"It's my hormones, doctor"--does physical activity help with menopausal symptoms?

OBJECTIVE: Many women experience health problems when going through menopause, and these health problems may result in a substantial reduction in quality of life. There are some indications that physical activity may play a role in ameliorating menopausal symptoms, but there is conflicting evidence about this. To assess the relationship between changes in physical activity and self-reported vasomotor, somatic, and psychological symptoms. DESIGN: Data from the third (2001) and fourth (2004) surveys of the Australian Longitudinal Study on Women's Health were used. Data from 3,330 middle-aged women were included in the analyses. In linear regression models, the relationships between changes in physical activity of at least moderate intensity and total menopausal, vasomotor, somatic, and psychological symptoms were determined. RESULTS: Physical activity was not associated with total menopausal symptoms, vasomotor or psychological symptoms. A weak association with somatic symptoms (B = -0.003; 95% CI: -0.005 to -0.001) was found. Weight gain was associated with increased total, vasomotor, and somatic symptoms. Weight loss was associated with a reduction in total and vasomotor symptoms. CONCLUSION: Changes in physical activity were not related to vasomotor or psychological symptoms and only marginally to somatic symptoms. Changes in weight showed a stronger relationship with menopausal symptoms. The relationship between weight change and menopausal symptoms merits further exploration.     

Exercise to reduce vasomotor and other menopausal symptoms: A review

Many women are reluctant to consider HRT as a therapeutic option for menopausal symptoms and are keen to use non-pharmacological treatments. Evidence from randomised controlled trials (RCTs) concerning the effects of aerobic exercise on vasomotor and other menopausal symptoms is limited but what evidence we do have suggests that aerobic exercise can improve psychological health and quality of life in vasomotor symptomatic women. In addition, several RCTs of middle-aged/menopausal-aged women have found that aerobic exercise can invoke significant improvements in several common menopause-related symptoms (e.g. mood, health-related QoL and insomnia), relative to non-exercise comparison groups. There is some evidence that alternative forms of low intensity exercise such as yoga are beneficial in reducing vasomotor symptoms and improving psychological well-being in menopausal women. Collectively, these RCTs highlight the broader potential that exercise could have for women during the menopause transition. Whilst both the Royal College of Obstetricians and Gynaecologists in the UK and the North American Menopause Society have recommended that women be advised to consider aerobic exercise as a treatment for vasomotor menopausal symptoms, to make any evidence-based conclusions regarding the effectiveness of exercise in managing these symptoms, more high quality research is needed.     

Hormonal and non-hormonal interventions for menopausal symptoms

Recent cohort studies confirm that only flushes, night sweats and vaginal dryness are provenly associated with ovarian failure. Experiments nave demonstrated that these symptoms and insomnia associated with nocturnal vasomotor symptoms are more effectively controlled by oestrogen than placebo. Hormonal interventions include a variety of oestrogen or oestrogen/progestogen regimes. Non-hormonal treatments of flushes include exercise, paced respiration and psychotherapy. After the menopause vaginal atrophy and some urinary symptoms respond to local oestrogen and vaginal dryness is also prevented by lubricants. Libido is not increased by oestrogen therapy but may be improved by testosterone. Depression is common in middle-aged women but is not specifically associated with the hormonal changes occurring at the menopause. Oestrogen therapy may improve and stabilise mood during the peri-menopause but there is no firm evidence that it is effective for depression after the menopause. Arthralgia is not a symptom specific to menopause and experimental evidence concerning the role of oestrogen in the treatment of rheumatoid arthritis is inconclusive. Cognitive function is not related to menopause and measures such as stopping smoking, exercise and maintaining body weight may be partly effective in preventing menopausal symptoms.     

Die Psyche in der Peri- und Postmenopause

During the menopausal transition biological and psychosocial factors are closely interrelated. The retrospective view on the previous life span and the attitudes towards the menopause influence the severity of climacteric complaints and symptoms as well as the acceptance of hormone therapy. Most women use hormones to suppress symptoms and not to prevent e. g. osteroporosis. Depressive symptoms become more frequent, however, more than half of the variance results from psychosocial factors and a positive history of depression. Sleep disturbances increase and can only in part be explained as the result of vasomotor symptoms or as correlates of depression. Sexual activity often changes. However, subjective feelings of being attractive and/or the quality of partnership are more important than the widely discussed genital atrophy and dyspareunia. Hormone therapy should be restricted to cases with objective vaginal atrophy. Sleep disturbances frequently respond to hormones, as well as minor depressive symptoms. More pronounced depressive syndromes should be referred to “classical” psychological and psychopharmacological treatments. Results obtained in studies with surgical menopause must not be easily generalized to women with a natural menopause.     

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.     

Poor sleep in middle-aged women is not associated with menopause per se

Whether sleep problems of menopausal women are associated with vasomotor symptoms and/or changes in estrogen levels associated with menopause or age-related changes in sleep architecture is unclear. This study aimed to determine if poor sleep in middle-aged women is correlated with menopause. This study recruited women seeking care for the first time at the menopause outpatient department of our hospital. Inclusion criteria were an age ≥40 years, not taking any medications for menopausal symptoms, and no sleeping problems or depression. Patients were assessed with the Pittsburgh Sleep Quality Index (PSQI), modified Kupperman Index (KI), and Menopause Rating Scale (MRS). A PSQI score of <7 indicated no sleep disorder and ≥7 indicated a sleep disorder. Blood specimens were analyzed for follicle-stimulating hormone and estradiol levels. A total of 244 women were included in the study; 103 (42.2%) were identified as having a sleep disorder and 141 as not having one. In addition, 156 (64%) women were postmenopausal and 88 (36%) were not menopausal. Follicle-stimulating hormone and estradiol levels were similar between the groups. Patients with a sleep disorder had a significantly higher total modified KI score and total MRS score (both, P<0.001) compared with those without a sleep disorder. Correlations of the PSQI total score with the KI and MRS were similar in menopausal and non-menopausal women. These results do not support that menopause per se specifically contributes to sleep problems.     

A Cross-sectional Survey of Menopausal Status, Symptoms and Psychological Distress in a Community Sample of Australian Women

While many researchers assume the menopause to be an endocrine deficiency disease, others argue that menopause is normally non-traumatic, associated with few and minor symptoms. An Australian sample of 304 female volunteers (128 pre-menopausal, 35 peri-menopausal, 80 post- menopausal and not taking hormone replacement therapy, 61 post-menopausal and taking hormone replacement therapy) completed the Women's Health Questionnaire and the Profile of Mood States. There were differences among the groups on some symptoms, although the only difference between the post-menopausal groups was on vasomotor symptoms. There were no between-group differences in depression, anxiety or mood states, nor did demographic variables affect these measures. There was no evidence that post-menopausal women experienced increased psychological distress, supporting the hypothesis that menopause is not particularly distressing for normal women.     

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.     

Cognitive–behavioral group treatment for menopausal symptoms: a pilot study

The menopausal transition is frequently accompanied by adverse physical and emotional changes that can significantly impact a woman’s quality of life. Hormone replacement therapy has been the most commonly used menopause-related treatment to date, particularly for the alleviation of vasomotor symptoms; recent studies, however, have questioned its long-term safety for some women. We aimed to develop a cognitive–behavioral group treatment (CBGT) program as an alternative or complementary treatment option for reducing the frequency and intensity of debilitating menopausal symptoms in midlife women. Eight subjects participated in two, 10-week pilot groups (n?=?4 participants per group) with participants being drawn from referrals through the Women’s Health Concerns Clinic and community advertising efforts. This pilot study confirmed a reduction in the frequency and interference associated with vasomotor symptoms, less depression and general anxiety, and an overall improvement in quality of life. Participants also reported high levels of satisfaction with this type of treatment for menopausal symptoms. Furthermore, there was a trend towards a reduction in sleep difficulties and sexual concerns over the course of treatment. This pilot CBGT program appears to be a promising alternative or complementary treatment for both the physical and emotional symptoms experienced during menopause. Further studies are needed on its efficacy through larger, controlled trials.     

Self-awareness during the menopause

OBJECTIVE: The aim of the study was to test the hypothesis that body-image and self-esteem are major contributors to the severity of menopausal symptoms, and furthermore to measure the influence of hormonal therapy and postmenopausal oestrogen level on specific complaints such as vasomotor symptoms. METHODS: For the random check 51 patients, aged 43-63 (x=53.8; s=4.4) of an independent medical institution for menopause referred to as 'Viennese ambulance' were questioned. RESULTS: It turned out, that their attitude towards menopause was of major influence on the degree of specific symptoms (e.g. depression, misery, headache etc.)-women who had a negative attitude towards the menopause suffered much more from such symptoms than women who had a positive one. Moreover, women who were satisfied with their physical appearance experienced fewer troublesome symptoms. There was a significant association between high self-esteem and fewer menopausal symptoms. The higher the self-esteem, the lower the symptoms. CONCLUSION: Women with a postmenopausal oestrogen level did not experience more menopausal symptoms than women with an average oestrogen level. Moreover, the symptoms were neither fewer nor more whether the women had undergone a hysterectomy or not whether they got hormonal treatment or not. That refutes the hypothesis, that the decrease of the oestrogen level during menopause is the main reason for the accompanying complaints.     

The treatment-seeking woman at menopause

Recent studies suggest that health care utilisation by women during menopause transition in general is highly idiosyncratic, despite the widespread advocation of prophylactic hormone therapy and increased health vigilance. The Melbourne Women's Midlife Health Study, a community-based cross-sectional study of 2001 urban Australian-born women aged 45–55 years, evaluated women's physical and emotional experiences, past and present health status, attitudes and beliefs about menopause, health behaviours and current menopausal status in a 30-min telephone interview. This paper reports on those factors related to help-seeking and health care utilisation. Findings show that treatment utilisers, in contrast to non-utilisers, reported a wider range of general symptoms, but reports on vasomotor symptoms did not contribute to the regression analysis. Treatment utilisers were further identified as problemrelated or prevention-related utilisers. In three-way analyses, the past and present social and physical health of the problem-related treatment user was reportedly worse than either the prevention-related utiliser or non-utiliser. These findings suggest that medical and societal views about the health of middle-aged women during menopausal transition are likely to be based on the experiences of a particular segment of the population only. It is proposed that biased views of menopause as a time of considerable distress and ill-health are being perpetuated and over-generalised. This perspective appears to have little relevance for the majority of middle-aged women.     

Symptom experience in Australian men and women in midlife

OBJECTIVE: To compare the experience of vasomotor, psychological and somatic symptoms in Australian men and women in midlife, to investigate whether symptoms often attributed to endocrine changes in midlife are associated with health and psychological well-being, and to evaluate their relationship to menopausal status in women. METHODS: A cross-sectional, correlational, population-based study based on self-report questionnaires. Participants comprised 451 men and 766 women, aged between 39 and 65, from urban and rural South Australia, who responded to invitations to participate, or who volunteered to participate following media releases. Outcome measures used comprised a 47-item symptom checklist of current presence and severity of vasomotor, somatic and psychological symptoms experienced by men and women during midlife, and measures of health and psychological well-being. RESULTS: The majority of men and women reported that they were not 'bothered' by vasomotor, psychological and somatic symptoms. For those symptoms in which men and women differed significantly, women generally reported being more 'bothered' than men, although the pattern of association between symptoms and measures of health and psychological well-being was the same for both men and women. Items from all three symptom clusters were independently related to menopausal status. CONCLUSIONS: Health and psychological well-being play a role in the genesis of symptoms experienced by men and women in midlife. Both men and women experience similar symptoms, although women are more distressed by them signifying support for a menopausal syndrome in women. The finding of an independent relationship between menopausal status and psychological and somatic symptoms, in addition to the vasomotor symptoms, contradicts the narrow-estrogen hypothesis of climacteric symptoms.     

Hot flashes are associated with psychological symptoms of anxiety and depression in peri- and post- but not premenopausal women

OBJECTIVE: To explore the relationship between anxiety, depression, vasomotor symptoms, and menopausal status among middle-aged women. DESIGN: A population-based study involving a rural Taiwanese population. Participants received a structured questionnaire, which included the hospital anxiety and depression scale (HADS), gynecological history and a checklist of menopausal symptoms in the most recent 2 weeks. RESULTS: A total of 1273 women with no history of surgical menopause and hormonal therapy history participated. The mean anxiety, depression, and total HADS scores were 4.3 +/- 3.3, 3.3 +/- 2.8 and 7.6 +/- 5.3, respectively, and did not differ according to menopausal status. A total of 10.5% participants reported hot flashes within the previous 2 weeks. After controlling for educational status and insomnia, anxiety (6.0 +/- 3.8 versus 4.1 +/- 3.1) and depression scores (4.0 +/- 3.3 versus 3.2 +/- 2.7) were significantly higher (p < 0.001) compared with those without hot flashes. These differences were attributed to peri- and postmenopausal subjects. CONCLUSIONS: Hot flashes in peri- and postmenopausal women were associated with anxious and depressive symptoms in East Asian population with low prevalence of vasomotor symptoms.     

Changes in Australian women''s perception of the menopause and menopausal symptoms before and after the climacteric

The symptoms and perceptions of menopause of 60 Australian women were studied, by questionnaire, when they were premenopausal and 10 years later when they were postmenopausal. Menopausal symptoms expected and experienced by the women were compared, fewer women experiencing hot flushes, headache, depression and nervousness and more experiencing insomnia, increase in appetite, abdominal fullness, numbness and muscular problems. The symptoms women thought were due to hormonal changes at menopause were compared. In 1993 more women cited osteoporosis, insomnia, loss of libido, obesity and loss of muscle tone as due to hormone change while fewer cited depression. The premenstrual symptoms and their severity experienced by a woman when she was premenopausal significantly predicts the type and severity of the menopausal symptoms experienced by the woman. The expected menopausal symptoms and their severity cited by a woman also significantly predicts the type of severity of the menopausal symptoms experienced. More premenstrual symptoms predict the menopausal symptoms than those menopausal symptoms the women expected. The expectation menopause will be ‘a relief’ or ‘a nuisance’ significantly predicted the overall menopause experience described by the women. Their negative attitudes about doctors' understanding and information available about menopause remained unchanged but they forget menstrual cycle problems over the 10 years. The results suggest a possible physiological basis for premenstrual and menopausal symptoms. Assistance for women with their premenstrual and menstrual cycle symptoms may improve their quality of life at menopause.     

A prospective,randomized, placebo-controlled study of the dose effect of oral oestradiol on menopausal symptoms,psychological well being,and quality of life in postmenopausal Chinese women

OBJECTIVES: Hypoestrogenism occurring in association with the menopause may result in the development of vasomotor symptoms and it may also have a detrimental effect on psychological well being and quality of life (QOL). The aims of this study were to measure menopausal symptoms, mood and QOL in postmenopausal Chinese women and to assess the effect of different doses of oestrogen on these outcome indicators. METHODS: A prospective, randomized, placebo-controlled study of the effect of 1 and 2 mg oestradiol on menopausal symptoms, anxiety and depressive symptoms, and QOL in 152 postmenopausal women over a 12 month study period. Menopausal symptoms were measured using a modified Kupperman's scale. Anxiety and depressive symptoms and QOL were measured using the Hospital Anxiety and Depression Scales and a modification of the World Health Organization Quality of Life questionnaire, respectively. RESULTS: Baseline scoring of vasomotor symptoms in our population was low whilst QOL scoring was relatively high. Over 12 months, after adjustment for differences in baseline scoring, there was a significant reduction in menopausal symptom scores in the 2 mg oestradiol group compared with placebo but not in the 1 mg group. There were no statistically significant changes in levels of anxiety and depression or QOL in either the 1 or the 2 mg group compared with placebo. CONCLUSIONS: These results suggest that relatively few Chinese women will be expected to benefit from hormone replacement in terms of either QOL or mood. In addition, the overall benefit of treatment for vasomotor symptoms will be less for a given number of Chinese women than for Caucasians. Therefore, when considering the reasons for prescribing hormone replacement therapy in this population, protection against osteoporosis will for most women be the prime consideration.     

To exercise,or, not to exercise,during menopause and beyond

Menopausal symptoms in women can be severe and disruptive to overall quality of life. Hormone replacement therapy, is known to be effective in ameliorating symptoms, however, reporting of side effects has resulted in alternative treatment options. Exercise has been assessed as an alternative treatment option for alleviating menopausal symptoms, including, psychological, vasomotor, somatic and sexual symptoms. Here we report the effects of physical activity and exercise on menopause symptoms in menopausal women.     

Psychological and somatic experience of the menopause: a prospective study [corrected

This study investigates the nature of psychological and somatic symptoms experienced during the menopause and attempts to predict individual differences using a prospective design. Thirty-six women, who were premenopausal during an initial investigation, became peri- or postmenopausal three years later. The Women's Health Questionnaire, developed specifically for this population, was used to assess general health, beliefs, psychosocial factors, and current symptoms. As expected, vasomotor symptoms were more prevalent in peri- and postmenopausal women. However, significant but small increases in depressed mood were also evident. The results of a stepwise regression analysis indicated that past depression together with cognitive and social factors accounted for 51 per cent of the variance in depressed mood reported by menopausal women. The clinical and theoretical implications are discussed.     

Hormonal substitution during menopause: what are we treating?

OBJECTIVES: It is suggested that during menopausal transition, women with vasomotor symptoms benefit from HRT, (hormone replacement therapy) whereas, the use of HRT for other cognitive-vegetative symptoms is questionable. METHODS: The occurrence of menopausal complaints and depressive symptoms was assessed cross-sectionally in 5896 Dutch Caucasian women (47-54 years) of a large community sample in the city of Eindhoven, The Netherlands. Menopausal complaints were assessed using a 22 items self-rating scale (consisting of a vasomotor, uro-genital and a cognitive-vegetative subscale). Depressive symptoms were assessed using the Edinburgh depression scale (EDS). Differences in mean scores were analysed between groups using ANOVA. The independent relationship of depressive symptoms to the intensity of menopausal complaints was assessed, by multiple linear regression analysis. RESULTS: Women using HRT showed the highest scores on all subscales. Oral contraceptive users had significantly lower scores on the vasomotor subscale compared to HRT users and to non users. Depressive symptoms contributed the most, to the explained variance on scores on the menopausal subscales. CONCLUSIONS: Women during menopause presenting several complaints, other than vasomotor origin might be suffering from underlying depression which makes it questionable to prescribe HRT for the latter symptoms.     

Stress,psychological distress,psychosocial factors,menopause symptoms and physical health in women

Objectives

Relatively few studies have evaluated relationships between stress, psychological distress, psychosocial factors and menopause symptoms, and none have evaluated emotional intelligence (EI) in relation to menopause. In this study, direct and indirect relationships were evaluated between stress, psychological distress, psychosocial factors (e.g. social support, coping, EI), menopause symptom severity and physical health in middle-aged women.

Methods

One hundred and sixteen women aged 45–55 years were recruited through women's health centres and community organizations. They completed a short questionnaire asking about stress, psychological distress (i.e. anxiety, depression), EI, attitude to menopause, menopause symptoms and physical health.

Results

Low emotional intelligence was found to be related to worse menopause symptoms and physical health, and these associations were partly mediated by high stress, anxiety and depression, a negative attitude to menopause and low proactive coping.

Conclusions

Women with high EI appear to hold more positive attitudes to menopause and experience less severe stress, psychological distress and menopause symptoms and better physical health. These results suggest that women who expect menopause to be a negative experience or are highly stressed or distressed may be more likely to experience a more negative menopause.     

Reproductive health, use of estrogen and experience of symptoms in perimenopausal women: A population-based study

Objective: The aim of the study was to examine reproductive health, use of estrogen, lifestyle, experience of menopausal symptoms and work-role related issues in a population-based sample of perimenopausal women. Methods: All women aged 48 years and residing in the catchment area of the Karolinska Hospital were recruited through the Swedish population register. They received a questionnaire covering sociodemographic background, reproductive health and gynaecological characteristics, social and work role related issues as well as a symptom rating scale. Results: Seventy percent of the women returned the questionnaire. Of these, 73% were premenopausal, 21% were postmenopausal and 6% were perimenopausal. Hormone replacement therapy was used by 7.5% of the respondents and the rate of hysterectomy was 8.6%. Regular exercise was reported by 44.4%. Factor analysis of the symptom ratings yielded four independent dimensions: Negative Moods, Vasomotor symptoms, Decreased Sexual Desire and Well-being. Multiple regression analyses showed that only vasomotor symptoms were significantly related to menopausal status. Negative Mood and Reduced Sexual Interest were better explained by the presence of vasomotor symptoms and by reproductive health and lifestyle variables such as current or previous PMS, dysmenorrhea, smoking and lack of exercise. Conclusions: Only vasomotor symptoms were significantly related to menopausal status. Psychosocial and lifestyle variables as well as past or current reproductive health are more important determinants of women's psychological well-being during transition to menopause than menopausal status.