample of the United States population. METHODS: Data were taken from the 1999 National Health Interview Survey (NHIS), limited to women aged 40-54 years who had not undergone surgical menopause. Menopausal transition was defined as absence of menstrual cycles for at least 3 but no more than 11 months or cycles that had become irregular in the past 12 months. Postmenopause was defined as absence of a menstrual cycle for 12 or more months. We used age-adjusted three-level logistic regression to examine the association between menopausal status and smoking, race/ethnicity, education, body mass index, exercise, and alcohol use. RESULTS: Twenty percent of women in this sample had experienced natural menopause, 18% were in the menopausal transition and 61% were premenopausal. Using premenopause as the reference group, current cigarette smoking was strongly associated with being postmenopausal (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.7, 3.0) and weakly associated with being in the menopausal transition (OR 1.4, 95% CI 1.1, 1.8). Education level was associated with being postmenopausal (OR 0.4, 95% CI 0.3, 0.6 comparing women with a college degree to women who had not completed high school), and alcohol use was weakly associated with being postmenopausal, with no evidence of a dose-response. CONCLUSIONS: The associations with smoking were stronger for postmenopause than for the transition phase, suggesting that the effect of smoking may be to shorten the transition period. Education level may be a marker for other exposures that affect ovarian senescence.

Adult↗

PubMed2005

Inhibin A and B as markers of menopause: a five-year prospective longitudinal study of hormonal changes during the menopausal transition.

OBJECTIVES: A more direct and precise hormonal marker of the menopause has been required for some time. The aim of this study was to identify the most accurate marker of the menopause, based on analyses of inhibin A and B, FSH, LH and estradiol (E(2)), among 59 healthy women without hormonal treatment during the perimenopause and early postmenopause. METHODS: Fifty-nine women, aged 46-56 years (mean age 51.2 years), were examined annually for 5 years during the menopausal transition and had venous blood drawn simultaneously for later analyses of the above-mentioned hormones. RESULTS: Inhibin A showed a steady decline from at least 4 years before the final menstrual period (FMP) until 1 year before menopause, whereas inhibin B had a shorter lasting decline from year 3 to year 2 before menopause, concomitant with a rise in FSH and LH. CONCLUSION: The present study confirmed previous observations that inhibin A had a continuous decline starting before the decline of inhibin B, suggesting that an increasing part of the cycle was anovulatory. The fall in inhibin B and the increase in FSH constitute markers of ovarian aging. One year prior to menopause neither inhibin A nor inhibin B could be detected. The disappearance of these peptide hormones is an important predictor of the approaching menopause.

Biomarkers↗

PubMed2003

Determinants of body mass index in women around menopause attending menopause clinics in Italy.

OBJECTIVE: To analyze determinants of body mass index (BMI, kg/m2) in women attending menopause clinics in Italy. METHODS: Eligible for the study were women attending a network of first-level outpatient menopause clinics in Italy for general counselling about the menopause or treatment of menopausal symptoms. Women observed consecutively during the study period were eligible. A total of 49 122 women (mean age 54 years) entered the study. RESULTS AND CONCLUSIONS: The mean BMI increased slightly with age, being 25.8 (standard deviation, SD 4.8) in women aged < 50 years and 26.3 (SD 4.6) in those aged 57 years or more. This trend was statistically significant also after taking into account the potential confounding effect of menopausal status. The mean BMI was higher in less educated women (27.2, SD 5.1) than in those with high-school education or a university degree (25.0, SD 4.5) (p < 0.05), in non-smokers (26.4, SD 4.9) than in smokers (25.4, SD 4.5), in never-users of hormone replacement therapy (HRT) (26.3, SD 4.9) than in ever-users of HRT (25.4, SD 4.4) and in women self-reporting no physical activity (26.5, SD 4.9) than in those reporting regular physical activity (24.9, SD 4.2). The BMI was higher in women following a surgical menopause than if it was spontaneous (p < 0.05), but there was no difference between the mean BMIs of premenopausal women and those with a spontaneous menopause. Women with diabetes and hypertension had a higher BMI. There was no relation between history of osteoporosis/osteopenia and BMI.

Age Distribution↗