Is there a link between an extremely poor response to ovarian hyperstimulation and early ovarian failure?

BACKGROUND: It has been previously reported that a group of 12 infertile women, who had a normal baseline hormonal profile and did not respond to repeated ovarian stimulation with gonadotrophins, developed ovarian failure within a few months. Based on this observation, we carried out a controlled retrospective cohort study to examine whether non-response to ovarian stimulation is linked to early ovarian failure. METHODS: All patients aged 35-40 years who had cancelled IVF cycles for non-response between 1991 and 1993 in our centre were asked to report on the subsequent development of menopausal symptoms, menopause or commencement of hormone replacement therapy. A control group consisted of patients with the same age and similar medical history, who had IVF the same year and responded well. RESULTS: Eleven out of the 12 patients of the non-response group developed menopausal symptoms within 7 years, compared with only four out of 24 in the control group. Similarly, eight out of 12 non-responders either went into menopause or started using hormone replacement therapy compared with one out of 24 in the control group. Using Fisher's exact test, the differences were highly significant (P < 0.0001). The median age at development of menopausal symptoms in the study group was 40 years (range 38-45). The median time between non-response and development of menopausal symptoms was 4 years (range 1-7). CONCLUSION: We carried out a controlled retrospective cohort study that showed a strong association between an extremely poor response to ovarian hyperstimulation and early ovarian failure.     

Age at menopause in women with type 2 diabetes mellitus.

OBJECTIVE: Considering that chronic diseases such as diabetes mellitus (DM) may determine premature ovarian failure by various mechanisms, we studied the age at menopause in women without diabetes and in women with type 2 DM. DESIGN: We studied 409 women without diabetes and 404 patients with type 2 DM, selected from 45 to 55 years of age, for analysis with the status quo method. The age at menopause was calculated with a logistic regression on the proportions of menopausal women for each age group. RESULTS: In the groups, 172 women without diabetes and 207 women with diabetes had menopause. The regression procedure gave a median age of 49.7 +/- SD 1.7 years for the whole group, 49.6 +/- 1.6 years for the nondiabetic group, and 49.8 +/- 1.7 years for women with diabetes. Women without diabetes were 1.4 years younger, but this factor did not have an influence on the results. Smoking habits, vegetarianism, and somatometric variables were similar in both groups, except for waist/hip and abdomen/hip ratios, larger in the group of women with diabetes. The mean for years since diagnosis in patients < 45 years of age was 4.9 years. For older patients, the figure increased to 8.9 years. CONCLUSIONS: No difference for age at menopause was found between women without diabetes and women with type 2 diabetes who were 5 to 8 years since the diagnosis was made.     

Assessment of the variation in menopausal symptoms with age, education and working/non-working status in north-Indian sub population using menopause rating scale (MRS)

OBJECTIVE: To study the variation of the menopause rating scale (MRS) scores with age, working/non-working and educated/uneducated status in a cohort of north-Indian subpopulation and to look for the possible reasons for the incurred variations. MRS is a well-known and validated instrument for assessing the frequency and intensity of menopausal symptoms. METHOD: A menopause clinic was organized in collaboration with a primary care centre (under the guidance of a gynecologist). A random sample of 208 women aged 35-65 years participated in the study. The MRS scale, a self-administered standardized questionnaire was applied with additional patient related information (age at menopause, level of education, working/non-working and exercising or not). RESULTS: The results were evaluated for psychological (P), somatic (S), and urogenital (U) symptoms. The average age at which menopause set in, in the cohort was found to be 48.7+/-2.3 years (46.4-51 years). Based on the average age at the menopause, the cohort was divided into peri (35-45), menopausal/early menopause (46-51) and the postmenopausal (52-65) groups. A significantly higher % of perimenopausal women (36%) showed a P score of > or =7; while a higher % of postmenopausal showed S score and U score > or =7 (>40%; p< or =0.001). Working women seem to suffer more from psychological symptoms whereas non-working women showed a greater incidence of somatic symptoms. Educated women showed a lower incidence of psychological and somatic symptoms. CONCLUSIONS: Present study indicates that age, level of education and working/non-working status (in a group of women with same socio-cultural background) may also contribute to significant variations in menopausal symptoms.     

Increased risk of early menopausal transition and natural menopause after poor response at first IVF treatment

BACKGROUND: Our aim was to examine whether women who had a low number of retrieved oocytes at their first IVF attempt reach the menopausal transition and/or the natural menopause earlier than women of similar ages with a high number of retrieved oocytes. METHODS: We conducted a retrospective cohort study among women in The Netherlands who received IVF treatment between 1983 and 1995. For the present study, we selected all cohort members who had a regular menstrual cycle at the time of the first visit to the gynaecologist (n = 4601). After a median follow-up of 5.5 years, 3871 (84%) women still had a regular menstrual cycle pattern, 547 (12%) women had entered the menopausal transition (i.e. no menses for 3-11 months, use of HRT or irregular menstrual cycles) and 27 (1%) women had reached natural menopause. We examined whether the quantity and the quality of the retrieved oocytes were related to an early menopausal transition and early menopause. The live birth rate per embryo transfer was used as indicative of the quality of the oocytes. RESULTS: The age-adjusted odds ratio (OR) for having entered the menopausal transition/natural menopause for women with a poor response (0-3 oocytes) at their first IVF attempt was 3.1 [95% confidence interval (CI) 2.4-3.8] compared with women with a normal response (>3 oocytes). Women who were stimulated with gonadotrophins during IVF treatment but did not undergo an IVF puncture because of an anticipated poor response (cancelled IVF cycle) had an age-adjusted OR of 3.2 (95% CI 2.3-4.3). There was no significant difference in the odds of reaching the menopausal transition/natural menopause, after adjustment for age and the number or retrieved oocytes, between women who did and did not have a live birth following their first embryo transfer (OR = 1.3; 95% CI 0.95-1.7). CONCLUSIONS: These results indicate that a low remaining quantity of oocytes, as reflected by a low number of retrieved oocytes at first IVF treatment, is an important predictor of the risk of an early menopausal transition/natural menopause. The quality of the oocytes did not affect the risk of an early menopausal transition/natural menopause once the number of retrieved oocytes had been taken into account. Our findings support the concept that the number of remaining follicles in the ovaries is one of the main aspects of reproductive ageing.     

Profile of menopausal women in west Anatolian rural region sample

OBJECTIVES: The aim of this study was to evaluate age at menopause, climacteric symptoms and related factors in women living in west Anatolian rural region of Turkey. METHOD: This study included 761 menopausal women living in three rural towns. Questionnaires regarding to 10 climacteric symptoms, menopausal status, sociodemographic characteristics, parity, breastfeeding, presence of chronic illness, direct sun exposure, smoking, caffeine use and hormone replacement therapy (HRT) were filled out by face-to-face interview. Logistic regression analysis was used to assess confounding factors on the age of menopause and menopausal status. RESULTS: Mean age at menopause was 44.38+/-5.30 years. Breastfeeding more than one year, low level of direct sun exposure and mother's early age at menopause were associated with early onset of menopause. The most prevalent climacteric symptoms were urine leakage, decreased libido, lack of energy and poor memory in post-menopausal and hot flushes in peri-menopausal women. Somatic and psychological symptoms were associated with hot flushes. HRT and osteoporosis treatment usage were higher in surgical menopause group. Osteoporosis and Type 2 Diabetes Mellitus (DT) were more common in natural menopause group. No association was found with onset of menopause and smoking, excess caffeine use, BMI, marital status and presence of chronic illness. Cardiovascular risk factors such as hypertension (HT), diabetes and obesity were common in post-menopausal women. CONCLUSION: Onset of menopause in Turkish women living in rural region is earlier on average women living in western or industrialized countries. Hot flushes in peri-menopausal, and urogenital, and psychological in post-menopausal women are the most prevalent symptoms. Primary care services in rural districts should focus on cardiovascular risks of menopausal women.     

The age at menopause and associated factors at the health center area in Ankara, Turkey

OBJECTIVES: This study is performed in one health center area in Ankara, Turkey on a women population of 50-65 years in order to demonstrate menopausal status of women, age at menopause and factors related with the age at menopause. METHODS: This is a cross-sectional study which has been performed on a women population of 50-65 years. The local population was 17,153 in this area by 2001. All of the household determining forms are screened in order to detect the all of the women who were in 50-65 years group, then name and addresses of the these women's are listed. There were 1089 women aged 50-65 years who were constituting 7% of the population. After choosing the first name randomly from the list of the women, 1/3 systematic sampling method was used and, the number of the women in the sampling was 363 (95% C.I., +/-5% S.E.). The response rate among those eligible women who were contactable during the study was 99% (360/363). Data were collected by interviews through questionnaires. The questionnaire consisted of a series of questions concerning age at menopause, socioeconomic status, age at menarche, age at first pregnancy, regularity of menstrual cycles, parity, duration of breast feeding, use of OCs, BMI, smoking habit, age at menopause of the mother and the sister. Chi-square and t-test methods were used for statistical analyses. RESULTS: 4.2% of the women were in premenopause, 13.3% were in perimenopause, 72.8% were in natural menopause and 9.7% were in surgical menopause. Average age at natural menopause was 47+/-4.2 years. Education, age at menarche, smoking, age at menopause of the mother and the sister were found to be related with the age at menopause. CONCLUSIONS: Ninety-six percent of the women over age of 50 years, are at menopause or perimenopause. The results of this study suggest that, for factors of genetic and age at menarche, there are not many possibilities for the lifestyle changes that would modify age at menopause with the subsequent reduction in risk for chronic diseases, but daughters or sisters of women with an early menopause and women who smoked or less educated could be counselled with respect to family timing.     

The Kinmen women-health investigation (KIWI): a menopausal study of a population aged 40-54

OBJECTIVES: This paper aims to report the methodology of a study of a cohort of middle-aged women in Taiwan, their age at menopause, and related factors and prevalence of menopausal symptoms, and to examine the relationships between symptoms and sociodemographic variables. METHODS: An epidemiological study of neuropsychological change during the menopausal transition among Chinese women aged 40-54 years old on the islet of Kinmen. RESULTS: Of a targeted population of 2256 individuals, 1497 (66%) participated in the study. The mean age at menarche was 15.6 years and that at menopause was 48 years. The hormone use rate at the time of study was 23% in surgical menopausal women, and 9% were past users. After excluding surgical menopausal and premenopausal women, 6% reported a current use of estrogen replacement therapy and 6% were past users. The most frequently reported discomforts for those women aged >45 were troubled sleep, backaches, and joint pain. Four symptom clusters: musculoskeletal, non-specific somatic complaints, urogenital, and vasomotor, were identified. After adjustment for age, the urogenital and vasomotor symptoms were significantly associated with menopausal status. CONCLUSIONS: The age at menopause did not differ much from Western studies, but the menopausal symptoms, especially the vasomotor symptoms, were much lower in our study population. Nevertheless, vasomotor symptoms were still significantly associated with menopausal status.     

Cigarette smoking and age of menopause: a large prospective study

Objectives

One of the possible consequences of tobacco consumption is that it contributes to an earlier age of menopause, though the causal relationship is yet to be confirmed. This study aimed to examine the prospective association between smoking and earlier age of menopause in a cohort of middle age Australian women after adjustment for a number of potential confounders.

Study design

21-Year follow-up of a cohort prospective study, Brisbane, Australia.

Main outcome measures

Age of menopause measured at the 21-year follow-up. Smoking and menopausal status were assessed by self-report. Other covariates were measured prospectively in the previous follow-ups.

Results

This study is based on 3545 women who provided data on their menopausal status at the 21-year follow-up of the study, and prospective as well as concurrent data on smoking. In univariate analysis tobacco smoking during the reproductive life course, socio-economic status and gravidity were significantly associated with earlier age of menopause. In multivariate analyses women who smoked cigarettes were more likely to experience earlier menopause than non-smokers. Compared to current smokers, risk of early menopause was significantly lower in those women who quit smoking in the past.

Conclusions

The data suggest that the impact of smoking is independent of other covariates associated with both smoking and age of menopause. The findings raise the possibility that effective quit smoking interventions may lead to a later age of menopause, and reduce the risk of adverse health consequences of early menopause.     

Lifetime estrogen exposure versus age at menopause as mortality predictor

OBJECTIVES: The aim of this study was to evaluate the relation between lifetime estrogen exposure and mortality and compare this with menopausal age as exposure variable. METHODS: We studied a cohort of 1462 naturally postmenopausal women, aged 37-77 at enrollment in the Belgian Interuniversity Research on Nutrition and Health study. After a follow-up time of 10 years, 181 women had died, of whom 76 of cardiovascular causes. Logistic regression analysis was used to investigate the relations between lifetime estrogen exposure (calculated as menopausal age minus menarcheal age) and death as well as the relations between age at menopause and death. RESULTS: The risk of mortality was lower in women with a longer lifetime estrogen exposure as well as in women with higher menopausal ages. For women with a lifetime estrogen exposure of >or=40 years the odds ratio of all-cause mortality was 0.58 (95% confidence interval (CI) 0.35-0.93) compared to women who had a lifetime estrogen exposure of 相似文献   

Assignment to menopausal status and estimation of age at menopause for women with missing or invalid data--a probabilistic approach with weighting factors in a large-scale epidemiological study.

OBJECTIVE: Gynaecologic surgeries and hormone medication increasingly interfere with the concept of determining menopausal status based on self-reported data about the last menstrual period-an approach frequently applied in epidemiological studies. This analysis compared different approaches of menopausal status determination, including a probabilistic approach that was developed to reduce misclassification of menopausal status. METHODS: Interview and questionnaire data relating to hormone status from about 16,000 German women were used to determine menopausal status using different approaches: menses based, age based, self-assessment based, and a probabilistic approach. RESULTS: Applying strict menses-based criteria, 29.1% of the women were found to be with undetermined menopausal status. The probabilistic approach was applied to determine menopausal status and age at menopause for these women. The proposed approach uses the current age of the women with undetermined menopausal status, and the relative age-dependent frequencies of pre- or postmenopausal status among those with natural menopausal status to calculate weighting factors, which represent the probabilities of being pre- and postmenopausal of each woman previously undetermined. Correspondingly, the missing age at menopause was estimated with the same probabilistic approach. Applying various approaches to determine menopausal status, the ratio of pre- to postmenopausal women differed considerably, ranging from 1.03 to 1.61. In addition, considerable differences were observed with respect to the number of missing values for both menopausal status and age at menopause. CONCLUSION: The probabilistic approach allowed to estimate menopausal status and age at menopause with the advantage that all available information from the entire study population and from the individual is used.     

Menstrual cycle length preceding menopause in relation to age at menopause

Objectives: In one of the earlier hypotheses of the etiology of breast cancer (Korenman's `oestrogen window' hypothesis (1981)), it was assumed that women with a later age at menopause have a longer period with irregular cycles preceding menopause than women with an early menopause. This assumption was tested in a prospective study. Methods: Subjects were 628 women, born between 1932 and 1941, who had participated in a breast cancer screening project in Utrecht, The Netherlands (the DOM-project) in 1982–1985, and who were still menstruating at that time. The women had filled out a questionnaire and a menstrual calendar every 2 years to determine their age at menopause prospectively. The women had not used oral contraceptives or medicines for menopausal complaints and had reached natural menopause by 1992. The median of the mean menstrual cycle length per woman and the median of the standard deviation of the mean menstrual cycle length per woman were plotted against number of years prior to menopause in three categories of age at menopause (44–49; 50–54; 55–59). Results: During the 9 years prior to menopause, women with a late age at menopause have a somewhat higher mean menstrual cycle length than women with a younger age at menopause (P=0.0008). Cycle length variability in the 9 years prior to menopause is not statistically significantly different between the three categories of age at menopause (P=0.16). Conclusions: The assumption that women with a late age at menopause have a longer period with irregular cycles than women with an earlier age at menopause was not corroborated by our results.     

A research on the level of urine neopterin to see if it may provide a vital clue for a provisional diagnosis of breast cancer in menopausal women

Objectives: To search the relation between the level of neopterin in urine and breast cancer developed in menopause. Methods: In this study, urine samples were collected from randomly selected menopausal and post-menopausal women who attended hospital, and from a control group. The participants were classified into two representative sample groups and a control group; 1st group: 30 menopausal and post-menopausal women whose ages varied from 45 to 80 and who suffered from breast cancer but had no viral infections, chronic inflammatory diseases and smoking habit; 2nd group: 30 menopausal and post-menopausal women aged between 48 and 63 with no complaint of any type of tumors, viral infections or chronic inflammatory diseases and with no smoking habit; 3rd group: A control group with 20 women aged between 20 and 28, who did not take part in sexual activities yet, and had no complaint of any type of tumors, viral infections or chronic inflammatory diseases and had no smoking habit. Urinalysis was carried out for each sample in order to measure the level of neopterin. Results: The mathematical results of neopterin levels for the groups showed that group I was significantly higher than group II and III (P=0.0001); group II was significantly higher than group III (P=0.003). Conclusions: If the results of this study were not confounded by another factor, then can we deduce that this relationship can be used as a risk factor that should warrent further investigation of breast cancer during the care and treatment of menopausal women.     

Psychological distress around menopause

The authors sought to identify a subgroup of women who are likely to experience psychological distress in the period around menopause. A sample of 189 women (mean age=49.49) was selected from the general population and rated for menopausal status, menopausal symptoms, depression, anxiety, perceived control, body image, and sex role. Menopausal symptoms were not found to discriminate between pre-, peri-, and postmenopausal women. Factor analysis of the symptoms yielded a specific somatic factor that correlated with menopausal status but not with psychological variables and a nonspecific psychosomatic factor that correlated with psychological variables but not with menopausal status. This suggests that psychological distress during the menopausal transition may indicate a personal psychological or physiological vulnerability rather than a specific reaction to the menopausal events.     

The age of menopause and the menopause transition in a multiracial population: a nation-wide Singapore study

OBJECTIVE: To describe the prevalence of menopausal symptoms, define the mean age of menopause, and determine contributory factors, which influence the experience of symptoms among Singaporean women of different racial groups. DESIGN: Cross-sectional nation-wide study of a random sample of 1000 women drawn from the entire population of Singaporean female (Chinese, Malay, and Indian) citizens between 45 and 60 years of age. Face-to-face interviews using structured questionnaires were conducted. RESULTS: The response rate was 69.9%. The mean age of natural menopause was 49.0 years. This was not significantly different between the three ethnic groups. Increasing parity delayed the age of menopause (P=0.007). Muscle and joint ache was the most commonly reported symptom (52.6%). Although the prevalence of significant hot flushes in the general study population was low (3.9%), it was the most commonly reported complaint by peri-menopausal women (14.6%). Prevalence of significant hot flushes decreased with time from menopause (P=0.007) and completely disappeared beyond the fifth year of menopause. Recent unhappy events were associated with an increased risk of symptoms (P<0.001). Women of Chinese origin experienced a lower risk of menopausal symptoms when compared with other ethnic groups (P<0.05). CONCLUSION: The mean age of menopause was 49.0 years among Singaporean women. Ethnicity and recent unhappy events were two major factors, which influenced the risk of experiencing menopausal symptoms. Among the three ethnic groups studied, Chinese women were the least likely to experience disturbing menopausal symptoms. The overall prevalence of menopausal symptoms was low when compared to studies on women in western societies.     

雌激素对绝经期妇女脑电图影响的研究

目的观察雌激素对绝经期妇女脑电图的影响。方法对６２名绝经期妇女前后二次进行脑电图监测。服药组中１３名绝经期＜５年，１７名绝经期＞５年，在一年中每隔１４天服维尼尔片一次，剂量分别为２ｍｇ／次和１ｍｇ／次。３２名未服药者为对照组。结果绝经期＜５年组服用雌激素后的脑电图异常率明显低于对照组（Ｐ＜００５），但绝经期＞５年者二组脑电图的异常率无显著差异性（Ｐ＞００５）。结论本文认为在绝经初期５年内给予补充雌激素口服能够改善脑电图的异常。     

The impact of hormonal therapy for infertility on the age at menopause

Objectives: To look for possible association between past history of ovulation induction and age at menopause. Design: Women attending our postmenopausal outpatient clinic were asked to fill questionnaires with demographic data, obstetrical history (including treatment for infertility), and medical details related to menopause. Patients: The study group (n=31) consisted of women with a history of ovulation induction, and a control group (n=200) included women who did not experience such intervention. Results: The age at the final menstrual bleeding was 46.4±5 in the study group, and 50±4 for the control group (P<0.001). This difference was most prominent for women who had induction of ovulation prior to age 35 years: they entered menopause at age 43.8±5 years. Smoking had a weak effect on the age at menopause (48.5±4 for current, vs. 49.9±4 for non- or past-smokers; P<0.03). Conclusions: This retrospective and preliminary study raises the question whether hormonal manipulations and ovarian over-stimulation during fertility treatments could be a risk factor for premature menopause.     

Impact of hormone replacement therapy on the body mass and fat compositions of menopausal women: a cross-sectional study

OBJECTIVE: The purpose of the study was to compare the body mass and fat compositions of menopausal women who were taking conventional doses of hormone replacement therapy (HRT) with that of menopausal women who were not taking any hormones. DESIGN: The body fat composition of 169 healthy postmenopausal women was measured using a noninvasive handheld machine, the Electrolipograph (BioAnalogics ELG, Beaverton, OR, USA). Impedance to electrical flow in tissues is lower with increasing water content of the tissue. Information on HRT, lifestyle, diet, smoking, and alcohol was obtained from the medical record and by a telephone interview before women were invited to participate. HRT and non-HRT groups were compared. Multivariate linear regression, which included age, years since menopause, type of menopause, and use of HRT, was performed for each of the two major outcomes: body mass index (BMI) and percentage of body fat. RESULTS: Comparisons between subgroups showed a large number of significant differences reflecting differences in age since menopause, baseline BMIs, and baseline waist to hip ratios. In the regression model, however, the only factor significantly associated with lower fat and BMI was the use of HRT. Women who were taking HRT had significantly lower percentages of body fat (-4.8%; p < 0.001) and BMI (-2.6 kg/m2; p < 0.001) compared with nonusers. Age and duration and type of menopause were not significant predictors of weight and BMI in this group of postmenopausal women. CONCLUSIONS: In this study, HRT seems to be associated with a significant reduction in postmenopausal weight and fat mass gains. This may be an important mechanism by which HRT exerts its beneficial long-term effects on cardiovascular health.     

Age at menopause and prevalence of its different types in contemporary Greek women

OBJECTIVE: This study attempted to estimate the mean age at menopause and also characterize and quantify its types and frequencies in Greek women who have recently become postmenopausal. DESIGN: A retrospective analysis of hospital records was used to record the frequency of natural, spontaneous or induced premature, and delayed natural menopause; the mean age at menopause of each group; and their possible interrelationships with major events of reproductive history in 1,747 women visiting an endocrine clinic 1 to 5 years after menopause. A group of 438 postmenopausal women drawn from 4,000 cases from the nongynecological clinics of this hospital comprised the control group. RESULTS: Natural menopause was found in 1,333 (76.3%) women with a median age of 51 (95% CI, 50.8-51.2) and mean +/- SD of 48.7 +/- 3.8 years. Medically induced menopause after the age of 40 was recorded in 204 women (11.7%), spontaneous premature in 127 (7.1%), medically induced premature in 60 (3.7%), and delayed menopause in 26 (1.5%), with mean ages of 43.6 +/- 1.7, 35.1 +/- 3.3, 37.2 +/- 1.6, and 59.6 +/- 2.1 years, respectively. No significant differences in mean age at menopause or its types were noted between the two groups. Furthermore, no significant correlations among the parameters examined could be demonstrated except between smoking and age at menopause in the spontaneous premature menopause subgroup (P < 0.05). Finally, ovarian autoantibodies were found in 6.7% of the tested women with premature menopause. CONCLUSIONS: Natural menopause occurred at a mean age of 48.7 years in Greek women, who displayed an unexpectedly high prevalence of spontaneous or induced premature cessation of menstruation.     

Voice impairment and menopause

OBJECTIVE: Menopause rating scales still do not regard voice impairment as a genuine climacteric symptom, although voice changes are frequently reported. The purpose of this study was both to register and differentiate voice alterations and disorders in menopausal women. DESIGN: A total of 107 women between 37 and 71 years of age who were rated as postmenopausal according to their hormonal status answered a questionnaire on voice changes and vocal discomfort. RESULTS: Of this group, 49 women mentioned voices changes, and 35 of those women associated these changes with subjective discomfort, whereas 58 women mentioned neither voice changes nor discomfort. Sixteen of the women who mentioned voice changes and eight who did not participated in a comprehensive investigation, which included completion of the Klimax questionnaire, a head and neck examination, videostroboscopy, perceptual evaluation of voice sound, voice range profile measurements, and voice dysfunction index determination. CONCLUSIONS: Voice changes during menopause might be a common problem seen in clinical practice. Therefore, an additional systematic registration of voice impairment in future menopause rating scales should be considered if further studies confirm our findings of a high prevalence of voice complaints associated with menopause. Severe menopausal voice impairments, even without other climacteric symptoms, should be regarded as an indication for phoniatric examination.     

Comparison of patient recall of hormone therapy with physician records

OBJECTIVE: The objective of this study was to compare patient recall of menopausal hormone therapy, obtained by personal interview, with that recorded in physicians' records. DESIGN: Data were from a case-control study of women aged 55 to 64 years at diagnosis of breast cancer in Los Angeles County, CA, between 1987 and 1989. Medical record information on 1,115 women reporting hormone therapy use (652 case patients and 463 control participants) was sought from 2,734 physicians and obtained from 1,350. Physician records for an additional 126 case patients and 90 control participants not reporting hormone therapy but reporting oral contraceptive use or benign breast disease were also obtained. RESULTS: Agreement between interview and physician records was 85% (kappa=0.59) for ever/never use of estrogen and 84% (kappa=0.59) for progestogen. The correlations for months of use were 0.43 and 0.34, respectively. For both drugs participants tended to report longer use, primarily because they reported earlier starting ages. Older and unmarried women recalled more unconfirmed estrogen use, whereas naturally menopausal women were more likely to report no estrogen use when the medical record was positive. We found no evidence of preferential recall bias by case patients. CONCLUSIONS: Interviews provide a moderately reliable measure for ever use of postmenopausal estrogen and progestogen. Recalled details are less reliable and may be affected by age, type of menopause, and recall interval.