Vasomotor symptoms and menopause: findings from the Study of Women's Health across the Nation

Vasomotor symptoms (VMS), or hot flashes and night sweats, are often considered the cardinal symptoms of menopause. SWAN, one of the largest and most ethnically diverse longitudinal studies of the menopausal transition, has allowed unique insights into VMS. Specifically, SWAN has helped yield important information about the prevalence of, racial/ethnic differences in, risk factors for, and implications of VMS for midlife women's mental and physical health. We have reviewed the literature on VMS, emphasizing findings that have emerged from SWAN and new areas of inquiry in the area of VMS.     

Menopause health decision support for women with physical disabilities

Menopausal women with disabilities present health care providers with unique and challenging health issues. Many women with disabilities already face an ongoing struggle to promote their health and prevent secondary disabling conditions, which may be exacerbated by menopause. This article highlights some of the special health concerns of this population and to suggest ways in which a health care professional might tailor general clinical guidance to meet these women's needs.     

成都市围绝经期和绝经后妇女对激素替代治疗的认知和接受程度

目的 :调查成都市中老年妇女绝经状况和激素替代治疗 (HRT)的使用和认知状况 ,为有针对性地开展生殖健康服务提供依据。方法 :经调查表对成都市市区和郊县的190 6名 4 4岁以上妇女进行横断面研究。结果 :成都市妇女平均绝经年龄为 4 8岁 ,2 5 .4 %的妇女应用过HRT。近 1/3的妇女了解HRT。 5 0 %的妇女希望得到这方面的教育。获得信息的主要途径是医生、亲友、医学书籍和传媒。结论 :成都市中老年妇女的生殖健康知识较为贫乏 ,应将宣传教育和医学服务相结合 ,提高妇女的生活质量     

绝经后宫内节育器去留的安全性研究

自１９６０年全国推广宫内节育器（ＩＵＤ）至今己有千万妇女进入绝经期，绝经后ＩＵＤ应予取出，但因种种因素尚有相当比例绝经后妇女并未取出ＩＵＤ。作为异物的ＩＵＤ长期不取是否安全？尚未报道。本研究调查了普查对象中绝经后妇女２６５８例，其中未取ＩＵＤ者３０２例（ＩＵＤ组）和无ＩＵＤ妇女２５４例进行比较。通过病史询问和妇科检查结果提示：１．绝经后未取ＩＵＤ者平均绝经年龄为４９．７３岁，明显高于对照组（４８．９９）；子宫明显萎缩者与对照组相似；对健康情况无明显影响；患病史中ＩＵＤ组明显低于对照组。２．通过２７６例宫腔分泌物直接涂片检查，白细胞和细菌计数与对照组相似。３．１２８例同时取出ＩＵＤ，取器困难率于绝经＜２年者为５％，≥２年者１８％～３５％。根据本研究结果，绝经后未取ＩＵＤ者未见明显的危害性，但建议有条件取器者应在１年内取器，如绝经２年以上遇有取器困难而临床又无症状，不宜强行取器，以免造成严重创伤，可严密随访。     

Aboriginal Women and Menopause

Objective: To determine the characteristics of menopause in Aboriginal women, in particular Canadian Aboriginal women.Methods: An extensive review of articles extracted from both medical and non-medical databases was undertaken. The search strategy combined the key word “menopause” with any of the following terms: Aboriginals. Native Americans, Natives, Indians, Métis, Inuit, Eskimo, and Indigenous people.Results: A total of 29 records were found, 13 of which had results relevant to the objective of the study. These articles suggest that menopause may have a positive effect on the lives of Aboriginal women with respect to increasing their freedom within the community. Aboriginal women appear to experience fewer vasomotor symptoms than other North American women.Conclusion: More research needs to be done to determine the effect menopause has on Canadian Aboriginal women and their coexisting diseases such as cardiovascular disease, hypertension, and diabetes mellitus. This work will allow health care providers to make more informed decisions on managing Aboriginal women’s transition through menopause in areas such as hormone replacement therapy.     

The timing of the age at which natural menopause occurs

The timing of natural menopause is a clinically important indicator of longevity and risk of morbidity and mortality. Demographic, menstrual, reproductive, familial, genetic, and lifestyle factors seem to be important in this timing. Smoking, lower parity and poor socioeconomic status are associated with earlier menopause. However, a number of relationships have been inconsistent; others remain largely unexplored. Much remains to be learned about factors that affect follicular atresia and the onset and duration of perimenopause and the timing of the natural menopause. Knowledge about these relationships offers women and their health care providers enhanced understanding and choices to deal with menopause.     

Bone and heart health in menopause

Age at menopause has been shown to have an impact on bone and heart health, with younger menopause age consistently associated with a higher risk of cardiovascular disease, osteoporosis, and fracture. These risks are particularly high increased among women who encountering menopause at an early age, including women with premature ovarian insufficiency (POI) and early menopause, due to a prolonged period of oestrogen deprivation. Several interventions are suggested to optimise the bone and cardiovascular health of women with menopause including lifestyle modification, dietary supplements, hormonal, and non-hormonal therapies. Hormone therapy (HT) is indicated for women with POI. For women with early menopause, there is a paucity of evidence for the management of bone and cardiovascular health. For women beyond the average age of menopause, HT is not indicated solely for bone protection and cardiovascular health. In this group, screening for bone and heart disease, as well as primary and secondary prevention, should be undertaken in line with national and international guidelines.     

A psycho-educational program for improving women's attitudes and coping with menopause symptoms

OBJECTIVE: To examine the impact of participation in a psycho-educational program on women's attitudes toward menopause, the perceived severity of their symptoms, and the association between the two. DESIGN: Quasi-experimental. Data were gathered at baseline and 3 months after termination of the program. SETTING: Two health maintenance organization clinics. PARTICIPANTS: Eighty-two healthy 40- to 60-year-old women who chose to participate in the study. Thirty-six women participated in the program, and 46 women comprised the control group. INTERVENTION: Program participants met for 10 weekly sessions to receive information from a professional team on subjects related to menopause and to share and discuss their experiences. MAIN OUTCOME MEASURES: Attitudes toward menopause and severity of menopause symptoms. RESULTS: The more negative the attitudes, the higher was the severity of symptoms. Participants reported significant improvements in attitudes and reductions in symptom severity compared to their own baseline scores and compared with the control group. CONCLUSIONS: Participation in a program that combines delivery of information and processing of experiences on the cognitive, emotional, and social levels may improve women's attitudes toward menopause and ease the perceived severity of their symptoms, thereby increasing quality of life.     

The menopausal transition and cardiovascular risk

The incidence of cardiovascular disease, which is the leading single cause of death among women, increases substantially after menopause. This may be related to adverse changes in cardiovascular risk factors that occur during the menopausal transition. Proatherogenic changes in lipid and apolipoprotein profiles seem to be specifically related to ovarian aging; unfavorable changes in other cardiovascular risk factors may be influenced more by chronologic aging. Whether these changes are due to aging or to menopause itself, increased attention to risk factor modification in the pre- and perimenopausal years will help reduce future cardiovascular disease risk among women.     

Malignant mesenchymoma arising from a uterine leiomyoma in the menopause

BACKGROUND: Malignant mesenchymoma is a rare tumor and location in the uterus is even rarer. We describe the first case of malignant mesenchymoma arising from a uterine fibroid in the menopause. CASE REPORT: A 64-year-old woman presented with abdominal pain and underwent surgery for a large "uterine fibroid" with suspicious features on ultrasound scan. The mass had developed after the menopause. Histology showed benign leiomyomatous tissue with malignant areas consistent with malignant mesenchymoma. CONCLUSION: We report the first case of malignant mesenchymoma arising from the uterus in menopause. Certain radiological features may be associated with this tumor. Due to its rarity, information on management of uterine malignant mesenchymoma is lacking and management options of uterine leiomyosarcomas are reviewed as a surrogate.     

Mood and menopause: findings from the Study of Women's Health Across the Nation (SWAN) over 10 years

Women are twice as likely as men to suffer from depressive symptoms/disorder. Research has focused on physiologic and psychosocial differences between men and women; an important target of study has been periods of reproductive changes. Controversy has existed regarding the extent to which the menopausal transition or postmenopause increases the risk for depressive symptoms/disorders. This paper presents findings from analyses of data from the SWAN study and an ancillary study on mental health. We found that risk for high depressive symptoms and disorder is greater during and possibly after the menopausal transition. Other factors contribute to risk for depression.     

Mood, energy, cognition, and physical complaints: a mind/body approach to symptom management during the climacteric

Recent studies suggest that energy and cognitive and physical complaints such as fatigue, disrupted sleep, concentration problems, and pain are more problematic than clinical depression during the climacteric and may contribute to depressed mood. Central nervous system pathways that mediate mood, cognition, and energy are influenced by fluctuations of circulating estrogen during perimenopause. Symptoms are also influenced by other factors, including psychosocial and environmental stresses and supports. Health care for women from perimenopause to postmenopause should include an accurate assessment of energy and cognitive, physical, and emotional symptoms. Multidisciplinary approaches that combine prevention, symptom management, and health promotion are most effective for women. A mind/body program for perimenopause and menopause is presented as an example of a comprehensive treatment approach for assessment and management of perimenopause and menopause. This 10-week group program combined information, self-education, relaxation training, group support, lifestyle modification, and psychological coping skills.     

Noninvasively measured radial pressure wave analysis provides insight into cardiovascular changes during pregnancy and menopause

ObjectivePregnancy and menopause are significant life events associated with major changes in female hormone levels and changes in cardiovascular health. The role of estrogen in influencing cardiovascular risk is an ongoing research topic. Many studies have provided evidence that radial pressure wave characteristics are an important indicator to consistently and independently predict cardiovascular events. The aim of this study was to investigate if radial pressure wave analysis provided statistical insights into the physiological variations due to pregnancy and menopause. Furthermore, the study investigated how these variations could serve as an indicator for cardiovascular risks. As the radial pulse measurement is non-invasive and speedy, it may be helpful in evaluating cardiovascular changes and risk during these transitions.Materials and methodA total of 702 randomly selected female subjects (90 pregnant and 97 post-menopausal), aged 20–59, enrolled in the study. The visit measured the subject's hemodynamic parameters including heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP) and radial pressure waves. SBP and DBP were evaluated by an automatic blood pressure monitor. Radial pressure wave data were continuously recorded for 12-s using a TD01C pulse measuring instrument. Spectrum analysis of the radial pressure wave was performed to evaluate the first five harmonic components (C1–C5).ResultsA comparison of pregnant women to non-pregnant women showed C3 and C5 were lower. Heart rate C2 and C4 were higher in pregnant women. A comparison of women pre-menopausal and post-menopausal showed no significant difference in SBP or DBP. Menopause significantly changed the C1 and C4 radial pressure wave harmonics. An increase in C1 and a decrease in C4 were observed.Conclusion and discussionThis study provided further clinical evidence to support the hemodynamic model that describes the cardiovascular changes and risks related to the harmonic components of the pulse spectrum. Beyond blood pressure, the effects of menopause on the radial pressure wave, especially on hemodynamic index C4, independent of age and BMI, may explain increased post-menopausal cardiovascular risk. This and past studies collectively suggest that radial pressure wave components may be an indicator of a female body's ability to supply oxygen and nutrients. Harmonic analysis of the radial pressure wave may provide additional insights into the underlying mechanism of the cardiovascular changes over the lifespan of a woman.     

Cognition and mental health in menopause: A review

Cognitive and mood changes are frequently mentioned as complaints before, during and after menopausal transition. There is substantial biological evidence for such associations to occur, as there are many mechanisms through which oestrogens can affect the brain: by regulating metabolism, increasing cerebral blood flow and dendritic outgrowth, by acting on nerve growth factors through the co-localisation of receptors via neurotransmitter synthesis and turnover and many more. However, the evidence for objective and longer-term changes in cognitive function and mental health over the menopausal transition and beyond is less clear. While hormone treatment (HT) including oestrogens could potentially reverse these psychological issues, the evidence of long-term benefit is also inconclusive. However, for women with severe menopausal complaints, and particularly for those who undergo early menopause, including women with premature ovarian insufficiency, personalised HT at least up to the natural age of menopause around 50 should be considered, which is probably safe up to 10 years of treatment, unless contraindicated. This paper reviews the evidence for changes in psychological health related to menopausal transition and HTs.     

Medicalization of Menopause and Public Health

The proposals for the medicalization of postmenopausal women with female hormones are based on theories which in summary consider that the fall in estrogenic levels that follows the menopause is either a disease in itself or a risk factor that is responsible for the increase in the appearance of many serious diseases. After criticizing the philosophical and scientific basis of these theories, the impact of these proposals on the health of women is discussed. Special attention is paid to the assessment of the impact of the proposals of the long-term medicalization of almost all postmenopausal women. As a result of theories pervaded with a male chauvinist rationale, millions of women are recommended treatment with therapies with an impact which is not properly assessed, exposed to known and unknown risks and involved in an important unjustified medicalization of their lives. The resources involved should be used in other social programs with a well-assessed positive social impact.     

Vaginal pH is similar to follicle-stimulating hormone for menopause diagnosis

OBJECTIVE: This paper is intended to demonstrate whether vaginal pH value is associated with menopausal status and symptoms, to review the sensitivity of follicle-stimulating hormone or vaginal pH to diagnose menopause, to compare these findings to a group of practice patients, and to determine whether vaginal pH could be used in place of follicle-stimulating hormone as an initial screen to determine menopause. STUDY DESIGN: Sixteen studies regarding vaginal pH and menopausal symptoms before and after estrogen administration were analyzed. Two epidemiologic studies that reported follicle-stimulating hormone or vaginal pH with menopause were reviewed. These findings were compared with similar data from the practice of one of the authors (J.C.C.). RESULTS: Menopausal women who do not receive estrogen therapy have a weighted average vaginal pH of 6.0, which is reduced significantly to 4.5 with estrogen therapy. To diagnose menopause, follicle-stimulating hormone >or=15 or >or=20 mIU/mL in the Third National Health and Nutrition Examination Survey had a sensitivity of 65% to 68%. In a study in Costa Rica, where 3 definitions of menopause were used, a pH of >5.0 had a sensitivity of 64% to 67%. From the practice patients, the 95% confidence interval sensitivities and positive predictive values of vaginal pH and follicle-stimulating hormone to diagnose menopause overlapped, while a pH 4.5 indicates menopause, because it demonstrates a similar sensitivity as follicle-stimulating hormone in epidemiologic studies. In the practice patients, the sensitivity of follicle-stimulating hormone was no different than vaginal pH in the diagnosis of menopause. Furthermore, with estrogen therapy, a vaginal pH of 相似文献   

Menopause symptoms in women infected with HIV: Prevalence and associated factors

Objective. To evaluate the prevalence and factors associated with menopause symptoms in HIV-infected women.

Methods. A cross-sectional study of two groups of women was conducted: 96 with HIV and 155 without HIV. Women aged 40 years or older, non-users of hormone therapy in the last 6 months and native Brazilians were included. The prevalence of menopause symptoms was calculated according to the studied variables. Symptoms were grouped into six categories: vasomotor, psychological, genitourinary, weight gain, palpitations and insomnia. The generalized estimating equation model was applied to identify the factors associated with menopause symptoms in all women and for HIV-infected women only.

Results. The mean (±standard deviation) age of women with and without HIV was 48.9 ± 7.4 and 51.0 ± 8.7 years (p = 0.07), respectively. The median age at menopause for HIV-infected women was 47.5 years. Menopause symptoms were more frequent in HIV-infected women, highlighting psychological and vasomotor symptoms. HIV infection was associated with menopause symptoms (odds ratio (OR) = 1.65, p = 0.03), as well as age ranging from 45 to 54 years (OR = 1.77, p = 0.01), higher parity (OR = 2.38, p = 0.01) and self-perception of health as fair/poor (OR = 2.07, p < 0.01). Among HIV-infected women, the likelihood of presenting symptoms decreased in those aged 55 or older (OR = 0.16, p = 0.03) and increased in retired women (OR = 2.61, p = 0.02).

Conclusion. Menopause symptoms were common in HIV-infected women. HIV infection was independently associated with menopause symptoms, whereas age and being retired were associated with the occurrence of these symptoms in HIV-infected women.     

Childbirth close to natural menopause: does age at menopause matter?

Research questionDoes a successful spontaneous pregnancy in the years close to natural menopause depend on age at menopause?DesignThis was a retrospective population-based study of 4157 parous postmenopausal women in Norway, born during the years 1925–1940. Data were obtained by two self-administered questionnaires in the HUNT2 Survey (1995–1997). We calculated the proportions of women who gave birth within 5 years and within 10 years prior to menopause both among all women, and according to categories of age at menopause.ResultsOverall, 2.7% (114/4157) of all women gave birth within 5 years, and 11.7% (487/4157) gave birth within 10 years, prior to menopause. Among women with menopause before the age of 45 years, 23.5% (81/344) gave birth within 5 years, and 55.5% (191/344) gave birth within 10 years, before menopause. Among the women with menopause at the age of 55 years or older, no women (0/474) gave birth within 5 years, and 0.2% (1/474) gave birth within 10 years, prior to menopause.ConclusionsMore than half of the women with menopause before the age of 45 years gave birth within the 10 years before natural menopause, whereas virtually no women with menopause at the age of 55 years or older did. Thus, the length of the sterile interval before natural menopause may vary by age at menopause.